Nursing Care Plan for Diabetes Mellitus
Ineffective peripheral tissue Perfusion related to decreased arterial flow as evidenced by decreased pulses, pale and cool feet, thick brittle nails, numbness and tingling of feet “when walks 1/4 mile.”
1. Verbalize understanding of relationship between chronic disease (diabetes mellitus) and circulatory changes within 48 hr (6/30, 7 p.m.).
2. Demonstrate awareness of safety factors and proper foot care within 48 hr (6/30, 7 p.m.).
3. Maintain adequate level of hydration to maximize perfusion (ongoing), as evidenced by balanced intake/output, moist skin and mucous membranes, and capillary refill less than 3 sec (ongoing).
1. Elevate feet when up in chair. Avoid long periods with feet in dependent position.
Rationale: Minimizes interruption of blood flow and reduces venous pooling.
2. Assess for signs of dehydration. Monitor intake/output. Encourage oral fluids.
Rationale: Glycosuria may result in dehydration with consequent reduction of circulating volume and further impairment of peripheral circulation.
3. Instruct client to avoid constricting clothing and socks and ill-fitting shoes.
Rationale: Compromised circulation and decreased pain sensation may precipitate or aggravate tissue breakdown.
4. Reinforce safety precautions regarding use of heating pads, hot water bottles, or soaks.
Rationale: Heat increases metabolic demands on compromised tissues. Vascular insufficiency alters pain sensation, increasing risk of injury.
5. Recommend cessation of smoking.
Rationale: Vascular constriction associated with smoking and diabetes impairs peripheral circulation.
6. Discuss complications of disease that result from vascular changes: ulceration, gangrene, and muscle or bony structure changes.
Rationale: Although proper control of diabetes mellitus may not prevent complications, severity of effects may be minimized. Diabetic foot complications are the leading cause of nontraumatic lower extremity amputations. Note: Skin dry, cracked, scaly; feet cool; and pain when walking a distance suggest mild to moderate vascular disease (autonomic neuropathy) that can limit response to infection, impair wound healing, and increase risk of bony deformities.
7. Review proper foot care as outlined in teaching plan.
Rationale: Altered perfusion of lower extremities may lead to serious or persistent complications at the cellular level.