Nursing Care Plans for Hyperglycemia – Best Nursing Care Plans(2022)

This article discusses Nursing Care Plans for Hyperglycemia plus its causes, symptoms, preventions, treatments and interventions.

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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Introduction

Hyperglycemia or High blood sugar affects people who have diabetes. Several factors can contribute to hyperglycemia in people with diabetes, including food and physical activity choices, illness, nondiabetes medications, or skipping or not taking enough glucose-lowering medication.

It’s important to treat hyperglycemia because if left untreated, hyperglycemia can become severe and lead to severe complications requiring emergency care, such as a diabetic coma. In the long term, persistent hyperglycemia, even if not severe, can lead to complications affecting your eyes, kidneys, nerves, and heart.

Symptoms of Hyperglycemia

Hyperglycemia doesn’t cause symptoms until glucose values are significantly elevated — usually above 180 to 200 milligrams per deciliter (mg/dL), or 10 to 11.1 millimoles per liter (mmol/L). Symptoms of hyperglycemia develop slowly over several days or weeks. The more prolonged blood sugar levels stay high, the more serious the symptoms become. However, some people who’ve had type 2 diabetes for a long time may not show any symptoms despite elevated blood sugar levels.

Early signs and symptoms

Recognizing early signs and symptoms of hyperglycemia can help you treat the condition promptly. Watch for:

• Frequent urination
• Increased thirst
• Blurred vision
• Fatigue
• Headache

Later signs and symptoms

If hyperglycemia goes untreated, it can cause toxic acids (ketones) to build up in the blood and urine (ketoacidosis). Signs and symptoms include:

1. Fruity-smelling breath
2. Nausea and vomiting
3. Shortness of breath
4. Dry mouth
5. Weakness
6. Confusion
7. Coma
8. Abdominal pain

Causes of Hyperglycemia

During digestion, the body breaks down carbohydrates from foods — such as bread, rice, and pasta — into various sugar molecules. One of these sugar molecules is glucose, a main energy source for the body. Glucose is absorbed directly into the bloodstream after a person eats, but it can’t enter most tissues’ cells without the help of insulin — a hormone secreted by the pancreas.

When the glucose level in the blood rises, it signals the pancreas to release insulin. The insulin unlocks the cells so that glucose can enter and provide the fuel cells needed to function properly. Any extra glucose is stored in the liver and muscles in the form of glycogen.

This process lowers the amount of glucose in the bloodstream and prevents it from reaching dangerously high levels. As the blood sugar level returns to normal, so does the secretion of insulin from the pancreas.

Diabetes drastically lowers insulin’s effects on the body. This may be because the pancreas cannot produce insulin (type 1 diabetes), or it may be because the body is resistant to the effects of insulin or doesn’t produce enough insulin to maintain a normal glucose level (type 2 diabetes). As a result, glucose tends to build up in the bloodstream (hyperglycemia) and may reach dangerously high levels if not treated properly. Insulin or other drugs are used to lower blood sugar levels.

Risk Factors of Hyperglycemia

Many factors can contribute to hyperglycemia, including:

1. Not using enough insulin or oral diabetes medication
2. Not injecting insulin properly or using expired insulin
3. Not following your diabetes eating plan
4. Being inactive
5. Having an illness or infection
6. Using certain medications, such as steroids
7. Being injured or having surgery
8. Experiencing emotional stress, such as family conflict or workplace challenges
9. Illness or stress can trigger hyperglycemia because hormones produced to combat illness or stress can also cause your blood sugar to rise. Even people who don’t have diabetes may develop transient hyperglycemia during severe illness. But people with diabetes may need to take extra diabetes medication to keep blood glucose near normal during illness or stress.

Complications of Hyperglycemia

Long-term complications

Keeping the blood sugar in a healthy range can help prevent many diabetes-related complications. Long-term complications of untreated hyperglycemia can include:

1. Cardiovascular disease
2. Nerve damage (neuropathy)
3. Kidney damage (diabetic nephropathy) or kidney failure
4. Damage to the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness
5. Clouding of the normally clear lens of your eye (cataract)
6. Feet problems caused by damaged nerves or poor blood flow can lead to serious skin infections, ulcerations, and in some severe cases, amputation.
7. Bone and joint problems
8. Teeth and gum infections

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Emergency complications

If blood sugar rises high enough or for a prolonged period, it can lead to two severe conditions.

Diabetic ketoacidosis. Diabetic ketoacidosis develops when a person doesn’t have enough insulin in their body. When this happens, sugar (glucose) can’t enter the cells for energy. Blood sugar level rises, and the body breaks down fat for energy.

This process produces toxic acids known as ketones. Excess ketones accumulate in the blood and eventually “spillover” into the urine. Left untreated, diabetic ketoacidosis can lead to a diabetic coma and be life-threatening.

Hyperglycemic hyperosmolar state. This condition occurs when people produce insulin, but it doesn’t work properly. Blood glucose levels may become very high — greater than 1,000 mg/dL (55.6 mmol/L). Because insulin is present but not working properly, the body can’t use either glucose or fat for energy.

Glucose is then spilled into the urine, causing increased urination. Left untreated, the diabetic hyperglycemic hyperosmolar state can lead to life-threatening dehydration and coma. Prompt medical care is essential.

Prevention of Hyperglycemia

Follow your diabetes meal plan.

 If you take insulin or oral diabetes medication, you must be consistent about the amount and timing of your meals and snacks. The food you eat must balance the insulin working in your body.

Monitor blood sugar. 

Depending on your treatment plan, you may check and record your blood sugar level several times a week or several times a day. Careful monitoring is the only way to ensure that your blood sugar level remains within your target range. Note when your glucose readings are above or below your goal range.

Take medication as prescribed by the doctor.

Adjust your medication if you change your physical activity. The adjustment depends on the blood sugar test results and on the type and length of the activity.

Nursing Diagnosis for Hyperglycemia

1. Nursing diagnosis -Diabetes (NANDA I – 2012)

Definition:  A carbohydrate, fat, and protein metabolism disorder is usually characterized by elevated blood glucose levels due to low insulin production or utilization. It can lead to severe complications if left untreated.

Diagnosis Rationales:

-Functional Oral Intake (NANDA I – 2012)

Applicable for patients who are unable to tolerate their usual diet due to vomiting or nausea

– Nutrition, Less Than Body Requirements (NANDA I – 2012)             

Applicable for patients who are unable to eat because of symptoms such as nausea and vomiting or have difficulty chewing or swallowing

– Disturbed Body Image (NANDA I – 2012)           

Applicable for a patient who is unable to perceive their body shape due to excess weight

-Chronic pain (NANDA I – 2012) 

Applicable for patients with diabetes-related problems such as neuropathy, eye problems, foot ulcers that cause chronic pain

-Thermal Incompetence (NANDA I – 2012)        

Applied for patients with diabetes mellitus or hyperthermia

– Acute Pain (NANDA I – 2012)               

Applicable for patients experiencing acute illness related to complications from diabetes

-Constipation (NANDA I – 2012)                 

Applicable for patients with neuropathy and other body issues that cause constipation

–Impaired Skin Integrity, Risk for (NANDA I – 2012)        

Applied to diabetic foot ulcer patient who is at risk of skin breakdown

-Altered Nutrition, Less Than Body Requirements (NANDA I – 2012)                  

Applicable for a patient with nausea and vomiting who are unable to tolerate oral intake

-Chronic Sorrow (NANDA I – 2012)           

Applicable for patient grieving a loss of skin integrity or limb related to diabetes 1

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2. Nursing diagnosis -Electrolyte imbalance

Diagnosis Rationales:

-Fluid Volume Deficit (NANDA I – 2012)          

Applicable for a patient who presents with dehydration due to vomiting or diarrhea

-Deficient Knowledge (NANDA I – 2012)               

Applied to a patient who makes errors in medication dosage or timing

– Alteration in Consciousness, Unilateral (NANDA I – 2012)

Applicable for a patient with unilateral stroke due to hypertension

– Altered Nutrition: Less Than Body Requirements (NANDA I – 2012)                 

Applicable for a patient with malnutrition due to metabolic disorders 1

3. Nursing diagnosis -Metabolic acidosis

Diagnosis Rationales:

–Fluid Volume Deficit (NANDA I – 2012)           

Applicable for a patient with diabetes mellitus who are unable to maintain their fluid balance

-Deficient Knowledge (NANDA I – 2012)               

Applicable for the patient who is unable to manage their treatment because of lack of education or support

– Sensory-Perceptual Alterations (NANDA I – 2012)          

Applied for the patient with blurred vision due to severe hyperglycemia

Other Nursing Diagnosis:

-A medical history and physical examination

-A blood test to measure glucose levels such as:

• Hemoglobin A1c
• Fasting glucose test

-A test measuring the amount of sugar in a sample of urine

Nursing diagnosis of diabetes can be challenging if it is undiagnosed. Failure to diagnose and treat hyperglycemia can lead to severe complications such as:

-Vision loss

-Nerve damage

-Kidney damage

-Heart disease

–Stroke

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Nursing Care Plans for Hyperglycemia

The nursing care plan should be prepared by a registered nurse and include the following;

Patient Education

-Educate diabetic patients on the following:

-How to monitor their blood glucose level

-When and how many times per day they should check their glucose levels (usually before meals, at bedtime, and any time they feel like they need to)                      

-What the average blood sugar range is for a healthy individual (70-110)

-Signs of hyperglycemic episodes

-How diabetes mellitus can be treated using a medication, insulin, or other means.                         

-Ways to decrease the risk of hyperglycemia (eating a healthy diet, exercising)

-Encourage the patient with diabetes to check their blood glucose level throughout the day and be aware of the symptoms of hyperglycemia.

-Teach the patient with type 2 diabetes how to monitor their hemoglobin A1C levels for evidence of lacking control over hyperglycemia.

-Encourage diabetic patients to participate in activities they enjoy, such as walking or swimming, even if they have an illness.

-Teach a patient how to recognize and treat diabetes mellitus or hyperglycemia episodes using the evidence-based steps from previous studies.

Nursing Interventions for Hyperglycemia

1. Prevent complications related to hyperglycemia:

Educate the patient on the importance of monitoring blood glucose levels throughout each day and report any changes to a health care provider.

Provide mental health interventions as appropriate:

1. Ensure a patient with diabetes follow a healthy diet and exercises regularly to prevent diabetes mellitus or hyperglycemia episodes.
2. Provide counseling when a diabetic patient is unable to maintain adequate blood glucose levels on their own.

2. Patient Education:

Teach the patient about how to manage their blood glucose level.

Insulin injection and monitoring of blood glucose levels should be taught to diabetic patients who are not self-managing their disease with diet or oral medications.

Teaching diabetes management requires sound knowledge of each component that contributes to the overall metabolism in the human body.

3. Insulin injection:

Insulin injection is the primary means of managing type 1 diabetes in today’s society. The timing and amount of insulin administered depend on several factors:

• Age
• Weight
• Physical activity level
• Blood glucose level and any other medications that may be used (Wittels 1996).

Teaching diabetic patients to administer their insulin injections is of utmost importance because this allows them to become self-reliant in the long run. This reduces the number of doctor appointments and reduces health care costs in the long run.

Incidentally, administering insulin injections requires proper knowledge and understanding of how it works. Insulin acts as a key that unlocks cells from burning glucose for fuel because of a lack of insulin in the body. Hence, glucose is stored as glycogen and fat.

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The cells are now locked away from burning glucose for fuel and instead start to burn the now available energy source: fat and protein. Thus, when the body has enough insulin, all excess glucose that does not get used in the body receives transferred into fat and then stored. This is how insulin works in a nutshell.

The goal of diabetes management is to maintain blood glucose levels within the normal range (70-110mg/dl) as much as possible. However, this may not always be possible, and a therapeutic range must be set for each individual.

Related FAQs

1. What are nursing interventions for hyperglycemia?

Emergency treatment for severe hyperglycemia

• Fluid replacement. You’ll receive fluids — usually through a vein (intravenously) — until you’re rehydrated. …
• Electrolyte replacement. Electrolytes are minerals in your blood that are necessary for your tissues to function properly.
• Insulin therapy.

2. What nursing interventions would you consider for a patient with diabetes?

Nursing Interventions

• Educate about home glucose monitoring. …
• Review factors in glucose instability. …
• Encourage client to read labels. …
• Discuss how client’s antidiabetic medications work. …
• Check viability of insulin. …
• Review type of insulin used. …
• Check injection sites periodically.

3. What is a diabetic care plan?

A diabetes care plan, or diabetes medical management plan (DMMP), is a tool that helps people manage diabetes in day-to-day life. DMMPs are helpful, because diabetes is a challenging, long-term condition, and it often requires a person to change their diet, lifestyle, and daily routines.

4. What is the nursing care plan for hypoglycemia?

Provide food or other sources of glucose as directed for hypoglycemia. A rapidly absorbed form of glucose is indicated to manage hypoglycemia. These forms of glucose may include oral intake of hard candy or fruit juice. For the patient who cannot take something orally, intravenous injection of glucose may be indicated.

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