NURSING PROCESS NURSING CARE PLAS FOR DIABETES MELLITUS Nursing Assessment

According to Jeffrey (2004), the main activity of the assessment phase is for the nurse to obtain a history of current problems, family history, and general health history. The nurse should investigate among other things, whether the patient has experienced the signs of diabetes mellitus such as polyuria,polydipsia, polyphagia and any other symptoms. Then consider the patient history. For example, the number of years that have elapsed since the patient was diagnosed with diabetes and whether there is any family member of his who has been diagnosed with diabetics. Consider also the subsequent treatment that was administered to the family member with a sharp concentration on any complications that may have developed. 

In the next phase of assessment, the nurse should perform a review 0on the systems and conduct physical examinations to look for signs and symptoms of diabetes and the general health condition of the patient as well as any other complications associated with the particular patient. The examinations to be carried out include the following:

• General tests: consider common and general issues like weight gain and loss, increased fatigue, anxiety and general body weakness occasioned by abnormal tiredness,
• Skin tests: look for skin lesions, skin infections, manifestations of dehydration on the skin, and any evidence of wounds with poor healing history
• check the eyes: consider checking the noted changes in the patient's vision, for example, floaters, halos or halo effects, blurred vision, dry or burning eyes, cataracts and signs of glaucoma,
• Mouth checks: consider mouth related problems such as gingivitis and periodontal diseases
• check the heart of the patient: carry out cardiovascular tests for orthostatic hypotension, cold extremities, the strength of pedal pulses and leg claudication
• GI tests: test for diarrhoea, constipation, hunger or thirst, increased flatulence, stomach bloating, and early satiety.
• Genitourinary tests: test for cases of increased urination, impotence, vaginal discharge, and nocturia.
• Neurological tests: test for decreased pain and temperature perception, numbness, and changes in gait and balance.

Nursing Diagnosis

In the case provided of Mr. Paul B., the following common cases in diabetes mellitus patients can be found. Firstly, imbalanced nutrition in the patient. Mr. Paul’s history shows that he doesn’t have a strict diet at home, and he eats whatever he likes. Some of the foods that he eats like fast foods from restaurants, high carbohydrate content foods such as potatoes and pastas are common causes of sharp nutritional imbalances. The patient ingests more sugar and carbohydrates than his body requires. Edmonds (2000) argues that this results in excess of sugars and glucose remaining in the body after normal metabolism. The second diagnosis is the fear of the patient towards insulin injections. The patients of diabetes mellitus are advised to take insulin injections to assist in their bodies insufficient insulin secretions. In a majority of cases of diabetes mellitus, the patients usually have the fear of taking the ingestions. The fear can be attributed to various reasons including embarrassments and general phobia.

Another diagnosis common in diabetes is inefficiency of the body in coping with chronic diseases and complex self care regimes. In this case,Muhlhauser (2000) postulates the patient will always have a history of common chronic ailments and diseases in which the body is too weak to fight and they take a long time to heal completely. Mr. Paul's health history shows that he had been admitted in a hospital previously with hypertension, mild dystharia, atonomic dysfunction, and a previous stroke. The patient diagnosis therefore shows that the body has difficulties in coping with some diseases. Another diagnosis include risks associated with impairment of skin integrity that is related to a decrease in the sensation and circulation of the blood to very low extremes. The diagnosis of Mr. Paul in the musculoskeleton system shows this kind of diagnosis. It has been noted that he experiences mild weaknesses in his right and lower leg, and a decreased sensation in both of his legs bilaterally. This can be attributed from a general perspective to reduced circulation in the patients system.

Patients of this kind of diabetes are also likely to suffer from activity intolerance that is relate to deficiencies in the control of glucose and sugar levels in the blood. The patient may also be diagnosed with a relatively high risk for injury, or hyperglycaemia that comes as an effect of insulin and inability to eat. Mr. Paul’s lack of a proper diet exposes him to this situation. Lack of a good diet means that the patient is likely to have problems in eating, skips a