In assessing the diabetic client, the nurse should identify specific body systems that the disease effects. Always look first. Is the client obese, frail, emaciated or well nourished? Notice the client's face and skin color, are they pale, flushed or diaphoretic. Ask them how they feel. Are they hungry, thirsty, do they need to use the rest room? Offer them a drink of water if they are thirsty.
While taking their vital signs notice their skin turger, are they dehydrated? Dose their skin form a peak if you pinch it lightly? Does the client appear edematous? Are their socks cutting into their skin, leaving deep indentations? Have they gained over three pounds in the last couple of days? (This is a classic danger sign of CHF, congestive heart failure. The client should be instructed to see their doctor immediately) Does their skin leave a white indentation when you press on their lower extremities? Listen to their heart sounds and lung sounds.
If the client has been a diabetic for a long time without monitoring their blood glucose levels, you may detect heart problems. Assess the client's skin for any lesions or wounds. If you notice a wound, ask the client how they injured themselves, when it occurred and what if any first aid was used. Notice the location of the wound, is there any drainage, does it look infected or has it scabbed over. Be sure to document the dimensions of the wound on the chart.
It is also good in assessing the diabetic client to perform a neuro-check. Peripheral neuropathy can be ascertained through a neuro-check, as well as possibly detecting early eye disease. Diabetic client's that have peripheral neuropathy with have decreased feeling in their lower extremities. When you touch their feet lightly with the tip of a pencil or a feather, if they don't feel this it could be a sign that they are experiencing peripheral neuropathy. Ask them if they experience any numbness or tingling in their hands or feet. Palpate their pedal pulses for rhythm and symmetry.
Pay close attention to their toes. Notice if the toe nails are long, brittle, if there is redness around the nail and if they feel any pain. With peripheral neuropathy the diabetic's feet become compromised. They could have an ingrown toe nail and not even realize it. By inspecting their toes and the nail beds, you will be able to catch the infection before if spreads.
Above all else, be sure that the diabetic client is comfortable during your assessment. Be sure that you guard their privacy judiciously. No matter where the assessment is taking place, you can make the client feel safe if you demonstrate that their privacy is of the utmost importance.
Developing good assessment skills can help save lives. The nurse can enhance the client's life style by teaching the diabetic client how to take proper care of themselves and what signs and symptoms to look for. Explain how to care for their feet. Encourage comfortable shoes that allow room for the toes so there is no constriction.
Wear comfortable cotton socks that absorb sweat and keep the feet dry. Teach the diabetic not to use hot water to wash their feet. Many times the diabetic may not realize how hot the water is, and they can severely burn themselves if they are not careful. Suggest that they see a Podiatrist on a regular basis for toe nail trimming. Trimming the toe nails of a diabetic improperly can cause unnecessary complications, such as ingrown toe nails, infection, and pain. Regularly scheduled visits to a Podiatrist will prevent such occurrences.
Instruct the client to eat well balanced meals and to avoid high sugar content processed sweets and to get sufficient cardiovascular exercise on a daily basis. Walking is the best. Tell the diabetic client to inspect their skin regularly for any cuts or lesions that are not healing properly, and to see a doctor if they notice any.
If the diabetic is elderly and has a difficult time maneuvering or walking, suggest that they get a bedside commode. This will make if easier on them when they have frequent toileting needs throughout the night such as nocturia. Be sure to tell them to put sufficient water in the commode so that they don't have to smell the odor of urine.
A commode cover does not always work to prevent the odors. This way the elderly client can get up, toilet and go back to bed to get their needed sleep. It is also dangerous when elderly people wake up at night to walk to the bathroom. Throw rugs, imbalance, disorientation and the urge to urinate can be the recipe for a fall.
Ask the client to demonstrate verbally that they understand what they have been taught. Ask them if they have the ability to follow through with their care. Some client's may be physically or mentally unable to care for their diabetes. The nurse should recognize this and ask for the visiting nurse to consult the patient.
A thorough nursing assessment of the diabetic client can be the catalyst for the client to begin making positive changes in their life.
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