Risk for Unstable Blood Glucose Level Nursing Diagnosis and Nursing Care Plan
Risk for Unstable Blood Glucose Level
Risk for unstable blood glucose level is the presence of possible variation of blood glucose/sugar levels from the normal range. Glucose is one kind of sugar which the body utilizes most and used it a source of energy. Serum glucose is transported from the intestines or liver to body cells via the bloodstream and is made available for cell absorption via the hormone insulin which is a hormone produced by the body found in the pancreas. Sometimes due to different causative factors, glucose levels is beyond normal ranges. Hyperglycemia or the elevated blood glucose levels may occur in a variety of clinical situations. In the occurrence of increase blood glucose level at a constant basis, it detects the presence of Diabetes Mellitus which is a disorder that causes inability to normalize the blood glucose levels of the body. There are certain treatments for this DM but there are instances that it can produce hypoglycemia which is the opposite of Diabetes. Patients with DM are at risk of having unstable blood glucose levels. They need to maintain the blood glucose levels at all times. It should not be above or below normal ranges because it will cause certain symptoms.
An important part of managing blood glucose levels, as well as the overall health of a person, is maintaining a healthy weight through a healthy diet and exercise plan. Diabetes needs a strict management of the disease process to prevent several complications thereafter.
Risk Factors for unstable blood glucose level
- Alteration in mental status
- Average daily physical activity is less than recommended for gender and age
- Compromised physical health status
- Delay in cognitive development
- Does not accept diagnosis
- Excessive stress
- Excessive weight gain
- Excessive weight loss
- Inadequate blood glucose monitoring
- Ineffective medication management
- Insufficient diabetes management
- Insufficient dietary intake
- Insufficient knowledge of disease management
- Nonadherence to diabetes management plan
- Pregnancy
- Rapid growth period
Nursing Assessment
| Assessment | Rationales |
| 1. Assess for signs of hyperglycemia. | · It signals the occurrence of diabetes which needs immediate intervention |
| 2. Assess for signs of hypoglycemia. | · It will let the nurse assess and manage effectively the symptoms experienced |
| 3. Assess medications taken regularly. | · It determines strict compliance to treatment |
| 4. Assess blood glucose level before meals and at bedtime. | · This will help determine whether the blood glucose levels are in the normal range. It will detect the need for immediate intervention. It will serve as a guide on the necessary food to be taken |
| 5. Assess eating patterns. | · It may indicate signs of diabetes due to excessive eating |
| 6. Assess the patient’s current knowledge and understanding about the prescribed diet. | · To ensure strict compliance on the recommended diet |
| 7. . Assess the pattern of physical activity. | · it helps lower the blood glucose levels |
| 8. . Assess alcohol intake. | · It has negative effects to patients with diabetes |
Desired Outcomes
- Patient maintained a blood glucose reading of less than 180 mg/dL
- No signs and symptoms of hyperglycemia
- No signs and symptoms of hypoglycemia
- Increase engagement in activities
- Increased knowledge on the importance of maintaining the normal blood glucose levels
Nursing Interventions/Rationale for Risk for unstable blood glucose level
| Nursing Interventions | Rationale |
| 1. Assist the patient in the need of modifying the diet as recommended | · It will let the patient adjust his/her food intake in accordance to the limitations of glucose-rich foods. This will prevent hyperglycemia. |
| 2. Choose foods for the patient following the recommended diet | · It will prevent worsening of the imbalances of glucose levels |
| 3. Educate the patient about the importance of following a prescribed diet in accordance to the existing condition | · It maintains the blood glucose levels |
| 4. Educate the patient about the importance of following the prescribed treatment regimen | · It will have a better understanding on the importance of such treatment and to comply with it |
| 5. encourage patient to engage in exercise programs | · It balances the glucose levels of the body |
| Collaborative | |
| 1. Administer insulin as needed and prescribed | · It will give the correct and proper management of imbalanced glucose level |
| 2. Administer hypertensive medications as prescribed. | · Diabetes can cause increased in the blood pressure due to increase viscosity of the blood. It is important to monitor the blood pressure to prevent complications |
| 3. Refer the patient to an exercise physiologist if needed for specific exercise necessary for the patient | · It motivates patient to undergo such recommended exercises |
| 4. Refer to a dietitian for the recommended diet | · It will let the patient have a better understanding of the needed meal plan and to determine the importance of following it strictly. |