I need help with doing a care plan for a patient starting on insulin

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Hi,

This is what i have got from my assessment and info about my pt.

Pt is 76 year old married man who is a sheep farmer

Never smoked

Past health history:

Diagnosed with type 2 diabetes in 1996 (17 years).

March 2012: Cardio Vascular Risk Assessment (CVRA) = 27%

August 2012: Hba1c was high at 126mmol/mol - Normal range

Present health:

Blood test showed HBA1c 101mmol/mol (

He came in after the 3 days with his recordings BGL 4-4.5 in mornings than high prior to lunch 16-18. maintain lantus 10 u and glicazide BD and melformin TDS. Suggested to change diet- is not hhaving supper so advised to have 1 piece of toast before bed.

Advised to reduce breakfast reduce to 1 weetbix instead of 2 and 2 toast instead of 4,

Pt rang in a few days later saying his morning BGL readings had doped to 2.9 and 2.2. Advised to reduce lantus to 8u and glicazide to 1 tab nocte. advised re his carb intake for rest of the day post hypo.

I rang him the following day to check his BGL was 6

waiting to see diabetic nurse.

Can anyone help with how i write this up into a care plan

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Well what are your three priority nursing diagnoses? Once you think you have the top three NDs, you can look up desired outcomes for each ND, what interventions you are going to/would provide to achieve those outcomes for each ND, and evaluations of outcomes, achieved or not, and why.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

We are happy to help...but I need to know some information first.....what semester are you? You are not in the US (the lab work was a give away)......What care plan book do you use?

Let the patient/patient assessment drive your diagnosis. Do not try to fit the patient to the diagnosis you found first. You need to know the pathophysiology of your disease process. You need to assess your patient, collect data then find a diagnosis. Let the patient data drive the diagnosis.

Think of the care plan as a recipe to caring for your patient. your plan of how you are going to care for them. how you are going to care for them. what you want to happen as a result of your caring for them. What would you like to see for them in the future, even if that goal is that you don't want them to become worse, maintain the same, or even to have a peaceful pain free death.

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I would be willing to swear we saw this same sheep farmer here a year ago. :)

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I think it's a standard imaginary patient scenario for school

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Im not understanding some of the terminology, and values, is this another country?

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Yes Europe...probably England or Australia.

Formula for calculation of mg/dl from mmol/l: mg/dl = 18 × mmol/l

Formula for calculation of mmol/l from mg/dl: mmol/l = mg/dl / 18

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Specializes in ER, Addictions, Geriatrics.

Formula for calculation of mg/dl from mmol/l: mg/dl = 18 × mmol/l

Formula for calculation of mmol/l from mg/dl: mmol/l = mg/dl / 18

Ah! I never thought to look for a conversion before. I am always having to take an extra long look at most of the posters lab values on here as I'm in Canada and its different than in the US!

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

everything has a conversion....;)

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Although there are a lot of sheep in the British Isles, my bet is on Oz. :)

Anyway, OP, a care plan looks at the nursing diagnoses you make based upon your assessment of Bob's status. I'm guessing you want to think about something like whether he understands his disease and therapy primarily. Your nursing diagnosis might be something like one of the following: (Look them up for the defining characteristics required to use any of them as diagnosis)

  • Risk-Prone Health Behavior: Impaired ability to modify lifestyles/behaviors in a manner that improves health status (Domain 1, Health Promotion; Class 2, Health Management)
  • Ineffective Health Maintenance: Inability to identify, manage, and/or seek out help to maintain health (Domain 1, Health Promotion; Class 2, Health Management)
  • Ineffective Self-Health Management: Pattern of regulating and integrating into daily living a therapeutic regimen for treatment of illness and its sequelae that is unsatisfactory for meeting specific health goals (Domain 1, Health Promotion; Class 2, Health Management)
  • Readiness for Enhanced Self-Health Management:A pattern of regulating and integrating into daily living a therapeutic regimen for treatment of illness and its sequelae that is sufficient for meeting specific health-related goals and can be strengthened (Domain 1, Health Promotion; Class 2, Health Management)
  • Risk for Unstable Blood Glucose: Risk for variation in blood glucose/sugar levels from the normal range (Domain 2, Nutrition; Class 4, Metabolism)
  • Readiness for Enhanced Decision-Making A pattern of choosing courses of action that is sufficient for meeting short and long-term health-related goals and can be strengthened (Domain 10, Life Principles; Class 3, Value/Belief/Action congruence)
  • Deficient Knowledge: Absence or deficiency of cognitive information related to a specific topic (Domain 5,Perception/Cognition; Class 4: Cognition)
  • Readiness for Enhanced Knowledge: the presence or acquisition of cognitive information related to a specific topic is sufficient for meeting health-related goals and can be strengthened (Domain 5, Perception/Cognition; Class 4: Cognition)
  • Sorry about the indents, can't seem to make them go away in this format.

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Im from New Zealand, in my final year, 1st time doing care plan.

1st nursing diagnosis i thought - Anxiety and lack of knowledge relating to insulin administration.

2nd Unstable BGL related to irregular testing and knowledge regarding importance of stable BGL

3rd Knowledge deficit related to diet.

Is this the sort of thing i should be looking at?

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Do you use NANDA I there?

GrnTea gave some great suggestions....

  • Risk-Prone Health Behavior: Impaired ability to modify lifestyles/behaviors in a manner that improves health status (Domain 1, Health Promotion; Class 2, Health Management)
  • Ineffective Health Maintenance: Inability to identify, manage, and/or seek out help to maintain health (Domain 1, Health Promotion; Class 2, Health Management)
  • Ineffective Self-Health Management: Pattern of regulating and integrating into daily living a therapeutic regimen for treatment of illness and its sequelae that is unsatisfactory for meeting specific health goals (Domain 1, Health Promotion; Class 2, Health Management)
  • Readiness for Enhanced Self-Health Management:A pattern of regulating and integrating into daily living a therapeutic regimen for treatment of illness and its sequelae that is sufficient for meeting specific health-related goals and can be strengthened (Domain 1, Health Promotion; Class 2, Health Management)
  • Risk for Unstable Blood Glucose: Risk for variation in blood glucose/sugar levels from the normal range (Domain 2, Nutrition; Class 4, Metabolism)
  • Readiness for Enhanced Decision-Making A pattern of choosing courses of action that is sufficient for meeting short and long-term health-related goals and can be strengthened (Domain 10, Life Principles; Class 3, Value/Belief/Action congruence)
  • Deficient Knowledge: Absence or deficiency of cognitive information related to a specific topic (Domain 5,Perception/Cognition; Class 4: Cognition)
  • Readiness for Enhanced Knowledge: the presence or acquisition of cognitive information related to a specific topic is sufficient for meeting health-related goals and can be strengthened (Domain 5, Perception/Cognition; Class 4: Cognition)

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