CARE PLANNING

Nursing Diagnostic Statement 1:

The most important problem patient was diagnosed with was cellulitis due to which the
patient has pain and fever. So the infection when treated will help reduce the pain and fever.
So cellulitis will be the first priority of the nursing care plan.
Expected Outcome 1:
Prevention of the infection and devising proper interventions to prevent the risk of getting
infection. Changes in lifestyle to prevent infection.
Nursing intervention 1
It is important to obtain the specimen from the cellulitis in order to treat the infection
appropriately.
Rationale 1
It will allow the doctors and nurse to follow the required therapy for the patient. Specimen
enables the doctors to understand the cause of the infection because there are many causes of
cellulities and each cause is differently treated. As the patient is diabetic so there is a chance
that he might have got cellulitis because of slow healing of the wound as exposure of the
wound for long time can cause infections from pathogens.
Nursing intervention 2
The second important intervention is taking care of the infected area. Cleaning it and keeping
it dry is important to protect the wound.
Rationale 2
Patients with diabetes are at risk of damaging the surrounded tissues in the skin when they get
infected so keeping the wound clean and dry will protect the wound and the surrounding
tissues and will prevent the infection from spreading on the arm.
Nursing intervention 3
The nurse must observe the infection on hourly basis to determine and monitor the progress
in the process of healing and use appropriate barrier wound dressing as patient is diabetic so
intense care is to be taken while selecting a dressing and changing it.
Rationale 3
As the patient is diabetic it is very important to monitor cellulitis to check the progress
because in diabetics the wound takes longer to heal, also changing the dressing of the wound
will help the nurse monitor for the progress in the healing process.
Nursing Intervention 4
Creating a care plan for the patient and consulting a wound specialist is important as in
patients having higher blood glucose level have potential of getting serious wound.
Rationale
Diabetes type 1 is not curable so taking earlier preventions are better. Telling your patient to
take care of the wound and giving him insight into its important is very necessary as it takes
long in healing the wound. If the wound is getting worse they must go and consult a wound
specialist as he

Nursing diagnostic statement 2

Patient has the major problem of diabetes mellitus type 1. To treat all other issues of the
patient it is important to control blood glucose because wound on patient’s arm would not
heal unless his blood glucose becomes normal after proper care plan is being devised for him.
Expected outcome 2
Short term goal:
BGL of the patient will decrease as it is high, this will help him in healing of the wound as
well.
Long term Goal:
The patient will show improved lab reports in future if he sticks to the care plan and
interventions.
Nursing intervention 1
Patient’s HbA1c glycosylated haemoglobin is to be monitored.
Rationale 1
It is important to monitor HbA1C because it tells about the BGL of past 2 3 months. It has a
favourable range of 6.5% - 7% and it must be controlled to prevent issues related with
diabetes mellitus.
Nursing intervention 2
Checking the blood glucose of patient before meals and at bedtime is the second important
intervention in nursing care plan to maintain and monitor blood glucose.
Rationale 2
Blood glucose level between 140-180 mg/dl is advised for patients diagnosed with diabetes
mellitus. Patients who are not under intensive care must maintain BGL <140 mg/dl before
meals.
Nursing intervention 3
Access hypoglycaemia in patient and treat it with 50% dextrose. Access the patient for
anxiety, slurring of speech and tremors.
Rationale 3
These are the symptoms of hypoglycaemia and it is treated with D50.
Nursing intervention 4
Access the patient regarding the knowledge about the diet prescribed for him as patients with
diabetes type 1 have to follow the healthy diet.
Rationale 4
Diabetes type 1 is mainly dependent on healthy lifestyle and changes in diet. If a person
diagnosed with diabetes mellitus has made no necessary changes in his lifestyle and diet he is
at higher risk of hypoglycaemia so an individual diet plan is very important to maintain blood
glucose level and patient must be adhere to follow and understand how important healthy
eating is in maintaining glucose level.
Nursing diagnostic statement 3
Second problem the patient was diagnosed with was fever.
Expected outcome 3
In next 24 hours the patient’s temperature will be in the range of 97.8-98.6. Patient will
notice greater energy as compare to now in the next 72 hours. Patient will show less signs of
infection.
Nursing intervention 1
Administer medicines as required. Antipyretic medications and antibiotics are given when
required.
Rationale 1
Antipyretic medicines are given to reduce fever and antibiotics are given because the patient
is suffering from fever due to cellulitis.
Nursing intervention 2
Remove excess of clothes i.e. jacket, socks, cap etc, maximize heat loss from patient’s body.
Rationale 2
Removing excess of clothes help the patient to regulate the temperature, wearing bundle of
clothes make the fever worse.
Nursing intervention 3
Prevent shivering in the body.
Rationale 3
Shivering increases the metabolic activities and produce more heat, blood circulation
increases and demand for oxygen increases which intensify the fever.
Nursing intervention 4
Provide rest to the patient and maintain the temperature of the environment to help the patient
maintain normal body temperature.
Rationale 4
Peaceful environment is significant for patient to have rest as he has many health problems at
a time so providing a calm place and allowing him to respite is essential for quick recovery.
Nursing diagnostic statement 4
Patient reported acute pain in his arm.
Expected outcome 4
Relief in pain will help patient get some strength as he is depressed already because of
diabetes.
Nursing intervention 1
Access the patient for pain relief. Foresee the need for the relief of pain.
Rationale 1
Patient has acute pain and relief of the pain is the main consideration of the patient. Early
intervention will decrease the chances of giving patient higher dose of analgesic.
Nursing intervention 2
Acknowledge pain of the patient the moment he reports it.
Rationale 2
On time acknowledgement of pain strengthen the trust level of patient on the nurse and it
reduce the anxiety level that is associated with pain as pain increases with anxiety. Patient in
pain loses the perception of time and if immediate acknowledgment and care is not given the
patient may respond negatively.
Nursing intervention 3
Cognitive behavioural strategies can be applied i.e. imagery, distraction, music therapy,
relaxation and biofeedback techniques.
Rationale 3
These techniques involve the use of senses and this helps in distracting the patient from
thinking about the pain as it divert a person from the painful stimuli by increasing their
concentration. These techniques aim to reduce anxiety, pain, stress and tension.
Nursing intervention 4
Any additional stress and sources of discomfort must be getting rid of. The environment of
the patient must be calm and relax. Provide time for rest to the patient.
Rationale 4
The patient can exaggerate his pain if there is any kind of discomfort in his environment. If
he is seeing any person that is stressful for him he must not come in front of him as
interpersonal and intrapsychic stressors can aggravate the pain. Peaceful environment
facilitates quick recovery from pain.
Clinical handover
Identity:
I am a senior nurse at Curtin Hospital in Medical ward 9A. This is a clinical handover of Mr.
Shaun Jensen a 24 years old boy who is admitted to medical ward 9A this afternoon. He is
diagnosed with diabetes type 1.
Situation:
Mr. Shaun is admitted to hospital in afternoon. When he was admitted he was febrile and had
pain in left forearm due to piercing a week ago which got infected. As the patient is diabetic
the wound got worst and could not heal. The area around the wound was warm, red, purulent
discharged and was swollen. He complaint about the pain which he scored 7/10 and had
fever, temperature 38.8 degree Celsius. When he was admitted his blood glucose level was
unbalance i.e. 28.5mmol and currently it is 15mmol with less than 0.6mmol/L blood ketone.
There was no fainting, blood pressure and pulse rate measured were 120/68 mmHg and 90
bpm respectively and no respiratory complaints were reported.
Background:
The patient is a 24 years old boy with 172 com height and 64 kg weight. He is an Anglo-
Australian. He is a retail manager and is single. He speaks English. The patient came from his
work place as he was not feeling well. He was diagnosed with diabetes type 1 in January
2019 which made him really upset. He reported that he can’t eat what he used to eat before,
he even can’t go with friends for drink. He is so bound in his eating and when he eats
something other than his own diet he ends up in raising his BGL. He was in pain due to the
wound on forearm, he said that he did piercing a week ago that did not heal and his arm really
hurts.
Assessment:
The client had unstable blood glucose when he was admitted but now it is somewhat stable.
His leftarm is warm and has purulent discharge. He has fever when he was admitted which is
being treated.
Recommendation:
It is hereby recommended that the patient should take intensive care of his own body and
protect it from any type of infection as in diabetes the wound and infections takes longer to
heal, the wounds due to longer exposure gets infected which causes problem so taking care of
body is necessary. Monitoring of blood glucose level at home is also recommended to keep
tract of the BGL. Healthy diet and daily walk and is an important measure to keep mind and
body healthy.
Discharge plan for cellulitis:
 Keep the infected place dry and clean and take good care of hygiene. And use an
appropriate barrier bandage and clean infection properly.
 Medications prescribed for cellulitis must be taken as prescribed by the medical
officer even if you are feeling better as it treats the infection and let it not come again
 and talk to your healthcare when there is a puss or any discharge draining from the
wound, redness that is getting worse with time on the infected area.
 Wash your hands to avoid spreading of infection.
 Raise the left arm above your heart when possible.
Discharge plan for diabetes mellitus:
 Patient has to be aware of the signs, symptoms, causes and treatment of increased
blood glucose and he must know when and how to eat as in diabetes the patient must
have something to eat with him consistently to avoid the dropping of glucose level.
 Patient must know how to manage the blood glucose in days when he is sick.
 Disposal of needles and syringes must properly be done as patient is on insulin and
use needle on daily basis. To avoid infection the disposal must be appropriate.
Discharge plan for Fever:
 Take medicines as prescribed and see your healthcare if fever gets high.
 Drink liquid to wash your stomach for a healthy body.
 Take rest and do not stress. This will alleviate the fever and gives you energy to do
your daily basis tasks.
 Avoid germs from spreading. Take care of your body and wash it on regular basis.

Discharge plan for Pain:

 Stay active and gently exercise even if it is discomforting and think of going to see a
doctor.
 Inform others on time about the discomfort you have and ask for help, do not isolate
from others as it will bring something new and negative.
 Apply self managing strategies on self when you know the doctor is away. Anxiety
reduction and relaxation therapy can help coping with pain.
 Take drugs prescribed for pain immediately when pain starts to reduce the intensity.
Recommendations:
Belleza, M. (2017). cellulitis. Cellulitis: Nursing Care And Management. Retrieved from
https://nurseslabs.com/cellulitis/
Discharge Instructions for Cellulitis. Retrieved 31 August 2019, from
https://www.saintlukeskc.org/health-library/discharge-instructions-cellulitis
Discharge Planning for Patients with Diabetes Mellitus. Retrieved 31 August 2019, from
https://www.nursingcenter.com/clinical-resources/nursing-pocket-cards/discharge-planning-
for-patients-with-diabetes-mell
Ebob-Anya, B., Bassah, N., & Palle, J. (2019). Management of cellulitis and the role of the
nurse: a 5-year retrospective multicentre study in Fako, Cameroon. BMC Research
Notes, 12(1). doi: 10.1186/s13104-019-4497-4
Fever in Adults (Discharge Care) - What You Need to Know. (2019). Retrieved 31 August
2019, from https://www.drugs.com/cg/fever-in-adults-discharge-care.html
Nursing Care Plan, Diagnosis, Interventions Hyperthermia, Fever, High Temperature. (2019).
Retrieved 31 August 2019, from https://www.registerednursern.com/nursing-care-plan-
diagnosis-interventions-hyperthermia-fever-high-temperature/
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August 2019, from https://academy.nrsng.com/lesson/nursing-care-plan-for-fever-
dehydration/
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https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/older-
people/pain/pain-discharge
Thompson, H., & Kagan, S. (2010). Clinical management of fever by nurses: doing what
works. Journal Of Advanced Nursing, 67(2), 359-370. doi: 10.1111/j.1365-
2648.2010.05506.x
Vera, M. (2019). Diabetes Mellitus Nursing Care Plans: 13 Nursing Diagnosis - Nurseslabs.
Retrieved 30 August 2019, from https://nurseslabs.com/diabetes-mellitus-nursing-care-plans/
Wayne, G. (2016). Acute Pain – Nursing Diagnosis & Care Plan. Retrieved 30 August 2019,
from https://nurseslabs.com/acute-pain/#Nursing-Interventions-for-Acute-Pain
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based care pathway for cellulitis improves process, clinical, and cost outcomes. Journal Of
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