GDM Final Case Study

NCM 109
CARE OF MOTHER & CHILD AT RISK W/ PROBLEM (ACUTE & CHRONIC)
RELATED LEARNING EXPERIENCE
CHAPTER I
INTRODUCTION
Gestational diabetes mellitus is defined as diabetes that is first diagnosed in
the second or third trimester of pregnancy, and is not considered over type 1 or type
2 diabetes. For this reason, it is important that all pregnant women who have risk
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factors for diabetes be tested in the first trimester to rule out the presence of overt or
preexisting diabetes.
Gestational diabetes occurs as a result of insulin resistance during pregnancy.
Adequate blood glucose control is important in helping prevent complications in the
mother, such as preeclampsia, and in the fetus, such as macrosomia and stillbirth.
Nonpharmacologic measures, including diet and exercise, are often sufficient for
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many women to maintain appropriate glycemic control. However, some women may
require additional pharmacologic therapy, including insulin, metformin, or glyburide.
In 2021, according to the Irish Neonatal Health Alliance in previous years, one
or two women in every 10 are at risk of gestational diabetes. Gestational diabetes
mellitus (GDM) is prevalent in the Philippines. Published data from the Asian
Federation of Endocrine Societies Study Group on Diabetes in Pregnancy
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(ASGODIP) showed that the Philippines has a GDM prevalence of 14% in 1,203
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.
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It is proposed that gestational diabetes mellitus is related to a change in the
way a woman’s body responds to insulin during pregnancy. Insulin is the hormone
that allows glucose to move from the bloodstream to the body’s cells so that the
glucose can be used for energy. In order to increase nutrients - including glucose -
available to the fetus during pregnancy, the body naturally becomes more resistant
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to insulin. The body compensates for the resistance by increasing insulin levels;
however, in some women, this is insufficient to maintain blood sugar control.
Uncontrolled blood sugar can potentially impact the mother and/or fetus.
Gestational diabetes mellitus can increase the risk of complications such as stillbirth,
preeclampsia (onset of high blood pressure and proteinuria after 20 weeks’
gestation), and macrosomia (delivery of a larger-than-average baby). These
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complications may increase the rate of cesarean section in women with gestational
diabetes mellitus.
Due to that, one of our ways to apply all our learning was by conducting a
case study. Through this, the health status of our client was assessed. Thus, health
related problems were identified and have become a way for the student nurses to
know the right interventions that should be done for the client.
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Objectives:
General Objective:
The general objective of this case study is for students to acquire the
necessary knowledge, develop the right and appropriate attitude and skills in
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rendering care to patients to expand their understanding of providing optimum care
to the patient and family members who have and/ or are at risk of developing
diabetes mellitus.
Specific Objective:
For student:
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The student should be able to:
1.Establish a trusting relationship with the patient.
2. Comprehensively assess the patient with the different areas such: Personal
Data, Family Background, Health History (Family Health History, Personal
Health History), Developmental Data using Havighurst’s Theory,
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Pathophysiology, Physical Assessment, Patterns of Functioning and Medical
Management; Analyze the gathered data; Determine the needs of the client;
Determine the priority nursing/ health problem of the patient
3. Formulate the appropriate nursing diagnosis.
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4. Design nursing care plans that follow the format with appropriate
approaches, activities, strengths, and resources that can solve the nursing
problems of the client.
5. Perform the planned intervention that addresses the cause of the problem.
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6. Evaluate the intervention done that addresses the health nursing problem
of the client.
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CHAPTER II
PERSONAL DATA
Name of Client: Mrs. Grapes Fruit
Address: Bangui, Ilocos Norte
Age: 36 years old
Birthdate: January 08, 1987
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Birthplace: Bangui, Ilocos Norte
Civil Status: Married
Religión: Iglesia Filipina Independiente
Educational Attainment: High School Graduate
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Diagnosis: G3P2 (2002) 35 weeks AOG by LMP, Gestational Diabetes Mellitus,
insulin requiring; Obese III
Physician: Dr. Coconut
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CHAPTER III
FAMILY BACKGROUND
The collection of relatives that make up a family is known as the "family

structure." Legally married couples or common-law partners, children, economic,
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family, and other relatives are all included in this classification. Everyone in the
family feels significant, appreciated, and respected when there is open
communication. Family dynamics refers to how relatives interact, including their
responsibilities and connections, as well as the elements that influence how they
interact.
A. SOCIO-DEMOGRAPHIC PROFILE OF THE FAMILY
Table 1. Socio-Demographic Profile of the Family
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Name Birth Age Sex Civil Relation Educational Occup Religion and
Date Status ship to Attainment ation Affiliation
the head
of the
family
Mr. March 43 Male Married Head High School Painte Iglesia Filipina
Mango 18, years Graduate r Independiente
1980 old
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Mrs. January 36 Female Married Wife High School Snack Iglesia Filipina
Grapes 08, years Graduate Vendo Independiente
1987 old r
Mr. Septem 18 Male Single Child High School N/A Iglesia Filipina
Papaya ber 01, years Graduate Independiente
2004 old
Ms. March 13 Female Child Child Grade 7 N/A Iglesia Filipina

Kiwi 04, years (currently Independiente
2010 old studying)
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Mrs. Februar 77 Female Married Mother- High School House Iglesia Filipina
Strawb y 19, years in-Law Graduate wife Independiente
erry 1946 old
The Fruit family consists of five members including the grandmother of the
client. They are currently residing in Bangui, Ilocos Norte. Mr. Mango is 43 years of
age, male, born on 18th of November 1980, is the patient’s husband, a painter and
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also the head of the family. Mrs. Grapes, the client, is 36 years of age, a snack
vendor before, married to Mr. Mango, and she was born on January 9, 1987. Mr.
Papaya, 18 years of age, male, born on 1st of September 2004, who is the first child,
single and is a High School Graduate. Ms. Kiwi, 13 years of age, female, born on 4th
of March, 2010, is the second child, single and she is currently studying in junior high
school. Mrs. Strawberry is 77 years of age, female, born on February 19, 1946, a
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housewife and the grandmother of the client. Their two children also help Mrs.
Grapes in doing household chores sometimes, getting her the things that Mrs.
Grapes needs.
B. Type of Family Structure and Form
Fruit's family is a kind of an extended family. Mrs. Grapes has 2 children. She
worked as a snack vendor before, but she has stopped since she was pregnant,
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while her husband is a skilled painter. Inside their home, they live with the client’s
mother, his husband and two children. Their house is 8 meters by 10 meters. It is a
two-story house and is concrete which has 3 bedrooms - one on the first floor and
two on the second floor, a living room, a dining room, a comfort room and bathroom,
a kitchen and a small terrace. Their home environment can be described as calm
and secure. They have a clean and peaceful surrounding. Inside their house, it is
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clean and organized. The distance between their house and their neighbor’s is 5
meters away from each other. Their house is far from the barangay road which is 15
meters away. They have appliances like television, refrigerator, washing machine,
motorcycle and electric fan. Their source of water for drinking is Mineral Water.
C. Decision-Making
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As a family, in terms of decision making with regards to health management
and financial allocation, the patient including her husband are all involved in decision
making, but mainly, the husband is the one who makes most of the decisions. The
client also added that family problems are common, but if they had one, they talk as
a couple. They exchange their insights about the situation and talk about what is the
best thing to do. They fix their problems within the day and that keeps their
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relationship stronger. In terms of their children, when they are young, they often fight
with each other. But now that they are not kids anymore, they don’t fight and when
they do, their mother will talk to them and make them understand each other’s side.
Living with her grandmother was not that easy for her before, but as time went by,
she realized that it is a good opportunity to have a time with her grandmother. She
now enjoys looking out for her grandmother by giving her medications, feeding her
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and taking care of her everyday. They keep their relationships harmonious and
loving because they think that a happy and healthy family depends on it. In fact, the
patient confirmed that they use picnics, social meetings, and other outings to
strengthen their bonds with one another. The family’s religious affiliation is Iglesia
Filipina Independiente. Their family is considered to be religious because they attend
mass every Sunday.
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Analysis:
The Fruit Family is an extended family. There are five members in their
household. They are currently residing in Bangui, Ilocos Norte in a two-storey
house. They live in a peaceful and secure environment. Rarely, conflicts arise
between parents about financial management. These conflicts are frequently
addressed by exchanging arguments, justifications, and options. In times of
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disagreement, there may be yelling, but according to Mrs. Grapes, she and her
husband make sure that children do not witness it and that they receive an
explanation of why things are the way they are in a way that they can comprehend.
Their family values respect, understanding, as well as acknowledgement as part of
their foundation in order to raise their children.
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D. SOCIO-ECONOMIC AND CULTURAL CHARACTERISTICS
Socioeconomic status is known to reflect a family's social and economic
stature, as well as cultural characteristics. The influence of socioeconomic and
cultural characteristics on an individual's, group's, and family's state of health is
significant. Socioeconomic status refers to the family's social and economic status,
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whereas cultural characteristics refer to common beliefs, traits, attitudes, and
behaviors within the family.
Table 1: MONTHLY INCOME OF THE FAMILY
FAMILY MEMBER OCCUPATION MONTHLY INCOME
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Mr. Mango Painter Php. 21,800.00
Mrs. Grapes Foreign Remit Php. 10,000.00
All of the family members are residing at Bangui, Ilocos Norte. The father is
the only one working and earning for the family to have money to spend. Mrs.
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Grapes stated that her husband, Mr. Mango, works as a painter around the
municipalities of Bangui and Pagudpud. People love his works so it is not a problem
for him to look for a job because his schedule is always full for painting. His daily
salary is 700.00 pesos, and he is working Mondays to Saturdays, for a total of 24
days and he does contract once a month where he is usually making around Php
5,000.00 that makes his monthly income up to Php 21,800.00 per month. Mrs.
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Grapes has stopped from her job selling snacks, when she got pregnant, and she is
a housewife, but she does contribute to the family’s monthly income from the
assistance that her elder sister abroad is giving her, which is Php 10,000.00 a
month. In total, the whole family’s monthly income is Php 31,800.00.
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Figure 1. Pie Chart
Table 2: MONTHLY ALLOCATION
BASIC NECESSITIES BUDGET ACTUAL EXPENSES
Foods Php 10,000.00 Php 8,000.00
Check-up Php 3,000.00 Php 3,000.00
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Medication Php 4,000.00 Php 4,000.00
Vices Php 900.00 Php 900.00
Load Php 500.00 Php 500.00
Transportation Php 800.00 Php 500.00
Education & Allowance Php 4,000.00 Php 4,000.00
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Groceries Php 5,000.00 Php 4,000.00
Electricity Php 2,000.00 Php 1,500.00
TOTAL: Php 30,200.00 Php 26,400.00
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The family’s monthly expenses are broken down into nine portions: food,
grocery, medication, education and allowance, check-up, electricity, vices, load, and
transportation.
The red colored portion, which has the largest part in the pie chart, represents
the expenses of the family on their food. 30% of the family’s monthly expenses is for
their food. According to the patient, she goes to the market four times a month and
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she spends Php 2,000.00 a week which makes it to Php 8000.00 a month. The
family buys food such as vegetables, meat, and drinking water for a total of Php
8,000.00 They don’t buy sacks of rice because according to Mrs. Grapes, they get
sacks of rice every harvest season from their rice farm, which is enough to supply
them until the next harvest.
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The yellow colored portion of the pie chart represents the family’s grocery.
15% of their total monthly salary which is equivalent to Php 4,000.00 goes to their
grocery. This includes household and personal needs such as laundry soap,
dishwashing soap and liquids, toothpaste, shampoo, cotton buds, etc.
The green colored portion of the pie chart represents Mrs. Grapes’
grandmother’s medication including her maintenance for her condition. 15% of the
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family’s monthly income will go for her grandmother’s medicines. Her medicines cost
Php 4,000.00, which is good for one month.
The orange colored portion of the pie chart represents the children’s
education and allowance. 15% of the family’s income will go for the children’s
education and allowance. The firstborn is allocated with Php 2,000.00 a month for
his allowance, which is Php 500.00 weekly; and Php 2,000.00 also for the second
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born’s education including her allowance and other expenses for school supplies
since she is studying at a private school.
The blue colored portion of the pie chart represents the patient’s expenses for
her prenatal check up, including prenatal vitamins. 11% of the family’s income will go
for the patient’s prenatal check-up, medicines, and for her transportation to go to the
clinic. She had a prenatal check-up twice a month but since April 4, she now has a
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weekly check-up for monitoring. All in all she spends Php 3,000.00 monthly for her
prenatal check up and medications.
The violet colored portion of the pie chart represents their electric bill. 6% of
their total monthly income goes to their electric bill. The patient stated that they pay
around Php 1,500.00 every month for their electric bill.
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The pink colored portion of the pie chart represents her husband's vices,
which only includes smoking because he does not spend on alcoholic beverages.
Her husband smokes 4 sticks of cigarettes (Marlboro) per day. One stick costs Php
8.00, which makes it Php 32.00 every day, Php 224.00 every week, and Php 896.00
every month.
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The gray colored portion of the pie chart represents the family's monthly
expenses for load. 2% of the monthly income of the family goes to their load every
month for mobile data, calls and texts.
The brown colored portion of the pie chart represents Mr. Mango’s expenses
for transportation. 2% of the family's expenses is for his gas for transportation. As for
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the patient, her husband only spends Php 500.00 in a month for his gas which is
used to go to his work.
All in all, the family's total expenses every month is adequate to their monthly
income since their total monthly expenses is Php 26,400.00, while their monthly
income is Php 31,800.00. The remaining money is used for emergencies and in
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cases where they want to buy new stuff, like for their house, clothes, or if they want
to go outside to hang out and eat.
Php 1,600.00 of their monthly salary goes to their savings. The patient stated
that it is important for them to have savings, especially now that they will be having
their third baby, for them to have enough money to buy her needs. She is a member
of Card Inc., wherein she deposits Php 400.00 weekly as her savings. According to
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Mrs. Grapes, they do not have any loan because it is not practical for her and it is
better to just save.
Regarding their cultural traits, the family goes to church every Sunday. On
major occasions like Christmas Eve, New Year, Holy Week, and the funeral for a
deceased family member or relative, they also go to church.
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Moreover, the beliefs, traditions, and practices of the family can greatly
influence the health of each member. Mrs. Grapes mentioned that they don’t usually
go to the hospitals instead they go to their center. And if they can manage to treat
themselves, they use home remedies to treat family members who are sick.
Furthermore, they also believed in the practice that is called "atang," in which
one of the family members would prepare foods that would be placed on a single
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plate. They would leave this plate full of food on one side of their house. They
usually make "atang" when All Soul’s Days come. When it comes to celebrating
Christmas and New Year's, they make sure that each of them goes to church during
these holidays.
Analysis
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All in all, the family's total expenses every month is adequate to their monthly
income since their total monthly expenses is Php 26,400.00, while their monthly
income is Php 31,800.00. With adequate resources and a supportive family
environment, this has an impact on their growth and development. The Fruit family's
income implies sufficiency to avoid the challenge when seeking health-promoting
and disease-prevention measures that would eventually lead to wellness.
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On the family’s emergency funds, they set aside money for emergency
situations that would suffice the needs of the members in the event of income losses,
expenditure shocks, and other financial emergencies. The family's preparedness has
a favorable impact on reducing the chance of hardship and other undesirable
outcomes (Despard, 2020). This means that if a family member needs a health
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emergency fund, the family will not put their member's life at risk just because they
lack finances.
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CHAPTER IV
HEALTH HISTORY
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Figure 2. Genogram
A. FAMILY HEALTH HISTORY
In terms of Fruit Family's health practices, members of the family usually
apply Vicks to their chests and buy over-the-counter medications if they were
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experiencing cough, cold, or fever. Mrs. Grapes also mentioned that they use "suob"
as home remedy for coughs and colds that would make the family member's illness
less severe and enable them to breathe more easily. When a family member has
been ill for a long period of time and thinks that medications are not effective, that is
the time that they go to a faith healer. Additionally, they visit RHU in Bangui for
consultation
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According to Mrs. Grapes, she comes from a family with a complex medical
history that includes a range of conditions and health concerns. Her father, Mr.
Blueberry, has Type 2 Diabetes, a condition that requires careful management to
prevent complications such as nerve damage, heart disease, and vision problems.
Mrs. Grapes claims that she is unaware about her fathers’ medication since they are
not living together at the same house. Her mother, Mrs. Melon, has high blood
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pressure, a common condition that can lead to heart disease, stroke, and other
health problems if not properly managed. She asserts that her mother has elevated
blood pressure however she is not diagnosed with hypertension and doesn’t take
any medications. Also, Mrs. Melon has Parkinson's disease, a degenerative
neurological disorder that can be associated with a variety of symptoms such as
tremors, stiffness, and difficulty with balance and coordination.
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On her father's side, Mrs. Grapes' grandfather, Mr. Lemon, passed away in
2010 due to liver cirrhosis, a condition that can be caused by excessive alcohol
consumption or other factors. Her paternal grandmother, Mrs. Calamansi, has no
existing medical conditions and is healthy.
Mrs. Grapes' maternal grandfather, Mr. Watermelon, passed away at the age
of 65 due to unknown reason but the patient verbalizes “agdakkel- dakkel sa ngamin
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idi jay puso na”, a condition that can be genetic and may put Mrs. Grapes at an
increased risk for heart problems. Her maternal grandmother, Mrs. Strawberry has
Type 2 Diabetes, a condition that can run in families and increase the risk of
complications such as nerve damage, kidney damage, and vision problems. Also,
Mrs. Strawberry has hypertension and is having maintenance which are Pregabalin
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50 mg/once a day, Levodopa + Carbidopa 100 mg/once a day, Hemarate 60
mg/once a day, and Amlife 50 mg/once a day.
Mrs. Grapes also has four siblings. Her eldest sister, Ms. Cherry has no
existing medical conditions and is healthy. Her younger brother, Mr. Apple, passed
away last year due to a vehicular accident. Her youngest brother, Mr. Peach and
youngest sister, Ms. Orange has no existing medical conditions and is healthy too.
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Given this complex family history, Mrs. Grapes may be at an increased risk for
a variety of health conditions, including diabetes, high blood pressure, heart disease,
liver disease, and Parkinson's disease. It is important for her to discuss this family
history with her healthcare provider and to be proactive in managing her health
through regular check-ups, healthy lifestyle habits, and appropriate screenings and
monitoring for any potential health concerns.
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B. PERSONAL HEALTH HISTORY
I. Past Health History
Mrs. Grapes experienced childhood illnesses, like chickenpox, mumps,
measles , cough, and fever. When it comes to their management, they do the usual
remedies for fast healing. For chickenpox and measles, Mrs. Grapes experienced
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this illness when she was in grade 3. They usually use boiled guava leaves for
bathing. To avoid spreading or triggering chicken pox, they stay out of open spaces
and they don’t take any medicine. According to Mrs. Grapes, the mumps lasted one
week and she stated that it appeared right after chickenpox. They used something
to cover it which she called “akut-akut” to relieve the pain and to fully recover. Also,
Mrs. Grapes experienced hives wherein she ate eggs to trigger the illness and for
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the mumps to fully appear. When mumps fully appeared, she just drank milk and ate
a banana. Mrs. Grapes also experienced common illnesses like mild fever, cough,
and cold and with the said illnesses, they did not go to the hospital. Instead she just
washed her face using vinegar and she didn't take any medicines. She does not
have any history of accidents, hospitalization, aside from giving birth, and surgery.
She did the usual remedies when she has wounds by means of herbal plants and
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cleansing it with Betadine (Povidone-iodine) + Hydrogen Peroxide or Agua Oxinada
to cure the wound. Mrs. Grapes cannot recall all the immunizations that were given
to her when she was a child, she just stated that their childhood immunizations
together with her brothers and sister were complete during their time. She was
already vaccinated with COVID-19 vaccine and a booster shot- 1st and 2nd dose,
which are both Sinovac.
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II. OBSTETRICAL HISTORY
NAME YEAR HOSPITAL REMARKS
1st Pregnancy 2003 Bangui Hospital NSVD
2nd Pregnancy 2009 Bangui Hospital NSVD
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Mrs. Grapes didn’t have any complications in her last 2 pregnancies. She
delivered both of them through Normal Spontaneous Vaginal Delivery.
III. MENSTRUAL HISTORY
Mrs. Grapes shared that her first menstruation occurred when she was 10
years old during her fifth grade in elementary school. She claimed that she had a
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regular menstrual cycle, which is usually 29 days. Her menstrual cycle began with
heavy bleeding that occurred from the first to the fifth day. Afterward, her flow will
gradually become lighter until it stops. Mrs. Grapes characterizes her menstruation
as normal due to having no foul odor and its dark red color. She also mentioned that
she prefers to use diapers because she feels more comfortable and secure
compared to other normal pads that she has tried, which tend to easily fold and shift.
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She typically changes her pad three times a day to maintain cleanliness and prevent
any unwanted odor. Moreover, Mrs. Grapes has never experienced any abdominal
pain or menstrual cramps during her menstrual cycle, making the experience
relatively comfortable for her. When it comes to their beliefs and practices during the
client's teenage years, she frequently applies and washes her face with her
menstruation to prevent acne. She doesn’t take a bath during her period because
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they believe it will let cold air enter the body, through her vagina. Additionally, she
avoids eating peanuts and other sour foods, drinking cold water, and lifting heavy
objects.
IV. PRESENT HEALTH HISTORY
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According to Mrs. Grapes, now that she is currently pregnant with her
upcoming third child, her routine on a daily basis is quite altered from before. She
usually wakes up at 5:30 a.m. and cooks the family’s breakfast, like eggs, dried fish,
and rice. After cooking, Mrs. Grapes does the laundry. At 10 a.m., Mrs. Grapes takes
a bath, and after that, she cooks their lunch. Their lunch usually includes vegetables
such as pinakbet, and a variety of meats like fish meat, pork meat, and beef meat.
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Mrs. Grapes finds herself taking a nap at noon for at least 1-2 hours, and after she
wakes up, she will watch TV while making snacks, like oatmeal.
Mrs. Grapes is urinating about eight times at night, which is why she
frequently wakes up. Now that she is currently diagnosed with Gestational Diabetes
Mellitus (GDM), every time she wakes up, she checks her blood sugar level. In the
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afternoon and in the evening, she eats her meal and takes her blood sugar again
after 2 hours.
When Mrs. Grapes went for a check-up last December 29, her blood sugar
level was elevated. As stated by Mrs. Grapes, she was advised by her doctor to not
eat sweet foods and limit her rice intake. As per the patient when she was in her 24th
week of pregnancy, February 7, 2023, she went for a check-up and got diagnosed
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with Gestational Diabetes Mellitus, where she was prescribed medications but didn’t
buy them. According to Mrs. Grapes, during her first and second pregnancies, she
was not diagnosed as diabetic; it was only during her third pregnancy that she was
diagnosed with GDM. On March 13, 2023, her physician asked her to start
monitoring her glucose level since it was high.
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According to the patient, there were also times which she can’t recall the
exact date when Mrs. Grapes felt dizzy as her blood pressure elevated. She just sat
on the chair next to her and kept resting. She further confirmed that she is not
diagnosed with any hypertensive disorder. She also keeps herself hydrated,
replenishing thirst with water, not coffee, or caffeine teas. Since Mrs. Grapes was
prescribed insulin on April 4, she visits the clinic every Tuesday for follow-up check,
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as instructed by her doctor until she gives birth. On April 4, she started injecting
insulin, which is Glysolin, twice a day, 2 hours after having lunch and 2 hours after
having dinner.
When it comes to her medications, she takes Ferrous Sulfate + Folic Acid 300
mg/PO/OD, which is an iron supplement used to treat or prevent low blood levels of
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iron, and Multivitamins 600 mg/PO/OD, which is essential for fetal development,
particularly for bone formation, teeth, heart, muscles, nerves, and hormones.
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CHAPTER V
DEVELOPMENTAL DATA
This chapter presents the client’s development as a person in context of
different developmental theories.
A. Havighurst Developmental Theory
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In the twentieth century, Robert J. Havighurst was a psychologist who
developed a theory about how people develop throughout their lives. Developmental
tasks serve three important functions. For starters, they are guidelines that help
individuals understand what society expects of them at various ages. Second,
developmental tasks motivate people to do what their social group expects them to
do at different stages of their lives. Finally, developmental tasks show people what is
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ahead of them and what they will be expected to do when they reach the next stage
of development. These personal factors are the result of the interaction of genetic
and environmental factors, and they play an active role in the emergency of a
specific developmental task.
Virtues/ General Developmental Tasks:
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The patient is 36 years old and she is under the period of Middle Age which
encompasses from the age of 30 to age 60, this is the time when most people start a
family and settle into their adult lives. Therefore, the patient is expected to achieve
these tasks: (1) Achieving adult civic and social responsibility (2) Establishing and
maintaining an economic standard of living (3) Assisting teenage children to become
responsible and happy adults (4) Developing adult leisure-time (5) Relating oneself
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to one's spouse as a person (6) Accepting and adjusting to the physiologic changes
or middle age (7) Adjusting to aging parents.
TASK NOT PARTIALL FULLY JUSTIFICATION

ACHIEVE Y ACHIEVED
ACHIEVED
Achieving The patient fully achieved this
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adult civic task. It means that she exercises

and social her rights and responsibility by
responsibility / voting, obeying the law, and
participating in church activities.
She also verbalized that,
“Mapmapan nak met nukwa ag at-
atendar iti meeting ken dadduma
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pay a programa barangay”.
Establishing The patient was able to manage

and their home well by keeping their
maintaining house clean and organized,
an economic / having meals well cooked, doing
standard of laundry, and allocating the budget
living for their family. The client's family
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has a good relationship towards

each other. She also verbalized
that, “Tatta a nataengan nakon a
ket masapol met a adda nasayaat
a pagyanan ken pagubraanen, isu
nga ikarkarigatan mi agubra”.
Assisting According to the client, she is
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NCM 109
teenage always given time to spend with

children to her family, especially her children.
become They spent most of their bonding
responsible time at home. She was able to
and happy teach her children to learn how to
adults / express and control their feelings
such as joy and anger to avoid
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quarreling and misunderstandings.

She also verbalized that, “Nu
panggep annakko, bagbagaak
met isuda ken it-ited ko met amin
a masapol ken kailangan da tapno
haan da a mapaay”.
Developing During her free time, she enjoys
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NCM 109
adult leisure- spending time with her family and

time / neighbors when her family is not
activities at home. She also verbalized that,
“Pasaray innak agtamtambay
karruba mi pakarel-relaxak ta
mauma ak met ag f-fb”.
Relating According to the patient, she had
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oneself to been fulfilling the role of a nice

one’s spouse / spouse. She spent some time with
as a person her husband, and they both view
themselves as one. She also
verbalized that, “Tatta a agasawa
kamin a ket maymaysa kamin,
pagdamdamayan mi ti mesa ken
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mesa panggep iti aminen”.
Accepting She has accepted the physical

and changes in her body as she grows
adjusting to older. She simply had to deal with
the them because she believes that it
physiologic / is normal. Her health is very
changes of important to her, especially
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middle age because she has diabetes

mellitus. She also verbalized that,
“Idi balasangak a ket naarte ak iti
bagik ngem tatta a adda
pamilyakon ket naka-adjust nak
met kadgiti banag a agsukat
bagik, kasla normal met amin
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para kanyakon”.
Adjusting to She has adjusted to being with an

aging aging parent. She believes that it
parents / is her turn to take care of them,
especially her grandmother who
has a Parkinson’s disease. She
also verbalized that, “Alisto ak met
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nga nakapag-adjust kadetuy ta

adda met kabbalay ko nga
agsasakit, han ko met rigaten nga
alagaan ken tulongan isuna”.
ANALYSIS
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Under the developmental task of Havighurst, the client needs to achieve 7
tasks. Based on the enumerated tasks, the patient had fully achieved all the tasks.
Thus, she is doing well with the tasks she is expected to acquire and to perform.
Even though she is still at the age of 36, she has already fulfilled those tasks.
B. Erik Erikson’s Psychosocial Developmental Theory
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Mrs. Grapes is 36 years old and belongs to Young Adulthood of Erik
Erickson’s Psychosocial Development. At this stage, intimacy and isolation are the
focus of development. This stage begins at age 19 and lasts until age 40. During this
time, they are establishing and building upon relationships.
Intimacy is characterized by the ability to be linked to and close to another
person while maintaining your own identity. It is able to create long - lasting
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NCM 109
friendships with others, not only with members of the opposite sex but also with
members of one’s own sex. Isolation is described as the failure to maintain close
relationships and/or maintain one’s own identity in relationships. Avoiding intimacy,
fearing commitment and relationships can lead to isolation, loneliness, and
sometimes depression. Success in this stage will lead to the virtue of love.
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Virtues/ General Developmental Task
This aspect of Intimacy and Isolation is centered with herself more intimately
with others. We explore relationships leading toward longer-term commitments with
someone other than a family member without a sense of intimacy may have more
difficulty than others accepting a pregnancy and beginning to love a newborn child.
TASK NOT PARTIALLY FULLY JUSTIFICATION
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ACHIEVED ACHIEVED ACHIEVED
Forming The patient has a great

intimate relationship with her partner.
relationship She also verbalized that “na-
/ sweet kami met, haan kami met
unay managapa a ta
mapagsarsaritaan mi met
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amin”.
Learning to The patient is living together

live happily with his partner. She was able
with the to learn how to express and
partner control her feelings such as joy
/ and anger on his partner to
avoid quarreling and
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misunderstanding. She also

verbalized that,
“mapagsarsaritaan mi a dagos
iti problema mi ti mesa ken
mesa nu kaspagarigan adda
dumteng a problema”
Deep The patient shows her
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meaningful sympathy for others by assisting

connection them in listening and resolving
their problems. She also
verbalized that, “Nu talaga
pamilyak mapagsasaritaan ket
/ haan mi a papaunegen ti
probleman, dengdenggen mi
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tumunggal maysa kadakami isu

nga naasideg latta rikna mi
mesa ken mesa”.
Bonding The patient is always given time

with loved to spend with her family and her
ones partner. She also verbalized
that, “kanayon kami met
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/ rumwar iti pamilyak lalo dgituy

annak ko tapno makaliwliwa
kami met”
ANALYSIS:
Mrs. Grapes had completed or met all of the tasks appropriate for her stage.
She is performing well on the tasks she is expected to acquire and complete. Erikson
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believed that at this stage, it was critical to form close, committed relationships with
others. During this time, major conflict can arise as we attempt to form longer term
commitments outside of our family, with varying degrees of success. And yet,
positive outcomes result in healthy, happy relationships that are secure and
enduring, developing the virtue of love and the ability to love marks the ultimate
success when relationships are meaningful and lasting.
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As people reach adulthood, these emotionally intimate relationships become
increasingly important for their emotional well-being. The patient has romantic and
loving relationships with others, as well as long-lasting friendships with people
outside of her family.
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CHAPTER VI
PATHOPHYSIOLOGY
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This chapter presents interpretation and analysis of data, this portion
discusses the anatomy and physiology of the system/organs affected by the
disorder, and its schematic diagram.
ANATOMY AND PHYSIOLOGY
A. ENDOCRINE SYSTEM
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The endocrine system is made up of a group of organs that orchestrate
a state of metabolic equilibrium among the various organs of the body.
Endocrine glands secrete hormones, which are natural chemicals that exert
their effects on specific tissues known as target tissues. Target tissues are
usually located some distance from the endocrine gland, with no connecting
duct between the endocrine gland and its target tissue. For this reason,
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endocrine glands are called “ductless” glands and use the blood to transport
secreted hormones to the target tissues (Ignatavicius et al., 2016). Negative
feedback is the mechanism for regulating hormone concentration in the
bloodstream. When the hormone concentration increases, further production of
that hormone is inhibited. Conversely, when the hormone concentration
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decreases, the rate of production of that hormone increases (Smeltzer et.al.,
2010).
B. PANCREAS
Pancreas is a long, slender organ, found posterior to the stomach
between the duodenum on the right and the spleen on the left which is in the
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upper abdomen behind the stomach. It is about 6 inches (15.24 centimeters)
long, oblong and flat organ positioned at the level of the transpyloric plane . The
pancreas is divided into four parts: head, neck, body and tail. It functions as an
exocrine and endocrine gland. The exocrine pancreas secretes a variety of
digestive enzymes through ducts that empty into the duodenum while the islets
of Langerhans function as endocrine pancreas. About one million clusters of
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islet cells are found in the endocrine pancreas. It has three types: alpha, beta
and delta cells.20
The alpha cell produces the hormone glucagon and makes up
approximately 20 percent of each islet; this plays an important role in blood
glucose regulation; low blood glucose levels stimulate its release. Glucagon
helps stimulates the liver to convert its stores of glycogen back into glucose
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(GLYCOGENOLYSIS), stimulates the liver to convert its stores of glycogen
back into glucose(GLUCONEOGENESIS) and stimulates lipolysis, the
breakdown of stored triglycerides into free fatty acids and glycerol
(GLUCONEOGENESIS).
The beta cells produce insulin and are the most abundant of the islet
cells. They are endocrine cells that synthesized, store, and release insulin, the
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anti-hyperglycemic hormone that antagonizes glucagon, growth hormone,
glucocorticosteroids, epinephrine, and other hyperglycemic hormones, to
maintain circulating glucose concentrations within a narrow physiologic range.
The delta cell accounts for four percent of the islet cells and secretes
the peptide hormone somatostatin. Recall that somatostatin is also released by
the hypothalamus (as GHIH), and the stomach and intestines also secrete it.
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An inhibiting hormone, pancreatic somatostatin inhibits the release of both
glucagon and insulin.
C. PLACENTA
The placenta is an organ that is shaped like a pancake or disk. In most
pregnancies, the placenta is located at the top or side of the uterus. The
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placenta, an organ that develops inside your uterus, provides a connection
between you and your baby as it is connected to the mother’s uterus. This
connection (via the umbilical cord) is what helps to sustain your developing
baby throughout pregnancy.
The placenta is a temporary endocrine organ formed during pregnancy
which gives nutrients and water to the growing baby . The placenta also makes
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several hormones to keep the pregnancy healthy. These hormones can be a
Placental Steroid Hormones which include estrogen, progesterone,cortisol and
human placental lactogen or can be a placental protein hormones which
includes Human Chorionic Gonadotropin and Human Placental Lactogen.
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These hormones can affect how the body uses insulin (contra-insulin
effect). This often begins about 20 to 24 weeks of pregnancy and could lead to
gestational diabetes.
During pregnancy, more fat is stored into the body as it takes in more
calories and at the same time gets less exercise because strenuous activity
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and exercises are prohibited . All of these things can make blood sugar
(glucose) levels higher than normal and possibly lead to gestational diabetes.
As the placenta grows, it makes more of the hormones. The risk for
insulin resistance becomes greater. Normally the pancreas is able to make
more insulin to overcome insulin resistance. But if it can't make enough to
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overcome the effects of the placenta’s hormones it can result in development
of gestational diabetes.
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Non-Modifiable Risk Factors:
A. Advanced Maternal Age
Older women are more prone to gestational diabetes mellitus because
as we age, changes naturally occur. Some target tissues become less
sensitive to their controlling hormones, hence the amount of hormones
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produced may also change. In older women, estrogen levels often decrease
significantly that leads to insulin resistance.
B. Pregnancy (2nd/3rd Trimester)
During pregnancy, there are changes in the amount and function of
the hormones estrogen, cortisol, and human placental lactogen can block
insulin. When insulin is blocked insulin resistance occurs.
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C. Family History (Diabetes)
During pregnancy, the placenta produces hormones that can make it
harder for the mother's body to use insulin effectively, which can result in high
blood sugar levels and GDM. If a woman has a family history of diabetes, she
may inherit genes that make her more susceptible to insulin resistance, which
can increase her risk of developing GDM. A variation in the TCF7L2 gene,
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which is involved in insulin secretion, was associated with an increased risk of
GDM in women with a family history of diabetes.
Modifiable Risk Factors:
A. Lifestyle
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Poor diet can be a contributing factor to developing gestational
diabetes because excessive intake of saturated fats can cause inflammation
in the hypothalamus, leading to resistance to the satiety signaling of insulin.
B. Obesity
In obese people, excessive fat in the bloodstream can build up inside
the muscle cell and create toxic fatty breakdown products and free radicals
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that can block the insulin signaling process. Hence, the ability of the
pancreas to synthesize insulin decreases, leading to a decrease in the ability
to metabolize glucose.
C. Existing Condition (PCOS and Hypertension)
Women with PCOS have an increased risk of developing insulin
resistance, which is a major risk factor for GDM. Women with PCOS often
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have elevated levels of androgens, such as testosterone, which can interfere
with insulin signaling. In addition, women with PCOS may have increased
levels of inflammation in their bodies, which can also impair insulin sensitivity.
Similarly, women with hypertension have an increased risk of developing
GDM because high blood pressure can also cause insulin resistance.When
blood pressure is elevated, it can lead to damage in the blood vessels,
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including those that supply the pancreas, which produces insulin. This
damage can impair the function of the pancreas and reduce the production of
insulin, leading to higher blood sugar levels and insulin resistance.
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Figure 2. Schematic Diagram
During pregnancy, the levels of hormones estrogen, cortisol, and Human
Placental Lactogen increase in the body. These hormones have an insulin-
counteracting effect that blocks the action of insulin, which is a hormone that helps
to regulate blood sugar levels in the body. This can lead to insulin resistance, a
condition where the body becomes less responsive to the effects of insulin. As a
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result, the beta cells in the pancreas that produce insulin may decrease the amount
of insulin they produce, leading to a buildup of glucose in the blood.
This increase in glucose levels can cause the blood to become thicker and
more viscous, which can impede its flow through the blood vessels. This slow flow
can lead to a further increase in glucose levels in the blood, as the glucose is not
able to be transported efficiently to the body's tissues and organs.
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On the other hand, high blood glucose levels in the mother can lead to an
increase in the amount of glucose that crosses the placenta and enters the baby's
bloodstream. This is because glucose molecules can easily cross the placenta, and
the baby's pancreas may not be able to produce enough insulin to regulate the
increased glucose levels. When the baby is exposed to high levels of glucose in the
womb, the baby's body responds by producing more insulin to try to lower the
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glucose levels. Fetal hyperinsulinemia, which is caused by increased insulin
production in response to high levels of glucose, can stimulate anabolic metabolism
in the fetus. Anabolic metabolism is the process of building up larger molecules from
smaller ones, which can lead to the accumulation of fat, protein, and other molecules
in the fetus's tissues. This increased anabolic metabolism can lead to macrosomia,
which is a medical term for a large baby. Macrosomia can cause difficulties during
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delivery and increase the risk of injury to the baby during birth. Also increased insulin
production in response to high levels of glucose, can lead to neonatal hypoglycemia
in the newborn baby. This is because the excess insulin produced by the fetus can
continue to lower the baby's blood glucose levels after birth. And increased insulin
production in response to high levels of glucose, can lead to induced fetal lung
maturity in the fetus. This is because insulin can stimulate the production of lung
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surfactant, a substance that helps the lungs expand and contract properly. However,
if the fetus is exposed to high levels of insulin for a prolonged period of time, its lungs
may produce too much surfactant, which can lead to Neonatal Respiratory Distress
Syndrome (NRDS). NRDS is a condition that affects premature infants and is
characterized by difficulty breathing due to immature lungs.
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Additionally, high levels of glucose in the blood can cause water to be drawn
out of the body's cells and into the bloodstream. This can cause a shift in fluids from
the intracellular compartment (within the cells) to the extracellular compartment
(outside of the cells), resulting in dehydration within the cells. This cellular
dehydration can activate the thirst mechanism in the body, leading to a condition
called polydipsia. This excessive thirst can lead to increased fluid intake, which can
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result in the kidneys excreting more water from the body, leading to increased urine
output or polyuria. This can further intensify dehydration and lead to a cycle of thirst
and fluid loss.
Furthermore, when there is a high concentration of glucose in the blood, the
body's cells may not receive enough glucose to meet their energy needs. This
cellular starvation can trigger the body's hunger mechanism, causing an increase in
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appetite, known as polyphagia. This can lead to excessive eating and weight gain
during pregnancy.
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CHAPTER VII
PHYSICAL ASSESSMENT
Date of assessment: March 19, 2023 at 1:00 pm
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Age of the patient: 36 years old
I. General Appearance
Upon assessment, the patient was sitting in their living area wearing a green
pair of clothes and the patient was able to express her feelings clearly, follow verbal
cues, and she was cooperative as well. Despite the hot weather causing her to
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sweat, she maintains good hygiene. Moreover, she was interacting with us
pleasantly while examining her. She was oriented with the situation, the people
around her, and the time and date. The patient is fat and short in height.
Vital Signs:
Blood Pressure: 130/90 mmHg
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Respiratory Rate: 19 bpm
02 SAT: 98 %
Pulse Rate: 93 bpm
Temperature: 36.5 degrees Celsius
Height: 153 cm
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Weight: 119 kg
BMI = 50/Obese III
Head
· Normocephalic and symmetrical
· No presence of lesions and masses upon palpation
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· No tenderness upon palpation
Skin
· Slight discoloration in the underarm and neck
· She has good skin turgor
· No foul odor
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· Brown in skin color
Hair
· Hair is long, smooth and black
· No dandruff and minimal split ends upon inspection
Face
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· Symmetric and round
· The face of the client appeared smooth
· No involuntary facial movement
· No masses or lesions noted
Eyes
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· Eyebrows are equally aligned and showed equal movements when
asked to raise and lower eyebrows
· No presence of discharges
· Pupils are equally round, responsive to light and accommodation
· Pupils are black and equal in size
· The client can see objects in the peripheral when looking straight
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Ears
· Ears are symmetric
· Both ears are intact
· No deformities
· No lesions noted
· No scars noted
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Nose
· Nose is in the midline of the face
· Same color with the face and body
· No presence of discharge or flaring
Mouth
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· Lips are brownish in color
· No lesions noted
· Gums are pinkish in color
· Teeth are whitish in color
· No dental caries seen
· Tongue is in the midline, moist, pinkish, and can move freely
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· No odor noted
Neck
· The client showed coordinated, smooth head movement with no
discomfort
· Lymph nodes are not palpable
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· No swelling, enlargement or tenderness is present
Chest
· No presence of tenderness and masses
· There’s a full and symmetric expansion
· Keloid is present
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Abdomen
· No lesions noted
· Umbilicus is in the center, slightly dirty
· Striae Gravidarum is present with a red hue
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· Linea Nigra is present
· Stretch marks are present
Upper Extremities
· Nails are clean and square in shape
· Normal Capillary refill (2 seconds)
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· Both hands can exert movements and good muscle tone
Lower Extremities
· Can flex and extend feet
· Nails are clean and square in shape
II. Leopold's Maneuvers
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Upon performing the first maneuver which is the fundal grip, the uterus
is irregular and soft, and less mobile. The second maneuver is the umbilical
grip, and upon palpation, the fetal back is firm and is on the right side of the
mother's abdomen. On the left side of the mother's abdomen, the fetal
extremities have an irregular and nodular bony prominence.The fetal heart
rate is 135 beats per minute. The determination of the fetal presentation is the
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third maneuver. The patient's lower abdomen feels hard and round when I put
my hands on it, indicating a cephalic presentation. The last maneuver
confirms the findings of the third maneuver, which is that the fetus is still
floating.
III. Roll Over Test
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Roll over test was performed for the early diagnosis of pre-eclampsia.
In lateral positioning, the patient lies on her left side. During the assessment in
the roll over test, we take the blood pressure of Mrs. Grapes in her lateral
position with a result of 130/90 and on the left lateral position is 120/80,
therefore Mrs. Grapes is not at risk of toxemia.
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CHAPTER VIII
ONGOING APPRAISAL
This chapter presents the summarized 48-hour activity and progress during
the home visit and her appointment at the clinic.
Day (1) March 19, 2023
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She woke up around 5:30 in the morning. She went to the bathroom to
urinate. Then at 6:00 AM, she took her capillary blood sugar level, which had a result
of 161 mg/dL. She prepares their breakfast then sweeps their house. At 7 AM, she
ate her breakfast which was scrambled egg, rice and she drank milk.
During lunch time, she consumed 1 cup of rice, a scoop of meat and
vegetables. She drank 2 cups of water after eating.
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At around 1 pm, we visited her, and she was sitting in their living area wearing
a green pair of clothes, which is appropriate for the weather.
Vital Signs was taken as follow:
Body Temperature: 36.5 degrees Celsius
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Pulse Rate: 93 bpm
O2 Sat: 98%
Blood Sugar Level: 159 mg/dL
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Day (2) April 9, 2023
On the second visit, she woke up around 5:00 in the morning. First, she took
her capillary blood sugar level before eating her breakfast, with a result of 115
mg/dL. Her breakfast is egg, dried fish, and milk. She then takes her medication after
breakfast which is Ferrous Sulfate + Folic Acid and Multivitamins which is taken once
a day.
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Mrs. Grapes had her lunch at around 11:00 am, she ate a cup of rice, a slice
of fish, and a serving of vegetables, and drank 2 glasses of water. After 2 hours, at
around 1:00 pm, she injected insulin with a dosage of 10 I.U/0.1 mL.
At around 1:30 pm, we visited her, and she was sitting on a rocking chair
wearing a plain dress, which is appropriate for the weather, making her comfortable.
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Vital Signs was taken as follow:
Body Temperature: 36.7 degrees Celsius
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Pulse Rate: 97 bpm
Blood Sugar Level: 120 mg/dl
O2 Sat: 98%
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7 - DAY DIETARY MEAL PLAN FOR DIABETIC PATIENT
BREAKFAST SNACK AM LUNCH SNACK DINNER

PM
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DAY 1 1/2 cup garlic 1/2 cup of Chicken adobo 1 small Grilled tilapia
fried rice, 1 pineapple with 1/2 cup of banana, with 1/2 cup of
scrambled and 10 brown rice, 1 cup 1/2 cup of steamed white
egg, 1 small cashews of mixed yogurt rice, 1/2 cup of
apple, and 1 vegetables sauteed
cup of (squash, okra and kangkong, and 1
unsweetened eggplant), and 1 cup of vegetable
tea. glass of soup (onions,
unsweetened tomatoes and
calamansi juice. green beans)
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DAY 2 1/2 cup of 1 small Chicken tinola, 1/2 cup of Pork adobo with
champorado, mango, and 1/2 cup brown sliced 1/2 cup of brown
1 hard boiled 1 low fat rice, and 1 glass cucumber rice, 1 cup of
egg, and 1 string of unsweetened s, 2 mixed
small orange cheese calamansi tablespoo vegetables
n of (cabbage,
hummus carrots, and
green beans),
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DAY 3 ½ cup of 1 small Grilled bangus ½ cup of Beef sinigang, ½

arroz caldo, 1 apple, 1 low- with ½ cup of baby cup of brown
small banana, fat cheese steamed white carrots, 2 rice, and 1 glass
and 1 cup of stick rice, ½ cup of tablespoo of unsweetened
unsweetened ensaladang n of calamansi juice
tea talong, and 1 hummus
glass of
unsweetened
calamansi juice
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DAY 4 ½ cup of fried 1 small Grilled pork ½ cup of Beef kare-kare,

bangus belly, pear, and 10 skewers, ½ cup of low-fat ½ cup of brown
½ cup of raw almonds brown rice, ½ cup yogurt, ¼ rice, and 1 glass
garlic fried of ensaladang cup of of unsweetened
rice, and 1 kangkong with strawberr calamansi juice
small orange tomato, and 1 y
glass of
unsweetened
calamansi juice
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DAY 5 2 pieces of 1 small Chicken inasal, ½ ½ cup of ½ cup pinakbet,

medium size apple apple, cup of brown rice, baby ½ cup of white
turon, 1 hard and 1 low-fat ½ cup of mixed carrots, 2 rice, and 1 glass
boiled egg, string vegetables tablespoo of unsweetened
and 1 cup of cheese roll ( carrots, beans, ns of calamansi juice.
unsweetened and broccoli), 1 hummus.
tea glass of
unsweetened
calamansi juice
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DAY 6 ½ cup of 1 small Grilled bangus ½ cup of Beef nilaga

champorado, banana, and with ½ cup of fresh (with white
1 hard boiled ½ cup of steamed white pineapple potatoes, carrots
egg, and 1 low-fat rice, ½ cup of , and 10 and cabbage), ½
small orange yogurt ensaladang raw cup of white rice
malunggay, and 1 cashews
glass of
unsweetened
calamansi juice
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Grilled chicken
DAY 7 ½ cup of ½ cup of Pork adobo with ½ cup of inasal
garlic fried fresh ½ cup of brown low-fat ( marinated in
rice, 1 cucumber, 2 rice, 1 cup of yogurt,
scrambled tablespoons mixed vegetables and ¼ calamansi,
egg, 1 small of hummus ( cabbage, cup of lemongrass, and
apple, and 1 carrots, beans) blueberrie annato oil), ½
cup of and 1 glass of s cup of brown
unsweetened unsweetened rice, ½ cup of
tea calamansi juice mixed vegetable
( carrots, beans,
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broccoli), 1 glass
of unsweetened
calamansi juice
ANALYSIS:
This chapter offers a detailed analysis of a 48-hour period, encompassing both a
home visit and an appointment at the clinic. The chapter provides valuable insights
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into the individual's daily activities, health parameters, and overall progress during
this time.
On the first day, March 19, 2023, the individual began their day at 5:30 AM,
indicating a regular waking routine. The fact that she immediately went to the
bathroom to urinate suggests normal urinary function. At 6:00 AM, the individual
measured their capillary blood sugar level, which was 161 mg/dL. This reading
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indicates elevated blood sugar levels and may warrant further attention. The
individual proceeded with their daily tasks, preparing breakfast and performing
household chores, showcasing their ability to engage in regular activities
independently. The breakfast consisted of scrambled eggs, rice, and milk,
suggesting a balanced meal to start the day. During lunch, the individual maintained
a moderate portion size, consuming 1 cup of rice, meat, and vegetables, along with
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an adequate intake of water. These choices demonstrate a mindful approach to
nutrition and hydration. The visit conducted at 1:00 PM found the individual
appropriately dressed in green attire suitable for the weather, indicating a sense of
self-care and consideration. The vital signs recorded during the visit, including body
temperature, blood pressure, respiratory rate, pulse rate, oxygen saturation, and
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blood sugar level, provide a comprehensive overview of the individual's health
status, reflecting normal ranges for most parameters.
On the second day, April 9, 2023, the individual maintained a similar waking routine,
suggesting consistency in their daily habits. The capillary blood sugar level
measured before breakfast yielded a result of 115 mg/dL, indicating improved blood
sugar control compared to the previous day. The breakfast choices of eggs, dried
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fish, and milk continued to showcase a balanced meal with a good protein source.
The individual diligently followed their medication regimen, taking Ferrous Sulfate +
Folic Acid and Multivitamins after breakfast, ensuring proper nutrient
supplementation. During lunch, the individual displayed a well-rounded meal,
including a cup of rice, a slice of fish, and a serving of vegetables, along with
adequate hydration. Two hours after lunch, the individual administered insulin with
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the prescribed dosage, suggesting proper management of their diabetes condition.
During the visit at 1:30 PM, the individual was found comfortably seated in a rocking
chair, dressed in a plain dress suitable for the weather, indicating a consideration for
comfort and well-being. The vital signs recorded during this visit reflected normal
ranges for body temperature, blood pressure, respiratory rate, pulse rate, blood
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sugar level, and oxygen saturation, reinforcing the stability of the individual's health
parameters.
CHAPTER IX
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PATTERNS OF FUNCTIONING
Functional
Health Before Illness During Illness Analysis
Patterns
1. Health During the assessment, Upon assessment, the The patient's

Perception/ the patient conveyed her patient reported feelings condition before and
Health personal understanding of fatigue and lethargy in during illness is
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Management of health as a condition the past few days. In significantly

in which her body is in a order to better different. Before
state of optimal well- understand her illness, she was in a
being, and free of any condition, it was state of optimal well-
pain or discomfort. She discovered that the being and was able
further elaborated that patient has a history to carry out her daily
she is able to carry out where, at times, her activities without any
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her daily activities blood pressure can hindrance or

without any hindrance or increase. As part of the complications.
complications. She patient's examination, However, during
mentioned that whenever her blood glucose level illness, she is
she encounters any was tested after 2 hours experiencing fatigue
health concerns or of eating, and the results and lethargy, and
illness, her first course of showed that it was her blood pressure
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action is to resort to over- elevated beyond the and blood glucose

the-counter medication normal range of 120 levels are elevated.
such as Biogesic. mg/dL. These changes in
Additionally, she stated her condition are
that getting enough rest likely due to the
and sufficient sleep plays illness she is
a significant role in experiencing.
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improving her overall

physical and mental
health, which in turn
enhances her ability to
function effectively
throughout the day.
2. Nutritional During the consultation, During the consultation, The patient's diet
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- Metabolic the patient provided the client shared that and hydration habits
information regarding her while she can eat three have improved
dietary habits. She meals a day, she makes significantly since
reported that she a conscious effort to limit she became ill. She
typically eats three meals her intake of foods that is now eating a
a day, consisting of a are not good for her healthier diet and
combination of health, such as sweets, drinking more water.
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vegetables, meat, fish high-fat foods, junk This is likely due to

and snacks which consist foods, and carbonated the fact that she is
of junk foods and sweet drinks. The client's diet now more aware of
beverages. While she mainly consists of the importance of a
regularly includes vegetables, fresh fruits, healthy lifestyle in
vegetables in her diet, and an increased intake order to maintain
she expressed a of fluids, especially good health.
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preference for meat and water. She has made a However, the patient
fish. For her lunch, which deliberate effort to steer has admitted that
she usually consumes clear of unhealthy foods she has had some
around 11:30 AM, she and beverages that difficulty adjusting to
typically eats 2 cups of could adversely affect her new dietary plan
rice along with a serving her health. However, the and physical
of vegetables and either client admitted that she activities. This is
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meat or fish. Afterward, has had some difficulty because she was
she drinks 1-2 glasses of adjusting to her new previously
soft drinks. For dinner, dietary plan and physical accustomed to
which she eats between activities, as she was consuming a lot of
6:00 and 7:00 PM, she previously accustomed fatty, sweet, and
again consumes 2 cups to consuming a lot of unhealthy foods. It is
of rice along with a fatty, sweet, and important for the
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portion of vegetables and unhealthy foods. patient to continue

meat. In terms of to make healthy
hydration, the patient choices and to
shared that she drinks 8 gradually increase
to 10 glasses of water her physical activity
per day. level. This will help
her to maintain her
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new healthy lifestyle

and to prevent future
illnesses.
3. Elimination The patient's bowel The patient's bowel The patient's bowel
movement was normal, movement appears to movement and
indicating that she had a be normal in terms of urinary output have
regular schedule for consistency, but there both changed since
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passing stool. She has been a change in she became ill. The
reported defecating once the frequency of frequency of her
a day, typically in the defecation. The patient bowel movements
morning with a normal is now passing stool has increased, and
consistency of stool. The three times a day, after the consistency of
patient also had a each meal, and the her stool has
consistent urinary output, consistency of the stool become slightly
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voiding approximately is slightly watery. This watery. This may be

every 3 hours, with a indicates that the patient due to a change in
volume of approximately may be experiencing her diet or to some
100 ml. However, this some digestive issues or digestive issues.
volume may vary based may have made The frequency of her
on the patient's fluid changes in her diet urinary output has
intake. The patient recently. The patient's also increased, but
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mentioned that her urine urinary output occurs 10 she reports that
had a yellow color and - 12 times a day, mostly there are no issues
no unusual odor or during bedtime. It is not with elimination. The
discharges. Additionally, clear to her whether this color and odor of her
she reported that she frequency is normal or urine are normal.
urinated almost not as it can vary based
consistently every 3 on a person's fluid intake
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hours. and other factors.

However, the patient
reports that despite the
frequency of urination,
there are no issues with
elimination. The color of
the urine is yellow,
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which is a normal color.
4. Activity - The patient engages in The client reports that

Exercise physical activity through her activity and exercise The patient's
walking within their pattern has been limited physical activity and
barangay and performing due to her current breathing have both
household chores such condition. She changed since she
as cooking and cleaning. experiences slower became ill. She is
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These activities serve as reactions to stimuli and

her exercise pattern, and is only able to perform now less active and
the client reports no stretching exercises with experiences
issues breathing, limited range of motion, breathing problems.
with
such as shortness of and engage in a small These changes may
breath or coughs. amount of walking that is be due to the illness
However, the client has comfortable for her itself or to the
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noticed changes in their given her condition. The

heart rate during client also experiences a medications she is
exercise, with a decrease in strength, taking.
progressive increase in which becomes weak
heart rate as they during prolonged
engage in physical activities. As a result of
activity. Despite the her condition, the client
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increase in heart rate, reports experiencing

the client reports feeling breathing problems and
refreshed and energized becoming easily fatigued
after engaging in these during her usual
activities, rather than activities at home. She
feeling weak or pale. notices that her
breathing pattern is
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abnormal and becomes

progressively faster,
unlike before.
5. Cognitive - The patient is fully aware The patient is fully There is no

Perceptual of their surroundings, oriented to people, time, significant change in
including people, time, and place. She is able to the patient's mental
and place. She is express her emotions status or language
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responsive to verbal and clearly and understand skills during her

physical stimuli and has them as well. The illness. However,
a good memory, being patient is now aware of she is now more
able to recall information her present condition aware of her present
and make decisions and demonstrates a condition and is
independently. In willingness to follow her willing to follow her
addition, she is proficient treatment plan. treatment plan. This
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in speaking and is a positive sign, as

understanding multiple it suggests that the
languages. She is also patient is coping well
literate, being able to with her illness and
read and write. The is motivated to get
patient is also aware of better.
her current condition.
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6. Sleep - According to the patient's The patient has been The patient's illness
Rest daily routine, she usually experiencing frequent has had a significant
retires to bed between urination, especially at impact on her sleep
the hours of 8:00 and night, which has been patterns. She is now
9:00 every night. The causing disruptions to getting less restful
patient seems to have her sleeping patterns. sleep, which is
developed a habit of She has been struggling making it difficult for
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waking up early as she to get enough rest due her to function

gets up by 5:30 in the to the need to frequently during the day.
morning to prepare use the bathroom
breakfast. Despite throughout the night. As
waking up early, the a result, her usual sleep
patient appears to be routine has been
managing her energy disrupted. Moreover, the
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levels throughout the day patient has also been

efficiently, as she only experiencing changes in
takes a short nap after her routine of taking a
lunch. This nap perhaps nap after lunch. Due to
helps her to re-energize her condition, she finds
for the rest of the day it difficult to continue
and complete her daily napping for an extended
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activities without feeling period of time, and often

overly fatigued. wakes up feeling
unrested. This has been
causing further
disruptions to her sleep
patterns, and making it
hard for them to
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maintain her usual daily

routine.
7. Self - The patient is remarkably The patient is happy The patient's illness
perception/ self-aware and with her appearance and has caused her to
Self - concept possesses a deep sense does not easily get question her self-
of self-acceptance that upset or angry. She worth. She is now
allows her to embrace all accepts her wondering if she is
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of her imperfections with imperfections and feels good enough, and

an unwavering sense of good about herself. This she is starting to
confidence. She positive self-image is a doubt herself. This is
recognizes that it is reflection of her ability to a normal reaction to
precisely these embrace her flaws and illness, but it is
imperfections that make recognize that they important for the
her unique and make her unique. She patient to remember
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contribute to her identity. maintains a sense of that she is still a

Her body image, in self-worth, which means valuable person.
particular, is something that she values herself She has many
that she holds in high as a person. The strengths and
regard and is genuinely patient’s ability to remain qualities, and she
happy with. This positive composed in difficult should not let her
self-image is not situations is noteworthy.
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something that is easily She doesn't let her illness define her.
shaken, as the patient emotions control her and
possesses an incredible stays calm under
ability to remain pressure. This emotional
composed and grounded resilience is an
in the face of challenging important quality to
situations. She is a have, and it is a witness
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shining example of to her inner strength and

someone with a healthy self-control
level of self-esteem,
which is a reflection of
her unwavering self-
confidence and positive
attitude towards herself.
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8. Role The patient has good The patient believes that The patient's illness
Relationship relationships with her even if she is not feeling has caused her to
husband, children, well, she should not become more self-
relatives, and friends. treat others any focused. She is now
She values her family differently. She more concerned
and enjoys spending continues to spend time about her own
time with them. She is with her loved ones and health and well-
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friendly and pleasant to maintains her being, and she is

be around. The patient relationships with them. less able to focus on
takes her roles as a wife, The patient is specially the needs of her
mother, and daughter, close to her husband, loved ones. This is a
and seriously and does children, relatives, and normal reaction to
her best to fulfill these friends. She enjoys illness, but it is
responsibilities. She being around them and important for the
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recognizes that these is very fond of them. As patient to remember

relationships are a mother, the patient that her
important and works hard takes her responsibilities relationships are still
to maintain them. seriously and does her important. She
Communication is also a best to fulfill them. She should make an
priority for the patient. also places a lot of effort to stay
She never stops talking importance on connected with her
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to her loved ones and communication and loved ones, even

friends, making sure that never stops talking to when she is feeling
she stays in touch with her friends and family. unwell.
them and keeps their
relationships strong.
9. Sexuality - The patient's Due to the patient’s The patient's

Reproductive menstruation, or pregnancy, this prohibits menstrual cycle has
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menarche, started when her to engage in any changed

she was 10 years old. sexual activity, and significantly since
She claimed that her menstruation is absent. becoming pregnant.
menstrual flow was According to the patient, Her menstrual flow
heavy and she uses they never had sex has stopped, and
three diapers each day. since the beginning of she is no longer able
Her menstruation was her pregnancy. to engage in sexual
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normal which usually activity. These

lasts up to 7 days. Before changes are due to
engaging in sexual the hormonal
activity, they usually changes that occur
bathe. After giving birth during pregnancy.
to their second child, she The hormones
apparently stopped using estrogen and
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pills. progesterone are

responsible for
regulating the
menstrual cycle.
During pregnancy,
the placenta
produces high levels
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of these hormones,
which prevents
ovulation and
menstruation.
10. Coping/ The patient indicates that The patient claims that The patient's coping
Stress her method of coping when she is sick, she is mechanisms before
tolerance with problems is to undoubtedly stressed and during illness
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simply relax her mind to out and her mind is are significantly
get through the issue that confused, making it different. Before
is troubling her and difficult for her to deal illness, she is able to
usually praying to God. with the situation at relax her mind and
hand. pray to God to help
her through difficult
situations. However,
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during illness, she

becomes stressed
and confused,
making it difficult for
her to cope. Illness
can be a very
stressful experience.
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The patient may be

worried about her
health, her ability to
work, and her
financial situation.
This stress can
make it difficult to
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relax and think

clearly.
11. Values/ According to the patient, The patient's faith in The patient's faith in
Beliefs she is a member of God has not changed. God has helped her
Iglesia Filipina Religion-related to cope with her
Independiente and limitations on the illness. She believes
considers God to be the approach were absent. that God is with her
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one who will aid She prays to God for the and that He will help
humanity in finding blessings bestowed her to get better.
solutions to all of its upon them. She has also found
problems, and has a comfort in her faith
strong faith in God. and in the prayers of
her family and
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friends.
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CHAPTER X
MEDICAL MANAGEMENT
A. LABORATORY PROCEDURES
Date Ordered: November 11, 2022 Date Performed: November 11, 2022
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Name of the Diagnostic and Laboratory Examination: Urinalysis
Definition: A urinalysis (also known as a pee test) is a test that looks at the visual,
chemical, and microscopic characteristics of urine. It may include several tests that
use a single urine sample to identify and evaluate numerous substances that travel
through your urine. It tests a urine sample to detect and assess the presence of
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bacteria and other compounds in the urine.
Purpose of the study: This test is done on a patient to diagnose a disease or
screen for health problems such as urinary tract infection and also detect if there
are ketones present in the urine, which means that the blood sugar level is off
balance.
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Result:
PHYSICAL EXAMINATION:
Color: Yellow
Transparency: Slightly Turbid
pH: 6.5
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Specific Gravity: 1.030
CHEMICAL EXAMINATION:
Glucose: Negative
Bilirubin: Negative
Urobilinogen: Negative
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Ketone: Negative
Protein: Trace
Blood: 3+
Nitrite: +
Leukocytes: 2+
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MICROSCOPIC EXAMINATION:
Pus Cells: 15-20 /hpf
Red Blood Cells: >100
Bacteria: few
Epithelial Cells: few
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NURSING RESPONSIBILITIES RATIONALE
Check the doctor’s order. To verify what examination is to be done
on the patient
Inform the patient of the reasons why To reduce the anxiety of the patient, and
this procedure was ordered, and the for her to know why the test is being
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specimen that is to be collected. done to her
Fill out the laboratory request properly To inform the medical technologist what
and forward it to the laboratory. procedure is to be done with the patient
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Place the collected urine into a sterile; To prevent contamination of the
specimen bottle. specimen
Cover the specimen tightly, label it To avoid contamination and loss of
properly with identifying data (test, time specimen
started, and time of completion), and
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send it immediately to the laboratory.
Advise the patient to facilitate proper To prevent the spread of
hand washing. microorganisms
Refer the results immediately to the To determine and address any
attending physician, then attach it to the abnormal results and for further actions
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patient’s chart. needed
Carry out the doctor’s orders with regard To address and correct any abnormal
to the management of abnormal results. findings
Document the procedure. For legal purposes
Analysis:
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According to the results of the urinalysis, the urine contains bacteria, leukocytes,
and nitrite. Since numerous types of bacteria can cause UTIs, many of them can
alter nitrites, a common chemical found in urine. So, if they have nitrites in their
urine, it typically indicates that they have a UTI. Also, the most likely reason for
leukocytes in your urine is an infection in your urinary tract. The immune system
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increases the creation of these cells to combat the bacteria if you get an infection.
262
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Name of the Diagnostic and Laboratory Examination: Serology
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Definition: A laboratory test that looks for antibodies or other chemicals in a
sample of blood. The immune system of the body produces antibodies, which are
proteins, in response to a foreign substance or bacterium, such as a virus. In order
to determine whether a person has been exposed to or infected with a virus or
other infectious agent, serology tests check for specific antibodies. The immune
system produces antibodies, which are proteins, to fight foreign substances.
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Pathogens, including viruses and bacteria, are frequently present in these
compounds.
Purpose of the study: This test is done to look for certain antibodies in order to
determine whether a person has been exposed to or infected with a virus or other
infectious agent.
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Result:
HBsAg Screening: NON-REACTIVE
RPR/VDRL Screening: NON-REACTIVE
Check the doctor’s order. To verify what examination is to be done
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on the patient
Explain to the patient the rationale To help ease the patient's concern and
behind the procedure's order and how to inform her of the purpose of the test
the sample will be obtained.
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and forward it to the laboratory. the procedure is to be done with the
patient.
Place the collected blood or plasma in a To prevent contamination of the
tube specimen
Cover the specimen tightly, label it To avoid contamination and the loss of
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properly with identifying data (test, time specimens.
started, and time of completion), and
send it immediately to the laboratory.
Advise the patient to facilitate proper To prevent the spread of
hand washing. microorganisms
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Refer the results immediately to the To determine and address any
attending physician, then attach it to the abnormal results and for further actions
patient’s chart. needed
Instruct the patient to wait for the results To address and correct any abnormal
of the test, and the doctor will be the findings
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one to go into depth about it.
Document the procedure. For legal purposes
Analysis:
According to the findings of the serology tests, HBsAg screening and RPR/VDR
screening are both non-reactive, which suggests that the test found no evidence of
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the Human Immunodeficiency Virus (HIV) or other, Sexually Transmitted Diseases
(STDs).
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Name of the Diagnostic and Laboratory Examination: Fasting Blood Sugar
Definition: Fasting blood sugar levels are recommended for the patient in order to
check for prediabetes or gestational diabetes. It is also recommended to check
blood glucose levels after not eating for at least 8 hours.
Purpose of the study: The purpose of this test is to look for gestational diabetes.
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In most cases, between 24 and 28 weeks of pregnancy, pregnant women receive a
glucose screening test. If you have a high urine glucose level during your routine
prenatal visits or if you have a high risk for diabetes, the test might be performed
earlier.
Result:
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Fasting Blood Sugar: 138.6 mg/dL
Instruct the patient to be NPO 8 hours This is done to collect more accurate
before the procedure. test results.
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and forward it to the laboratory. the procedure is to be done with the
patient.
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Provide support and comfort as To address the women’s fear without
measured during the procedure. being nervous about the procedure
Instruct the patient about the results and To ensure that the patient is aware of
the physician will be the one who will the test results
explain the results
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Teach the patient how to correctly To improve the general health and well-
regulate and maintain normal blood being of the patient
sugar levels.
Clean the glucometer and record the To ensure cleanliness/sterility and to

results of the blood glucose test in make an analysis of the result
accordance with agency policy.
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Analysis:
A healthy individual without diabetes should aim for an FBS score or result of
between 74-100 mg/dL. The patient is screened for gestational diabetes mellitus
since the FBS test result indicates that her FBS level is higher than the normal
range.
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Name of the Diagnostic and Laboratory Examination: Hematology
Definition: A hematology test measures the blood's content of its biological
components. Hemoglobin, hematocrit, red blood cells, white blood cells, platelets,
and microscopic analysis of a stained blood smear are among the factors
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examined.
Purpose of the study: This test is done to look for and determine significant
changes in the different blood components.
Result: Reference Range:
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Hemoglobin: 141 Female: 120-160 g/L
Hematocrit: 0.47 Female: 0.37-0.47
Red Blood Cells: 5.02 Female: 4.5-5.5
White Blood Cells: 11.5 5-10
Neutrophils: 0.21 0.50-0.70
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Lymphocytes: 0.79 0.20.0.40
Check the doctor’s order. To determine the examination to be
done to the patient
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and forward it to the laboratory. procedure is to be done with the patient
Secure consent from the patient. To achieve a common goal and avoid
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misunderstandings
Explain that there is no need for fasting To avoid false results since fatty foods
but instruct the patient to avoid eating may alter the result because of lipidemia
fatty meals before the test
Cover all the specimens tightly, label To avoid contamination and loss of
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properly with identifying data, test, time specimens
started and time of completion and send
immediately to the laboratory
Assist the patient during the procedure To give ease for the patient and not be
confused by the flow of the test
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Inform the patient about the need of To improve the patient's overall health,
good hand washing is recommended. and well-being
When the laboratory result comes out, In order for the physician to assess and
immediately report it to the attending deal with any abnormal results, as well
physician and attach it to the patient's as to select the next course of action.
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chart.
Carry out the doctor’s order with regard To address and correct any abnormal
to the management of abnormal results. findings
Analysis:
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The results of the hematological test show that increasing NLR ratios are early
symptoms or indications of a pathological condition or process, such as infection,
and are represented by higher WBC, low neutrophils, and high lymphocytes in
relation to the reference range.
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Date Ordered: December 29, 2022 Date Performed: December 29, 2022
Name of the Diagnostic and Laboratory Examination: OGTT
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Definition: OGTT is recommended for the patient in order to check for
prediabetes or gestational diabetes. It is also recommended to check blood
glucose levels after not eating for at least 8 hours.
Purpose of the study: The purpose of this test is to look for gestational diabetes.
In most cases, between 24 and 28 weeks of pregnancy, pregnant women receive a
295
NCM 109
glucose screening test. If you have a high urine glucose level during your routine
prenatal visits or if you have a high risk for diabetes, the test might be performed
earlier. The 2-hour test is the confirmatory test of the procedure to determine
whether the patient has gestational diabetes mellitus.
Result: Normal Values
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Fasting Blood Sugar: 158.4 mg/dL 74-100 mg/dL
1-hour: 288 mg/dL <160 mg/dL
2-hour: 253.8 mg/dL <140 mg/dL
Instruct the patient to be NPO 8 hours This is done to collect more accurate
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before the procedure. test results.
and forward it to the laboratory. procedure is to be done with the patient.
Provide support and comfort as To address the women’s fear without
measured during the procedure. being about the procedure
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Inform the patient of the results of the To ensure that the patient is aware of
test procedure. their own medical history
Educate the patient on how to correctly To improve the general health and well-
regulate and maintain normal blood being of the patient
sugar levels.
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Clean the glucometer and record the To ensure cleanliness/sterility and to
results of the blood glucose test in make an analysis of the result
accordance with agency policy.
Analysis:
A healthy individual without diabetes should aim for an FBS, 1-hour, 2-hour score,
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or a result between the normal reference values. The patient is screened for
gestational diabetes mellitus since the FBS test result indicates that her FBS level
is higher than the normal range.
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B. DRUG STUDY
Generic Name: Ferrous Sulfate + Folic Acid
Brand Name: Ferolitab
Dosage / Route / Frequency: 300mg/Oral/OD
Pharmacologic Classification: Iron Supplement
Physiologic Classification: Nutritional Supplement
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Mechanism of Action: Enters the bloodstream and is transported to the
organ of the reticuloendothelial system, where it is
separated out and becomes part of the iron
stores.
Indication: To prevent iron deficiency on the recommended
daily allowance
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Desired Effect: It lowers the risk of hypertensive disorders and to
prevent anemia in pregnant women.
Contraindication: Hemochromatosis, hemolytic anemias,
hemosiderosis, hypersensitivity to iron salts or
their components, and other anemic conditions
unless accompanied by iron deficiency
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Side Effects: Constipation, diarrhea, or an upset stomach
Adverse Effects: Chest pain, hypertension, hypotension, and
tachycardia
Rationa
Nursing Responsibilities
le
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➢ Assess nutritional status and ➢ To determine possible causes of
dietary history. anemia and the need for patient
teaching
➢ Assess bowel function for ➢ To easily refer and notify the
constipation and diarrhea. physician, and for them to take
immediate action using appropriate
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nursing measures
➢ Advise the client to report signs ➢ To refer it easily to the doctor when
of chest pain. something adverse happens
➢ Tell the patient to take tablets ➢ It may alter the therapeutic effect of
with juice or water but not with the drug and may upset the stomach.
milk or antacids.
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➢ Tell the patient about the ➢ For the patient to not be confused and
naturally occurring side effects, anxious about the normally occurring
including dark discoloration of side effects of the drug
the feces.
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Generic Name: Minerals+Cholecalciferol (Vitamin D3)
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Brand Name: Calciumade
Dosage / Route / Frequency: 60mg/Oral/OD
Pharmacologic Classification: Phosphate binder
Physiologic Classification: Calcium supplement
Mechanism of Action: When calciumade acetate is
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consumed with meals, it interacts with
dietary phosphate to generate an
insoluble calciumade phosphate
complex that is eliminated in the
stools, resulting in a drop in blood
phosphorus concentration.
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Indication: To help strengthen bones and make joints
flexible
Desired Effect: It helps to maintain optimal bone function
and lowers the risk of osteoporosis later in
life.
Contraindication: Patients with hypersensitivity to any of its
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components, hypercalcemia, hypercalciuria,
kidney failure, or severe renal disease.
Side Effects: Constipation, diarrhea, nausea, and an upset
stomach
Adverse Effects: Hypercalcemia, hypercalciuria, fever,
vomiting, increased thirst
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Rationa
le
➢ Record the amount and ➢ To determine possible causes of
consistency of stools. anemia and the need for patient
teaching
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➢ Inform the patient not to take ➢ It may alter the therapeutic effect of
their medications with milk or the drug and upset the stomach.
antacids, but rather with
water.
➢ Assess bowel function for ➢ To easily refer and notify the
constipation and diarrhea. physician, and for them to take
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immediate action using appropriate
nursing measures
➢ Instruct the client to report ➢ To refer it easily to the doctor when
adverse effects immediately. something adverse happens
➢ Encourage the patient to eat ➢ To facilitate absorption of calcium in
fruits rich in Vitamin C the body
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➢ Administer laxatives or stool ➢ To manage constipation
softeners as prescribed by
the physician.
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Generic Name: Biphasic Isophane Insulin
Brand Name: Glysolin
Dosage / Route / Frequency: 10 I.U/0.1ml /Subcutaneous/BID
Pharmacologic Classification: Short-acting insulins
Physiologic Classification: Antidiabetic
Mechanism of Action: Following injection into the subcutaneous
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tissue, the acidic solution is neutralized,
resulting in the formation of micro
precipitates from which minute amounts
of insulin glargine are continuously
released. This results in a smooth,
predictable time/concentration profile
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with fewer peaks and a longer duration of
action.
Indication: It is primarily used for the treatment of
type 1 and type 2 diabetes mellitus by
maintaining blood glucose levels.
Desired Effect: It enables the transfer of blood sugar to
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other bodily tissues, where it is used as
an energy source. It helps control blood
sugar and to prevent complications of
diabetes.
Contraindication: Hypoglycemia and hypersensitivity to
insulin or any component of it
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Side Effects: Drowsiness, edema, constipation, and
itching at the injection site
Adverse Effects: Hypoglycemia
Rational
e
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➢ Always check the label for the ➢ To make sure that it is the right
name and type of insulin. medication and for the patient’s safety
➢ Instruct the patient to alter the ➢ To prevent muscular injury, lower the
injection site with each injection. possibility of developing lumps, and
prevent atrophy behind the skin
➢ Ensure that the patient follows a ➢ To increase insulin’s efficiency and
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diet, exercise, and decent lessen the condition’s negative
hygiene routine. consequences
➢ Provide patient education about ➢ To increase patient understanding,
drug effects, and warning signs prevent patient anxiety, and encourage
to report. compliance
➢ Tell the patient to keep their ➢ To maintain its efficiency as it becomes
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insulin in the fridge at all times. less effective when exposed to

extremely high temperatures
CHAPTER XI
NURSING CARE PLAN
Nursing Assessment:
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➢ Subjective: The patient verbalized, “Magustwak ti mangan ngamin aglalo idi
haan nak pay masikog nalaing nak a mangan idi ti nasasam-it. Paboritok
tay native a mangga”.
➢ Objective:
Weight: 119 kg, BMI = 50/Obese III
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Nursing Diagnosis:
Obesity related to excessive food consumption as evidenced by body mass index
of 50
Nursing Inference:
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When food intake exceeds the body's needs, it can lead to imbalance nutrition
because the body is receiving more nutrients than it requires. This can lead to an
excess intake of calories, fats, carbohydrates, and proteins, which can contribute
to weight gain.
Nursing Goal:
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Within 1 to 2 hours of rendering nursing interventions, the client will be able to
identify behaviors that remain under her control, and verbalize accurate information
about the benefits of weight loss.
Nursing Interventions Rationale
1. Explore and discuss emotions This helps identify when the client is
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and events associated with eating to satisfy an emotional need,
eating. rather than physiological hunger.
2. Emphasize the importance of Fad diets can be harmful to one's health
avoiding fad diets. and are often unsustainable in the long
run. These diets can lead to nutrient
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deficiencies, metabolic damage, and
even disordered eating habits.
3. Identify realistic increment goals Reasonable weight loss results in more
for weekly weight loss. lasting effects. Excessive and rapid loss
may result in fatigue and irritability and
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ultimately lead to failure in meeting
goals for weight loss.
4. Develop an appetite re-education Developing an appetite re-education
plan with the client. plan, the client can learn to recognize
their body's signals of hunger and
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fullness, differentiate between emotional
and physical hunger, and develop
healthier eating habits.
5. Emphasize the importance of Reducing tension provides a more
avoiding tension at mealtimes relaxed eating atmosphere and
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and not eating too quickly. encourages more leisurely eating
patterns. This is important because a
period of time is required for the
appestat mechanism to know the
stomach is full.
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6. Encourage the client to eat only Techniques that modify the behavior
at a table or designated eating may be helpful in avoiding diet failure.
place and avoid standing while Behavioral modification for weight loss
eating. addresses learned behaviors that
contribute to excessive food intake, poor
dietary choices or habits, and sedentary
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activity habits
7. Consult with a dietitian to Individual intake can be calculated by
determine caloric and nutrient several different formulas, but weight
requirements for individuals’ reduction is based on the basal caloric
weight loss. requirement for 24 hours, depending on
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the client’s sex, age, current and desired
weight, and length of time estimated to
achieve the desired weight.
Nursing Evaluation:
After 2 hours of rendering nursing intervention, the client was able to identify and
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understand inappropriate behaviors and consequences associated with excessive
food intake or weight gain.
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Nursing Assessment:
➢ Subjective: The patient verbalizes “Mamin-ado nak a agriing ti rabii ata
agkaraisbo ak, isu putol-putol ti pinag turog ko, pasaray narigat ko pay a
maala nukwan”.
➢ Objective:
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Frequent urination, lack of energy
Nursing Diagnosis:
Disturbed sleep pattern related to physiological interruption as manifested by
frequent urination, lack of energy, and verbal complaints of difficulty falling asleep
Nursing Inference:
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Due to the affectation of the kidney in GDM, it causes increased glucose attraction
from water resulting in increased urine output or polyuria, causing the patient to
need to void during the night, which leads to interrupted sleep.
Nursing Goal:
Within 5 - 7 days of rendering nursing interventions, the client will be able to
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achieve an improved sleeping pattern.
1. Assess past patterns of sleep in Sleep patterns are unique to each
a normal environment, amount, individual.
length, position, and bedtime
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rituals.
2. Encourage the patient to void To reduce the amount of urine in the
before going to sleep. bladder therefore decreasing the
number of voiding at night
3. Advised patient to take afternoon Afternoon naps will help reduce
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naps. fatigue due to lack of sleep.
4. Suggest use of soporifics To facilitate sleep, because milk is
such as milk if permitted by composed of L-tryptophan, which can
the doctor. improve sleep by increasing melatonin
5. Instruct the patient to follow as This promotes regulation of the
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consistent a daily schedule for circadian rhythm and reduces the
retiring and arising as possible. energy required for adaptation to
changes.
6. Provide a comfortable To promote minimal interruption in sleep

environment. or rest
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Nursing Evaluation:
After 6 days of rendering nursing intervention, the client was able to able to
achieve an improved sleeping pattern.
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➢ Subjective: The patient verbalizes “Madlaw ko ket medyo agkapsut nak nu
malpas nak a umisbo”.
➢ Objective:
Increased thirst, frequent urination, weakness, poor skin turgor, and sunken
352
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eyeballs
Nursing Diagnosis
Fluid volume deficit related to increased metabolic rate as evidenced by poor skin
turgor, weakness and frequent urination
Nursing Inference:
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An increased metabolic rate can lead to fluid volume deficit because it can cause
the body to lose fluids through sweating, urination, and breathing. When the body's
metabolism increases, it produces more heat. This heat is released through
sweating, which can cause the body to lose fluids. Additionally, an increased
metabolic rate can cause the kidneys to produce more urine, which can also lead
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to fluid loss. Finally, an increased metabolic rate can cause the body to breathe
faster, which can lead to fluid loss through the lungs.
Nursing Goal:
Within 2-3 hours of rendering thorough nursing interventions, the patient will be
able to understand lifestyle changes to avoid progression of dehydration.
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1. Urge the patient to drink the Oral fluid replacement is indicated for
prescribed amount of fluid. mild fluid deficit and is a cost-effective
method for replacement treatment.
Older patients have a decreased sense
of thirst and may need ongoing
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reminders to drink.
2. Emphasize the importance of oral A fluid deficit can cause a dry, sticky
hygiene. mouth. Attention to mouth care
promotes interest in drinking and
reduces the discomfort of dry mucous
membranes.
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3. Teach the patient about possible Enough knowledge aids the patient in
causes and effects of fluid loss or taking part in their plan of care.
decreased fluid intake.
4. Emphasize the relevance of Increasing the patient’s knowledge level

maintaining proper nutrition and will assist in preventing and managing
hydration. the problem.
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5. Identify an emergency plan, Some complications of deficient fluid

including when to ask for help. volume cannot be reversed in the home
and are life-threatening.
Nursing Evaluation:
After 3 hours of rendering nursing intervention, the patient was able to verbalize
the understanding of lifestyle changes to avoid progression of dehydration.
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CHAPTER XII
GENERAL EVALUATION
Gestational Diabetes Mellitus can have serious effects on both the mother
and the fetus if not treated properly. A major part of managing Gestational Diabetes
Mellitus involves educating the patient about diet, exercise, blood glucose self-
monitoring, and self-administration of insulin.
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The patient is a 36-year-old woman, who is currently residing at Bangui,
Ilocos Norte, diagnosed with Gestational Diabetes Mellitus on February 07, 2023.
She always goes for a clinical visit/check-up twice a month at Dr. Coconut’s Clinic.
But ever since April 04, 2023, she has gone to the clinic weekly for a checkup to
monitor her condition. With an OB score of G-3 P-2 T-2 P-0 A-0 L-2 M-0, Dr.
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Coconut prescribed her Ferrous Sulfate + Folic Acid, to be taken once a day,
Multivitamins once a day, and Insulin (Glysolin), which is to be injected twice a day.
Our first visit was on March 19, 2023. We took her blood sugar level using a
glucometer, with a result of 159 mg/dL. At that time, the patient was not injecting
insulin yet, but since April 04, 2023, her doctor has prescribed her insulin, which is
Glysolin, which helps her lower her blood sugar level. On our second visit (April 09,
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2023), we took her blood sugar level again, and it resulted in 120 mg/dL. Now that
she has given birth to her third child, she is still continuously monitoring her blood
sugar. On May 19, 2023, we again assessed our patient's blood sugar using a
glucometer, and its result was 110 mg/dL.
With those data, it can be seen that a case study is really important because,
through it, some of the health problems and health needs of the patient have been
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identified, and thus, solutions have also been planned. Through this case study, the
student nurses were able to achieve their goal, which was to identify, plan,
implement, and evaluate the results of the strategies that had been implemented in
the patient. Through that, the patient will also be helped because her knowledge has
also been expanded, just as it has for the student nurses.
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DOCUMENTATION
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REFERENCES
Gestational Diabetes Mellitus. (2004, August 2). Medscape.

https://www.medscape.com/viewarticle/483810_7
Diabetes and Pregnancy

https://nnc.gov.ph/regional-offices/mindanao/region-ix-zamboanga-
peninsula/5187-diabetes-and-pregnancy
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Nitrite-Positive Urine: Causes & Treatments. (n.d.). Cleveland Clinic.

https://my.clevelandclinic.org/health/symptoms/24400-nitrite-positive-urine
Phn, A. C. R. B. (n.d.). NurseStudy.Net. NurseStudy.Net.
https://nursestudy.net/
Bsn, P. M., RN. (2023). 8 Gestational Diabetes Mellitus Nursing Care Plans.
375
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Nurseslabs. https://nurseslabs.com/gestational-diabetes-mellitus-nursing-
care-plans/8/
Urinalysis: What It Is, Purpose, Types & Results. (n.d.). Cleveland Clinic.
https://my.clevelandclinic.org/health/diagnostics/17893-urinalysis
What is the Havighurst Developmental Tasks Theory?
https://www.psychologynoteshq.com/development-tasks/
376
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NCI Dictionary of Cancer Terms
https://www.cancer.gov/publications/dictionaries/cancer-terms/def/serology-
test
Iron-Folic Acid Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing -
WebMD. (n.d.).
https://www.webmd.com/drugs/2/drug-2557/iron-folic-acid-oral/details
377
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Havighurst's Developmental Task Theory. (n.d.). Peoi.org.
https://www.peoi.org/Courses/Coursesen/nursepractice/ch/ch6a.htm
Havighurst's Developmental Task Model - Video & Lesson Transcript. (2021,

October 20). Study.com.
https://study.com/academy/lesson/havighursts-developmental-task-
model.html
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Diabetes. (n.d.). Cleveland Clinic.

https://my.clevelandclinic.org/health/diseases/7104-diabetes
Cirrhosis - Symptoms and causes - Mayo Clinic. (2023, February 11). Mayo
Clinic. https://www.mayoclinic.org/diseases-conditions/cirrhosis/symptoms-
causes/syc-20351487
Parkinson’s Disease: Causes, Symptoms, and Treatments. (n.d.). National

Institute
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on Aging. https://www.nia.nih.gov/health/parkinsons-
disease#:~:text=Parkinson's%20disease%20is%20a%20brain,have
%20difficulty%20walking%20and%20talking.
High blood pressure (hypertension) - Symptoms and causes - Mayo Clinic.

(2022, September 15). Mayo Clinic.
https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/sympto
s-causes/syc-20373410
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O’Connell, K. (2018, May 29). What Is Serology? Healthline.

https://www.healthline.com/health/serology#followup
News-Medical.net. (2019, February 27). Hematology Tests.

https://www.news-medical.net/health/Hematology-Tests.aspx
Insulin isophane Uses, Side Effects & Warnings. (n.d.). Drugs.com.

https://www.drugs.com/mtm/insulin-isophane.html
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Iron and Folic Acid: Indications, Side Effects, Warnings. (n.d.). Drugs.com.
https://www.drugs.com/cdi/iron-and-folic-acid.html
Conditions. (n.d.).
https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx
?%20hwid=ad1603
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Diabetic neuropathy - Symptoms and causes - Mayo Clinic. (2022, April 29).
Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/diabetic-
%20neuropathy/symptoms-causes/syc-20371580
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NCM 109

CARE OF MOTHER & CHILD AT RISK W/ PROBLEM (ACUTE & CHRONIC)

RELATED LEARNING EXPERIENCE

Gestational diabetes mellitus is defined as diabetes that is first diagnosed in

CARE OF MOTHER & CHILD AT RISK W/ PROBLEM (ACUTE & CHRONIC)

RELATED LEARNING EXPERIENCE

Gestational diabetes occurs as a result of insulin resistance during pregnancy.

Adequate blood glucose control is important in helping prevent complications in the

CARE OF MOTHER & CHILD AT RISK W/ PROBLEM (ACUTE & CHRONIC)

RELATED LEARNING EXPERIENCE

require additional pharmacologic therapy, including insulin, metformin, or glyburide.

or two women in every 10 are at risk of gestational diabetes. Gestational diabetes

Federation of Endocrine Societies Study Group on Diabetes in Pregnancy

CARE OF MOTHER & CHILD AT RISK W/ PROBLEM (ACUTE & CHRONIC)

RELATED LEARNING EXPERIENCE

CARE OF MOTHER & CHILD AT RISK W/ PROBLEM (ACUTE & CHRONIC)

RELATED LEARNING EXPERIENCE

It is proposed that gestational diabetes mellitus is related to a change in the

CARE OF MOTHER & CHILD AT RISK W/ PROBLEM (ACUTE & CHRONIC)

RELATED LEARNING EXPERIENCE

however, in some women, this is insufficient to maintain blood sugar control.

preeclampsia (onset of high blood pressure and proteinuria after 20 weeks’

gestation), and macrosomia (delivery of a larger-than-average baby). These

CARE OF MOTHER & CHILD AT RISK W/ PROBLEM (ACUTE & CHRONIC)

RELATED LEARNING EXPERIENCE

CARE OF MOTHER & CHILD AT RISK W/ PROBLEM (ACUTE & CHRONIC)

RELATED LEARNING EXPERIENCE

CARE OF MOTHER & CHILD AT RISK W/ PROBLEM (ACUTE & CHRONIC)

RELATED LEARNING EXPERIENCE

rendering care to patients to expand their understanding of providing optimum care

CARE OF MOTHER & CHILD AT RISK W/ PROBLEM (ACUTE & CHRONIC)

RELATED LEARNING EXPERIENCE

The student should be able to:

1.Establish a trusting relationship with the patient.

Data, Family Background, Health History (Family Health History, Personal

Health History), Developmental Data using Havighurst’s Theory,

CARE OF MOTHER & CHILD AT RISK W/ PROBLEM (ACUTE & CHRONIC)

RELATED LEARNING EXPERIENCE

Pathophysiology, Physical Assessment, Patterns of Functioning and Medical

Determine the priority nursing/ health problem of the patient

3. Formulate the appropriate nursing diagnosis.

CARE OF MOTHER & CHILD AT RISK W/ PROBLEM (ACUTE & CHRONIC)

RELATED LEARNING EXPERIENCE

problems of the client.

CARE OF MOTHER & CHILD AT RISK W/ PROBLEM (ACUTE & CHRONIC)

RELATED LEARNING EXPERIENCE

CARE OF MOTHER & CHILD AT RISK W/ PROBLEM (ACUTE & CHRONIC)

RELATED LEARNING EXPERIENCE

CARE OF MOTHER & CHILD AT RISK W/ PROBLEM (ACUTE & CHRONIC)

RELATED LEARNING EXPERIENCE

CARE OF MOTHER & CHILD AT RISK W/ PROBLEM (ACUTE & CHRONIC)

RELATED LEARNING EXPERIENCE

Name of Client: Mrs. Grapes Fruit

Address: Bangui, Ilocos Norte

Age: 36 years old

Birthdate: January 08, 1987

CARE OF MOTHER & CHILD AT RISK W/ PROBLEM (ACUTE & CHRONIC)

RELATED LEARNING EXPERIENCE

Birthplace: Bangui, Ilocos Norte

Civil Status: Married

Religión: Iglesia Filipina Independiente

Educational Attainment: High School Graduate

CARE OF MOTHER & CHILD AT RISK W/ PROBLEM (ACUTE & CHRONIC)