Concept Map Nutrition

Imbalanced Nutrition:

More than body requirements

(Obesity)

Risk for Knowledge Deficit of Diabetic Management

Risk for Unstable Blood Glucose

Diagnosing Data:

Risk for Impaired Skin Integrity

• Adult Obesity with BMI between 32 – 32.9

Diagnosing Data:

Diagnosing Data:

Supporting Data:

• Adult Obesity with BMI between 32 – 32.9
• History of Type 2 Diabetes
• Two past ER visits for hypoglycemia

• no wounds yet

Supporting Data:

• Weight: 210lb
• BMI: 32.9
• BMI is greater than 30, which is considered obese.
• M.R states he has no time to exercise.

Diagnosing Data:

Supporting Data:

• BMI 32.9
• Weight 95.5 kg (210 lbs)
• Height 170.2 cm (67 in)

• no wounds as of yet, but "tingling in his feet"

• two ER visits in the past year for hypoglycemic episodes

Supporting Data:

• monitors blood glucose "a couple times a day"
• urinates frequently b/c he consumes a lot of water
• takes medication twice "most days"

NIC/INTERVENTIONS:

NOC/OUTCOMES:

NOC/OUTCOMES:

Long term goal

• Reasonable goal weight per month: Weight loss of 4 lbs a month until BMI is in normal range.

Short term goal

• Establish reasonable goal weight per week: Pt will lose 1 lb a week.
• Make time for walking/exercise.

- M.R will walk to son’s baseball practice.

• M.R will verbalize accurate information about benefits of weight loss.
• M.R verbalizes desire to achieve set goals for a healthier lifestyle.
• M.R packs himself healthier meals and selects healthier options when eating out.

NIC/INTERVENTIONS:

• Pt has glucose reading less than 180 at all times
• Fasting glucose less than 110
• A1C less than 7
• Adequate tissue perfusion
• Good appetite and healthier diet at the next clinic visit.
• Patient will check blood glucose levels regularly throughout the day
• Patient will not be admitted to hospital for skin-related injury.
• Patient will self-care and moisturize skin.
• Patient will be able to inspect feet and care daily.

NIC/INTERVENTIONS:

NIC/INTERVENTIONS:

• Assess for sign of hyperglycemia

- Polydipsia, polyphagia, and polyuria are common signs of hyperglycemia. This may occur when there is not enough insulin to glucose within the body.

• Assess eating patterns

- Being non adherent to a diabetic diet may cause fluctuations in blood glucose.

• Assess patients knowledge and understanding of their prescribed diet.

- Patient may need further guidance as to what they should and should not be eating. A better understanding may promote better glucose control.

- Low Carb, High protein and fiber diets are beneficial

- Eating concentrated carbs and sweets should be done in moderation and not everyday

• Check blood glucose before meals and bedtime (fasting and postprandial)

- Monitors effectiveness of medication and the need for a different dose or medication

• Administer insulin as prescribed

- Keeping glucose within normal range decreases risk of complications that are secondary to DM.

• Encourage and educate patient on how to check blood glucose at home

- Keeping track of glucose at home especially before meals and bedtime help maintain levels within normal range, therefore reducing future complications. This also allows for greater control of glucose levels and reducing the trips and admissions into the ER and hospital.

• Monitor lab values (A1C)

- Monitoring labs would indicate changes in kidney function, showing complications from DM.

- A1C should be less than 7. This shows how controlled your glucose levels have been within the past few months

• Educate patient on proper skin care. Avoid harsh soaps and moisturizers.

- Rationale: Skin dehydration and risk of impaired skin integrity due to DX.

• Educate patient on proper foot care, and daily visual inspection of feet.

- Rational: High risk of ulcers and damage to feet due to poor circulation in lower extremities.

• Patient will lose 2.3 kg (5 lb) per month until BMI is <25.0

- Rationale: Poor circulation and at risk of ulcers from DX. Patient’s feet are highly susceptible to damage.

• Patient’s skin remains healthy and free of impairment.

NOC/OUTCOMES:

NOC/OUTCOMES:

• Patient will not be admitted to hospital for skin-related injury.
• Patient will self-care and moisturize skin.
• Patient will be able to inspect feet and care daily.

• Assess the patient's knowledge about his nutritional needs, food intake, and/or appropriate food preparation.

- This information can help us develop a teaching plan.

• Educate the patient on adequate nutrition intake.

- Educate M.R on the benefits that weight loss can have to his diabetic condition.

- Educate M.R on the risks of heart and cardiovascular diseases that come with obesity.

• Determine his readiness to begin a weight loss plan/ diet.

- It is important to work with the patient by asking the patient how he feels about starting a diet and making sure any worries can be addressed.

• Work together with the patient to modify his diet.

- Eat meals with more nutritional value so that he is no longer “hungry all the time”. This will decrease his need to snack as much.

- Modify M.R’s snacks to incorporate fruits and healthier diet choices.

- Make lunch/pack lunch the night before, instead of stopping at fast food restaurants for lunch while in a rush.

- When eating out, try healthier choices on the menu.

- Let the patient know that it is good that he drinks a lot of water, but he should consider lowering his soda intake.

• Make time for exercise

- Talk to the patient about riding a bike to work or to his son's baseball practice.

- Walk/ exercise 30-45 min, 5 days a week. If not enough time, set a goal to do one form of physical activity a day even if it is only for 10 min.

• Weigh patients at least once a week under the same conditions.

- This will show M.R his progress which can act as a reward. It will also keep him motivated to his goals.

• Assess ability to learn or perform desired health-related care.

- Cognitive impairments must be recognized so an appropriate teaching plan can be outlined.

• Assess motivation and willingness of patient to learn.

- Learning requires energy. Patients must see a need or purpose for learning. They also have the right to refuse educational services.

• Determine priority of learning needs within the overall care plan.

- This is to know what needs to be discussed especially if the patient already has a background about the situation. Knowing what to prioritize will help prevent wasting valuable time.

• Allow the patient to open up about previous experience and health teaching.

- Older patients often share life experiences to each learning session. They learn best when teaching builds on previous knowledge and experience.

• Identify cultural influences on health teaching.

- Interventions need to be specific to each patient considering their individual differences and backgrounds.

• Consider the patient’s learning style, especially if the patient has learned and retained new information in the past.

- Every individual has his or her learning style, which must be a factor in planning an educational program. Some may prefer written materials over visual materials, while others prefer group sessions over an individual instruction. Matching the learner’s preferred style with the educational method will facilitate success in mastery of knowledge.

• Determine the patient’s self-efficacy to learn and apply new knowledge.

- Self-efficacy refers to a person’s confidence in his or her own ability to perform a behavior. A first step in teaching may be to foster increased self-efficacy in the learner’s ability to learn the desired information or skills. Some lifestyle changes.

• Assess barriers to learning (e.g., perceived change in lifestyle, financial concerns, cultural patterns, lack of acceptance by peers or coworkers).

- The patient brings to the learning situation a unique personality, established social interaction patterns, cultural norms and values, and environmental influences.

• Render physical comfort for the patient.

- Based on Maslow’s theory, basic physiological needs must be addressed before the patient education. Ensuring physical comfort allows the patient to concentrate on what is being discussed or demonstrated.

• Grant a calm and peaceful environment without interruption.

- A calm environment allows the patient to concentrate and focus more completely.

• Provide an atmosphere of respect, openness, trust, and collaboration.

- Conveying respect is especially important when providing education to patients with different values and beliefs about health and illness.

• Include the patient in creating the teaching plan, beginning with establishing objectives and goals for learning at the beginning of the session.

- Goal setting allows the learner to know what will be discussed and expected during the session. Adults tend to focus on here-and-now, problem-centered education.

• Consider what is important to the patient.

- Allowing the patient to identify the most significant content to be presented first is the most effective.

• Involve patient in writing specific outcomes for the teaching session, such as identifying what is most important to learn from their viewpoint and lifestyle.

- Patient involvement improves compliance with health regimen and makes teaching and learning a partnership.

• Explore reactions and feelings about changes.

- Assessment assists the nurse in understanding how the learner may respond to the information and possibly how successful the patient may be with the expected changes.

• Support self-directed, self-designed learning.

- Patients know what difficulties will transpire in their own environments, and they must be encouraged to approach learning activities from their priority needs.

Patient Demographics:

M.R. is a 43-year0ld Hispanic male who has a follow-up appointment at the diabetic clinic. One and a half years ago, he was diagnosed with type 2 diabetes mellitus (DM). He has been to the emergency department (ED) twice in the past year for hypoglycemic episodes. M.R. is divorced and lives alone. He has a 16-year-old son who he sees frequently. His family history includes type 2 DM in both his father and paternal grandfather. M.R. was raised Roman Catholic but currently does not attend church. He has no allergies.

Medications

Labs

AOx4, Denies pain, PERRLA, Head & neck exam are normal with no JVD. Apical pulse is 76 and regular; lungs are clear. Abdomen is soft and round with BS present in all four quadrants. MAE. Peripheral pulses 2+. No edema. Skin is dry and warm. Normal Gait.

Evaluation:

Created By:

Breakfast: Coffee & Muffin

Lunch: Sandwhich or Fast Food

Snacks frequently

Dinner: Something quick if home, if out eats pizza

Drinks: Lots of water & Diet coke

• Family history of type 2 DM: father & paternal grandfather
• Type 2 DM for 1 1/2 years
• ED twice in past year for hyperglycemic episodes

Kimberly Echeverry,

Jacquelyn Shtitsberg,

Kiara Gonzalez,

& Shena Debow

MacBook Pro

Medication List

References:

https://nurseslabs.com/diabetes-mellitus-nursing-care-plans/11/.

https://nurseslabs.com/diabetes-mellitus-nursing-care-plans/

https://nurseslabs.com/diabetes-mellitus-nursing-care-plans/2/

https://nurseslabs.com/imbalanced-nutrition-more-body-requirements/

https://www.mayoclinic.org/drugs-supplements/glipizide-and-metformin-oral-route/description/drg-20061984

https://nurseslabs.com/diabetes-mellitus-nursing-care-plans/11/.

P.G. Chambers School General Information

General Email: info@chambersschool.org

Phone: 973-829-8484

Fax: 973-829-8485

1. Metformin 850mg BID

2. Glipizide 5mg QD

• With two actions, the combination of glipizide and

metformin helps your body cope with high blood sugar.

• Glipizide stimulates the release of insulin from the

pancreas, directing your body to store blood sugar.

• Metformin has three different actions: it slows the absorption of sugar in your small intestine; it also stops your liver from converting stored sugar into blood sugar; and it helps your body use your natural insulin more efficiently.

• Unstable Blood Glucose:

Patient had glucose readings less than 180 at all times.

Patient has A1C of 6

Patient has increased fiber and protein intake and decreased the amount of

simple sugars within diet.

Patient checks blood glucose with meals and at bedtime.

• Impaired Skin Integrity:

Patient demonstrated proper foot care at one week follow up visit.

Patient’s skin remained intact and free of impairment.

Skin is dry and warm, no edema, and good turgor.

• Knowledge Deficit:

Goal has partially been met. He has been checking his blood glucose levels around

three times a day and it is usually between 140-180 mg/dL. He states that he filled the new prescription immediately and has been diligent about taking his medications

• Imbalanced Nutrition:

Goal has partially been met. M.R has been eating healthier and has noticed some weight loss but not enough to have reached his goal. M.R has been packing meals for lunch the night before and eating out a lot less. When he eats out, he tries ordering healthier options. M.R finds himself snacking less because of his filling meals during the day. However, he will still have a snack of his liking once in a while. M.R has not been able to make time for exercise during the week. He has not been walking to his son’s baseball games or riding a bike to work because he is often running late. M.R is still committed to his diet/weight loss plan.