Form NDP20M "Risk for Unstable Blood Glucose Level" - Alabama

What Is Form NDP20M?

This is a legal form that was released by the Alabama Department of Mental Health - a government authority operating within Alabama. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2018;
  • The latest edition provided by the Alabama Department of Mental Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form NDP20M by clicking the link below or browse more documents and templates provided by the Alabama Department of Mental Health.

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Download Form NDP20M "Risk for Unstable Blood Glucose Level" - Alabama

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NDP 20m
July 2018
NAME __________________________________________________
Risk for Unstable Blood Glucose Level
Date
Problem
Goal/Outcome
Interventions
Date
Evaluation
NOTES
Related To:
1. BS level <200;
(Address all items listed
NURSING
in “goal/outcome”
□ Type I Diabetes
A1C <7
1. Assess for signs if ↑
column. If goal not met,
□ Type II Diabetes
2. Demonstrated
or ↓ Blood Sugar
revise plan)
□ Diagnosis of
diet and med
2. Teach actions to
Hypoglycemia
compliance
raise blood sugar as
□ other (list)
needed
3. Assess med regime
and compliance
4. Assess dietary
AEB:
intake
□ BS > 200
5. Monitor target Blood
□ BS <60
Sugar /A1C
□ polydipsia
_______ (freq)
□ polyuria
6. Administer insulin
□ blurred vision
as ordered
□ dry mouth
Monitor person
□ increased
self-
administering
tiredness
at least
□ leg pain
quarterly
□ nausea/vomiting
7. Educate about
□ confusion
diabetes and dietary
□ weakness
restrictions
□ nervousness/
8. Assess and monitor
anxiety
feet
□ hunger
9. Monitor VS as
□ headaches
ordered/appropriate
□ cold/clammy
10. Monitor physical
□ sweaty
activity and alcohol
□ heart rate >100
intake ______(freq)
□ irritability
□ slurred speech
□other (list)
Risk for Unstable Blood Glucose Level
NDP 20m
July 2018
NAME __________________________________________________
Risk for Unstable Blood Glucose Level
Date
Problem
Goal/Outcome
Interventions
Date
Evaluation
NOTES
Related To:
1. BS level <200;
(Address all items listed
NURSING
in “goal/outcome”
□ Type I Diabetes
A1C <7
1. Assess for signs if ↑
column. If goal not met,
□ Type II Diabetes
2. Demonstrated
or ↓ Blood Sugar
revise plan)
□ Diagnosis of
diet and med
2. Teach actions to
Hypoglycemia
compliance
raise blood sugar as
□ other (list)
needed
3. Assess med regime
and compliance
4. Assess dietary
AEB:
intake
□ BS > 200
5. Monitor target Blood
□ BS <60
Sugar /A1C
□ polydipsia
_______ (freq)
□ polyuria
6. Administer insulin
□ blurred vision
as ordered
□ dry mouth
Monitor person
□ increased
self-
administering
tiredness
at least
□ leg pain
quarterly
□ nausea/vomiting
7. Educate about
□ confusion
diabetes and dietary
□ weakness
restrictions
□ nervousness/
8. Assess and monitor
anxiety
feet
□ hunger
9. Monitor VS as
□ headaches
ordered/appropriate
□ cold/clammy
10. Monitor physical
□ sweaty
activity and alcohol
□ heart rate >100
intake ______(freq)
□ irritability
□ slurred speech
□other (list)
Risk for Unstable Blood Glucose Level
NDP 20m
July 2018
Date
Problem
Goal/Outcome
Interventions
Date
Evaluation
NOTES
DELEGATE
1. Assist with po meds
as ordered
2. Check Blood Sugar
_______ (freq)
3. Weigh _____ (freq)
4. Encourage daily
exercise according
to ability/instruction
(active/passive)
5. Monitor and
encourage
appropriate
food/liquid intake
6. Monitor and
encourage foot care
and protection (No
bare feet)
5. Other (list)
RN SIGNATURE:
DATE:
Risk for Unstable Blood Glucose Level
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