Question

A 45 yo female presents with a CC (chief complaint) of numbness, tingling, and burning in her hands and feet (also known as peripheral neuropathy). Pt has a h/o (history of) uncontrolled Type II DM (Type 2 Diabetes). On assessment you observe that pt has decreased sensation to her extremities. Palpation of dorsalis pedis and posterior tibial pulses are 1+/4 bilat (bilaterally). You perform an accucheck, which shows a blood glucose level of 200 (normal range 70-110). You ask the pt when was the last time she took her medication, and she states “four days ago.”

Develop a nursing diagnosis and work through the table using the above information

Assess	Diagnose	Plan/Outcome	Intervention/ Implementation	Evaluation/ Goal Achieved
Subjective Objective		Short-term Long-term		Short-term Long-term
Subjective Objective		Short-term Long-term		Short-term Long Term

Answer 1

Diabetic Mellitus

It is a condition in which there is decreased amount of insulin production in the body or the tissues can not effectively o use the insulin in order to absorb glucose from the blood to cells leads to increased blood sugar in the blood (Hypercyclemia).If the condition presists for a long time leads to various complications including damage to internal organs such as kidney, nerves, blood vessels, eyes, heart, brain etc. The chronic disease that damage the nerves is called as diabetic neuropathy. When it affects peripheral blood vessels and nerves it is called as peripheral neuropathy.

Nursing Assessment:

• Assessment of sensation: numbness, tingling, burning in her hands and feet (decreased sensation in the extremities)
• Pulses: dorsalis pedis and posterial tibial pulses:1+/4 bilateral (weak pulse)
• Blood sugar:200mg/dl (hyperglycemia)
• On assessment she is following poor medication regimen (knowledge deficit)

Nursing Diagnosis

1. Unstable blood glucose level (hyperglycemia) related to lack of adherence to diabetic management and poor monitoring of blood glucose level.
2. Disturbed sensory perception (tactile) related to hyperglycemia, poor circulation in the extremities.
3. Risk for impaired skin intergrity due to lack of blood circulation and tactile sensation in extremities.
4. Deficient knowledge regarding disaese process, treatmant and individual care needs.

Nursing care plan

Assess	Diagnosis	Plan/Outcome	Intervention/ implementation	Evaluation/Goal achieved
Subjective data: Patient said" I have numbness, tingling, burning in my hands and feet. I took diabetic medicine 4 days ago" Objective data: Patient has decreased sensation in extremities blood glucose: 200mg/dl Weak peripheral pulses: Dorsalis pedis& posterial tibial 1+/4 bilateral	Unstable bood glucose level (hyperglycemia related to lack of adherence to diabetic management and poor monitoring of blood glucose as evidenced by blood glucose 200mg/dl	Short term: maintains blood glucose within normal range Long term:identifies the factors leads to hyperglycemia Maintain a good medication regimen Improves sensation in the extremities	Assess blood glucose level of the patient and inform the patient about the current blood sugar Explain to the patient regarding factors that influences increased blood sugar level: low poor diet, lack of exercise, improper medication intake, stress etc Provide diabetic diet to the patient Educate patient regarding balanced diet:low calorie diet and regular exercises Refer the patient to a dietition in order to plan a diabetic diet for the patient Educate the client how to monitor the blood glucose at home and maintain a blood glucose chart Teach the patient about the importance of anti diabetic medication Inform the patiet regarding the name, dose, frequency of medicine administration Provide information regarding the risk factors and complications of diabetic	short term: Patient blood sugar is 120mg/dl Long term: patient HbA1c level is within normal range client got relief from tingling, numbness, blurring sensations
Subjective data: Patient said" I have numbness, tingling and burning sensation in extremities Objective data: Patient has decreased sensation in extremities patient peripheral pulses are weak: dorsalis pedis and posterior tibial 1+/4 Patient blood glucose is 200mg/dl	Disturbed sensory perception (tactile) related to hyperglycemia and poor circulation in the extremities as evidenced by weak peripheral pulses and lack of sensation in extremities	Short term: Patient verbalises improved sensation in extremities Long term: Patient maintains normal blood sugar maintain good skin intregrity	Assess the extremities of the patient for mumbness tingling and burning sensations Check the peripheral pulses of the extremities teach the patient regarding the importance of exercise in diabetic control Encourage the patient to do physical exercise atleast for 30 minutes Provide peripheral nerve stimulation and massaging Educate the patient how to avoid cuts and wounds in extremities Advice the patient regarding importance of diet control and medication regimen	short term patient got relief from numbness, tingling and burning of extremities long term patient maintained normal blood sugar and HbA1c le vels patient is free from wounds and cuts