Nursing interventions

Daytonite, BSN, RN · Nov 3, 2008

first of all, these diagnoses are listed in the wrong priority. . .secondly, i disagree with imbalanced nutrition: more than body requirement as even being an appropriate problem here.

imbalanced nutrition: more than body requirement r/t defect in glucose metabolism

so, she doesn't take her insulin and "drinks 8 bottles of beer daily" and "smokes marijuana" which is how her blood sugar got out of control. is that right? what is her weight? if she isn't taking her insulin, then her body has to be utilizing her store of fat to survive. that is the pathophysiology behind type i diabetes. i'm trying to picture this in my mind and

imbalanced nutrition: more than body requirements

seems like the wrong diagnosis.

imbalanced nutrition: less than body requirements r/t poor dietary intake aeb [evidence such as: poorly controlled glucose, ketonuria, weight loss]

seems more appropriate because it sounds like she isn't following a diet, she's focused on empty calories (beer), probably not eating much anyway and you've stated she's not taking insulin. so whatever she is eating, her body is not able to process and her body is not able to get the benefit of it for energy. but, i don't think that is a priority for this patient at the moment.

did you look up and read about dka? people with dka are super dehydrated. had she not come into the hospital with dka for treatment she would have died because of the dehydration and coma. in addition, that alcohol consumption is very dehydrating to the system. it sounds to me like her diagnosis should be

deficient fluid volume r/t elevated blood sugar secondary to dka aeb blood sugar of 220 [and other symptoms of dehydration].

the symptoms (defining characteristics) of dehydration are listed on this webpage:

deficient fluid volume

and if you go back over them i am sure you will find that this patient had a number of them that you probably missed.

the physician's treatment for dka is listed here:

http://www.fpnotebook.com/endo/dm/dbtcktcdsmngmntinadlts.htm

. notice that their first focus is on correcting the fluid deficits, then the electrolyte imbalances. you might want to go back through the notes you have to see if you have any of this evidence so you can add to this diagnosis. your interventions for a fluid volume deficit won't be all that different from the physician's. you will monitor fluid and electrolyte status as well as encourage fluids and foods with electrolytes, monitor i&o, maintain iv fluids, monitor for signs of dehydration.

ineffective health maintenance r/t knowledge regarding care of diabetic condition

you stated that she "has not taken any medication or insulin for the past 2 years due to financial issues". this is evidence of a history of lack of health-seeking behaviors, one of the defining characteristics that nanda lists for this diagnosis. it refers to people who miss appointments, don't take medication or don't perform their treatments on a regular basis. that certainly sounds like your patient. the question is why (etiology) she has done this. you say she has told you it was strictly for financial reasons, not "knowledge regarding care of diabetic condition". so, this diagnosis needs to be re-written as

ineffective health maintenance r/t lack of adequate financial resources aeb not taking necessary medication or insulin for the past 2 years

.

your interventions then become focused on the financial problem. she needs some kind of financial help so she can get her medications. consider reviewing her budget and finding ways that she can fit getting insulin and syringes into it. if she qualifies for mediaid or disability get her referred to the right people so the process can get put in motion.