How to Complete Nursing Care Plan For Diabetic microvascular multiple cranial neuropathy

 

INSTRUCTIONS.

Include a brief introduction of your patient:

• Patient’s “name”, gender, admitting diagnosis, brief introductory background

Complete an assessment. Including, but no limited to the following:

• Admission history
• Medical/surgical diagnosis
• Current status
• Resuscitation (DNR) status
• Psychosocial status using a theory similar to Erikson (and explain your assessment)
• Social support status
• Tests, bloodwork, most recent head to toe and vital signs.

Select a primary nursing diagnosis (must be NANDA approved).

Explain the pathophysiology that relates to your primary nursing diagnoses.

• 1-2 pages in length
• primarily written in student’s own words
• Uses quotes when appropriate and cites correctly using APA
• Quotes should not be over 40 words in length.

Complete a medication list:

• Both generic and trade names
• Assessments
• Patient indication
• Common side effects
• Patient teaching

Create a Care plan chart that clearly indicates the following related to your primary ND:

• Include 3 goals, two short term, one long-term
• Goals must be Specific, Measurable, Attainable, Relevant to this patient, Time oriented
• List at least 6 interventions with their rationale to achieve the above goals. You can have 2-3 interventions for each goal or mix it up.
• Each intervention must include the rationale – referenced in APA
• Include teaching throughout the care plan when possible (ie pre-medication assessments, interventions)
• Include how you will determine if the goal is met, and next steps if the goal is or is not met.

Include a reference page, as per APA guidelines:

• You must reference at least one journal article or one book outside of those used in this program.
• In total you must use at least 4 reference materials, 2 of these references must not be an assigned text book (example: journal article)

Primary diagnosis: Diabetic microvascular multiple cranial neuropathy

No Known Allergies

Dite: Oral, Therapeutic Diet Customization, Diabetic with Snacks, Food Texture: 7 Regular,

Capillary glucose frequency: BID Alternating times

Vitals, 02/02/21 @ 7:43am

BP: H, PO2:, HB: b/m, Tep: 36oc , BR: 12br/min

 

02/02/21	03/02/21
BP = 150/83 (mmHg) Pulse = 87 (bpm) SpO2 = 97 % Resp = 12(BPM) Temp(tymp) = 36 ℃   No pain No breathing problem No bowel movement	BP = 137/81(mmHg) Pulse = 88(bpm) SpO2 = 97 % Resp = 12(BPM) Temp(tymp) = 36.2 ℃   No pain No breathing problem No bowel movement

 

He is A spiritual person with inter-denomination, a swami-Indian monk practitioner. He does not quarrel with anyone. Originally from Scottland, he Moved to Canada in 1976 from Australia, where he stayed there for 3years. His last job was in England as a Government employee. He was admitted to the hospital in May of last year. He was diagnosed with gangrene infection, which leads to left leg amputation above the knee. No families to visit him, but he has contact with his two brothers and an aunt. He also has two sisters and a brother in Australia who lost his brother due to brain cancer. They all call once in a while. When he gets better, He is thinking of moving back to a small town called Marmora, Ontario.

The patient’s history reveals that he accepts Resuscitation,  any intervention, including CPR and transfer to acute care.

Treatment includes capillary blood glucose(CBG) monitoring, scheduled insulin orders, gGlargins 100units/ml, Latus.

He previously Diagnosed UTI. 1^st dose of antibiotics, 500mg amoxicillin PO per tube, Q12h for five days.

July 21/2020 Fluid restriction, 1500ml.

Wound management on Right toes: clean wound using a 30ml syringe with irrigation tip. Fro dry necrotic foot ulcers: paint ulcer with povidone-iodine 10%topical solution(Betadine). Daily dressing changes.

Allergies-NKDA

continue prophylaxis(as care plan)

Diet type: Diabetic with snacks, regular food texture

Capillary Blood Glucose(CBG), monitoring @Breakfast, Lunch, Dinner

Neurological: Oriented x 3, coordinate, able to communicate verbally, vision and hearing are ok. Impaired  Sensation to limbs, the client states he does not feel much in his thumbs, unable to grab items firmly.

Pain status, Sleep and Rest: client stats no pain, sleep well

Cardiovascular: apical pulse is within the normal range, regular rhythm. Capillary refill on tumps normal but hard to determine on toes due to ulceration on one foot and the other being amputated.

Respiratory: Easy and non-laboured, regular rate and rhythm, normal breath sounds, O2 saturation 97%

Genitourinary: The client claim he has difficulty in voiding and continence. As observed from His urine bucket, the urine is clear and odourless, an approximate amount of about 1500ml /day.

Gastrointestinal: Diabetic with snacks, regular food texture, able to eat at all times, foot ulcer due to existing condition; otherwise skin integrity is maintained, active bowel sounds, soft and non-tender.

Musculoskeletal: Limited ROM; both hands are weak to grab firmly; otherwise strong in resisting outside force. Unable to assess the leg due to amputation on the left leg and ulceration edema on the right foot. Unable to ambulate, he uses an electric wheelchair.

Integumentary: Edema, Redness, Ulceration and Necrotic toe Right foot. A scar on the amputated left foot.

Psychosocial: No visit from the family, occasional phone calls. The patient loves reading from computers and books, not physically active before his hospitalization. The client depends on the government support system. He grief on his brother due to cancer. Client display clear evidence of emotional distress due to his inability to ambulate, otherwise optimistic and pleasant personality to give care.

Sixty-one years old, male,  alone, no children, claim to work for the British Government before moving to Canada.

His health history reveals that he has been Diagnosed with Neurosarcoidosis. Left leg Above-knee amputation of lower extremity, anxiety disorder, ascites, Cranial nerve palsy, Depression, Type 2 Diabetic Mellitus, Diabetic foot infection, Diabetic neuropathy, Diarrhea, Diverticulitis, GERD, High cholesterol, Hypertension, Neurosarcordosis, Orthopenea, Peripheral edema, has some left eye ptosis as a result of neurosarcoidosis, Obese, DKA

It is observed that he has a superficial right toe ulcer

Code Status= Category 1(Full Code)

Lab values: 2021/01/14 (Only out of range lab values)

	Result Values	Range	Date
Sodium	131	136-146mmol/l	n/a
Creatinine	5.5	60-110umol/l	2020/12/21
Chloride	93	95-108mmoll	2020/12/21

 

MEDICATIONS

1. ACETAMINOPHEN 500MG TAB(TYLENOL), 1000MG, 2TAB, TID, PO,

MAX 4G/DAY(REGULAR + PRN)

FOR PAIN

2. ASA EC 81MG TAB(ENTROPHEN), 81MG, 1TAB, DAILY, PO.

ENTERIC COATED

FOR INFLAMMATION

3. ATROVASTATIN 10MG TAB(LIPITOR), 10MG, 1TAB, DAILY, PO.

FOR CHOLESTEROL.

4. carBAMazepine 200MG TAB(TEGRETOL), 400MG, 2TAB, BID, PO.

FOR TRIGEMINAL NEURALGIA-ANTIMATIC

5. INSULIN GLARGINE, LANTUS 100 UNIT(LANTUS SOLOSTAR), 44UINTS, DAILY, SUBCUT
6. KETOCONAZOLE 2 % CR 30G (HYDROCORTISONE 1 % CR), 30G, DAIY, TOPICAL.

FOR RASH ON FACE

7. KETOCONAZOLE 2% SHAMPOO 120ML(NIZORAL), SHAMPOO, ON BATH DAYS, TOPICAL.
8. LATANOPROST 0.005% OPHTH DROP 2.5ML(XALATAN), 1DROP, HS, BOTH EYES.
9. MOCLOBEMIDE 150MG TAB(MANERIX), 300MG,2TAB DAIY, PO.
10. MOCLOBEMIDE 150MG TAB(MANERIX), 150MG, 1TAB, HS, PO.
11. PANTOPRAZOLE EC 40MG TAB(PANTOLOC), 40MG, 1TAB, DAILY, PO.

ENTRIC COATED, FOR GERD.

12. POLYETHYLENE GLYCOL 3350 PWD 17 G PACK(LAX-A-DAY/RESTORALAX), 17G, BID, PO.
13. PREGABALIN 150MG CAP(LYRICA), 150MG, 1CAP,BID, PO.

FOR DIABETIC NEUROPATHY.

14. QUEtiapin XR 200MG TAB (SEROQUEL XR), 600MG, 3TAB, HS, PO.

EXTENDED-RELEASE

15. SEMAGLUTIDE PEN 4MG /3M (OZEMPIC), 1MG, Q-THURSDAY, SUBCUT.
16. SENNOSIDES 8.6MG TAB (SENOTOKOT), 17.2MG, 2TAB, BID, PO.
17. SODIUM CHLORIDE 1,000MG CAP (SALT CAPSULE), 1000MG, 1CAP, BID, PO.

TO REGULATE ELECTROLYTE

18. TAMSULOSIN SR 0.4MG CAP (FLOMAX), 0.4MG, 1CAP, DAILY, PO.

SUSTAINED RELEASE.

19. traZoDone 100MG TAB(DESYREL), 100MG, 1TAB, HS, PO.

PRN:( NO WORK IS NEEDED, JUST COPY PASTE)

1. ACETAMINOPHEN 500 MG TAB (TYLENOL), 1000MG, 2TAB, Q12H, PO, PRN

MAXIMUM 4G ACETAMINOPHEN/DAY(REG + PRN)

2. BISACODYLE 10MG SUPP (DULCOLAX), 10MG, 1SUPP, Q3DAYS, RECTAL, PRN

IF NO BOWEL MOVEMENT

3. ClonazePAM 2MG TAB(RIVOTRIL), 2MG, 1TAB, HS, PO, PRN

FOR SLEEP

4. DimnhyDRINATE 50MG TAB(GRAVOL), 50MG, 1TAB, Q4H, PO, PRN

FOR NAUSEA

5. HYDROMORPHONE 0.25MG TAB(DILAUDID), 0.25MG, 1TAB, Q4H, PO, PRN

*high ALERT DRUG*

6. LORazepam 1MG TAB(ATIVAN), 1MG, 1TAB, Q6H, PO, PRN.

FOR ANXIETY.

7. MELATONIN 3MG TAB, 3MG, 1TAB, HS, PO.

FOR SLEEP.

8. POLYETHYLENE GLYCOL 3350(LAX-A-DAY/RESTORALAX), 17G, BID, PO, PRN.

FOR CONSTIPATION.

9. PREGABALIN 50MG CAP(LYRICA), 50MG, 1CAP, HS, PO, PRN.

FOR SEVER PAIN.

10. SENNOSIDES 8.6MG TAB(SENOKOT), 17.2MG, 2TABS, DAILY, PO, PRN.

FOR CONSTIPATION.

11. SODIUM PHOSPHATE ENEMA 13ML(FLEET), 1ENEMA, Q3 DAYS, RECTAL, PRN.

FOR CONSTIPATION.

Primary diagnosis: Diabetic microvascular multiple cranial neuropathy

NURSING DIAGNOSIS:  Risk for Impaired Skin Integrity

SOLUTION : Nursing Care Plan For Diabetic microvascular multiple cranial neuropathy 

Diabetic microvascular multiple cranial neuropathy 

Patient’s Care Plan

Introduction

Admitting diagnosis: Diabetic microvascular multiple cranial neuropathy

Patient demographics: This care plan is for SD, a 61-year-old man who has been admitted to the facility with a diagnosis of diabetic microvascular multiple cranial neuropathy. The patient has a risk for impaired skin integrity. SD is experiencing distress as he is unable to ambulate. The patient visited the health facility two days ago, where he was diagnosed with high blood pressure (150/83mmHg), impaired limb sensation, and a wound on his amputated right toe.

Religion: SD is a Swami-Indian Monk practitioner

Pertinent social history: SD is a spiritual man who lives alone. Originally, the patient lived in Scotland and later moved to Canada in 1976 where he stayed for 3 years. Lastly, he worked as a government employee in England. He is currently not working, and therefore dependent on a government support system. SD has two brothers, two sisters, and an aunt. They rarely visit him but do make calls occasionally to check on his progress. SD lost a brother recently due to brain cancer. He has not yet stopped grieving his brother, an issue that has caused him immense emotional distress. Indeed, his inability to ambulate has further led to his deteriorating health. He contends that once he gets better, he is moving to a small town known as Marmora, Ontario.

Code status: category 1 (Full Code).

Smoking history: SD has no known history of smoking.

Surgical history: Amputation of the left foot.

Dietary history: Patient takes snacks and regular food texture.

Oxygen therapy: Not required

Pain rate: No pain

Fall Risk: SD’s left foot has been amputated, which increases his risk for falls.

Allergies: NKA

Patient past Medical History: SD was previously diagnosed with UTI on 21^st July 2020 and was out on the first dose of antibiotics, 500MG amoxicillin PO per tube, Q12h for five days. He has a wound on his right toe, which is being managed through daily cleaning. His paint ulcers are being managed by cleaning using povidone-iodine 10% topical solution.  SD is also suffering from neurosarcoidosis, left leg above-knee amputation of lower extremity, anxiety disorder, ascites, depression, type 2 diabetes, diabetic food infection, peripheral edema, diarrhea, GERD, high cholesterol, hypertension, diverticulitis, diabetic neuropathy, cranial nerve palsy, orthopenea, right to ulcer, obesity, and left eye ptosis as a result of neurosarcoidosis.

Current treatment: Capillary blood glucose (CBG) monitoring, scheduled insulin orders, gGlargins 100units/ml, Latus. The patient also takes several other medications to manage his different medical conditions.

Most recent vital signs on admission

Temperature: 36.2^oC, Blood pressure=150/83mmHg, Pulse rate=87bpm, SpO2= 97%, Resp= 12BPM.

Most recent lab values

	Result Values	Normal Range	Date undertaken
Sodium	131	136-146mmol/l	N/A
Creatinine	5.5	60-110umol/l	2020/12/21
Chloride	93	95-108mmoll	2020/12/21

 

Head to Toe Assessment

Neurological: The patient is oriented to place, person, and time. SD communicates verbally and can coordinate. Her vision and hearing are okay. However, he has impaired sensation of the limbs, has lost sensation of the thumbs, and is thus unable to grab things firmly. 

Pain, sleep, and rest: The client experiences no pain and states that he sleeps well.

Cardiovascular: SD’s pulse rhythm is regular and within the normal range. Capillary refill on thumps is normal. However, this cannot be determined accurately on his toes due to ulceration on one foot and amputation on the other.

Genitourinary: The patient has difficulties in voiding and continence. SD’s urine is clear and odorless.

Gastrointestinal: Diabetic with snacks and regular food texture. The patient can eat at all times. SD has active bowel sounds, they are soft and tender. His skin integrity is well maintained.

Musculoskeletal: SD has limited ROM. Both hands are weak and thus cannot grab objects firmly. The client cannot assess the leg due to amputation on the left leg and ulceration edema on the right foot. He is unable to ambulate and moves using an electric wheelchair.

Integumentary: The client has edema, redness, ulceration, and necrosis of the toe of the right foot. Furthermore, he has a scar on the amputated left foot. 

Plan of care: the patient should be provided with adequate fluids. Infusing intravenous IV sodium and chloride is critical to raising the concentration of these ions to normal levels.

Pathophysiology of Diabetic microvascular multiple cranial neuropathies

Vascular complications are among the most common disorders that cause significant mortality and morbidity among patients with either type 1 or Type 2 diabetes. Neuropathy refers to disorders that damage the body’s nerves thus affecting one’s ability to feel and move. Diabetes cranial neuropathies occur when the nerves of the brain are damaged by illnesses such as type 1 or type 2 diabetes. There are different types of microvascular cranial neuropathies and include Bell’s palsy, microvascular cranial nerve palsy, third nerve palsy, fourth and sixth nerve palsy. When almost all of these cranial nerves are affected, an individual suffers from multiple cranial neuropathies (John Hopkins University, 2023).

Varghese, Jialal, & Doerr (2023), argue that diabetic microvascular multiple cranial neuropathy results from multiple abnormalities in cell signalling, insulin resistance, gene expression, and the regulation of physiological processes in diabetic patients. Other causes of the disorder include high blood pressure especially for patients with microvascular cranial nerve palsy, viruses in patients with Bell’s palsy, infections, congenital birth defects, stroke, and tumors (John Hopkins University, 2023). The underlying driver for multiple cranial neuropathy is the excessive exposure of tissues to chronic hyperglycemia, which causes glucose-mediated endothelial damage, oxidative stress, and the production of sorbitol. These injuries cause blood flow fluctuations, changes in endothelial permeability, protein deposition, and coagulation, and thus the dysfunctioning of the different body organs (Vithian, 2010). Symptoms of multiple microvascular neuropathies include a drooping face, blurred vision, muscle weakness, numbness, pain, loss of sensation on the face and cheek swelling, and a tingling sensation (Tu, Chang, & Lin, 2010).

 

Medication

Medication	Patient Indication	Dosage	Common side effects	Patient teaching
Trade name: Tylenol Generic name: Acetaminophen 500mg Tab	For management of pain	1000mg, 2tab, Tid, PO (Max 4g/Day(Regular + Prn)	Side effects of the medication include skin rashes and peeling, itching, swelling of the face, throat, eyes, feet, and lower legs, and difficulties in breathing.	The patient should not take more medication than prescribed.
Trade name: ASA EC 81MG TAB Generic name: Entrophen	An antiplatelet for reducing inflammation	81MG, 1TAB, Daily, PO	Common side effects of the medication include nausea, vomiting, heartburn, and may cause stomach ulcers.	The medication should not be chewed or crashed. Should be swallowed whole. The patient should take the medication regularly as prescribed to maximize its benefits. The patient should report any adverse side effects to their healthcare providers.
Trade name: Lipitor Generic name: Atrovastatin 10MG TAB	For treating high cholesterol levels	10MG, 1TAB, Daily, PO.	Side effects of the medication include nausea, headache, sore throat, diarrhoea, and constipation.	Educate the patient to rest and drinking plenty of fluids.
Trade Name: Tegretol Generic name: Carbamazepine 200MG TAB	For Trigeminal Neuralgia	400 mg, 2 TAB, BID, PO	Side effects of the medication include dizziness, drowsiness, constipation, nausea, and vomiting.	Teach the patient to avoid certain foods such as grapefruit. Patients with seizures should not prescribe to the medication as it increases the frequency of convulsions.
Trade name: Lantus Solostar Generic name: Insulin Glargine, Lantus 100 Unit	To treat type 2 diabetes	44 units, Daily, Subcutaneous	Common side effects include rapid increase in weight, swelling of the feet, shortness of breath, low blood potassium, increased thirst and urination, and irregular heartbeat.
Trade name: Hydrocortisone 1 % CR Generic name: Ketoconazole 2 % CR 30G	Used to treat face rashes	30G, Daily, Topical.	The most common side effects include burning, irritation, and redness on the applied area. An unusual air growth and small red bumps may also be formed on the skin.	The patient should be advised to use the medication on the skin only. Once the patient applies the medication, he should gently rub the affected area. The area should not be bandaged or covered.
Trade name: Nizoral Generic name: Ketoconazole 2% Shampoo 120mL	Used to treat sun fungi and other skin infections	Shampoo, On Bath Days, Topical	The medication may cause acne, bleeding from the mouth, cracked skin, discolouration of fingernails, reddening of skin, and eye swelling.	The patient should be advised to take medication as prescribed The patient should report any adverse events to healthcare providers.
Trade name: Xalatan Generic name: Latanoprost 0.005% Ophth Drop 2.5ml	To treat glaucoma and high pressure inside the patient’s eyes	1drop, HS, Both Eyes	Common side effects include reddening of the eyes, inflamed eyelid, and increased sensitivity to light.	Educate the patient to always drop the prescribed number of drops into the eye pockets and not the surface of the eyeballs as this may cause stinging. The patient should also press lightly against the eyes to ensure that the medication stays in the eyes.
Trade name: Manerix Generic name: Moclobemide 150MG TAB	To treat the patient’s depression.	300Mg, 2 TAB Daily, PO.	The medication can cause blurred vision, irregular heartbeat, emotional problems, slurred speech, and severe headache.	The patient should be advised to avoid excessive cheese, yeast extracts, and soya beans products.
Trade name: Pantoloc Generic name: Pantoprazole EC 40mg Tab	To treat acid reflux	40Mg, 1TAB, Daily, PO.	Common side effects caused by the medication include headache, nausea, joint pain, diarrhoea, and dizziness.	The patient should be advised not to crush chew, or break the tablets as this affects its effectiveness.
Trade name: Lax-A-Day/Restoralax Generic name: Polyethylene Glycol 3350 Pwd  17 G Pack	To relieve constipation	17G, BID, PO.	The medication may cause stomach ache, bloating, and nausea.	Advise the patient  to take plenty of fluids
Trade name: Lyrica Generic name: Pregabalin	For treating Diabetic Neuropathy	150MG, 1CAP, BID, PO.	These tablets may cause blurred vision, dizziness, drowsiness and trouble thinking.	The patient should be advised to swallow the tablet whole. The patient should not operate any machinery after taking the drug.
Trade name: Seroquel XR Generic name: Quetiapin XR 200MG TAB	Used to treat manic and major  depressive disorder	600 mg, 3 TAB, HS, PO.	The medication causes tiredness, drowsiness, constipation, and blurred vision.	The patient should be advised to report to a healthcare provider in case of severe symptoms.
Trade name: Ozempic Generic name: Semaglutide Pen 4MG /3M	To improve blood sugar due to type 2 diabetes	1MG, Q-Thursday, Subcutaneous	Common side effects may include exesssive sweating, increased heart rate, hunger, blurred vision, headache, and dizziness.	Educate the patient to start injecting the medication at low doses to minimize risk of side effects. Furthermore, to gain maximum benefits, teach the patient to carefully follow the treatment plan, meal schedule, and exercise program.
Trade name: Senotokot Generic name: Sennosides	It is used to treat constipation	17.2 Mg, 2 tabs, BID, PO.	The most common side effects include rectal bleeding, decreased bowel movement, chest pain, and irregular heartbeat, numbness, and muscle weakness.	Teach the patient not to use the medication seven days after starting since overuse may cause serious side effects.
Trade Name: Flomax Generic name: Tamsulosin SR 0.4mg Cap	To treat symptoms of enlarged prostate such as difficulty urination, painful urination, and urinary frequency	0.4mg, 1Cap, Daily, PO	Dizziness, drowsiness, and running nose	Advise the patient to get up slowly when rising to avoid sudden falls. The patient should also avoid using machinery when under this medication.
Trade name: Sodium Chloride 1,000MG Generic name: Salt Capsule	To regulate electrolytes	1000mg, 1Cap, BID, PO.	Side effects include increased heart rate, join pains, skin rash, irritation, shortness of breath, and swelling of eyelids, face, and feet.	Educate the patient to take plenty of fluids to minimize build-up of sodium ions.
Trade name: Desyrel Generic name: Trazodone	To treat depression and anxiety	100MG, 1TAB, HS, PO.	Tiredness, headache, constipation, and dry mouth.	To obtain maximum benefits, the patient should swallow the tablet whole. Furthermore, the patient should be advised to take enough fluids.

 

Some of the PRN medications provided to the patient include;

1. Acetaminophen 500 Mg Tab (Tylenol), 1000mg, 2tab, Q12h, PO, PRN

Maximum 4g Acetaminophen/Day (REG + PRN). To relieve mild pain

2. Bisacodyle 10mg Supp (Dulcolax), 10mg, 1supp, Q3days, Rectal, PRN

If No Bowel Movement

3. Clonazepam 2mg Tab(Rivotril), 2MG, 1TAB, HS, PO, PRN

For Sleep

4. Dimnhydrinate 50mg Tab(Gravol), 50mg, 1tab, Q4h, PO, PRN

For Nausea

5. Hydromorphone 0.25mg Tab (Dilaudid), 0.25mg, 1tab, Q4h, PO, PRN

*High Alert Drug*

6. Lorazepam 1mg Tab (Ativan), 1mg, 1tab, Q6h, PO, PRN.

For Anxiety.

7. Melatonin 3mg Tab, 3mg, 1tab, HS, PO.

For Sleep.

8. Polyethylene Glycol 3350(Lax-A-Day/Restoralax), 17g, BID, PO, PRN.

For Constipation.

9. Pregabalin 50mg Cap (Lyrica), 50mg, 1cap, HS, PO, PRN.

For Sever Pain.

10. Sennosides 8.6mg Tab (Senokot), 17.2mg, 2tabs, Daily, PO, PRN.

For Constipation.

11. Sodium Phosphate Enema 13ml (Fleet), 1enema, Q3 Days, Rectal, PRN.

For Constipation.

 

Patient’s Care Plan

Goal ( 3 goals)	Interventions (2-3 interventions)	Assessment for attainment of goal
Patient will main intact skin integrity	·       The nurse should assess blood supply and sensation. This is critical in ensuring that the parts of the body that have lost sensation due to the disorder are treated to improve skin integrity (Wagner, 2023). ·       Support the patient to obtain proper nutrition. Optimum nutrition is critical in improving tissue health and circulation. ·       Support the patient to reduce exposure to environmental hazards.  This is due to the fact that patients with multiple cranial neuropathies have decreased sensation and thus are at a risk for burns and injury from sharp objects (Wagner, 2023).	·       Reduced blood pressure ·       Improved body organ sensation ·       Improved diabetes management ·       Reduced or no injuries
Patient will demonstrate lifestyle changes to manage diabetes and improve blood sugar levels at or below 125mg/dL	·       Perform blood glucose testing regularly to ensure that the patient’s glucose levels are within the normal range. ·       Conduct meal planning to ensure that the patient eats nutritious foods. Diet is an important component of managing diabetes (Wagner, 2023). ·       Administer medications as prescribed. Medications are the primary pharmacologic therapies for diabetes and high blood pressure.	·       Glucose level maintained within the normal range ·       Improved nutrition and exercise ·       Ability to ambulate ·       Improved diabetes management activities ·       Adherence to treatment plan
Patient will develop an understanding of his condition and remain free from infections.	·       Nurses should support the patient to undertake aseptic procedures. Such procedures help reduce infections (Wagner, 2023). ·       Educate the patient how to administer antibiotics. They are critical in destroying pathogens and reducing the risk for infections. ·       Educate the patient on wound healing. Indeed, diabetes and high blood pressure reduces the body’s ability to heal, and therefore, it is necessary to educate the patient to take extra precautionary measures to avoid new infections (Wagner, 2023).	·       Reduced risk for infections ·       Monitoring vital sings such as temperature ·       Monitoring for signs of infection or inflammation

 

References

John Hopkins University (2023). Multiple cranial neuropathies. retrieved on 4^th June 2023           from https://www.hopkinsmedicine.org/health/conditions-and-diseases/multiple-           cranial-            neuropathies#:~:text=This%20condition%20occurs%20when%20the,who%20have%   20high%20blood%20pressure.

Tu, M., Chang, Y., & Lin, T. (2010).  Recurrent multiple cranial neuropathies in a diabetic           patient. Acta Neuro Tiiwan, 19, 208-212.

Varghese, R., Jialal, I. & Doerr, C. (2023). Diabetic Nephropathy (Nursing) In: Treasure Island (FL): Stat Pearls Publishing; 2023 Jan-. Available from:   https://www.ncbi.nlm.nih.gov/books/NBK568691/

Vithian, K. (2010).  Microvascular complications: Pathophysiology and management.       Clinical Medicine, 10(5), 505-509.

Wagner, M. (2023). Diabetic neuropathy nursing diagnosis and care plan. https://www.nursetogether.com/diabetic-neuropathy-nursing-diagnosis-care-plan/