questions about DM and care plan

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Hello!! I am writing a care plan for a pt w/ DM. Pt was in ER for hypoglycemia episode. I hope someone can answer my question below so I can better understand this.

what is consider normal glucose level for DM patients? is it the same as a person who does not have DM? how is it possible to keep them between 70-110mg/dL ? the reason I ask is because his dx was hypoglycemia, but the lab value indicated 138mg/dL in the ER. so, 138mg to a DM patient is considered hypoglycemia?

I heard the shift report as saying his glucose level was 50mg, and I thought I heard it wrong, but it was confirmed by the nurse, but as I went through his chart, I did not see anything written as his level was that low.

my nursing diagnoses would be 1. uncontrolled glucose level 2. impaired skin integrity r/t psorasis 3. risk for fall r/t to right side weakness 4. knowledge deficit r/t DM

do you think I have prioritized it correctly?

thanks

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Specializes in ER/ICU/STICU.

His glucose probably was 50 and they gave him some D50 prior to having labs drawn. Another scenario is that he was brought in by medics and they gave him the D50 prior to getting to the hospital. That could also be why you are having a hard time finding documentation of the low BS.

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Specializes in Emergency Department.
my nursing diagnoses would be 1. uncontrolled glucose level 2. impaired skin integrity r/t psorasis 3. risk for fall r/t to right side weakness 4. knowledge deficit r/t DM

do you think I have prioritized it correctly?

Why did you choose knowledge deficit rather than noncompliance or ineffective health maintenance for your psychosocial? Is this person a new DM patient?

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Why did you choose knowledge deficit rather than noncompliance or ineffective health maintenance for your psychosocial? Is this person a new DM patient?

Hi Apgar!!

While I was doing assessment I found out that he has been a diabetic pt for 20+ years, he knows about insulin and what it does for the body but nothing else as how to take care of himself and what to watch out for.

For example, he does not monitor his glucose level regularly at home. Second, he does not take care of his feet and he does not know that the nerve can be damaged from DM. So he often goes barefoot and there's a gangrene on his toe. He also lack knowledge of how to properly inject insulin because he injected too much that led to the hypoglycemia episode. He was wearing a pump before, but for some reason he took it off and decided to inject it himself. So he fell down and was sent to ER. I thought he needs more teaching about the disease and how to maintain it because the doctor mentioned to him that his kidneys are in horrible shape now may soon need to go on dialysis.

Please correct me if I am wrong, because I am clueless too!! thank you!

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Specializes in Emergency Department.
While I was doing assessment I found out that he has been a diabetic pt for 20+ years...

Okay it makes sense. The reason I asked is because you'll learn the instructors get bored of reading "Knowledge Deficit", "Fear", and "Anxiety" psychosocial NANDAs. But clearly you have data to support knowledge deficit and aren't using it because you can't think of anything else or can't stretch your brain, or worse, didn't talk to your patient enough to determine a better nursing diagnosis for him.

Only a few more weeks and onto the second semester! Homestretch for me! :yeah:

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thanks Apgar!! yes, I did a thorough assessment, but I wish I could become better at it, because I was sorta of everywhere. I ask a lot of questions and it often just comes from whatever I have in my head at the time, also from observing him and looking at his physical condition. sighs.....I cannot wait till this semester is over. But I am afraid I will forget it all in the summer, so I am gonna keep reading, keep doing nclex questions and review the skills. thank you so much for your help!!

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