- Decreased Cardiac Output related to elevated blood glucose levels and decreased myocardial oxygenation as evidenced by Reduced oxygen saturation and decreased central venous pressure
- Ineffective Tissue Perfusion related to Impaired oxygen transport and elevated blood glucose level leads to Neuropathy and Peripheral vascular disease as evidenced by Weak or absent peripheral pulses and Numbness
- Risk For Unstable Blood Glucose Level related to Alterations in physical activity and Inadequate glucose monitoring as evidenced by hypoglycaemia and hyperglycaemia
| Assessment | Nursing Diagnosis | Planning/Outcomes | Intervention | Evaluation |
| Subjective Data: Verbalizes shortness of breath and fatigue Objective Data: -Tachypnoea -Dyspnoea -Orthopnoea -Reduced oxygen saturation -Hypotension -Dysrhythmia -Fatigue -Anxiety/Restlessness -Decreased peripheral pulses | Decreased Cardiac Output related to elevated blood glucose levels and decreased myocardial oxygenation as evidenced by Reduced oxygen saturation and decreased central venous pressure | Patient will manifest adequate cardiac output as evidenced by the following: Systolic BP within 20 mmHg of baseline Heart rate: 60 to 100 beats/min with a regular rhythm Respiratory rate: 12 to 20 breaths/min Urine output 0.5 to 1.5 cc/kg/hour Strong peripheral pulses Patient will not experience dyspnoea, heart palpitations, or altered mentation. Patient will not experience wounds or skin breakdown. | 1. Administer supplemental oxygen as needed. Supplemental oxygen increases myocardial oxygen availability, relieving hypoxemia symptoms. Resting hypoxia or oxygen desaturation may indicate fluid overload. 2. Maintain physical and emotional rest. Activity restrictions and a quiet environment reduce oxygen demands. 3. Assist in diagnostic modalities such as echocardiography. Echocardiography is the gold standard non-invasive approach to diagnose structural cardiac abnormalities such as diabetic cardiomyopathy. 4. Administer medications as ordered. Sodium-glucose cotransporter 2 (SGLT2) inhibitors such as canagliflozin, dapagliflozin, and empagliflozin are considered one of the most effective medications against heart failure associated with diabetes. Aside from inducing hypoglycemic effects, they protect the body against lipotoxicity, promote weight loss, improve insulin resistance, decrease blood pressure, and attenuate sympathetic activity that overall aids in preventing or improving heart failure. 5. Emphasize how diabetes mellitus contributes to cardiac dysfunction. A thorough understanding of the therapeutic regimen and the sequelae of uncontrolled diabetes mellitus are necessary for increased adherence to treatment and lifestyle modifications. | Patient manifested adequate cardiac output as evidenced by the following: Systolic BP within 20 mmHg of baseline Heart rate: 60 to 100 beats/min with a regular rhythm Respiratory rate: 12 to 20 breaths/min Urine output 0.5 to 1.5 cc/kg/hour Strong peripheral pulses Patient relieved from dyspnoea, heart palpitations, or altered mentation. Patient relieved from wounds or skin breakdown |
| Subjective data: Nausea Abdominal pain Bloating Objective data: -Hypoactive or absent bowel sounds -Distended abdomen -Vomiting -Electrolyte imbalance | Ineffective Tissue Perfusion related to Impaired oxygen transport and elevated blood glucose level leads to Neuropathy and Peripheral vascular disease as evidenced by Weak or absent peripheral pulses and Numbness | Patient will maintain optimal peripheral tissue perfusion as evidenced by the following: Strong, palpable pulses Warm and dry extremities Capillary refill time of <2 secs Patient will report the absence of burning or numbness in extremities. | 1. Maintain controlled glucose levels. Maintaining glucose levels within a therapeutic range is the most important way to prevent complications in perfusion. Educate the patient on using glucose monitoring equipment and administering the correct dose of insulin or adhering to an oral diabetes medication regimen. 2. Encourage compression stockings. Compression stockings improve blood flow in the lower legs and reduce swelling. 3. Provide proper foot care. Refer to a podiatrist if needed. Patients with DM have a high risk for the development of foot ulcers due to lowered sensations from neuropathy. Being the most distal body part, the feet are susceptible to ischemia, making them vulnerable to injury and slow to heal. 4. Instruct on quitting smoking. The chemicals in cigarettes damage blood vessels, causing plaque buildup, constriction, and poor perfusion. 5. Inform on lifestyle factors that promote improved tissue perfusion. Patients must adhere to recommendations regarding healthy eating and exercise to control their diabetes, reduce cholesterol levels, and improve hypertension. | Patient maintained optimal peripheral tissue perfusion as evidenced by the following: Strong, palpable pulses Warm and dry extremities Capillary refill time of <2 secs Patient reported the absence of burning or numbness in extremities. |
| Subjective Data: Verbalizes unable to maintain normal blood glucose level Objective Data: -Hypoglycaemia -Hyperglycaemia | Risk For Unstable Blood Glucose Level related to Alterations in physical activity and Inadequate glucose monitoring as evidenced by hypoglycaemia and hyperglycaemia | Patient will achieve and maintain blood glucose levels within acceptable range. Patient will verbalize factors that may cause variations in glucose levels. Patient will verbalize symptoms of hypoglycaemia and hyperglycaemia. | 1. Administer diabetic medications (oral and insulin) as prescribed. Patients who are hospitalized may require additional insulin due to infection or medications like steroids that increase glucose levels. Glucose levels are usually monitored AC and QHS. 2. Instruct on counting carbohydrates. When carbohydrates are metabolized in the body, they are broken down into glucose and will cause a rise in the blood glucose level. Counting carbohydrates ensures the appropriate insulin dose is given with each meal or snack. 3. Educate patients on how to monitor blood glucose levels. Have the patient demonstrate using a glucometer to monitor their glucose levels. The patient may benefit from a continuous glucose monitor if insulin regimens are complex. 4. Teach patients how to treat hypoglycaemia. If the patient experiences symptoms of hypoglycaemia or their glucose level is below 70 mg/dL, they need to consume glucose. Recommend the patient keep glucose tablets with them or advise on foods high in glucose or carbohydrates like milk, orange juice, fruit, or candy. 5. Refer to Diabetes Self-Management Education (DSME). Patients newly diagnosed with diabetes may benefit from DSME classes that instruct on how to manage diabetes, cope with the diagnosis, and prevent complications. | Patient achieved and maintained blood glucose levels within acceptable range. Patient verbalized factors that may cause variations in glucose levels. Patient verbalized symptoms of hypoglycaemia and hyperglycaemia. |