Republic of the Philippines

CAMARINES SUR POLYTECHNIC COLLEGES

Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

Gestational
Diabetes
Mellitus
(CASE STUDY)

By:

Adorable, Phil Michelet R.

Ballester, Daniela M.
Bedural, Kate Danielle O.
Bustarga, Menneth P.
Dacara, Hedda Ruth A.
Estadilla, Jana Shaine T.
Gimenez, Desiree Ann S.
Lagatic, Ma. Jasa Mae E.
Parce, Dyanne Marie L.
Samson, John Carlo A.

BSN 2H - Group 2

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Table of Contents

Brief description of the disease………………………………………………………3

Etiology/Cause……………………………………………………………………….3
Anatomy and Physiology…………………………………………………………….4
Clinical Manifestations: with rationale (Theoretical/Actual)………………………..5
Diagnostic Procedures (Theoretical and Actual)……………………………………..8
Risk Factors………………………………………………………………………….10
Pathophysiology……………………………………………………………………..11
Complications………………………………………………………………………..14
Nursing Management………………………………………………………………...15
Medical Management including the Medications / Drug Study……………………..17
Surgical Management (If necessary)…………………………………………………21
Nursing Care Plan……………………………………………………………………22
Discharge Plan, Patient's education………………………………………………….24
References……………………………………………………………………………26

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Brief description of the disease

Gestational diabetes is a type of diabetes that develops during pregnancy and

usually resolves after giving birth. It is characterized by high blood sugar levels that
can pose risks to both the mother and the baby if not properly managed. Risk factors
for gestational diabetes include a family history of diabetes, previous history of
gestational diabetes, obesity, and being older than 25 years old.
In the case of Mrs. Munoz, her history of gestational diabetes during her
previous pregnancy and family history of type 2 diabetes mellitus put her at an
increased risk of developing gestational diabetes again. Close monitoring of her blood
sugar levels and dietary management will be essential in managing her condition to
prevent complications for both her and her baby. Additionally, Mrs. Munoz may
require regular check-ups and potentially medication to control her blood sugar levels
during her pregnancy.

Etiology/Cause

The exact cause of GDM is not fully understood, but it is believed to be

related to hormonal changes during pregnancy that make the body less sensitive to
insulin, a hormone that regulates blood sugar levels. This can lead to elevated blood
sugar levels, which can pose risks to both the mother and the fetus if left untreated. In
Mrs Munoz's case, she previously developed GDM during her pregnancy with her
second child (G3P2), which suggests that she is at higher risk for developing GDM
again in this pregnancy due to her family history of type 2 diabetes mellitus. Type 2
diabetes mellitus is a chronic condition characterized by high blood sugar levels
resulting from the body's inability to use insulin effectively or produce enough insulin.
It is often associated with obesity, physical inactivity, and unhealthy eating habits.
The exact cause of type 2 diabetes mellitus is not fully understood, but it is believed
to be related to a combination of genetic and lifestyle factors.

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Anatomy and Physiology

Anatomy:

1. Pancreas: Produces insulin, a hormone that regulates blood sugar levels.

2. Placenta: A temporary organ that develops during pregnancy, allowing exchange
of nutrients and waste between the mother and fetus.

Physiology:

1. Insulin Resistance: During pregnancy, hormonal changes can lead to insulin

resistance, where cells become less responsive to insulin.
2. Increased Insulin Production: Initially, the pancreas tries to compensate by
producing more insulin to overcome insulin resistance.
3. Placental Hormones: Hormones produced by the placenta, such as human
placental lactogen, can further contribute to insulin resistance.
4. Glucose Intolerance: Despite increased insulin production, some women may not
be able to maintain normal blood sugar levels, leading to glucose intolerance.
5. Diagnosis: GDM is typically diagnosed around the 24th to 28th week of pregnancy
through glucose tolerance testing.
6. Risks: Untreated GDM can lead to complications for both the mother and fetus,
including macrosomia (large birth weight), neonatal hypoglycemia, preterm birth, and
increased risk of cesarean delivery.
7. Management: Treatment often involves dietary changes, exercise, and in some
cases, insulin therapy to help control blood sugar levels. Understanding the anatomy
and physiology of GDM is crucial for effective management and reducing risks for
both mother and baby.

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Patient Case Scenario

Mrs. Munoz, a 28-year-old G3P2 woman, arrives at the antenatal clinic at 30 weeks
gestation. In addition to her history of gestational diabetes and a family predisposition
to type 2 diabetes, she may be experiencing various symptoms common at this stage
of pregnancy.

Clinical observations include the cervix undergoing potential changes, with softening
(effacement) and dilation possible as the body readies for labor. Fetal heart tones are
monitored, aiming for a healthy rate of 120 to 160 beats per minute. Fundal height,
currently expected to be around 28-32 centimeters, provides insights into the
appropriate fetal growth.

Mrs. Munoz might report symptoms such as nausea and vomiting, albeit generally
diminished at this point. Backache, shortness of breath due to the expanding uterus,
and occasional Braxton Hicks contractions could be part of her experience. Edema,
particularly in the ankles and feet, may also be noted, alongside the expected fatigue
associated with the advanced stage of pregnancy.

Regular prenatal check-ups become crucial to monitor these symptoms, ensuring a

comprehensive understanding of Mrs. Munoz's health and addressing any potential
concerns.

ACTUAL

Based on the clinical description, Mrs. Munoz are experiencing the following signs
and symptoms:

● Increased Thirst. This could be indicative of gestational diabetes or heightened

metabolic demands during pregnancy.

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● Frequent Urination. Common in pregnancy, it may be related to hormonal

changes affecting kidney function and the growing uterus pressing on the
bladder.
● Fatigue. Typical in the third trimester due to increased physical demands and
hormonal changes.
● Nausea and Vomiting. Although generally reduced after the first trimester,
some women may still experience mild symptoms.
● Backache. Likely due to the growing uterus shifting the center of gravity,
causing strain on back muscles.
● Shortness of Breath. As the uterus expands, it can press against the diaphragm,
leading to difficulty breathing.
● Swelling (Edema). Common in pregnancy, particularly in the ankles and feet,
due to increased pressure on blood vessels.
● Braxton Hicks Contractions. These mild, irregular contractions are a normal
part of pregnancy, often increasing as the due date approaches.
● Cervical Changes. Softening (effacement) and dilation may occur as the body
prepares for labor.

THEORETICAL

At 30 weeks of pregnancy, the provided information suggests several signs and

symptoms according to Mayo Clinic:

● Braxton Hicks Contractions. Mild, irregular contractions might be felt as a

slight tightness in the abdomen, increasing in frequency and strength as the
due date approaches.
● Backaches. Hormonal changes relaxing connective tissues can lead to
discomfort in the back during the third trimester. Adequate back support,
regular exercise, and proper footwear are recommended.
● Shortness of Breath. The expanding uterus can cause a feeling of
breathlessness. Maintaining good posture is advised to allow for optimal lung
expansion.

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● Heartburn. Pregnancy hormones may relax the valve between the stomach and
esophagus, leading to acid reflux. Dietary adjustments, such as eating small,
frequent meals and avoiding certain foods, are suggested.
● Spider Veins, Varicose Veins, and Hemorrhoids. Increased blood circulation
can cause spider veins, especially on the face, neck, and arms. Varicose veins
on the legs and painful, itchy hemorrhoids may also occur. Exercise, leg
elevation, a high-fiber diet, and fluid intake are recommended for relief.
● Frequent Urination. Increased pressure on the bladder as the baby descends
into the pelvis can lead to more frequent urination. This might also result in
occasional leakage, especially during activities like laughing or coughing.
● Emotional Changes. Anticipation and fears about childbirth may become more
persistent. Anxiety about parenthood may also arise, especially for first-time
parents.

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Diagnostic Procedures

For Mrs. Muñoz, given her history of gestational diabetes in a previous pregnancy and
family history of type 2 diabetes mellitus, both theoretical and actual diagnosis
procedures important for managing her current pregnancy.

THEORETICAL DIAGNOSTIC PROCEDURES

1.Risk Assessment: Assessing Mr. Muñoz risk factors for gestational diabetes
& type 2 diabetes, such as her age, family history and previous pregnancy history
2.Review of symptoms: Inquiring about any symptoms suggestive of diabetes,
such as Increased thirst, frequent urination, and fatigue.
3.Laboratory Test: Ordering laboratory test such as fasting plasma glucose
( FPG) or Oral glucose tolerance test (OGTT) to screen for gestational diabetes
4.Glycated Hemoglobin (HbAIc) Test: This test provides an indication of
average blood sugar levels over the past 2-3months & can help assess the risk of
developing gestational diabetes.
5.Urine Test: They are made in the liver from the breakdown of fats. Ketones
are formed when there is not enough sugar or glucose to supply the body’s fuel needs.
This occurs overnight and during dieting or fasting. During these periods, insulin
levels are low, but glucagon and epinephrine levels are relatively normal. High levels
of ketones and high blood glucose levels can mean your diabetes is out of control.

ACTUAL DIANOSTIC PROCEDURES

1.Physical Examination. Heart disease, chronic kidney disease, nerve damage,

and other problems with feet, oral health, vision, hearing, and mental health.
2.Blood glucose monitoring.
3.Consultation with a dietitian. A good meal plan will also: Include more
nonstarchy vegetables, such as broccoli, spinach, and green beans. Include fewer
added sugars and refined grains, such as white bread, rice, and pasta with less than 2

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grams of fiber per serving. Focus on whole foods instead of highly processed foods as
much as possible.
4.Gestational Diabetes Screening.
5.Educational counseling. High blood glucose levels can cause several
problems: Early in pregnancy, high glucose levels increase the risk of pregnancy loss
and congenital anomalies. Also check your blood sugar at least four times a day, or as
directed by your doctor. Check for fasting blood sugar first thing in the morning,
before having anything to eat or drink.

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Risk Factors

Risk factors for gestational diabetes mellitus (GDM), which is a type of diabetes
mellitus that develops during pregnancy, include:

1. Obesity: Women who are overweight or obese before pregnancy are at a higher
risk of developing GDM.
2. Age: Women over the age of 25, especially those over 35, are at an increased risk.
3. Family history: Having a close family member with diabetes increases the risk of
developing GDM.
4. Previous history of GDM: Women who had GDM in a previous pregnancy are
more likely to develop it again.
5. Ethnicity: Certain ethnic groups, including African American, Hispanic/Latina,
Native American, Asian American, and Pacific Islander women, have a higher risk.
6. Polycystic ovary syndrome (PCOS): Women with PCOS have an increased risk of
developing GDM.
7. Previous large baby: Giving birth to a baby weighing 9 pounds (4,082 grams) or
more in a previous pregnancy increases the risk.
8. Previous unexplained stillbirth: Women who have experienced unexplained
stillbirth in a previous pregnancy may have an increased risk.
9. History of prediabetes: Women with a history of prediabetes or impaired glucose
tolerance are at a higher risk.
10. Sedentary lifestyle: Lack of physical activity or low levels of exercise before and
during pregnancy can increase the risk.
11. Glycosuria: Presence of glucose in the urine during early pregnancy may indicate
an increased risk of GDM. These risk factors help healthcare providers identify
women who may be at higher risk for developing gestational diabetes mellitus and
implement appropriate screening and management strategies during pregnancy.

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Pathophysiology

Diabetes' etiology is multifaceted, including several hormones. The interaction of

these hormones with the liver, as well as their role in renal function, making
determining the pathogenic origins of this condition challenging and varies widely
across patients. More thorough descriptions of this pathophysiology may be found on
the American Diabetes Association's website and in medical pathology textbooks.
Diabetes, regardless of the etiology, is defined by decreased glucose absorption.
Insulin resistance is induced by both genetic predisposition and abdominal obesity.
Obesity is highly associated with the development of type 2 diabetes. Eighty percent
of type 2 diabetes patients are obese, and excess fat is often carried in the upper body.

Diabetes Mellitus is a chronic metabolic disorder characterized by elevated blood

glucose levels (hyperglycemia) due to either inadequate insulin production, insulin
resistance, or both. There are several types of diabetes, including Type 1, Type 2,
gestational diabetes, and other less common forms.

Type 2 Diabetes Mellitus (T2DM):

Pathophysiology: T2DM is characterized by insulin resistance and relative insulin

deficiency. Insulin resistance means that the body's cells do not respond effectively to
insulin.
Initially, the pancreas compensates by producing more insulin to overcome this
resistance. Over time, however, the pancreas may not be able to keep up with the
demand for insulin production, leading to relative insulin deficiency. Insulin
resistance is often associated with obesity, physical inactivity, and genetic factors.

Gestational Diabetes Mellitus (GDM):

Pathophysiology: GDM occurs during pregnancy when hormonal changes lead to

insulin resistance. In some women, the pancreas cannot produce enough insulin to

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overcome this resistance, resulting in hyperglycemia. GDM increases the risk of

complications for both the mother and the baby, and it may resolve after delivery.

Type 2 Diabetes Mellitus (T2DM) is the most common form of diabetes, accounting
for the majority of cases worldwide. Its pathophysiology involves a combination of
insulin resistance and relative insulin deficiency. Here's a more detailed breakdown:

1. Insulin Resistance:
 In T2DM, cells in the body, particularly muscle, liver, and fat cells,
become resistant to the action of insulin.
 Insulin normally acts as a key to unlock cells, allowing glucose from
the bloodstream to enter and be used for energy or stored for later use.
 With insulin resistance, cells do not respond adequately to insulin,
leading to decreased glucose uptake. As a result, blood glucose levels
rise.
2. Pancreatic Dysfunction:
 Initially, in response to insulin resistance, the pancreas increases
insulin production to try to overcome the resistance and maintain
normal blood glucose levels.
 Over time, however, the beta cells in the pancreas may become
exhausted or dysfunctional, leading to a decrease in insulin secretion.
This contributes to relative insulin deficiency.
 The combination of insulin resistance and relative insulin deficiency
results in persistent hyperglycemia characteristic of T2DM.

3. Inflammation and Adipose Tissue Dysfunction:

 Chronic low-grade inflammation is commonly associated with obesity,
which is a significant risk factor for T2DM.
 Adipose tissue (fat tissue) in obese individuals produces pro-
inflammatory cytokines and other substances that interfere with insulin
signaling, contributing to insulin resistance.

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 Dysfunctional adipose tissue also releases increased amounts of free

fatty acids, which further exacerbate insulin resistance.

4. Genetic and Environmental Factors:

 Genetic predisposition plays a significant role in the development of
T2DM. Certain genetic variants can increase the risk of insulin
resistance and impaired insulin secretion.
 Environmental factors such as obesity, sedentary lifestyle, poor diet
(high in refined carbohydrates and saturated fats), and aging also
contribute to the development of insulin resistance and T2DM.

5. Other Factors:
 Dysfunction in other organ systems, such as the liver, may also
contribute to the pathophysiology of T2DM. In particular, excessive
hepatic glucose production can exacerbate hyperglycemia.
 Impaired incretin hormone signaling, which normally helps regulate
insulin secretion, is another aspect of T2DM pathophysiology.

Overall, T2DM is a complex disorder involving multiple physiological

processes, including insulin resistance, beta cell dysfunction, inflammation, and
genetic and environmental factors. Management typically involves lifestyle
modifications (diet, exercise), oral medications to improve insulin sensitivity and/or
secretion, and sometimes insulin therapy to control blood glucose levels.

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Complications

 Gestational diabetes that's not carefully managed can lead to high blood sugar
levels. High blood sugar can cause problems for you and your baby, including an
increased likelihood of needing a surgery to deliver (C-section).For example is,a
large baby – which increases the risk of a difficult birth, having your labour
induced or needing a Caesarean section. a miscarriage.Diabetes in pregnancy
increases risk of fetal macrosomia, shoulder dystocia, pre-eclampsia, cesarean
delivery, stillbirth, and, if preexisting or gestational diabetes is poorly controlled
during organogenesis, major congenital malformations and spontaneous abortion.

Complications that may affect your baby.If you have gestational diabetes, your baby
may be at increased risk of:

 Excessive birth weight. If your blood sugar level is higher than the standard range,
it can cause your baby to grow too large. Very large babies. Those who weigh 9
pounds or more, are more likely to become wedged in the birth canal, have birth
injuries or need a C-section birth.
 Early (preterm) birth. High blood sugar may increase the risk of early labor and
delivery before the due date.
 Serious breathing difficulties. Babies born early may experience respiratory
distress syndrome, a condition that makes breathing difficult.

 Low blood sugar (hypoglycemia). Sometimes babies have low blood sugar
(hypoglycemia) shortly after birth. Severe episodes of hypoglycemia may cause
seizures in the baby. Prompt feedings and sometimes an intravenous glucose
solution can return the baby's blood sugar level to normal
 Obesity and type 2 diabetes later in life. Babies have a higher risk of developing
obesity and type 2 diabetes later in life.
 Stillbirth. Untreated gestational diabetes can result in a baby's death either before
or shortly after birth.

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Complications that may affect you as a mother:

 High blood pressure and pre-eclampsia. Gestational diabetes raises your risk of
high blood pressure, as well as pre-eclampsia, a serious complication of
pregnancy that causes high blood pressure and other symptoms that can threaten
both your life and your baby's life.

 Having a surgical delivery (C-section). You're more likely to have a C-section if

you have gestational diabetes.

 Future diabetes. If you have gestational diabetes, you're more likely to get it again
during a future pregnancy. You also have a higher risk of developing type 2
diabetes as you get older.

Nursing Management

There are no guarantees when it comes to preventing gestational diabetes, but

the more healthy habits you can adopt before pregnancy, the better. If you've had
gestational diabetes, these healthy choices may also reduce your risk of having it
again in future pregnancies

 Eat healthy foods. Choose foods high in fiber and low in fat and calories. Focus
on fruits, vegetables and whole grains. Strive for variety to help you achieve your
goals without compromising taste or nutrition. Watch portion sizes.
 Keep active. Exercising before and during pregnancy can help protect you from
developing gestational diabetes. Aim for 30 minutes of moderate activity on most
days of the week. Take a brisk daily walk. Ride your bike. Swim laps. Short
bursts of activity

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 Start pregnancy at a healthy weight. If you're planning to get pregnant, losing

extra weight beforehand may help you have a healthier pregnancy. Focus on
making lasting changes to your eating habits that can help you through pregnancy,
such as eating more vegetables and fruits.

 Don't gain more weight than recommended. Gaining some weight during
pregnancy is typical and healthy. But gaining too much weight too quickly can
increase your risk of gestational diabetes.

It involves providing the client or couple with information regarding the disease
condition, teaching insulin administration, achieving and maintaining normoglycemia,
and evaluating the present client or fetal well-being.

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Drug Study
Name Dosage/Frequen Mechanism of Indication Contraindi Adverse Nursing
of cy Action cation Effect Responsibilitie
Drug /Timing/Route s

I Typically The Inositol may While - In general, Nurses should

N administer myo- administration be beneficial inositol is inositol is assess the
O inositol in the of inositol for generally well-tolerated patient's
S range of 1–4 allows it to act individuals regarded as by most medical history,
I grams (1000– as a direct with type 2 safe for individuals. including any
T 4000 milligrams) messenger of the diabetes or most However, underlying
O once daily. insulin signaling metabolic people, potential side conditions and
L and improves syndrome, individuals effects may current
glucose tissue potentially with certain include medications,
uptake. This helping to medical gastrointestin before
mechanism is improve conditions, al recommending
extrapolated to insulin such as disturbances or
its functions in sensitivity kidney such as administering
diabetes and regulate disease, or nausea, gas, inositol. They
treatment, blood sugar those taking or diarrhea, should also
metabolic levels. specific particularly at monitor for any
syndrome, and medications higher doses.. signs of adverse
weight loss. should use effects and
caution and educate patients
consult with about the
a healthcare proper use and
professional potential risks
before using of inositol
inositol supplementatio
supplement n.
s.

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A Acarbose is Acarbose is a Acarbose is Acarbose Most common Explain what is

C available as a 25 complex indicated as use is adverse the use of the
A mg, 50 mg, or oligosaccharide an adjunct to contraindica effects are GI medication,
R 100 mg oral that acts as a diet and ted in symptoms, why it is
B tablet. It should competitive, exercise to patients including needed, and
O be administered reversible improve with known flatulence, what are the
S orally three times inhibitor of glycemic hypersensiti diarrhea, and adverse effects
E daily with the pancreatic control in vity, abdominal that the patient
first bite of each alpha-amylase adults with diabetic pain. might feel after
meal. Initial and membrane- type 2 ketoacidosis Acarbose taking the
dosing is 25 mg bound intestinal diabetes , liver decreased medication
orally three times alpha-glucoside mellitus. cirrhosis, skeletal
daily; however, hydrolase. inflammator muscle index, Give the
starting with Pancreatic y bowel handgrip medication the
once-daily dosing alpha-amylase disease, or strength, and exact time, the
may limit GI hydrolyzes colonic gait speed the frequency, and
adverse effects. complex ulceration. most the Dosage of
From 25 mg by carbohydrates to It also is compared the medication
mouth three times oligosaccharides contraindica with drug- as per the
daily, the dose in the small ted in naïve patients Doctor’s order
can be titrated intestine. patients and patients
every 4 to 8 Intestinal alpha- with taking insulin, One- to 2-hour
weeks to reach glucosidase intestinal metformin, postprandial
desired glycemic hydrolase breaks obstruction and blood glucose
control while down or those sulfonylureas concentrations
limiting GI oligosaccharides predisposed monotherapy. and
adverse effects. , trisaccharides, to intestinal Elevated glycosylated
The maximum and obstruction; serum hemoglobin
daily dose is 100 disaccharides patients transaminases require
mg three times (sucrose, with may occur monitoring to
daily. maltose) to chronic during assess efficacy.
If the patient monosaccharide intestinal acarbose Serum
weighs less than s (glucose, disease, therapy. transaminase
60 kg, the dose fructose) in the including Elevations concentrations
should not exceed brush border of those who usually are should be
50 mg three times the small have issues asymptomatic checked every
daily. intestine. By with and reversible three months
Patients with delaying the digestion or once stopping for the first
renal dysfunction digestion of absorption; drug therapy year of therapy.
(serum creatinine carbohydrates, or The clinician
greater than 2.0 acarbose slows conditions should decrease
mg/dL) have not glucose that will be the dose or
been studied. absorption, worsened discontinue
Safety and resulting in a by the therapy if
efficacy have not reduction of increased concentrations
undergone postprandial gas become
evaluation in glucose blood formation elevated during
pediatric patients. concentrations. in the treatment

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Studies have not intestine

established the
safety of acarbose
in pregnant
patients.
Nursing mothers
should not use
acarbose.
G Glyburide is Increasing Glyburide is Glyburide >Hypoglycem Close
L available in 1.25 insulin secretion indicated therapy ia and weight monitoring for
Y mg, 2.5 mg, and 5 from beta cells alone or as should not gain are the signs and
B mg tablets. in the pancreas. part of be re- most symptoms of
U Dosage for type 2 Specifically, combination initiated if frequently declining blood
R diabetes: 1.25 mg sulfonylureas product with the patient encountered glucose levels
I to 20 mg orally, bind to the metformin, as has a adverse is required
D once or divided SUR1 receptors an adjunct to history of effects of
E twice daily. in the diet and allergic glyburide. Monitoring
Formulation note: membranes of exercise, to reaction to >Nausea glyburide is
non-micronized the beta cells of improve the >upper also necessary
and micronized potassium ATP- glycemic medication. abdominal for patients in
glyburide dependent control in However, fullness circumstances
formulations are channels. adults with patients >heartburn that provoke
not bioequivalent. type 2 with >rash the onset of
Dosing must be These agents diabetes previous Some side hypoglycemia,
re-titrated when block these mellitus allergic effects can be including
switching channels, reactions to serious. If you exercise, lack
between releasing insulin  Manage drugs of the experience of eating, and
formulations. after the cell ment of same class any of these accidental
Glyburide is depolarizes. At Gestation may not symptoms, overdosage
orally times, al necessarily call your
administered in sulfonylureas Diabetes react to doctor Ensure patient
typical initial bind to SUR2 Mellitus glyburide. immediately: safety, it is
dosages of 2.5 mg receptors on  Used in >yellowing of crucial to be
to 5 mg, with a cells in cardiac combinat Also, the skin or aware of the
maximum of 40 tissue and the ion to prescribers eyes signs and
mg daily—the endothelium. manage must use >light-colored symptoms of
maximum dosage glycemic caution stools hypoglycemia
is rarely used, as After the initial control: with >dark urine when initiating
many patients insulin secretion, metformi glyburide in >pain in the glyburide
with type 2 sulfonylureas n hospitalized upper right therapy
diabetes do not can also  Manage patients, part of the
require dosages decrease insulin ment of who are stomach Educate patient
higher than 10 mg clearance in the Type 2 malnourishe >unusual on self-
per day. Clinical liver, increasing Diabetes d, misuse bruising or monitoring of
effects are also plasma insulin mellitus alcohol, bleeding blood glucose
insignificant levels. have renal >diarrhea levels and
beyond dosages Glyburide, along This focuses and cardiac - fever adhere to

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of 10 to 15 mg with glipizide, is who do not dysfunction - sore regularly

daily. classified as a have s, or with throat scheduled
Hepatic dosing: second- atheroscleroti gastrointesti swelling of blood glucose
Start dosing at generation c nal disease the eyes, face, and HbA1C
1.25 mg in sulfonylurea due cardiovascula lips, tongue, testing
patients with to its increased r disease or or throat
hepatic potency and chronic In patients with
impairment. difference in kidney liver
elimination, disease and dysfunction,
allowing their have not monitoring of
use in patients achieved their liver function
with renal and HbA1C target tests may be
hepatic despite necessary.
dysfunction. exhausting
first-line Educate the
treatment patient about
options. the importance
However, of positive
recent lifestyle
updates in modifications,
recommendati including
ons for first- smoking
line therapy cessation,
emphasize the adopting a
importance of healthy diet,
tailoring participating in
treatment an exercise
based on program, and
patient- maintaining
specific healthy body
factors, weight, as
including ample evidence
comorbidities supports the
such as benefits of
atheroscleroti lower body
c weight in
cardiovascula achieving better
r disease, diabetes
heart failure, control.
or chronic
kidney
disease, as
well as
individual
management
needs

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 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

Surgical Management

In the case of gestational diabetes, surgical treatment is not typically indicated

as it is primarily managed through lifestyle modifications, dietary changes, blood
glucose monitoring, and medication (such as insulin therapy) when necessary.
However, in cases where complications arise, such as severe preeclampsia or fetal
distress, a cesarean section may be performed for the safe delivery of the baby and to
mitigate risks to both the mother and the fetus.

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 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

NURSING CARE PLAN

ASSESSM NURSING PLAN OF INTERVENTION RATIONALE EVALUATION
ENT DIAGNO CARE
SIS
SUBJECT Risk for SHORT >Teach the patient >SMBG helps the SHORT TERM:
IVE maternal TERM: how to use a blood patient track blood After 30 mins of
DATA: injury After 30 glucose meter, glucose levels and health teaching the
“Lagi po related to minutes of properly clean the make informed patient is able to
akong elevated health testing site, obtain a decisions about diet, verbalize her
nauuhaw maternal teaching, the blood sample, and physical activity, and understanding
tapos serum patient will be interpret results. insulin therapy. about gestational
sobrang blood able to Monitoring allows diabetes. (GOAL
dalas ko glucose verbalize her >Collaborate with for early detection of MET)
din pong level understanding the healthcare team hyperglycemia or
umihi. about to develop a meal hypoglycemia,
Mabilis din gestational plan that meets the guiding appropriate LONG TERM:
po ako diabetes. patient's nutritional interventions to After a week of
akong needs while maintain glycemic nursing
mapagod at LONG controlling blood control. intervention, the
minsan TERM: After sugar levels. patient will be
lumalabo a week of >A balanced meal able to
ang nursing >Educate the patient plan helps provide demonstrate
paningin intervention, about the different essential nutrients improved
ko.” the patient types of insulin, while promoting behavior and
will be able to including rapid- satiety and lifestyle. (GOAL
OBJECTI demonstrate acting, short-acting, preventing extreme PARTIALLY
VE improved intermediate-acting, fluctuations in blood MET)
DATA: behavior and and long-acting sugar levels.
OGT lifestyle. insulin.
RESULT: >Understanding the
240 mg/dL >Demonstrate onset, peak, and
(13.3 proper injection duration of each type
mmol/L) technique, including of insulin helps the
site rotation, needle patient anticipate and
insertion angle, and manage blood sugar
insulin dosage fluctuations more
calculation. effectively.

>Offer emotional >Proper

support and administration and
counselling to dosage adjustment
address anxiety and help prevent
stress related to complications
managing diabetes associated with
during pregnancy. hyperglycemia or
hypoglycemia and

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 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

>Schedule regular promote optimal

follow-up maternal and fetal
appointments to outcomes.
assess the patient's
emotional well- >Building a trusting
being, discuss any relationship fosters
challenges or open communication
concerns, and adjust and allows the
support strategies as patient to feel heard
needed. and understood,
which is crucial for
effective emotional
support.
Ongoing support and
follow-up
demonstrate ongoing
commitment to the
patient's emotional
well-being and
reinforce the
importance of self-
care and stress
management in
diabetes management
during pregnancy.

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 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

Discharge Plan

1. Education: Mrs. Rodriguez will receive comprehensive education before discharge,

focusing on:
- Blood glucose monitoring: Instructions on how to continue monitoring her blood
glucose levels at home, including frequency and target ranges.
- Medication management: If insulin therapy is initiated during pregnancy, she will
be educated on proper administration techniques, storage, and dosage adjustments.
- Nutrition: Guidance on maintaining a balanced diet postpartum to support
glycemic control and overall health.
- Exercise: Recommendations for incorporating regular physical activity into her
daily routine to promote weight management and reduce the risk of diabetes-related
complications.
- Signs and symptoms: Identification of warning signs indicating hyperglycemia or
hypoglycemia and appropriate actions to take.
- Postpartum care: Guidance on scheduling follow-up appointments with her
healthcare provider for postnatal check-ups and screening for persistent diabetes.

2. Monitoring: Mrs. Rodriguez will be advised to continue monitoring her blood

glucose levels regularly and to keep a log of her readings for review during follow-up
appointments.

3. Follow-up Care: A schedule of postpartum follow-up visits with her obstetrician

and endocrinologist will be provided to ensure ongoing monitoring of her glycemic
status and overall health.

4. Support Services: Referrals to support services, such as lactation consultants or

diabetes educators, may be provided as needed to address specific concerns or
challenges Mrs. Rodriguez may encounter postpartum.

Page 24 of 26
 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

Patient's Education

Mrs. Rodriguez will be educated on the following key points:

- Importance of continued blood glucose monitoring postpartum to detect any

recurrence of hyperglycemia or development of type 2 diabetes mellitus.
- Adherence to a healthy diet and lifestyle to prevent or delay the onset of type 2
diabetes mellitus in the future.
- Risks associated with future pregnancies and the importance of preconception
counseling to optimize maternal and fetal outcomes.

By providing Mrs. Rodriguez with comprehensive education, a structured discharge

plan, and ongoing support, healthcare providers can empower her to effectively
manage her gestational diabetes postpartum and reduce the risk of long-term
complications.

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 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

References:

3rd trimester pregnancy: What to expect. (2022, March 9). Mayo Clinic.
https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-
depth/pregnancy/art-20046767

Pillitteri, A. (2013). Maternal and child health nursing: Care of the childbearing and
Childrearing family. Lippincott Williams & Wilkins.

https://www.mayoclinic.org/diseases-conditions/gestational-diabetes/symptoms-
causes/syc-
20355339?fbclid=IwAR1s7E9gYCjUr37ZyUWdqq_YG2HPeJxheI3tNg1yWN2_2-
rlle68-na45F8

https://www.mayoclinic.org/diseases-conditions/gestational-diabetes/symptoms-
causes/syc-20355339

https://www.sciencedirect.com/topics/medicine-and-dentistry/pathophysiology-of-
diabetes#:~:text=The%20pathophysiology%20of%20diabetes%20is,resist%20the%20
effects%20of%20insulin.

https://www.google.com/url?q=https://www.cdc.gov/diabetes/managing/eat-
well/meal-
planmethod.html%23:~:text%3DA%2520good%2520meal%2520plan%2520will%25
20also%253A,foods%2520as%2520much%2520as%2520possible.&sa=U&sqi=2&ve
d=2ahUKEwit3ty9hZmEAxVNklYBHZZ0DaQQFnoECA8QBQ&usg=AOvVaw2m
HnBzgJ57Hrspfd9Eij6T

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