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Discussion

Diabetic care plan

I'm trying to come up with a 4th nursing diagnosis for my patient and I'm having alot of trouble coming up with one

my patient had copd exacerbation with pneumonia. Also had type 2 DM but metformin was on hold and was receiving methylprednisolone so the blood sugars were all over 400. The lowest blood sugar i took was 364. They started the patient on lispro 8 units with every meal along with a sliding scale depending on the blood sugar.

So far i have impaired gas exchange, activity intolerance, and risk for falls

i wanted to use the risk for undtable blood glucose level but the patient already has unstable glucose levels and the outcome of meeting a 'normal' blood glucose is very unreasonable.

i was thinking of using risk for infection but also not sure if that would be appropriate.

i'm really stuck on this one and woulf love to here some input from you guys.

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    So I always look at what caused the situation and where it could lead, and what you want to prevent. If a pt has COPD which leads to pneumonia, chances are this was the result of an inability to properly clear the lungs effectively. Also, it a pt is in the 400's on blood sugar, there is a risk for DKA. Also with pneumonia there is a risk for pulmonary effusion, right? Now, these are medical diagnoses, so you have to relate them to what interventions you can identity to prevent or assist, but they are fairly easily correlated.

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    DKA is type 2 is extremely rare, HHNS might be more likely. If you are sticking with the lungs, you can always look at ineffective airway clearance. If the patient has pneumonia caused by COPD, I agree with SDBoy that the lungs are obviously not clearing effectively.

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    Risk for impaired skin integrity is a very common nursing diagnosis with DM, especially very uncontrolled like your patient. Think about your pathophysiology and holistic approach to DM care and why that might be so. Goals and interventions are quite simple. If your patient is immobile (which was a contributing factor in their pneumonia) the diagnosis makes even more sense.

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