Diabetes Mellitus Type 2 Nursing Dx

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Hi everyone, this is my first post so I hope I do this right!

So very long story short:

I am doing a process paper for a patient who has a plethra of issues, most of which I have covered but then I emailed my teacher to see how she felt about my dx and she said it was wrong:nono:, which would be fine but she told me to use "Alteration in blood glucose levels".

Is "Alteration in blood glucose levels" a real NANDA Dx? I have looked in all 16 books I own, googled for the past 3 or 4 hours and I can't find anything that says this is a dx.

My original plan was to use Imbalanced Nutrition: More then..., she is obese and has type 2 DM and is on bed rest so that made sense to me, this makes no sense to me but I need it to be good to her because I am not passing at the moment but I REALLY feel confused now.

Also, my teacher wants me to focus on a issue of pain for on of her problems so I decided I would use Acute Pain, my teacher said that that was no good and to use Alteration in Comfort which would be fine but NONE of my books have anything for me to reference to this and I also can't fine anything helpful on the internet. Is this still an approved NANDA dx?

Ugh :banghead:, please help.

Thanks so much :bowingpur

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Specializes in med/surg, telemetry, IV therapy, mgmt.

As of 2006 NANDA officially added the diagnosis Risk for Unstable Blood Glucose to the list of 188 ones that had been researched. It has only made it into the most recently published care plan books and the official NANDA publications. The use of terms like "Alteration in" as part of the NANDA diagnosis labels was changed some time ago. Alteration in Comfort never was an official NANDA diagnosis and has been a diagnosis that a number of care plan authors who are also nursing professors developed to be used in situations where patients are in bad shape, such as dying, and in a lot of pain and discomfort. NANDA has always maintained that nurses can use any diagnoses they come up with that they feel fit their patient's situation. And, it sounds like that is what your instructor is doing. You might want to clarify that to be sure. The thing is this. . .you need to make sure that you know and keep clear what the defining characteristics and related factors are going to be for these two diagnoses if you decide to use them. I would go back to your instructor and ask, "What, then are the signs and symptoms and related factors for Alteration in blood glucose levels and Alteration in Comfort because I can't find them in any of my reference books." It is, at least, an intelligent question.

Diagnosing is based upon the signs and symptoms that the patient has. Every nursing diagnosis has a set of signs and symptoms which NANDA calls defining characteristics. The reason we assess patients is to discover what signs and symptoms the patient has. The signs and symptoms of our nursing diagnosis, with the exception of a handful, do not come anywhere close to medical diagnoses. We diagnose nursing problems and figure out how to help patients get through living with their ADLs. In addition we also have to assist the physicians in carrying out their medical treatment plans.

For a patient with Type II Diabetes, you first break it down into the symptoms they exhibit. If she is obese and on bedrest as well as has fluctuating blood glucose levels you need to look for reasons why. Why is someone obese? Did you monitor her diet and what she eats? Get her weight? Look up what her weight should be? Talk to her about what she has been told she should eat? Why is she on bedrest? Can this be changed? What are the complications of bedrest? What self-care deficits has this created, because this is a nursing problem of big proportions? What causes fluctuations in blood glucose levels? Insulin dosage? Food intake? Infection? Activity? This is all assessment information that needs to be gathered that may lead to nursing diagnoses other than an altered blood glucose level.

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Thanks for your answer. Yeah, I don't understand it at all. This is my first semester so I am very book dependant at the moment.

So told me that risk for unstable blood glucose wouldn't work either.

I really can't wrap my brain arond what she is wanting me to do, expecially since I am sooo new. I really need this grade though.

I do not know what I am going to do but I REALLY APPRECIATE your help. THank you for responding so quickly.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

Post a list of the symptoms your patient has and their medications. Let me show you how to determine a list of nursing diagnoses from that. I may be slow getting back to you. It's soap opera time and my DSL service is down and I'm having to rely on dial up which is slow.

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there is no lack of issues....

chf, copd, mi, asthma, a fib, cva, cholecystectomy, hernia repair, pacemaker,

[color=#333333]cough secondary to post nasal drip. atrial fibrillation, numbness and tingling of 4th and 5th digits of left hand

mediations: lovenox, metoprolol succinate

xanax, pantoprazole sodium, amlodipine besylate (norvasc), montelukast sodium (singulair), insulin aspart novolin 70/30, lasix, codeine sulfate, robitussin, albuterol sulfate, warfarin, insulin glargine, pantoprazole sodium, sodium chloride 0.9% add azithromycin, cefotaxime sodium, nitroglycerin, morphine sulfate, acetaminophen

labs: high wbc, high rbc, high hct,

low mch, low mchc, high rdw, high mpv, high neut%, low lymph% high pt, high glucose, high blood urea nitrogen, high creatinine , low sodium , low glomerular filtration rate, high microalbumin,ur, high alb/creat ratio, high myoglobin, low albumin,

low sgpt alt, low a/g ratio, high globulin

thanks for yor help!

you are such an awesome assest to this forum!

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Specializes in med/surg, telemetry, IV therapy, mgmt.

ok. i see some of your problems already. what you have posted is a list of the patient's medical diseases, not their symptoms! medical diseases can't help much. you need to go back through this information and determine what this patient's symptoms were. medications are given to treat the symptoms they have. did you listen to the patient's lungs? was there any pedal edema? irregular heart rate? cough? those are symptoms that will be needed to help determine nursing diagnoses. was the patient able to walk without help? continent? bathe and dress by themself? i can't work with any of the information you posted.

  • lovenox - why is this being given?
  • warfarin - why is this being given?
  • metoprolol succinate -
  • xanax - doctors prescribe this for anxiety; does this patient have problems with anxiety? what symptoms are there?
  • pantoprazole sodium - this is given for gerd or to prevent gastritis especially of the patient is suspected of being under enough stress to develop it during a hospitalization
  • amlodipine besylate (norvasc) - this is a calcium channel blocker used for hypertension. what is this patient's cardiac assessment since there is a pacemaker, atrial fib and congestive heart failure?
  • montelukast sodium (singulair) - this is given for asthma and allergies. did you assess the lungs?
  • insulin aspart novolin 70/30
  • insulin glargine
  • lasix
  • codeine sulfate - this is pain medication! where is the patient's pain?
  • morphine sulfate - this is pain medication! where is the patient's pain?
  • robitussin
  • albuterol sulfate - lung symptoms?
  • sodium chloride 0.9% add azithromycin
  • cefotaxime sodium = this is an antibiotic! where's the infection and what are the signs and symptoms of this infection?
  • nitroglycerin - chest pain?
  • acetaminophen - why is the patient getting this?

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what is nursing diagnosis for acute gastritis

i'm blurr right now!

somebody please help me...

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