FREVILYN H.

ABASTA APRIL 08, 2021

BSN 2Y2-2A NCMA 219

Practicum:

Patient’s name: A. M
Pathophysiology: Gestational diabetes mellitus (GDM) is a serious pregnancy complication, in which women
without previously diagnosed diabetes develop chronic hyperglycemia during gestation. In most cases, this
hyperglycemia is the result of impaired glucose tolerance due to pancreatic β-cell dysfunction on a background
of chronic insulin resistance. Risk factors for GDM include overweight and obesity, advanced maternal age, and
a family history or any form of diabetes. Consequences of GDM include increased risk of maternal
cardiovascular disease and type 2 diabetes and macrosomia and birth complications in the infant.
GDM is usually the result of β-cell dysfunction on a background of chronic insulin resistance during pregnancy
and thus both β-cell impairment and tissue insulin resistance represent critical components of the
pathophysiology of GDM. In most cases, these impairments exist prior to pregnancy and can be progressive—
representing an increased risk of T2DM post-pregnancy. A number of additional organs and systems contribute
to, or are affected by, GDM. These include the brain, adipose tissue, liver, muscle, and placenta.

Diagnostic Test: Internal Examination, Pelvic Ultrasound, Cardiotocograph monitoring

Diagnosis: Gestational Diabetes Mellitus
Medical/ Surgical Rx: Oxytocin Infusion
Medications: nothing was mentioned
Significance: These concept map/ plan may help the healthcare workers for the effective and
successful delivery of the patient as well as the fetal delivery.

Risk Factor # 1: GDM

Signs and Symptoms:
 fatigue
 blurred vision
 extreme thirst
 Nausea
 Frequent urination

Nsg Dx:
 Risk for Fetal Injury

Intervention:
 Monitor fundal height
 Prepare and assist for delivery of fetus, normal delivery or cesarean if the test indicates
placental aging and insufficiency.
Expected Outcome:
 Maternal patient participated in the intervention to improve labour and her delivery.
 Fetal patient will normally display reactive normal stress test and negative CST.
Risk Factor # 2: Chin Presentation
Signs and Symptoms:
 The head did not extend normally.
Nsg Dx:
 Risk for fetal Injury
Intervention:
 Monitor fetal descent in birth canal in relation to ischial spine.
 Assess for malposition of the baby using maneuvers and findings on internal examination.
 Prepare client for the most expedient method for delivering the fetus.
Expected Outcome:
 Maternal patient participated in the intervention to improve labour and to have successful
delivery
 Fetal patient body fails to deliver after the interventions.

Risk Factor # 3: Shoulder Dystocia (Shoulder Presentation)

Signs and Symptoms:
 Restitution of the baby’s head
 Difficulty of delivering the baby’s face
Nsg Dx:
 Risk for Fetal injury
Intervention:
 Note effacement, fetal station and fetal presentation.
 Evaluate for episiotomy
 Perform McRobert’s maneuver and suprapubic (not fundal) pressure to disengage the anterior
shoulder.
 Graph cervical dilation and fetal descent against time. (Friedman curve)
 Prepare and assist for cesarean delivery if possible for CS Birth

Expected Outcome:
 The patient will accomplish cervix dilation and she successfully deliver the fetus within 30
minutes