NURSING CARE PLAN

ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION EVALAUTION

SUBJ. DATA: Altered  To Weigh client on each prenatal  Client’s weight is 56kg Patient maintains
nutritional visit. fasting serum
Patient says her status less  To Assess calorie intake and  Advised the patient to eat well glucose level
appetite has than body dietary pattern using 24 hour balanced diet. It should be highly between 60-
increased. requirement recall. nutritious and easily digestable 100mg/dl and
r/t inability to  To Review importance of  Take meals after 15 minutes of follows the
OBJ. DATA: utilize regularity of meals and snacks insulin administration. diabetic diet
nutrients when taking insulin. chart.
Blood glucose appropriately(  To Discuss dosage ,schedule,type  Diet with 2000-2500kcal/day for
levels: imbalance of insulin normal women weight and
between  To Adjust diet or insulin regimen restriction to 1200-1800kcal/day
FBS-155mg/dl glucose intake to meet individual needs. for overweight women is
and glucose  To Refer to registered dietician to recommended. High protein diet
PP-204mg/dl utilization) individualize diet pattern.
 To Monitor serum glucose levels(  Avoid foods containingexcess of
HbA1c-9.3
FBS, preprandial,postprandial) carbohydrate like sweets,
 To Ascertain results of HbA1c honey,sugar, fried foods, cold
every 2-4 weeks. drinks

 Avoid foods rich in fats and

calories.
SUBJ. DATA: Risk for fluid  To assess the hydration status of  Examined the skin turgor and Hydration
volume deficit client and observe the skin mucus membrane. maintained and
Patient c/o r/t loss of turgor. vitals are normal.
frequent and fluids from  Monitored the intake and output
excessive body due to  Take assess intake and output of client
urination. polyuria. daily.

OBJ. DATA:
 Vitals monitored.
 To monitor vital signs.
Patint loks
lethargic and  Advised patient to have adequate
 To have adequate fluid fluid consumption and small
dehydrated. consumption. frequent meals at regular interval.
Total urine
output is  To monitor for signs of edema.
2700ml/day  Mild edema present over lower
extremities.
 To Discuss signs and symptoms of
 Signs and symptoms of
hypoglycemia and hyperglycemia
hypoglycemia and hyperglycemia
discussed.
 To Recommend monitoring urine
for ketones on awakening and
 Recommended monitoring urine
when a meal is delayed.
for ketones on awakening and
when a meal is delayed.
SUBJ. DATA: Activity  To assess patient’s level of  patient’s level of tolerance of Patient is able to
intolerance r/t tolerance of activity. activity assessed. do self care acivity
Patient c/o increased and takes
weakness and energy  To encourage to do self activity  Encouraged to do self activity adequate rest and
fatigue and demands due sleep.
reduced self to disease
care activity. condition and  To advise rest in between periods  Advised rest in between periods of
increased fetal of activity activity
OBJ. DATA: nutrient
uptake.  To advise to take night sleep of 6-  advised to take night sleep of 6-8
Patient looks 8 hours hours
dull and activity
is limited.
 Provide dietary information  dietary information Provided about
about sources of iron and the sources of iron and the need for
need for iron supplements. iron supplements.

 Provide information about need  Information Provided about need

for regular daily mild exercise for regular daily mild exercise
program (regularly, 20 min after program (regularly, 20 min after
meals). Warn against exercising if meals). Warn against exercising if
glucose exceeds 300 mg/dL. glucose exceeds 300 mg/dL.

 Provide information regarding  information Provided regarding the

the impact of pregnancy on the impact of pregnancy on the
diabetic condition and future diabetic condition and future
expectations. expectations.
SUBJ DATA: Risk for fetal  To Determine white’s  fetal movement and fetal heart Display normally
injury r/t classification for diabetes, rate monitored and FHS is reactive NST and
Nil elevated  To assess for fetal movement and 132beats/min negative CST.
serum glucose fetal heart rate.  client encouraged to count and
OBJ DATA: levels and  To encourage client to count and record periodically fetal
consequent record periodically fetal movements, beginning about 18
Blood glucose changes in movements, beginning about 18 weeks of gestation and daily from
levels: circulation. weeks of gestation and daily from 34 weeks onward.
34 weeks onward.  fundal height is 32-34 weeks.
FBS-155mg/dl  To measure fundal height each  information provided about
visit. possible effect of diabetes on fetal
PP-204mg/dl
 To Provide information about growth and development.
possible effect of diabetes on  procedure and rationale for
HbA1c-9.3
fetal growth and development. periodic NSTs (e.g., weekly NST
 To Review procedure and after 30 weeks’ gestation, twice-
rationale for periodic NSTs (e.g., weekly NST after 36 weeks’
weekly NST after 30 weeks’ gestation) reviewed with client.
gestation, twice-weekly NST after  procedure and rationale for
36 weeks’ gestation). periodic OCTs BEGINNING AT 30-
 To Review procedure and 32 WEEKS gestation. reviewed with
rationale for periodic OCTs client.
BEGINNING AT 30-32 WEEKS  signs of PIH (edema, proteinuria,
gestation. increased blood pressure)
 To Monitor for signs of PIH monitored.
(edema, proteinuria, increased  No ketone bodies in urine .
blood pressure).
 To Monitor urine for ketones.
Note fruity breath
SUBJ. DATA: Knowledge  Assess client’s/couple’s
deficit r/t knowledge of disease process
Mother asks diabetic and treatment, including
questions condition, relationships between diet,
regarding how prognosis, and exercise, illness, stress, and
long to self care insulin requirements.
continue insulin treatment  Discuss importance of home
therapy. needs serum glucose monitoring using
reflectance meter, and the need
OBJ. DATA: for frequent readings (at least 4
times/day), as indicated.
Client looks  Demonstrate procedure, observe
confused about return demonstration by the
insulin therapy client.
and oral  Review reasons why oral
hypoglycemic hypoglycemic medications should
agents. be avoided, to control diabetes
before pregnancy.
 Provide information about action
and adverse effects of insulin.
Assist client to learn
administration by injection,
insulin pump, or nasal spray as
indicated.
 Recommend client maintain a
diary of home assessment of
serum glucose levels, insulin
dosage, diet, exercise, reactions,
general feelings of well-being,
and any other pertinent thoughts
 client’s/couple’s knowledge of Participate in the
disease process and treatment, management of
including relationships between diabetes during
diet, exercise, illness, stress, and pregnancy.
insulin requirements assessed. Verbalize
 importance of home serum glucose understanding of
monitoring using reflectance the procedures,
meter, and the need for frequent laboratory tests,
readings (at least 4 times/day), as and
indicated discussed. activities involved
 Demonstrate procedure, observe in controlling
return demonstration by the client. diabetes.
 reasons explained why oral Demonstrate
hypoglycemic medications should proficiency in self-
be avoided, monitoring and
 Information provided about insulin
action and adverse effects of administration.
insulin. Client assisted to learn
administration by injection,
 Recommend client maintain a diary
of home assessment of serum
glucose levels, insulin dosage, diet,
exercise, reactions, general
feelings of well-being, and any
other pertinent thoughts.
 

Mother Anxiety r/t  To assess patients level of  patients level of anxiety assessed. Mother shows
verbalizes her outcome of anxiety. less anxiousness
concern for her pregnancy and  To the ways to improve pregnancy about the
baby as her health of  To discuss with mother the ways outcome like by regular antenatal outcome of
previous two unborn child to improve pregnancy outcome checkup , maintained blood labour.
deliveries were as witnessed like by regular antenatal checkup glucose levels within normal range,
still birth. by mother’s etc.
frequent
doubts about
pregnancy  To allow mother to ask questions
outcome. and ventilate her feelings
 Assess client’s/couple’s
knowledge of disease process
and treatment, including
relationships between diet,
exercise, illness, stress, and
insulin requirements.
 To involve family members in
care of the client.
 To educate the mother about
maternal as well as fetal hazards
of gestational diabetes and hence
educate her to maintain her
serum glucose levels within
normal range.
consuming diabetic diet. discussed
with mother
 mother allowed to ask questions
and ventilate her feelings
 client’s/couple’s knowledge of
disease process and treatment,
including relationships between
diet, exercise, illness, stress, and
insulin requirements assessed.
 family members involved in care of
the client.
 the mother educated about
maternal as well as fetal hazards of
gestational diabetes.
Prepare for hospitalization if diabetes is
not controlled.

 Teach/review method to self

monitor blood glucose.
.

Assess understanding of the effect of

stress on diabetes. Provide information
about stress management and
relaxation.