Nursing Care Plan for Hyperglycemia - Assessment and Diagnosis

Nursing Care Plan for Hyperglycemia
Hyperglycemia is a condition where there is an increase in plasma glucose levels in the blood. A condition called hyperglycemia is when blood glucose levels exceeded 180 mg / dL, but sometimes symptoms of hyperglycemia did not appear and was not detected even though the levels are already very high (270-360 mg / dL).

The following symptoms may be found in hyperglycaemia, where 3 of the first symptoms is a classic triad of symptoms of hyperglycemia:
  • Polyphagia (frequent hunger)
  • Polydipsia (frequently thirsty)
  • Polyuria (frequent urination)
  • Vision shaded
  • Weakness and feeling sleepy
  • Weight loss
  • Wounds difficult to heal
  • Dry mouth
  • Recurrent infections
  • Cardiac arrhythmias
  • Stupor
  • Commas

Nursing Assessment for Hyperglycemia

1 Activity / Rest
  • Symptoms: Weakness, fatigue, difficult to move / run. Muscle cramps, decreased muscle tone. Impaired sleep / rest.
  • Signs: tachycardia and tachypnea in the state of rest or with activity.

2 Circulation
  • Symptoms: A history of hypertension; Acute MI. Claudication, numbness, and tingling in the extremities.
  • Foot ulcers, healing old. 
  • Signs: Tachycardia. Postural changes in blood pressure; hypertension. Decreased pulse / no
  • Dysrhythmias. Crackles; DVJ (CHF). Skin hot, dry, and redness; sunken eyeballs.

3 Ego Integrity
  • Symptoms: Stress; dependent on others. Financial problems associated with the condition.
  • Signs: Anxiety, sensitive excitatory.
4 Elimination
  • Symptoms: Changes in the pattern of urination (polyuria), nocturia. Pain / burning, difficulty urinating (infection), the new UTI / repetitive. Abdominal tenderness. Diarrhea.
  • Signs: dilute urine, pale, yellow; polyuria (may progress to oliguria / anuria in case of severe hypovolemia).
  • Misty urine, foul smell (infection). Abdomen hard, the presence of ascites. Weak and decreased bowel sounds; hyperactive (diarrhea).
5. Food / Fluid
  • Symptoms: Loss of appetite. Nausea / vomiting. Do not follow the diet; increase in input glucose / carbohydrate. Weight loss over a period of several days / weeks. Thirsty. The use of diuretics (thiazides).
  • Signs: Dry skin / scaly, ugly tugor. Stiffness / abdominal distension, vomiting. Enlargement of the thyroid (increased metabolic demand with increased blood sugar). Odor halotosis / sweet, fruit odor (acetone breath).
6 Neurosensory
  • Symptoms: Dizziness / reel. Headaches. Tingling, numbness weakness in the muscles. Paresthesias.
  • Visual impairment. 
  • Signs: Disorientation; drowsiness, lethargy, stupor / coma (advanced stage). Memory impairment (new, past); mentally screwed. Deep tendon reflexes, decreased (coma). Seizure activity.

7 Pain / Leisure
  • Symptoms: Abdominal tension / pain (moderate / severe).
  • Signs: face grimacing with palpitations; looks to be very careful.
8 Respiratory
  • Symptoms: Feeling a lack of oxygen, cough with / without sputum purulent (depending on the presence of infection / no).
  • Signs: Hungry air. Cough, with / without purulent sputum (infection). Respiratory frequency.
9. Security
  • Symptoms: Dry skin, itching; skin ulcers.
  • Signs: fever, diaphoresis. Damaged skin, lesion / ulceration. Decreased general strength / range of motion.
  • Paresthesia / paralysis of muscles, including respiratory muscles (if potassium levels decreased with quite sharp).
10 Sexuality
  • Symptoms: vaginal discharge (likely an infection). Impotence problem in men; orgasm difficulties in women.

Nursing Diagnosis for for Hyperglycemia
  1. Deficient Fluid Volume
  2. Imbalanced Nutrition: Less Than Body requiremen.
  3. Risk for Infection.
  4. Risk for Disturbed Sensory Perception
  5. Fatigue
  6. Powerlessness
  7. Knowledge Deficit (learn) about the disease, prognosis, and treatment needs.

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