Hypoglycemia

I don't get where the assessment data is coming from to support a nursing diagnosis of Altered LOC (NANDA: Acute or Chronic Confusion?) because none of the symptoms that are listed supports this nursing diagnosis.

People with diabetes often have one or more of the following symptoms: polyuria, polydipsia, nausea, anorexia, polyphagia, headaches, fatigue, lethargy, reduced energy levels, muscle cramps, irritability, vision changes, numbness and tingling in extremities, or abdominal discomfort.

What is the etiology of the slurred speech? Does this patient have any cerebrovascular problems and this is just one manifestation of it? It is not uncommon to see long term diabetics having problems related to atherosclerosis. With cool, clammy, pale skin I would wonder if there were peripheral vascular problems going on. Any peripheral edema? Any foot problems? Also, with a B/P as low as you've listed, what is going on with this person's heart? What medications is this patient on? They may provide clues as to other problems they may be having in addition to the diabetes.

For the nausea and vomiting you can use the nursing diagnosis: Nausea.

Without any other information, you could also use the nursing diagnosis of Impaired Verbal Communication. However, I suspect that there is much more going on with this patient than you've actually gotten data on. With blood sugars of 40, there is a much bigger problem occurring--an infection or the patient isn't taking their medication properly. If infection is the problem, where is it and what is being done about it. If not taking their insulin properly is the problem, then Knowledge Deficit is another nursing diagnosis you can use.

Any nursing care plan ALWAYS starts by looking at the abnormal data you have collected. In my experience when having problems finding nursing diagnoses for a patient, it is usually because abnormal data has been missed during the assessment process. The only abnormal data that you've listed was:

• BS of 40
  
• BP of 88/50
  
• heart rate of 120 bpm
  
• respirations of 28
  
• cool, clammy, pale skin
  
• nausea and vomiting
  
• slurred speech

the steps of the nursing process (and writing a care plan) are:

1. assessment (collect data)
   
2. formulate nursing diagnoses
   
3. write measurable outcomes and interventions
   
4. initiate the care plan
   
5. determine if outcomes have been met

to formulate nursing diagnoses in step #2 of this process, you make a list of all the abnormal symptoms that you obtained during the assessment, or data collection that you did in step #1. these abnormal symptoms are called defining characteristics by nanda. each nursing diagnosis (nanda now has 188 of them) has a definition, defining characteristics and related factors. to determine what nursing diagnoses are going to be appropriate for any particular patient, you need to know what the definitions, defining characteristics and related factors are for the various nursing diagnoses. there are all kinds of books on the market that have this information for you and there are currently two care plan constructors that can be accessed online for free that contain the information for approximately 50 to 75 of the most commonly used nursing diagnoses. you can get that information on these two threads on allnurses:

• https://allnurses.com/forums/f205/desperately-need-help-careplans-170689.html - desperately need help with careplans (in nursing student assistance forum)
  
• https://allnurses.com/forums/f50/careplans-help-please-r-t-aeb-121128-7.html - careplans help please! (with the r\t and aeb) (in general nursing student discussion forum)

you are now telling me that your patient is getting the following medications: lasix, norvasc, nexium, baby aspirin, lantus and humalog. i know why the patient is on lantus and humalog. but why is the patient on lasix, norvasc and baby aspirin? and why the nexium? norvasc (amioidipine) is a calcium channel blocker that is often given for hypertension and sometimes to keep angina under control. lasix (furosemide) which is a loop diuretic is often given along with antihypertensives, but it is often given as well when there is edema due to congestive heart failure. i am suspicious that there is something of a cardiac nature that the physician is either treating or attempting to head off prophylactically. it is not uncommon, as i mentioned, before for diabetics to develop atherosclerosis. manifestations of atherosclerosis in the heart would be arteriosclerotic diseases such as coronary artery disease or ashd. any degree of heart failure could also be going on and which i would be suspicious of since lasix is being given. lasix is also often given for pulmonary edema, one of the many symptoms of congestive heart failure. nexium (esomeprazole) is a newer antiulcer and proton pump inhibitor given when there is gerd or known duodenal ulcers caused by h. pylori bacteria. obviously, this patient has either of these problems or symptoms that may have led to them that the physician is trying to allay. if gastritis or an ulcer is already present, the nausea and vomiting may be symptoms of it. gastroparesis is also not an uncommon problem in diabetics. is it possible that your patient has this? elderly diabetics, particularly when they have been diabetics for some time, often have a number of diabetic complications as well. this is why i am suspicious that there are other things going on here beside just this patient's diabetes by itself. i am also wondering why the patient is receiving home health services as well? why does she need the services of an rn checking up on her? there has to be a reason that medicare is paying for these services.

when gathering the assessment data of a patient one has to look at the physician's history and physical, er physician's documentation (if there is any), the reports of any consulting doctors, x-ray reports, reports of any procedures or endoscopic procedures that might have been done, lab results and physician's progress notes. all of these will yield more clues and symptoms of the patient's problems. not all your assessment data has to come from what you observe with your own eyes. i am mentioning this only because there is so much more data that you could have to help develop a plan of care for this patient that you just don't have. the home health nurses are generally notorious for having tons of documentation about their patients in order for medicare to pay for the services they provide. and, while it would be nice if we could just make up a care plan based on medical diagnoses, that just isn't how it is supposed to be done.

based on what you've provided, this is what i can come up with:

• imbalanced nutrition: less than body requirements r/t inability of the body to adequately metabolize and use glucose and nutrients aeb blood sugar of 40 on am of assessment, cool clammy, pale skin and slurred speech
  
• nausea r/t gastric irritation (?) aeb statement by patient that she vomited her breakfast
  
• ineffective health maintenance r/t knowledge deficiency in caring for disease condition aeb inability to recognize symptoms of illness.
  
• risk for infection r/t chronic disease

You have been a tremendous help and I thank you so much, I also looked in my Nanda Diagnosis handbook by Ackley and Ludwig. You saved the day. Thanks again so much.:nuke:

You are welcome. Eventually, the critical thinking on all this falls in place and it all starts to make sense. Keep working at doing these care plans no matter how frustrating they seem. The idea is to help you learn to put it all in perspective. Good luck with this care plan. If you need more information on the diagnoses or need nursing interventions, go to the care plan threads I posted above.