Nursing Student Asked:

As part of your capstone project, you are tasked with developing a comprehensive care plan for a 55-year-old male patient who was recently diagnosed with Type 2 Diabetes Mellitus (T2DM). The patient has a history of hypertension and hyperlipidemia and is overweight with a BMI of 32. He reports a sedentary lifestyle and poor dietary habits, including a high intake of processed foods and sugary beverages.

The goals of the care plan are to achieve optimal blood glucose control, reduce cardiovascular risk, and promote healthy lifestyle changes.

Tasks:

• Identify three priority nursing diagnoses for this patient.
• Develop one SMART goal for each of the identified nursing diagnoses.
• Outline three evidence-based interventions for each nursing diagnosis that you would implement to achieve the SMART goals.
• Explain how you would evaluate the effectiveness of each intervention.

Step 1: Identify Three Priority Nursing Diagnoses

Based on the patient’s condition and history, the following nursing diagnoses are appropriate:

1. Imbalanced Nutrition: More than Body Requirements
   Related to poor dietary habits and sedentary lifestyle as evidenced by a BMI of 32.

2. Risk for Unstable Blood Glucose Levels
   Related to newly diagnosed Type 2 Diabetes Mellitus and poor dietary control.

3. Risk for Cardiovascular Disease
   Related to hypertension, hyperlipidemia, and obesity.

Step 2: Develop SMART Goals

For each nursing diagnosis, create a specific, measurable, achievable, relevant, and time-bound goal:

1. Imbalanced Nutrition:

   • SMART Goal: The patient will reduce BMI from 32 to 29 by following a balanced diet and increasing physical activity within the next 6 months.

2. Risk for Unstable Blood Glucose Levels:

   • SMART Goal: The patient will maintain blood glucose levels within the target range of (70-130 , \text{mg/dL}) before meals and less than (180 , \text{mg/dL}) after meals within 3 months by adhering to prescribed medication and dietary recommendations.

3. Risk for Cardiovascular Disease:

   • SMART Goal: The patient will reduce LDL cholesterol to below (100 , \text{mg/dL}) and blood pressure to below (130/80 , \text{mmHg}) through medication adherence and lifestyle changes within the next 4 months.

Step 3: Outline Evidence-Based Interventions

For each diagnosis, propose three evidence-based interventions:

1. Imbalanced Nutrition:

   • Intervention 1: Provide patient education on a balanced diet, focusing on reducing processed foods and increasing fruits, vegetables, and whole grains.
   • Intervention 2: Collaborate with a dietitian to develop a personalized meal plan that supports weight loss and blood glucose control.
   • Intervention 3: Encourage and develop a gradual exercise plan starting with 30 minutes of moderate-intensity physical activity 5 days a week.

2. Risk for Unstable Blood Glucose Levels:

   • Intervention 1: Educate the patient on the importance of regular blood glucose monitoring and demonstrate the correct use of a glucometer.
   • Intervention 2: Reinforce adherence to prescribed antidiabetic medications, including discussing potential side effects and when to take each medication.
   • Intervention 3: Implement a diabetes self-management education (DSME) program to improve the patient’s understanding of diabetes care.

3. Risk for Cardiovascular Disease:

   • Intervention 1: Monitor blood pressure regularly and educate the patient on the importance of tracking blood pressure at home.
   • Intervention 2: Encourage adherence to prescribed antihypertensive and lipid-lowering medications, ensuring the patient understands their purpose.
   • Intervention 3: Educate the patient about the risks of smoking and alcohol consumption, and refer to a smoking cessation program if needed.

Step 4: Evaluation of Interventions

To determine the effectiveness of the interventions, the following evaluations should be made:

1. Imbalanced Nutrition:

   • Evaluation: Track the patient’s weight and BMI monthly. Assess the patient’s dietary logs and physical activity levels to ensure adherence to the plan. Positive progress will be indicated by steady weight loss and improved dietary habits.

2. Risk for Unstable Blood Glucose Levels:

   • Evaluation: Monitor the patient’s blood glucose levels at each visit and compare them to the target range. Evaluate adherence to medication and diet by discussing any deviations with the patient. Successful management will be shown by stable blood glucose levels within the prescribed range.

3. Risk for Cardiovascular Disease:

   • Evaluation: Regularly monitor blood pressure and LDL cholesterol levels. Discuss any barriers to medication adherence or lifestyle changes with the patient. Effective management will be evident through improved lipid profiles and controlled blood pressure.

GoodNurse Explanation:

This comprehensive question is designed to challenge your ability to integrate nursing theory with practical application, especially in managing a patient with multiple chronic conditions. By identifying appropriate nursing diagnoses, setting SMART goals, and implementing evidence-based interventions, you demonstrate your ability to create a holistic and effective care plan.

Remember, the key to success in your capstone project is not just identifying what needs to be done but understanding why each step is necessary and how you will measure the outcomes. Be thorough in your assessments, clear in your goal-setting, and diligent in evaluating the effectiveness of your interventions. This approach not only ensures quality patient care but also prepares you for real-world nursing practice where critical thinking and evidence-based practice are paramount.