Nurse's Pocket Guide

ACTIONS/INTERVENTIONS RATIONALE
Teaching: Disease Process (NIC)
Determine client’s level of Establishes baseline and
knowledge, priorities of direction for teaching/
learning needs, desire/need planning. Involvement of
for including wife in wife, if desired, will provide
instruction. additional resource for
recall/understanding and
may enhance client’s follow
through.
Provide teaching guide, Provides different methods
“Understanding Your for accessing/reinforcing
Diabetes,” 6/29 AM. Show information and enhances
film “Living with Diabetes” opportunity for learning/
6/29 4 PM, when wife is understanding.
visiting. Include in group
teaching session 6/30 AM.
Review information and
obtain feedback
from client/wife.
Discuss factors related to/ Drug therapy/diet may need
altering diabetic control to be altered in response
(e.g., stress, illness, exercise). to both short-term and
long-term stressors.
Review signs/symptoms of Recognition/understanding
hyperglycemia (e.g., fatigue, of these signs/symptoms
nausea/vomiting, polyuria/ and timely intervention
polydipsia). Discuss how will aid client in avoiding
to prevent and evaluate this recurrences and preventing
situation and when to seek complications.
medical care. Have client
identify appropriate
interventions.
Review and provide informa- Reduces risk of tissue injury;
tion about necessity for promotes understanding
routine examination of feet and prevention of stasis
and proper foot care (e.g., ulcer formation and
daily inspection for injuries, wound healing difficulties.
pressure areas, corns,
calluses; proper nail cutting;
daily washing, application of
good moisturizing lotion
[e.g., Eucerin, Keri, Nivea]
BID). Recommend wearing
loose-fitting socks and
properly fitting shoes (break
new shoes in gradually)
60 NURSE’S POCKET GUIDE