REVISION OF CASESTUDY GDM GROUP - 3obligado

THE COLLEGE OF MAASIN
“Nisi Dominus Frustra”

College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
A CASE STUDY OF GESTATIONAL DIABETES MELLITUS
In Partial Fulfillment of the Requirements in NCM-104 RLE

Semester A.Y 2021-2021
Presented to:
Ms. Miraluna D. Caturan, RN, Man
Dean of College of Nursing and Allied Health Sciences
Presented by:
Lurzano, Fretzie
Malatamban, Purity
Obligado, Trisha Mae
NOVEMBER 2021
Pregnancy has been recognized for a long time as a diabetic state in which insulin
sensitivity decreases with advanced gestational age — those who cannot meet the increased
demand develop diabetes. Diabetes is the most common medical complication.
A 29-year-old woman at 20 weeks' gestation visits the office for a routine prenatal
examination. This is her second pregnancy, and she has gained 15 lb (6.8 kg). According to
her medical record, the patient's pre-pregnancy body mass index (BMI) was 27 kg per m2.
She mentions that her father was recently diagnosed with diabetes, and she asks whether
she should be tested for diabetes. Results showed that she has 3+ glycosuria and she was
diagnosed with Gestational Diabetes Mellitus.
Gestational diabetes mellitus (GDM) happens when a placenta hormone prevents the
body from using insulin effectively. Glucose accumulates in the blood instead of being
absorbed by cells. Unlike type 1 diabetes, it is gestational diabetes not caused by a lack of
insulin. It is caused by other hormones produced during pregnancy that can make insulin less
effective. A condition referred to as insulin resistance. Women with GDM have decreased
quality of life and increased risks of cesarean section, gestational hypertension, preeclampsia
and type 2 diabetes.
According to the study of Keshavarz 2005, hyperglycemia develops during pregnancy
due to the secretion of placental hormones, which causes resistance to insulin. Gestational
diabetes occurs in about 14% of pregnant women and increases their risk for hypertensive
disorders. Women who are considered at high risk of GDM must undergo blood glucose tests
at their first prenatal visit are those who have marked obesity, a personal history of GDM,
glycosuria, or a strong family history of diabetes.

What is Gestational Diabetes Mellitus? Provide 3 definitions.
Gestational Diabetes Mellitus (GDM) is a condition of abnormal glucose metabolism that

arises during pregnancy. Blood sugar usually returns to normal soon after delivery. But
having gestational diabetes makes it more likely to develop type 2 diabetes.
Source:https://nurseslabs.com/gestational-diabetes-mellitus-nursing-care-
plans/#risk_for_maternal_injury
Gestational Diabetes Mellitus (GDM) as glucose intolerance first detected during pregnancy”.
Various adverse maternal and neonatal outcomes were complicated by GDM, while its
complex care requires risk reduction strategies beyond the control of blood glucose level.
Source: World Health Organization
Gestational diabetes mellitus (GDM) is a condition in which a hormone made by the placenta
prevents the body from using insulin effectively. Glucose builds up in the blood instead of
being absorbed by the cells.
Source:https://www.hopkinsmedicine.org/health/conditions-and-
diseases/diabetes/gestational-diabetes
What are possible complications of GDM?

The chronic effects or the uncontrolled glucose level during pregnancy would lead to the
development of the following complications:
1. Urinary Tract Infection (UTI)
2. Infertility
3. Stillbirth
4. Preterm labor and delivery
5. Pregnancy-induced hypertension (PIH) pre-eclampsia and eclampsia
6. Congenital anomalies
7. Spontaneous abortion
Also, a woman who developed or experienced Gestational Diabetes Mellitus is expected to
have Type II Diabetes Mellitus within 5 years for the rest of her life.
Make a table showing the difference of sign and symptoms of GDM and Diabetes
Mellitus.
The clinical manifestations of gestational diabetes mellitus coincide with the signs and
symptoms of other types of diabetes mellitus. These are popular known as the “3 P’s” or
polydipsia (excessive thirst), polyphagia (excessive hunger), polyuria (frequent urination).
Aside from these manifestations, there are also other signs and symptoms that are general
manifestations and pregnancy-specific manifestations.
GESTATIONAL DIABETES MELLITUS DIABETES MELLITUS (GENERAL)
1. Higher glucose level (20-30 mg/dL) than 1. Blurred vision
the pre-pregnant level
2. Vulvar puritus
2. Very rapid weight gain
3. Paresthasia
3. Polyhydramnios
4. Peripheral neuropathy
4. Recurrent monilial infections
5. Weakness
5. Glycosuria
6. Normal/elevated pulse rate and
6. Nocturia temperature
7. Large for gestational age (LGA) or small
for gestational age (SGA) fetus 7. Normal/decreased blood pressure
8. More severe state of edema 8. Kussmaul’s respirations
9. Dehydration
10. Recurrent infections
11. Non- healing wounds
Make 5 possible nursing diagnosis with this condition.
1. Risk for Altered Nutrition: Less than Body Requirements related to inability to utilize
nutrients appropriately
2. Risk for Maternal Injury related to changes in diabetic control
3. Activity intolerance related to increased energy demands due to disease condition and
increased fetal nutrient uptake
4. Risk for fetal related to elevated maternal serum glucose level
5. Deficient knowledge related to unfamiliarity with information resources.
CONCEPT MAP
RISK FACTORS
LABORATORY RESULT
Predisposing Factor:
WBC: 12,000 per cubic mm
 Age
 Family History Hematocrit: 45%
 Ethnicity Urinalysis: Glucose +3
Precipitating Factor: 1-hr post-prandial: 200 mg/dL

2-hr post-prandial: 170 mg/dL
 Obesity
FBS: 125 mg/dL
 Sedentary Lifestyle
EFW: 550 grams
 Diet
 Glycosuria
CLINICAL MANIFESTATIONS:
 Fatigue
 More than 5% body weight

gain
 Normal vital signs

PATHOPHYSIOLOGY
Refer to page 32
MEDICAL DIAGNOSIS
GESTATIONAL DIABETES
MELLITUS

MEDICAL TREATMENT NURSING MANAGEMENT

1. Nutrition
1. Complete Blood Count  Assess the timing and content of meals
 Instruct on importance of a well-
A complete blood (CBC) test in performed to balanced diet
determine whether the pregnant mother as developed  Explain the importance of exercise
any health problems. It helps to diagnose illnesses or  Plan for a weight reduction course
infections in the expecting mother. 2. Insulin use
2. Urinalysis  Encourage verbalization of feelings
 Demonstrate and explain insulin therapy
is a test for urine. It is used to detect and manage a
 Allow the client to do self-administration
wide range of disorders  Review mastery of the whole process
24-hour urine sample is needed 3. Activity tolerance
3. OGGT- is a routine test during pregnancy that checks  Plan for regular exercise
 Increase carbohydrate intake before
a pregnant woman’s blood glucose level. exercise
4. Fasting blood sugar  Instruct to avoid exercise if blood
glucose level exceeds 250 mg/dL and
It is often the first test done to check for urine ketones are present
prediabetes and diabetes.  Advise to use abdomen for insulin
injection if arms and legs are used for
5. Biophysical Scoring exercise
ABPP test may include a non-stress test with 4. Fetal well-being
electronic fetal heart monitoring and a fetal  Continuous monitoring of fetal activities
and fetal heart tone
ultrasound. The BPP measures the fetus’ heart  Monitor fetal activities during maternal
rates, muscle tone, movement, breathing, and activities
 Monitor early signs of labor
the amount of amniotic fluid around the fetus.  Advice to report of any discharge coming
from the vagina
 Monitor daily weight and advice to report
Pharmacologic Treatment on rapid weight gain.
5. Educative
 Insulin- it lowers blood glucose by
stimulating peripheral glucose uptake by  Teach on lifestyle modifications
 Advice to see psychologists with other
skeletal muscle and fat, and by inhibiting family members for therapy on the
possibilities of fetal abnormalities
hepatic glucose production.
 Advice to call emergency response team
in cases of emergency
 Advise to religiously follow health
instructions

PATHOPHYSIOLOGY
Precipitating Factors: Etiology: Reduced insulin secretion, Predisposing Factors:
 Obesity increased insulin degradation,  Age

 Diet increased secretion of hormones with  Family History
 Sedentary Lifestyle an anti-insulin, or combination of two  Ethnicity
 Pre-eclampsia or more these mechanisms  Pre-gestational
 Glycosuria DM
 History of
autoimmune
Normal metabolic changes High risk for pregnancy  Late pregnancy
during pregnancy induced glucose tolerance  PCOS
Pancreatic beta cells work

overtime to keep up with the
High fetal Placenta releases increasing insulin demands
demands after hormones that are
15-week diabetogenic (Growth
gestation hormone, human
placental lactogen,
progesterone, Pancreatic beta cells “tire out”
corticotropin releasing and are unable to keep up with
hormone) insulin demands
Increase in
carbohydrate
intake
High insulin
resistance
Plasma glucose rises
Increase in insulin
requirements
GESTATIONAL DIABETES
MELLITUS
PROGNOSIS
PROGNOSIS
Cells don’t get enough glucose for
consumption.
THE COLLEGE OF MAASIN HOSPITAL
"Nisi Dominus Frustra"
Alter cellular functioning If left untreated.

If Treated:
Mother will have increased incidence of
Normoglycemia will usually occur after birth and
Cesarean section and gestational hypertension.
mother is at risk of nongestationa diabetes
Study by Langer, et. Al revealed that 58% of the
within 5 to 16 years after the index pregnancy. Affects the whole organ respondents with untreated GDM had a higher
However, a study by Langer, et. Al revealed that
risk of adverse neonatal outcome such as
18% of those with treated GDM still had adverse
stillbirth, neonatal macrosomia/LGA, neonatal
neonatal outcome such as stillbirth, neonatal
Organ degeneration hypoglycemia, erythrocytosis, and
macrosomia/LGA, neonatal hypoglycemia
hyperbilirubinemia.
Organ malfunction
Fetal
Macrosomia
MATERNAL FETAL
Preterm
birth
Kidneys Liver Pancreas Nerves Erythropoeisis
Affects the renin- Increase Increase Uncontrolled Decrease production of blood

angiotensinaldoster compensatory compensatory products
one system
mechanism mechanism
Decrease Decrease Decrease
Increase vascular Over usage Over usage Elevated blood
RBC WBC platelet
resistance glucose
Hypertension Malfunctioning Malfunctionin Decrease Anemia Recurrent Bleeding

g metabolism infection
Proteinuria Hepatic Pancreatic Rapid weight gain Vaginal UTI
problems problems
Decrease osmolarity
Fluid
shifting
If not treated:
DEATH
Edema Polhydramnios
Rapid weight gain

A. BIOGRAPHIC DATA
Name: Alexa Bernardo
Address: Panan-awan, Maasin City
Age: 29-year-old
Birth Date: June 17, 1992
Sex: Female
Marital Status: Married
Occupation: Housewife
Religion: Roman Catholic
Nationality: Philippines
Health Care Financing: Philhealth
B. CHIEF COMPLAINT
The patient visited for prenatal examination and verbalized that “arang pagdako man naho
ron, hilig man kog tam-ison na mga pagkaon lagi”
C. HISTORY OF PRESENT
Alexa is currently at her 20 weeks of gestation and when she was about to visit the the
nearest primary hospital for her prenatal check-up, she suddenly felt tired and weak.
“magpa-prenatal ra unta ko karon pero gibati man kog kakapoy ug kaluya” as verbalized by
the client.
Her profiled showed that she is a 20-year-old multigravida woman, married and a
housewife. Her LMP was on June 15, 2021 and expected to give birth on March 22, 2022.
She claims that she eats high amount of sweet foods and fast foods. She also gained a
weight of 6.8 kg.
D. PAST HISTORY
Alexa has no other diseases. Her BMI was 27 kg per meter squared. Thus, in her age it is
considered as overweight. She had a regular menstruation which falls from 28-30 day
cycle lasting 3-5 days, in moderate to heavy flow. Alexa’s past obstetric history includes
her first pregnancy is a female infant at 40-week gestation, with good APGAR score
delivered via NSVD last August 24, 2018 and reportedly the child is doing well.
E. FAMILY HISTORY OF ILLNESS
Old Age Anemia Diabetes

Old Age
Diabetes
Patient
Legend:
- Patient
- Male
- Female
- Deceased
PHYSICAL ASSESSMENT
ANTEPARTUM RECORD
Obstetric and Neonatal History (put check if applicable)
Date/Year Term Preterm Aborted/Death Alive
2018 ✓ ✓
Last Menstrual Period (LMP): June 15, 2021

Expected date of Delivery (EDD): March 22,
2022 G2 T1 P0 A0 L1
Medical and General History
Check the box if the pregnant mother has this condition/s

Hypertension Epilepsy Diabetes
Others:
Further details (if checked):
Medications: Prenatal vitamins, Multivitamins
Operations (if any): None
Allergies: None
Physical Examination
 Pre-pregnant weight: 63.50 kg Current weight: 69.58 kg Height: 152.4 cm
 Vital signs: Temperature: 36.5 C Pulse rate: 64bpm
Respiratory rate: 15 cpm Blood Pressure: 110/80 mm Hg
General Survey
The patient was conscious and responds appropriately. Her eyes are open but looks
sleepy. She was able to answer questions correctly. She independently brought herself in
the hospital; decreased movement and gait. She has a weak appearance. Her hygiene is
maintained and well groomed. She has a normal vital sign.
Skin
Shows no sign of erythema, jaundice or cyanosis. Generally, has uniform pigmentation
except in areas around the neck and areas exposed to the sun. No signs of skin
interruptions. Have warm ang good skin turgor.
Hair
Hair is black and evenly distributed. The scalp is free from dandruff. Slightly dry hair,
no infestation
Nails
Has smooth texture, highly vascular and pink in color, intact epidermis
Head
Normocephalic and smooth skull contour, absence of nodules, symmetric facial
features, symmetric facial movements
Eyes
Eyebrows symmetrically aligned and equal movement, skin intact, no discharge, no
discoloration, lids closed symmetrically, approximately 15-20 blinks per minutes, sclera
appears white shiny, smooth and pink conjunctiva, pupils black in color, equal in size,
positive reaction to light and accommodation able to read at a regular distance. Eyelids
were no presence of discharges, no discoloration and lids closed symmetrically, no
lesions and growth, drooping of the upper eyelid, dark shadow over the lower eyelid
noted. Distant visual acuity is 40/20
Ears
Color is same as facial skin, symmetric position, mobile, firm and not tender, able to
hear ticking sounds on both ears, has smooth texture and no signs of discharges.
Nose
Symmetric, straight, and uniform in color noted. No flaring of nose noted. Septum is the
same color as facial skin; intact and in midline. Mucosa is moist and not pale. No signs of
inflammation of mucous membrane. Able to smell normally.
Mouth and Buccal Cavity
Uniform pink color, ability to purse lips, no retraction of gums, pink gums, smooth, white
shiny tooth enamel, lips were red, soft and symmetrical in shape, no lesions, no bleeding
noted no gums, tongue is in central position, pink color, smooth lateral margins, moves
freely and has no lesions.
Neck
Muscles equal in size, head centered, coordinate, smooth movements with no discomfort,
has equal strength, lymph nodes not palpable.

Lungs and Thorax
Chest is symmetrical, skin intact, uniform temperature, full symmetric chest expansion,
clear breath sounds.
Breasts and Axillae
Skin is uniform in color, it is also smooth and intact, no lesions and absence of discharges.
No presence of tenderness and masses on the axillae
Abdomen
Fundal Height: 22 cm FHR: 140 bpm Fetal Position:
Other findings: none
Muscoskeletal System
No pelvic girdle pain or back was noted.
 Extremities
Homan’s sign: (+) (-) Capillary Refill: > 2 seconds
Presence of deep tendon Edema
Neurologic System: Conscious and coherent, no language deficiency, well oriented to
time and place, coordinated body movements, smooth and steady.
Genitourinary
Urine dipstick result shows 3+ glycosuria and negative ketones. No presence of vaginal
yeast infection.
Antepartal Plan
 Pre-natal Clinic visited: 1. Antenatal clinic
2. Antenatal clinic
 Total Number of visits: 2
 Next visit: October 21, 2021 Companion/s: Husband
 Laboratory tests done:
1. Complete Blood Count
2. Urinalysis
3. Oral Glucose Tolerance Test
4. Biophysical Scoring
 Immunizations done: (indicate number of

doses) 1. TT1 (0.5 mL)
2. TT2 (0.5 mL)

3. Tdap (0.5 mL)
4. Influenza (0.5 mL)
 Planned institution/hospital to deliver: Living Hope Hospital
 Lifestyle Counselling
User Non-
user
Alcohol /
Tobacco /
Drugs/Substance /
 HIV Counseling: none

 Infant feeding options: Breastfeeding Formula Feeding
DEVELOPMENTAL TASK
A. ERIK ERIKSON’S DEVELOPMENTAL STAGE
STAGE BASIC ACTUAL
The stage wherein the

sharing of oneself in a
more intimately way with
Intimacy vs. others occur. Exploring of Patient is 29-year-old and

Isolation 18 to 40 different relationships or happily married to her
years old commitments with husband together with
someone other than their child and is now
family members. expecting a second baby.
Successful completion of Thus, the patient is
this stage avoids self- engaged in sharing
isolation, loneliness, and intimately and is
even depression. committed to a relationship
Success in this stage will other than a family
lead to happy and member.
healthy
relationship.
B. JEAN PIAGET’S COGNITIVE DEVELOPMENT
STAGE BASIC ACTUAL
This stage the person

The patient can think and
can reason out, it can be
The Formal Operational make decisions and also
hypothetically or abstract
Stage: Age 11 and has the ability to identify
ones. The patient can
beyond and understand the
think hypothetically.
problem she has in
Their thinking is logical,
pregnancy.
organized and concrete.
C. JAMES FOWLER’S STAGE OF FAITH
STAGE BASIC ACTUAL
The person in this stage

can think outside the
box. Different
realizations about Patient is 29-year-old and a
different things occurs. Roman Catholic, she stated
that she is active in church
They explore and
Individuative Reflective and never skip attending
examine beliefs on their
Faith (from mid-20s to mass. Due to his condition,
own wants and needs.
late 30s her faith to God have
Basically, they start
strengthened more.
questioning things on
their own. The results
are in between being
non- religious and
staying religious
permanently.
D. SIGMUND FREUD’S PSYCHOSEXUAL DEVELOPMENT
STAGE BASIC ACTUAL
Sexual experimentations
are seen in this stage.
The patient has one
The person is most
daughter and is expecting
likely to settle down with
another baby which indicate
a one-to- one
that the patient is engaged
relationship with another
Genital Stage or is having a mature
person.
(Puberty to Adult) sexual interest. She also
During this period, the claimed that the patient
person seeks ways of settled down in a
satisfying sexual relationship with a person.
impulses in dyadic
relationships, and
aggressive impulses
through competition,
physically demanding
activities, exercise, and
argumentation.
E. KOHLBERG’S MORAL DEVELOPMENT THEORY
STAGE BASIC ACTUAL
This stage adolescents

and adults’ moral
development are
characterized by an
acceptance of social
rules concerning right The patient claimed that
and wrong. Most of the she is a law-abiding citizen
Conventional Morality adults begin to since she obeys the rules.

internalize the moral She is attentive and active
standards of valued and supporting every
adult role models. activity in their community.
This period focuses on

the acceptance of
authority and
confirming to the norms
of the group.
II. GORDON’S FUNCTIONAL HEALTH PATTERN

Name: Alexa Bernardo
Age: 29-year-old
Address: Panan-awan, Maasin City, Southern Leyte
GORDON’S FUNCTIONAL HEALTH PATTERN:
A. Health Perception Pattern
 Before Hospitalization:
The patient defines health as the absence of any disease or illness. Patient routinely visits
a doctor to have a prenatal check-up and seek for medical assistance. Practices healthy
lifestyle and depends on fruits and vegetables.
 During Hospitalization:
Patient is oriented, conscious and coherent. Her appearance is weak and tired. She is
willing to accept and listen to health teachings. Shows eager and interest to undergo
diagnostic test. The patient is following the doctor’s order.
B. Nutritional Metabolic Pattern
 Before Hospitalization: The patient stated that her favorite meals during her pregnancy
were mango, ice cream, chocolates and banana. She claimed that she eats a large
amount of rice and drinks 7-8 glasses of water a day and high amount of sweet foods .
She also takes snack in between meals.
 During Hospitalization: The patient does not eat or drink anything (other than sips of
water) for 8-14 hours for the glucose test.
C. Elimination Pattern
Patient defecates 2x a day with bulky and well-formed stool. She urinates 6-7x a day with
cloudy urine in color. She also verbalized that she has no difficulty in defecating and
urinating.
The urine color is yellow. There is a presence of low-level protein in urine and has
glycosuria. No bowel movement observed.
D. Activity- Exercise Pattern
According to patient, she ambulates within the house. She does household chores and
takes care of her child and husband. Buy a grocery at the store. However, she does not
perform exercises, even on the upper and lower extremities by means of shaking and
stretching and she stated that it is quite tiring if she would perform it.
Patient verbalized that she is turning side by side to prevent bed sores. She has difficulty in
moving because she feels weak and tired.
E. Cognitive-Perceptual Pattern
The patient is College graduate. She can understand Tagalog and English. She does not
have any problem with her senses.
Patient shows coherence in answering different questions by providing appropriate

answers. She claimed that despite her present health condition, she is still looking forward
for positive outcomes. She adheres to hospital rules and doctors advises.
F. Sleep-Rest Pattern
According to patient her earliest time in going to sleep is at 11:00 pm and latest time in
waking up is at 7:00 AM. She usually has 7-8 hours of sleep per night. She sometimes
takes a nap at noon for about 1-2 hours. Patient claimed that she does not have a problem
in going to sleep.
During her hospital stay, patient said that she sleeps at 7:00pm now and wakes up at
5:00am. She said that sometimes, she is distracted by the noise and sleep is interrupted
due administration of medication and visitors.
G. SELF-PERCEPTION-SELF CONCEPT PATTERN
 Before Hospitalization
The patient is happy and contented to her husband.
 During Hospitalization
Patient is thinking and worried about her condition. And frightened that she might be a
burden to her family/partner.
H. Role-Relationship Pattern
 Before Hospitalization:The patient feels the support of her family especially her
husband. She cannot perform her role due to her condition.
The patient maintains her good relationship with her family as well as her parents. She is
the youngest among the 4 children of her parents. She loves her husband and excited for
her 2nd child. She is a caring and a loving wife and mother to her husband and child.
I. Sexually-Reproductive Pattern
Patient had her menarche when she was 11 years old. She has no problem with her
menstruation and don’t experience dysmenorrheal during menstruation. She said that they
are not using any contraceptive method.
The patient is looking forward to giving birth to their second child which is now a baby boy.
J.Coping-Stress Pattern
Patient claimed that she is used to undergo stress and she can manage to handle it well.
Whenever she has a problem, she always makes sure that she can express it with her best
friend, siblings and to her husband. Sometimes, if she is stress she managed it by eating
and by socializing with their neighbors and friends.
According to her, her condition made her realized that to relieve her anxiety she needs to
pray to be strong, have faith and courage to face her current health problem braver. She
also takes a nap and rests when tired. Her family helps her too; her family became her
strength on facing her condition.
K. Values-Beliefs Pattern
The patient is a Roman Catholic and she attends the mass every Sunday when she has
nothing to do. She usually prays at night and she believed in quack doctor and traditional
hilot but never consulted to them.
According to patient, she always prays at night to recover from her condition and for the
wellness of her baby. She always asks guidance and a good health from Almighty God.
ETIOLOGY
PREDISPOSING RATIONALE ACTUAL JUSTIFICATION

FACTORS
Pregnant women
over the age of 25
Age The patient is a 29-
are more likely to
year-old.
develop gestational
diabetes than
younger women.
People with a
moderate to high
The patient’s father
family risk of
Family history was diagnosed with
diabetes were more
of Diabetes as well as
likely than those with
her grandmother.
Diabetes mellitus a low risk to confirm
Family history of
a diabetes diagnosis.
diabetes has been
And also, women
recognized as an
with any parental
important risk factor
history of diabetes,
of the disease.
compared with
Family medical
women with
history represents
nondiabetic parents,
valuable genomic
experienced a 2.3-
information because
fold increased risk of
it characterizes the
GDM.
combined
interactions between
environmental,
behavioral, and
genetic factors
Asian and Filipina The patient is

women had a Filipina. Therefore,
Ethnicity
prevalence of GDM there is a probability
of 9.9 and 8.5%. It that she can acquire
was relatively high gestational diabetes
than other ethnic mellitus.
groups.
The patient’s blood

Hypertension Gestational Diabetes
pressure level is
increases the risk of within normal range.
In current pregnancy
high blood pressure
and pre-eclampsia, a
severe pregnancy
complication that
causes high blood
pressure and other
symptoms that can
endanger both the
mother and the
baby’s lives
Insulin-resistant Women with PCOS The patient has no
conditions have a higher risk of PCOS.
gestational diabetes
(Polycystic Ovary
mellitus than women
Syndrome or PCOS)
without PCOS. Both
gestational diabetes
mellitus and
polycystic ovary
syndrome have
negative effects on
pregnant women.
PRECIPITATING RATIONALE ACTUAL JUSTIFICATION

FACTORS
Obese women are
even more likely to The patient’s BMI is
Obesity
develop the 30.09 kg/m2.
metabolic syndrome Therefore, she is
pregnancy. They are considered as obese.
more likely to
develop glucose
sensitivity.
Sedentary lifestyle Lack of physical The patient stated
activity raises the that she does not
risk of preterm birth performed exercises
and low birth weight like Zumba or yoga.
the weight of the Her routine is likely a
baby at birth. In lot of sitting and lying
addition, exercising down.
is one way to reduce
blood glucose levels.
Our muscles take in
more glucose as we
exercise. When this
effect wears off, our
muscles stay insulin-
sensitive for a while
longer.
In gestational The patient claimed
diabetes it is that she eats a lot of
important to keep sweet foods and
Diet your blood sugar loves fast foods.
levels in check, you Thus, consuming
will need to keep sugar, and fast foods
track of your is not a direct risk
carbohydrate intake. factor diabetes,
This will involve although it can have
limiting the sugary indirect effects, such
food consumption in as weight gain, that
diet your diet make the condition
more likely to
develop.
Glucose can be The patient’s urine

found in the urine of test revealed that her
up to half of pregnant urine has positive 3
Glycosuria women at some of glucose.
stage. Glucose in the
urine could indicate
that a woman is
suffering from
gestational diabetes.
SYMPTOMATOLOGY
SIGNS AND RATIONALE ACTUAL
SYMPTOMS
The client was showing signs of
exhaustion. Fatigue is normal in
Fatigue pregnant women, particularly in the first
12 weeks, due to hormonal changes;
however, it is also one of the positive
signs of GDM. Sugar remains in the
bloodstream rather than entering cells
to provide nutrition, causing fatigue.
This was not seen in the client. It is one

of the signs of GDM – a vaginal
infection. An abnormally high blood
Vaginal Yeast sugar level can prevent white blood
Infection cells from reaching the infection site,
leaving the individual vulnerable to
infection.
This was not seen in the client. It is one

of the signs of GDM – a vaginal
Polydipsia infection. An abnormally high blood
sugar level can prevent white blood
cells from reaching the infection site,
leaving the individual vulnerable to
infection.
Polyuria This was not reported by the client.

Polydipsia is excessive thirst or excess
drinking. It is nonspecific symptom in
various medical disorders. abnormally
large amounts of urine each time you
urinate. It is defined as the frequent
passage of large volumes of urine –
more than 3 liters a day compared to
the normal daily urine output in adults
of about 1-2 liters.
The patient is experiencing this one.

Glycosuria is a term that defines the
presence of reducing sugars in the
Glycosuria urine, such as glucose, galactose,
lactose, fructose, etc. Glucosuria
connotes the presence of glucose in
the urine and is the most frequent type
of glycosuria and is the focus of this
review.
Obesity There was an objective data reported
to this. The client weighing above the
normal weight.
Polyphagia This was not reported by the client.
Polyphagia is an excessive or extreme
hunger. It is different than having an
increased appetite after exercise or
other physical activity.
PATIENT’S NAME: Alexa Bernardo AGE: 29-year-old MARITAL STATUS: Married
DIAGNOSIS: Imbalance nutrition related to faulty foods eating habits as evidenced by increased intake of sweet foods during pregnancy
NURSING CARE PLAN
CUES/ DATA NURSING NSG GOAL AND NURSING RATIONALE EVALUATION

DIAGNOSIS OBJECTIVES INTERVENTIONS
SUBJECTIVE
DATA: After 8 hours of 1. Introduce yourself and 1. To gain client’s After 8 hours of
Imbalance establish rapport trust and nursing
“arang nutrition related to nursing intervention, cooperation. intervention, the
pagdako man faulty foods eating the client will be able 2. To help in goal was met after
naho ron, hilig to: 2. Assess and record
habits as evaluating client’s the client:
man kog tam- dietary pattern and
evidenced by
caloric intake using a 24- understanding
ison na mga increased intake  Verbalize
hour recall. and/or compliance  Verbalized as
pagkaon lagi of sweet foods understandin to a strict dietary “mokaon nako
ron” as during pregnancy g on the regimen. ug mga
verbalized by proper 3. It is proven that pagkaon nga
the client 3.Discuss the effect of
nutrition stress on diabetes. stress can increase nay taas ug
SCIENTIFIC during Teach patient about serum blood fiber sama sa
BASIS pregnancy stress management and glucose levels, mga
 Consume relaxation measures. creating variations gulay,sweet
Gestational adequate in insulin potatoes” “Di
diabetes is a type nutrients 4.Teach the importance requirements. na pud ko
OBJECTIVE of diabetes that of regularity of meals 4. Eating very magpalabi ug
through
DATA: develops during and snacks (e.g., three frequent small kaon ug tam-is
eating
pregnancy. Insulin balance diet meals or 4 snacks) when meals improves og gamayon ra
 Weight: insulin function nahog kaon
helps your body taking insulin.
69.58 kg ang mga
use glucose for  Change her 5.To allow the pagkaon nga
 Height:152. energy and helps personal 5.Teach and client monitor her taas ug
4 cm control your blood eating habits demonstrate client to sugar using finger- carbohydrates”
glucose levels. monitor sugar using a stick independently “magmonitor
 BMI: 30.09 finger-stick method. pud kos ahong
During
kg/m2  Maintain 6. Reducing the sugar ma’am
pregnancy, your
normal blood 6.Intsruct the client to amounts of para di na mo
 Obesity body makes more
glucose reduce carbohydrates carbohydrates and grabe ug
hormones and
 Recent through intake and sugar sugar a decreases malikayan pa
goes through
weight gain random blood the amount a naho”
other changes, person’s blood  Demonstrate
of 6.8 kg glucose test
such as weight sugar spike behaviors and
 Glycosuria gain. These lifestyle
changes cause 7. Fiber slows carb changes to
 Prior to your body's cells digestion and sugar
7.Instruct the client to regain and/or
prenatal to use insulin less Increase fiber intake absorption. It
check up maintain
effectively, a promotes a more
(nutritional condition called appropriate
gradual rise in
pattern) weight
insulin resistance. blood sugar levels.
8.Discuss food pyramid 8.Food Pyramid  Maintain fasting
 Blood serum blood
as well as dietary shows how much of
glucose glucose levels
requirement for pregnant what you eat
level: woman overall should 100 mg/dl and
FBS: 125 come from each 1-hour
mg/dL self to achieve a postprandial of
Pregestational healthy, balanced 140 mg/dl and
OGGT: 1 hr diabetes diet 2-hour
post-prandial: mellitus. Obstetrics 9. Provide food 9. Exchange lists postprandial of
200 mg/dL and exchanges list provide detailed 120 mg/dL
Gynecology. 2005;1 information about
2 hr post- 05(3):675–685. the nutrients in
prandial 170 Reaffirmed 2014 many foods and
beverages. They
mg/dL are designed to

help manage
diabetes, weight
management,
cardiovascular risk
reduction and
general healthy
eating.
10.Inform the client to 10. An excess of
negative effects of eating sweetened foods
too much sweets and beverages can
lead to weight gain
and sugar
problems.
11.Inform the client the 11.To be aware

kinds of foods that what are the foods
should be avoided by that should be
client’s Gestational avoided specifically
Diabetes Mellitus as a client who
have GDM
12.Perform exercise 12.Exercise helps

together with the client to lower blood
sugar levels by
encouraging the
body’s muscles to
use for energy.
13. Monitor Random 13.To identify if

Blood Test there are difference
from the baseline
data
14.Administer 14.To provide
pharmaceutical agents pharmaceutical
as ordered treatment that will
alleviate the
condition
15. Refer to a registered 15.Diet-specific to

dietician to individualize the individual is
diet and counsel necessary to
regarding dietary maintain
questions. normoglycemia and
to obtained desired
weight gain. In-
depth teaching
promotes
understanding of
own needs and
clarifies
misconceptions,
especially for a
client with
gestational
diabetes.

DIAGNOSIS: Risk for maternal injury related to changes in visual as evidenced by blurred vision secondary to uncontrolled glucose.
NURSING CARE PLAN
CUES/DATA NURSING DIAGNOSIS NSG GOAL AND NURSING RATIONALE EVALUATION

OBJECTIVES INTERVENTIO
NS
Subjective Risk for maternal injury After 8 hours of nursing 1. Monitor the 1.To identify the After the nursing
Data: related to changes in intervention, the patient will vital signs. baseline data. intervention, the
visual as evidenced by be able to: goal was met
“Nakabantay blurred vision because the patient
ko nga secondary to  Maintain 2. Provide 2.Frequent was able to:
mohanap uncontrolled glucose normoglycemia. information monitoring is
ahong panan- (less than 140 and reinforce important to  Maintain
aw usahay ug mg/dL (7.8 mmol/L) procedure maintain this tight normoglyce
niaging buwan  Remain for home range and to mia 100
nasamad ko normotensive. (110- blood reduce the mg/dL
dugay dugay SCIENTIFIC BASIS 130 mmHg systolic glucose incidence of fetal  Remain
siya naulian” High blood sugar levels and 70-90 mmHg monitoring hypoglycemia or normotensiv
as verbalized can cause fluid to diastolic) and diabetic hyperglycemia e of 120/75
by the client. move in and out of  Free of injury within management mmHg
parts of your eye, and nursing intervention  Free of signs
can often lead to 3. Instruct the 3.To promote and
swelling of the eye’s client to wellness symptoms of
lens. The lens is wear diabetic
Objective protective
Data: responsible for ketoacidosis
focusing light onto the eyewear
 Nausea retina at the back of
and your eye. When the 4. Thoroughly 4. The patient
vomiting lens swells, the shape conform must get used to
patient to the layout of the
 Glycosu of the lens is affected, surroundings environment to

ria consequently affecting . Put call avoid accidents. It
your ability to see light within ems that are too
 BMI: clearly. When blurry reach and far from the
30.09 vision is a result of teach how to patient may cause
kg/m2 hyperglycemia, clear call for hazard.
 Elevate vision will typically assistance;
d return when blood respond to
materna sugar levels fall within call light
l serum a normal range. immediately.
glucose
M.Macgill 5. Avoid use of 5. If patients are
 Blood (2018).https://www.me restraints. restrained, they
glucose dicalnewstoday.com/art Obtain a can sustain
level: icles/310894#how_doe physician’s injuries, including
_affect_the_eyes order if strangulation,
RBT: 200 restraints are asphyxiation, or
mg/dL needed. head injury from
leading with their
OGGT: 1 hr
heads to get out of
post-prandial:
the bed.
200 mg/dL .
2 hr post-
prandial 170
mg/dL 6. Eliminate or 6. This is to
drop all prevent the patient
 Vital possible from
signs hazards in any unpleasant
the room experience due to
T=36.5 dangerous
such as
C razors, objects.
medications,
RR=15 and
cpm matches.
PR=64 7. Educate 7.Patient’s
bpm patient about knowledge about
safety his or her
BP= ambulation condition is vital to
110/80 at home, safety and
mm Hg including the recovery.
use of safety
measures
such as
handrails in
bathroom.
8. Monitor 8.To help identify

random hyperglycemia
blood and decrease the
glucose risk for some
chronic
complications
9. Obtain 9.Helps prevent
urinalysis pyelonephritis.
and urine Note: Some
culture; antibiotics might
administer be contraindicated
antibiotic as because of the
indicated. danger of
teratogenic
effects.
10. Administer
Insulin 10.Insulin is the
traditional first-
choice drug
for blood sugar
control during
pregnancy
because it is the
most effective for
fine-tuning blood
sugar and it
doesn't cross the
placenta.
DIAGNOSIS: Activity intolerance related to increased energy demands due to disease condition and increased fetal nutrient uptake.
CUES/DATA NURSING NSG GOAL NURSING RATIONALE EVALUATION

DIAGNOSI AND INTERVENTIONS
S OBJECTIVES
SUBJECTIVE Activity After 8 hours 1. Establish 1. Motivation After the nursing
DATA: intolerance of nursing guidelines and and intervention, the
related to intervention, goals of activity cooperation a goal was met
”kapoy najud increased the patient with the patient re enhanced
ahong lawas, di because the client
energy demands will be able and/or SO. if the patient was able to:
ko ganahan due to disease to: participates
maglihok lihok condition and in goal
sukad sa pag- increased fetal
 Verbaliz setting.
abot ug 10 weeks nutrient uptake.
e the  Verbalized
sa ahong tijan.” as importan 2. Evaluate the 2. Coordinated “Importante
verbalized by the ce of need for efforts are jud diay ning
client. SCIENTIFIC continue additional help at more mag-exercise
BASIS d home. meaningful kanunay kay di
physical and effective man lagi ko
Vulnerable to exercise. in assisting hilig sauna
insufficient  Report the patient in mag exercise”;
physiological or an conserving  Report an
psychological increase energy increased
energy to endure d tolerance to
or complete toleranc 3. Have the patient 3. Helps in
perform
OBJECTIVE required or e to perform the increasing
desired daily perform activity more the tolerance activities;
DATA:
activities, which activities slowly, in a for the  Achieved an
 Fatigue may compromise  Achieve longer time with activity. increased
 Temperatur health. an more rest or conditioned
e: 97.7°F increase pauses, or with physical state.

(36.5°C) d assistance if
 Pulse condition necessary.
rate :64 Carpenito, L. J. ed
bpm (2013). Handboo physical 4. Gradually
 Respiratory k of nursing state. increase activity 4. Gradual
rate: 15 diagnosis. 14th with active progression
cpm ed. Philadelphia: range-of-motion of the activity
 Blood Wolters Kluwer exercises in bed, prevents
pressure: 1 Health/Lippincott increasing to overexertion.
10/80 mm Williams & sitting and then
Hg Wilkins. standing.
 Physical
and 5. Dangle the legs
emotional from the bed side 5. Prevents
stress as for 10 to 15 orthostatic hy
evidenced minutes. potension.
by increase
WBC:
12,000
cubic per 6. Refrain from 6. Patient with
mm performing limited
 Unable to nonessential activity
perform activities or tolerance
simple procedures. need to
routine prioritize
exercises important
such as task first.
stretching
 Moodiness,
such as 7. Assess the 7. In normal
patient’s baseline adults, HR
irritability cardiopulmonary should not

status (e.g., heart increase
rate, orthostatic more than 20
BP) before to 30
initiating activity. beats/min
above resting
with routine
activities.
Older
patients are
more
susceptible to
orthostatic
drops in BP
with position
changes.
8. Provide bedside 8. Use of

commode as commode
indicated. requires less
energy
expenditure
than using a
bedpan or
ambulating to
the
bathroom.
9. Encourage
physical activity 9. Helps
consistent with promote a
the patient’s sense of
energy levels. autonomy
while being
realistic
about
capabilities.
10. Instruct patient to
plan activities for 10. Activities
times when they should be
have the most planned
energy. ahead to
coincide with
the patient’s
peak energy
level. If the
goal is too
low,
negotiate.
PATIENT’S NAME: Alexa Bernardo AGE: 29 years old CIVIL STATUS: Married
DIAGNOSIS: Gestational Diabetes Mellitus
LABORATORY DIAGNOSTIC-STUDIES
LABORATORY TEST INDICATION REFERENCE VALUE ACTUAL FINDINGS SIGNIFICANCE OF NURSING

THE FINDINGS CONSIDERATIONS
Complete Blood Pre-procedural

Count nursing
Laboratory results
- A complete blood considerations
(CBC) test in indicates patient is
 It helps to
performed to diagnose having infection  Establish rapport to
determine whether illnesses or with a high white the client
the pregnant infections in
mother as the expecting blood cells. A high  Explain that a blood
developed any mother white blood cell sample will be taken
health problems. It
helps to diagnose count may indicate from the patient’s
illnesses or that the immune vein in the arm and it
infections in the
system is working will only take less
expecting mother.
to destroy an than 5 minutes.
A. .White Blood  Used to  12,0000 cu.
Cells - are part of screen for a infection. It may
 4,500-11,000 Mm
the body's immune variety of per cu. Mm also be a sign of
system. They help diseases and
the body fight conditions.Ass physical or
infection and other ist in the
diseases. diagnosis of emotional stress.

infections,
People with
inflammatory Intra procedural
processes, particular blood
and other nursing
cancers may also
diseases that considerations
affect the have high white
number of  Provide privacy to
blood cells counts.
white blood
cells. Also, a higher the client
hematocrit  Inform the patient

increased the risk that she may feel a
of type 2 diabetes, little sting when the
even after needle goes in or
B. Red Blood out.
Cells- a type of  The amount of  3.92-5.13  4 million restricting the
blood cell that is red blood cells million cells/L cells/L analysis to subjects  Assist the health
made in the bone in the blood (Within normal
that can imply range) with hematocrit care professional in
marrow and found
in the blood. her ability to measurements collecting blood
bring oxygen
to the fetus within the normal sample from the
through range. patient’s vein.
blood.It can be
used to help
diagnose
blood-related
conditions,suc
h as iron
deficiency
anemia.
Post procedural
 The test may Nursing Consideration

C. Hemoglobin- is be used to  11.6-15 g/dL  12.5 g/dL
the protein screen for, ( Within normal  Apply manual
molecule in red diagnose, or range)
blood cells that pressure and
monitor a
carries oxygen number of dressing over
from the lungs to conditions and
the body's tissues puncture site
diseases that
and returns carbon affect red  Monitor the puncture
dioxide from the blood cells
tissues back to the site for oozing or
and the
lungs amount of hematoma
hemoglobin in formation.
blood
 Instruct the patient to
take a rest to prevent
D. Hematocrit- is fluid loss while
the calculated  The test for  48 %
volume percentage hematocrit  35.5%- (Hematocrit is waiting for the test
of red blood cells measures the 44.9%
high, patient result.
(erythrocytes). It is volume of cells
shows risk for
also called packed as a
percentage of type 2 diabetes
cell volume (PCV) and could mean
the total
volume of cells dehydration)
and plasma in
whole blood.
E. Mean
corpuscular  This measures
volume - is a the average  80-100fL  100 fl
laboratory value size of the red (Within the
that measures the blood cells normal range)
average size and
volume of red
blood cell
F. Mean  This measures

corpuscular  33 pg
the average  27.5-33.2 pg (Within normal
hemoglobin - it is weight of
average amount in range)
hemoglobin
each of your red per red cell.
blood cells of a
protein
G. MCHC- mean  This measures

cell hemoglobin the average  33g/dL
concentration os a concentration  33.4-35.5 (Within normal
calculated value of hemoglobin g/dL range)
derived from the per
measurement of erythrocyte
hemoglobin and
the hematocrit
H. RDW-A
quantitative  This  12.2%-16.1%  12.5%
estimate of the measures the (Within the
uniformity of range in the normal
individual cell size volume and range)
size of your
red blood
cells.
I. Platelets- it
helps your body
form clots to stop
bleeding  The platelet  350,000 per
count is a test  150,000- microliter
that 450,000 per
microliter (Within normal
determines the range)
number of
platelets in
your sample of
blood. High or
low platelet
levels can be
sign of a
severe
condition.
J. Neutrophils- are  Can provide

a type of WBC. the doctor with
They kill and digest important  2,500-7,000  3,500 per
bacteria and fungi clues about per mmm mmm
to help your body the health of (Within normal
fight infections and the patient. range)
heal wounds. Having a high
percentage of
neutrophils in
the blood is
called
neutrophilia.
This is a sign
that the body
has an
infection
 The levels of  3,000 per

K. Lymphocytes- the main types  1,000-4,800 microliter
are cells that of white blood per microliter (Within the
circulate in your cells in the of blood
normal range)
blood that are part body are
of the immune measured.
system High
lymphocyte
blood levels
indicate the
body is
dealing with
an infection or
other
inflammatory
condition.
L. Monocytes- a  Help in  1%-10%  5%

type of immune cell diagnosing (Within the
that is made in the infection. Low normal range)
bone marrow and levels can
travels through the indicate the
blood to tissues in existence of
the body where it chronic
becomes a infections or
macrophage or an
dendritic cell. autoimmune
disease, while
high levels can
indicate the
presence of
chronic
infections or a
bone marrow
issue.
M. Eosinophils-  A blood test  0.0%-6.0%  3% (Within

are major effector that counts the the normal
cells in the immune number of range)
system. They have eosinophils,
a beneficial role in form of white
the host defence blood cell.
against in many
immune
responses.
 1%
N. Basophil - are  Tests to help  0.5%-1% (Within the
white blood cells diagnose normal range)
from the bone certain health
marrow that play a problems such
role in keeping the as allergic
immune system reaction if the
functioning basophil level
correctly is low.
LABORATORY INDICATION REFERENCE ACTUAL SIGNIFICANCE NURSING

TEST VALUE FINDINGS OF THE CONSIDERATIONS
FINDINGS
Urinalysis A routine  Volume: 600  Volume: 350 Pre-procedural
urinalysis usually to 2500 mL in mL in 24 nursing
is a test for urine. Laboratory
includes the 24 hours hours considerations
It is used to detect results indicate
following test:  Color: Pale  Color: Yellow
and manage a wide patient having  Label the bottle
Yellow to  Appearance:
range of disorders  Color glycosuria. It is a with patient
amber more
transparency, condition in which identifying
24-hour urine
 Appearance: concentrated person’s urine
specific information, the
sample is needed
clear to dark color contains more
gravity, pH, date, and time
slightly hazy  Specific sugar, or glucose,
protein, the collection
glucose,  Specific gravity: than it should be. begins and ends.
ketones, gravity: 1.020- 1.025 It is a symptom of  Instruct the
blood, 1.030  pH: 4.0 both type 1 patient to urinate,
bilirubin,  Urine pH: 4.6  Diminished diabetes and type flush down the
to 8.0
nitrite, or even urine down the
urobilinogen, absence of 2 diabetes. toilet when she

and leukocyte  Chloride: 20 chloride gets up in the
esterase. to 40 mmol/L  Glucose: morning.
 Glucose:
negative positive (+3)
 Ketones:
Some Intra-procedural
 Ketones: Positive
laboratories negative nursing
include:  Blood: considerations
negative
 Blood:
 Microscopic  Afterward, tell the
negative  Protein:
examination of patient to collect
rarely
urinary  Protein: the rest of her
negative
sediment with negative urine in the
 Biluribin:
all routine special bottle for
 Bilirubin: negative
urinalysis test. negative the next 24hours,
 Nitrate for
If not, it is bacteria: storing it in a cool
customary to negative environment. It
 Nitrate for
perform the bacteria: can be kept cool
negative  Casts:
microscopic negative, in the refrigerator
exam. If occasional or on ice in a
 Casts:
hyaline cast
transparency, negative, cooler.
occasional
glucose, hyaline casts  Instruct the
protein, blood, patient to drink

nitrite, or adequate fluids
leukocyte during the
esterase is collection period.
normal.  Emphasize
proper hand
hygiene before
and after each
collection.
Record each
amount on the
intake and output
(I&O) sheet.
 Exactly 24-hours
after beginning
the collection,
ask the patient to
void. This will
complete the
specimen
collection.
Post-procedural
Nursing
Considerations
 Instruct the
patient to
continue to keep
the collection
container
refrigerated until
transfer to
laboratory.
 Send the bottle
and laboratory
request form to
the lab.
LABORATORY INDICATION REFERENCE ACTUAL SIGNIFICANC NURSING

TEST VALUE FINDINGS E OF THE CONSIDERATIONS
FINDINGS
Oral Glucose Laboratory Pre-procedural nursing

Tolerance Test results considerations
and Fasting indicate that
Blood Sugar the patient
 Educate the patient
shows positive that managing her
for gestational blood glucose level
1.OGGT- is a  is a test that throughout the rest
diabetes of her pregnancy is a
is used to  1-hour
routine test  1-hour must, to avoid any
postprandial:
during pregnancy diagnose <120 mg/dL postprandial: complications
 2-hour  To fast before the
that checks a gestational 200 mg/dL test, any liquid and
postprandial:
pregnant diabetes <140 mg/dL  2-hour kinds of food should
not be ingested.
woman’s blood which can postprandial:  That she will be
develop asked to drink a pure
glucose level during 170 mg/dL glucose juice

dissolved in a 500
pregnancy.
mL, aware her that
The test the taste would not
be that the taste
measures
would not be that
your body’s good, must still she
is required to finish
ability to
to complete the test.
maintain a Intra-procedural
normal blood nursing considerations
glucose level
 Do not eat or
drink anything
(other than sips of
water) for 8-14
hours before the
test
 The client will
have blood drawn
before drinking
 A test that the liquid, 1 hour
2.Fasting blood
measures and again 2 more
sugar 70mg/dL-
blood sugar 100mg/dL 125 mg/dL times every 60
It is often the first levels. minutes.
test done to Elevated

check for levels are
Post-procedural
prediabetes and associated
Nursing
diabetes. with
Considerations
diabetes and
insulin  Explain the client
resistance, that some may
in which the have a reaction to
body cannot the oral glucose
properly solution, most
handle sugar commonly nausea
(e.g. and vomiting
obesity).  Monitor and treat

the patient
accordingly.
LABORATORY INDICATION REFERENCE ACTUAL SIGNIFICANCE OF NURSING

TEST VALUE FINDINGS THE FINDINGS CONSIDERATIONS
Pre-procedural
FHR: 120-160 bpm FHR: 138 bpm nursing
Biophysical The laboratory
considerations
Scoring Within normal results indicate that
range Fetus is large for  Obtain health
gestational age. history of the
A BPP test may Excessive weight patient
Test that measures Amniotic Fluid
include a non-stress Index:8-18 Amniotic Fluid gain of the mother
the health of the  Explain that this
test with electronic Index: 14 can translate to
fetus during test will involve
fetal heart increased fetal
pregnancy. Average two component-
monitoring and a weight. By far, non-stress test
fetal ultrasound. maternal diabetes is
Estimated Fetal portion and an
The BPP measures Weight: 331 grams Estimated Fetal the most common ultrasound.
the fetus’ heart Weight: 550 (Large for  Educate the
rates, muscle tone,
movement, grams Gestational Age) patient about the

breathing, and the cause of LGA procedure to be
amount of amniotic Placenta Grade 1-2 babies done, including
fluid around the Placenta Grade :2 why it is being
fetus done and how it
is done.
BPP: BPP= 8
Score 8-10
Normal Result Intra procedural
nursing
considerations
 Provide privacy
to the patient.
 Asked the patient
if she is
comfortable, so
she can place in
a position that is
more tolerable.
 During the
nonstress test,
asked the patient
to lie on an exam
table and have a
belt placed
across of her
abdomen.
 Evaluate the
baby’s breathing
movements,
body
movements,
muscle tone, and
amniotic fluid
level. If the baby
is asleep, this
portion of the test
might take a little
longer
Post procedural
nursing
considerations
 Instruct the
patient to take a
rest while waiting
for the test result.
 Refer to the
result to the
doctor. So, the
doctor will
explain.
 Answer some
questions of the
client
DRUG STUDY
DRUG NAME MODE OF INDICATIONS CONTRAINDICATIONS SIDE NURSING
ACTION EFFECTS/ADVERSE INTERVENTIONS
EFFECTS
Generic Name: Regulates RYZODEG 70/30 is CNS: asthenia,  Refrigerate
Insulin degludec glucose contraindicated: headache, fever, unopened FlexTouch
Whether the pens at 36 ° to 46 ° F
– Insulin Aspart metabolism by pain.
pregnancy is (2 ° to 8 ° C) until
binding to
classified as CV: peripheral ready to use; discard
insulin  Use cautiously in
pregestational edema after expiration date.
Brand Name: receptors on pregnant women
diabetes or as  Unrefrigerated (below
Ryzodeg muscle, liver, and only if clearly EENT: pharyngitis,
gestational needed. 86 ° F [30 °])
and fat cells; rhinitis
diabetes  Monitor blood unopened pens must
facilitates
mellitus, the goal glucose levels GI: abdominal pain, be used within 28
Therapeutic cellular uptake days or discarded.
of treatment is to closely in pregnant diarrhea, nausea
Class: of glucose; and  Don’t refrigerate
maintain patients, in women
Antidiabetics promotes GU: UTI, opened pens. Keep
maternal glucose who have recently
uptake and dysmenorrhea at room temperature
levels as near to given birth, and in
storage of (below 86 ° F [30 °]),
normal as breastfeeding Metabolic:
Actual Dose, glucose in the women; insulin away from direct heat
possible hypoglycemia,
Timing, and form of requirements may and light for up to 28
throughout the hypokalemia, weight days.
Route: glycogen in the change.
pregnancy. gain  Don’t dilute or mix
liver.  It isn’t known if
Ryzodeg 100 insulin appears in with other insulin
Musculoskeletal:
units/mL human milk. Use products or solutions.
myalgia
solution for cautiously in  Warn patient not to
injection in pre- breastfeeding Respiratory: share multidose pen

filled pen 70% women. bronchitis, cough with other people,
insulin degludec  During episodes of even if the needle is
hypoglycemia or Skin: lipodystrophy, changed, because of
/ 30% insulin
ketoacidosis. injection-site risk of bloodborne
aspart. About
 In patients with a reactions, rash pathogen
25hours (insulin
history of transmission,
degludec) Other: allergic
hypersensitivity to including HIV and
reactions, insulin hepatitis.
drug or its
components. antibody production,  Observe injection
Route: Severe, life- flulike syndrome, sites for reactions,
Subcutaneous threatening, infection such as redness,
(ryzodeg 70/30) generalized allergy, swelling, itching, or
including burning.
anaphylaxis, can  Assess patient and
occur with insulin notify prescriber for
products. signs and symptoms
 Changes in insulin of hypoglycemia
or oral antidiabetic (sweating, shaking,
dosages may affect trembling, confusion,
glycemic control and headache, irritability,
should be made only hunger, rapid, pulse,
under medical nausea), and
supervision. hyperglycemia
 Use cautiously in (drowsiness, fruithy
patient susceptible breath odor, frequent
to hypokalemia, urination, thirst).
such as patients  Monitor blood
who are fasting, or glucose level and
taking potassium- adjust insulin
lowering drugs,or dosages as needed
are concurrently with medical
taking drugs that supervision.

may affect  Advise patient that
potassium levels, hypoglycemic
including I.V. insulin. episodes can impair
Untreated the ability to
hypokalemia can concentrate and
cause respiratory react; advise patient
paralysis, ventricular to use caution while
arrhythmias, and driving and operating
death. machinery.
 Hypoglycemia is the  Advise pregnant
most common patient of the change
adverse reaction. in insulin
Severe requirements that
hypoglycemia can may occur during
cause seizures, and pregnancy and after
may be life- childbirth.
threatening or fatal.
Hypoglycemia can
occur suddenly, and
signs and symptoms
may differ. Risk
increases with
intensity of glycemic
control and changes
in glycemic
treatment, meal
patterns, physical
activity, or
concomitant
medications, and in
patients with renal or
hepatic impairment.
 Use cautiously in
elderly patients, who
may be at increased
risk for adverse
effects; signs and
symptoms of
hypoglycemia m ay
be more difficult to
recognize in these
patients.
DRUG STUDY
DRUG NAME MODE OF INDICATIONS CONTRAINDICATIONS SIDE NURSING
ACTION EFFECTS/ADVERSE INTERVENTIONS
EFFECTS
Probably Glyburide may be  Contraindicated in EENT: changes in  Teach patient about
stimulates used to treat GDM patients accommodation or diabetes and the
Generic hypersensitive to importance of
insulin release as a treatment blurred vision
Name: drug and in those following therapeutic
from pancreatic option if insulin
GLYBURIDE with type 1 diabetes GI: nausea, regimen, adhering to
beta cells, and metformin are
(glibenclamide) or diabetic epigastric fullness, specific diet, losing
reduces glucose not able to be
ketoacidosis with or heartburn weight, getting
output by the used; however,
without coma. exercise, following
liver, and glyburide does Hematologic:
Brand Name: increases  Insulin is drug of personal hygiene
cross the placenta leukopenia, hemolytic programs, and
Glynase choice to control
peripheral and long-term diabetes during anemia, avoiding infections.
sensitivity to safety data are not pregnancy. If used agranulocytosis,  Explain how and
insulin. available; during pregnancy, thrombocytopenia, when to monitor
Therapeutic glyburide appears aplastic anemia
discontinue at least glucose level, and
Class: associated with a 2 weeks before teach recognition of
Antidiabetics higher rate of expected delivery Hepatic: cholestatic and intervention for
neonatal date. jaundice, hepatitis low and high
hypoglycemia and  Prolonged severe Metabolic: glucose levels.
Actual Dose, macrosomia than hypoglycemia (4 to hypoglycemia,  Tell patient not to
Timing, and insulin or 10 days) has been hyponatremia change drug dosage
Route: metformin. reported in neonates without prescriber’s
born to mothers consent and to
Adults receiving a Musculoskeletal: report abnormal

sulfonylurea at the arthralgia, myalgia blood or urine
20 mg/day PO time of delivery. glucose test results.
for  Drug may cause Skin: rash, pruritus,  Advise patient not to
conventional hypoglycemia in other allergic take supplements or
glyburide (e.g., breastfed infants. reactions other drugs,
Diabeta); 12 Patient should including OTC
Other: angioedema
mg/day PO for discontinue drugs, without first
micronized breastfeeding or checking wit
glyburide (e.g., discontinue drug. prescriber.
Glynase).  Advise patient to
Geriatric avoid alcohol, which
may lower glucose
level.
Route:
Oral
Administration
HEALTH TEACHING PLAN

TOPIC: Gestational Diabetes Mellitus
LEARNING CONTENTS LEARNING TIME ALLOTMENT LEARNING PROCESSING
OUTCOME METHODOLOGY MATERIALS QUESTIONS
After this health  Definition of General time allotted: The following are  In your own
teaching plan, Gestational Diabetes 40 minutes materials understanding, what
Mellitus In this health is gestational
the client/patient needed:
teaching plan, we diabetes mellitus?
will be able to:
will discuss and - Manila Paper
 Causes of Specific time each
demonstrate our
Gestational Diabetes content: - Marker  What are the causes
topic through visual
Mellitus aids. - 5 minutes for the -Bond paper of gestational
discussion of the diabetes mellitus?
definition. - Ball pen
 Risk Factors
Associated with  What are the risk
Gestational Diabetes - 5 minutes for the factors associated
Mellitus discussion of the with gestational
causes. diabetes mellitus?
 Treatment for
Gestational Diabetes - 5 minutes for the  What is the
Mellitus discussion of the treatment for
risk factors. gestational diabetes
mellitus?
 Possible
Complications for the - 5 minutes for the
Baby discussion of the  What are the
treatment. possible
complications for the

baby?
- 10 minutes for the
discussion of the
possible
complications for
the baby.
- 5 minutes for the

short video clip
presentation.
- 5 minutes for the

processing
questions.
PATIENT’S NAME Alexa Bernardo AGE: 29-year-old
DIAGNOSIS: GESTATIONAL DIABETES MELLITUS
DISCHARGE INSTRUCTION PLAN
S Subjective cues
 “Baskog na ahong lawas, di pareha ahong una pagbisita diri” as
verbalized by the client
O Objective cues
 T - 36.7°C
 P - 75 bpm
 R - 17 cpm
 BP - 120/75 mmHg
 OXYGEN SAT. - 97%
Oral Glucose Tolerance Test

 1-hour post prandial - 140mg/dl
 2-hour post prandial - 120mg/dl
Fasting Blood Sugar

 100mg/dL
M Medications (include definite instructions)
1.Insulin- Insulin is the traditional first-choice drug for blood sugar control
during pregnancy because it is the most effective for fine-tuning blood
sugar and it doesn't cross the placenta. Therefore, it is safe for the baby.
Insulin can be injected with a syringe, an insulin pen, or through an
insulin pump.
2.Glyburide- (glibenclamide) was associated with increased birth weight,

macrosomia and neonatal hypoglycemia compared with insulin, and
similar to metformin, crosses the placenta. Glyburide therapy during
pregnancy is not recommended as first- or second-line treatment, but it
may be used as third-line treatment if insulin is refused, and metformin is
either refused or insufficient to reach targeted glycemic control.
3.Ferrous Sulfate- The prevalence of GDM is reduced in iron deficiency
anemia, which probably served as a surrogate for other factors such as
nutritional inadequacy and reduced gestational weight gain.
E Environmental Modifications
 If you have to stay in bed, do leg exercises.
 Treatment:
 Start an exercise program, if not exercising. Ask healthcare provider how
to get started. Try walking, inside or out.
 Stay at a healthy weight. Get help to lose any extra pounds (kilograms).
 Keep blood pressure in a healthy range
 If patient is smoking, make a plan to quit. Ask healthcare provider about
stop-smoking programs to help in quitting.
T Treatment (non-pharmacologic treatment)

 Low-calorie diet - Moderate amounts of whole grains, such as bread,
cereal, pasta, and rice, plus starchy vegetables, such as corn and peas.
Weight loss- Pancreas is better able to keep up with your body's need for
insulin. In some cases, weight loss is enough to restore blood sugar to a normal
level, which eliminates diabetes.
Regular vigorous exercise- Our muscles take in more glucose. When this
effect wears off, our muscles remain more sensitive to insulin for some time.
The end result is lower blood glucose levels. Along with following a healthy diet,
getting plenty of exercise is an important part of managing gestational diabetes.
H Health teachings
 Teach on lifestyle modifications
 Advice to see psychologists with other family members for therapy on the
possibilities of fetal abnormalities
 Advice to call emergency response team in cases of emergency
 Advise to religiously follow health instructions
D Diet modifications
 A carbohydrate with every meal and snack (spread your carbohydrate
intake over 3 small meals and 2 to 3 snacks each day)
 A variety of foods that contain the nutrients you need during pregnancy.
 Eat high-fibre foods.
 Avoiding foods and drinks that contain a lot of sugar.
 Limiting fat, especially saturated fats
 Eat three small-sized meals and three to four healthy snacks.
 Eat every two to three hours to space food evenly throughout your day.
 Do not skip meals or snacks.
 The bedtime snack is especially important to help keep your fasting (first
blood sugar of the day before eating) in range.
JOURNAL READINGS
GESTATIONAL DIABETES MELLITUS
Gestational diabetes (GDM) is prevalent in the Philippines. Published data from the Asian
Federation of Endocrine Societies Study Group on Diabetes in Pregnancy (ASGODIP)
showed that the Philippines has a GDM prevalence of 14% in 1203 pregnancies surveyed.
Because of this high prevalence rate, the Unite for Diabetes Clinical Practice Guideline
(CPG) recommends universal GDM screening for the Filipino population. The ASGODIP
data found that about 40.4% of high-risk women were positive for GDM when screening
was performed beyond the 26th week of pregnancy. In a cohort of Filipino women with
GDM delivering babies with macrosomia in the Cardinal Santos Medical Center, >75%
were diagnosed between gestational weeks 26 and 38. In another cohort population from
the Veterans Memorial Medical Center, 50% of GDM cases were diagnosed between
gestational weeks 31 and 40. The Filipino CPG recommends adopting the criteria by the
International Association of Diabetes & Pregnancy Study Groups for interpretation of the
75-g oral glucose tolerance test as GDM screening. In the 2014 prevalence estimates
published by the International Diabetes Federation, it is estimated that there are 3.2
million cases of T2D in the Philippines with a 5.9% prevalence rate in adults between the
ages of 20 and 79 years.15 Around 1.7 million people with T2D remain undiagnosed. The
estimated cost per person with T2D in 2013 in the Philippines is $205, which is
comparable with neighboring countries such as Thailand ($285) and Indonesia ($174.7).
A.D. Litonjua, R. Boedisantoso, S. Serirat, et al.AFES Study Group on Diabetes in Pregnancy.Phil J Int
Med, 34 (1996), pp. 67-68
http://endo-society.org.ph/v5/wp-content/uploads/2013/06/Diabetes-United-for-Diabetes-Phil.pdf.

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THE COLLEGE OF MAASIN

“Nisi Dominus Frustra”

A CASE STUDY OF GESTATIONAL DIABETES MELLITUS

In Partial Fulfillment of the Requirements in NCM-104 RLE

demand develop diabetes. Diabetes is the most common medical complication.

diagnosed with Gestational Diabetes Mellitus.

and type 2 diabetes.

According to the study of Keshavarz 2005, hyperglycemia develops during pregnancy

glycosuria, or a strong family history of diabetes.

What is Gestational Diabetes Mellitus? Provide 3 definitions.

Gestational Diabetes Mellitus (GDM) is a condition of abnormal glucose metabolism that

Source: World Health Organization

What are possible complications of GDM?

Make 5 possible nursing diagnosis with this condition.

 Ethnicity Urinalysis: Glucose +3

Precipitating Factor: 1-hr post-prandial: 200 mg/dL

 More than 5% body weight

 Normal vital signs

“Nisi Dominus Frustra”

College of Nursing & Allied Health Sciences

MEDICAL TREATMENT NURSING MANAGEMENT

“Nisi Dominus Frustra”

College of Nursing & Allied Health Sciences

Precipitating Factors: Etiology: Reduced insulin secretion, Predisposing Factors:

 Obesity increased insulin degradation,  Age

Pancreatic beta cells work

Alter cellular functioning If left untreated.

Kidneys Liver Pancreas Nerves Erythropoeisis

Affects the renin- Increase Increase Uncontrolled Decrease production of blood

Hypertension Malfunctioning Malfunctionin Decrease Anemia Recurrent Bleeding

Proteinuria Hepatic Pancreatic Rapid weight gain Vaginal UTI

Rapid weight gain

ron, hilig man kog tam-ison na mga pagkaon lagi”

weight of 6.8 kg.

E. FAMILY HISTORY OF ILLNESS

Old Age Anemia Diabetes

Date/Year Term Preterm Aborted/Death Alive

Last Menstrual Period (LMP): June 15, 2021

Medical and General History

Check the box if the pregnant mother has this condition/s

Further details (if checked):

Medications: Prenatal vitamins, Multivitamins

Operations (if any): None

Respiratory rate: 15 cpm Blood Pressure: 110/80 mm Hg

maintained and well groomed. She has a normal vital sign.

Shows no sign of erythema, jaundice or cyanosis. Generally, has uniform pigmentation

interruptions. Have warm ang good skin turgor.

Eyebrows symmetrically aligned and equal movement, skin intact, no discharge, no

were no presence of discharges, no discoloration and lids closed symmetrically, no

noted. Distant visual acuity is 40/20

inflammation of mucous membrane. Able to smell normally.

Mouth and Buccal Cavity

freely and has no lesions.

has equal strength, lymph nodes not palpable.

Lungs and Thorax

clear breath sounds.

Breasts and Axillae

No presence of tenderness and masses on the axillae

Other findings: none

No pelvic girdle pain or back was noted.

Presence of deep tendon Edema

Neurologic System: Conscious and coherent, no language deficiency, well oriented to

time and place, coordinated body movements, smooth and steady.