SISTER NIVEDITA GOVERNMENT NURSING COLLEGE IGMC, SHIMLA

SUBJECT- NURSING EDUCATION

LESSON PLAN ON
Gestational diabetes

SUBMITTED TO: SUBMITTED BY:

Mrs. Sarita Thakur Madam Anjali Bhardwaj
Clinical Instructor cum Tutor MSc Nursing 1st year
S.N.G.N.C, IGMC,SHIMLA Roll no 1

SUBMITTED ON:
15-12-2017

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IDENTIFICATION DATA

 Name of the student teacher : Ms. Anjali Bhardwaj

 Class : M.Sc Nursing Ist year

 Name of the subject : Nursing Education

 Name of the topic : Gestational Diabetes

 Group : Post Basic B Sc. Nursing 1st year student

 Name of the evaluator : Mrs. Sarita Thakur Madam

 Duration of teaching : 45min

 Method of teaching : Lecture cum discussion

 Av aids : White board, power point presentation, charts, handouts

 Previous knowledge of the group : Students have some previous knowledge about the topic

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 OBJECTIVES
 General objective -
 At the end of the teaching,the student will gain the knowledge about the Gestational Diabetes

 Specific objective
At the end of the teaching, the students will be able :

1. To introduce the topic.

2. To define gestational diabetes

3. To discuss carbohydrate metabolism in pregnancy.

4. To enlist potential cases for gestational diabetes

5. To explain clinical manifestations in gestational diabetes.

6. To discuss screening in gestational diabetes.

7. To discuss management in gestational diabetes.

8. To Summarize and conclude the topic.

9. To recaptualize the topic.

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S. No. TIME SPECIFIC CONTENT TEACHING A/V AIDS EVALUATION
OBJECTIVE LEARNING
ACTIVITY
1. 1 min Self introduction: Myself Anjali Bhardwaj student of M.Sc.
Nursing 1st year. Today my topic of teaching is "Gestational
Diabetes”

2. 1 min Introduction: Discussion PPT

method
Pregnancy induces progressive changes in maternal carbohydrate
metabolism. As pregnancy advances insulin resistance and
diabetogenic stress due to placental hormones necessitate
compensatory increase in insulin secretion. When this compensation
is inadequate gestational diabetes develops.
Gestational diabetes and impaired glucose tolerance (IGT) in
pregnancy affects between 2-3% of all pregnancies and have been
associated with pregnancy complications.
3. 2 min To define Definition- Lecture cum Blackboard Students are
gestational discussion able to define
 The term Gestational Diabetes Mellitus includes cases with
diabetes method. gestational
abnormal carbohydrate tolerance with onset or first detected
during the present pregnancy. diabetes.
 Gestational Diabetes Mellitus’ [GDM] is defined as
carbohydrate intolerance with onset or recognition during
pregnancy.
4. 5 min To discuss Carbohydrate Metabolism In Pregnancy- Lecture cum chart Students
carbohydrate discussion became able to
The fetus obtains glucose from its mother via the placenta by a process of
metabolism in facilitated diffusion. From the 10th week of pregnancy, there is a
method. discuss
pregnancy. progressive fall in the maternal fasting glucose level. carbohydrate
metabolism in
During the third trimester, the mother begins to utilize fat stores, which pregnancy.
were laid down during the first two trimesters. This results in a rise in free
fatty acids and glycerol in the blood stream and the woman will become
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 ketotic more easily.
The fetoplacental unit alters the mother’s carbohydrate metabolism in
order to make glucose more readily available. The placenta manufactures
human placental lactogen (HPL), which produces a resistance to insulin in
the maternal tissues.
This result in blood glucose levels, which are higher after meals and
remain, raised for longer than in the non-pregnant state.
Estrogen and progesterone contribute to these changes and at the end of
pregnancy cortisol level rise, which also leads to rise in blood glucose.

5 2 mins To enlist Potential Cases For Gestational Diabetes Mellitus- Lecture cum PPT Students
potential discussion became able to
 positive family history of diabetes (parents or siblings).
cases for method enlist potential
gestational  Having a previous birth of an overweight baby of 4kg or more. cases for
 Previous stillbirth with pancreatic islet hyperplasia revealed on
diabetes gestational
autopsy.
diabetes.
 Unexplained perinatal loss
 Presence of polyhydramnios
 Persistent glycosuria
 Age over 30

6. 3min To describe Lecture cum Flash cards Students became

Clinical Manifestations-
clinical method able to clinical
manifestations Symptoms may manifestations of
of gestational  Blurred vision gestational
diabetes.  Fatigue diabetes.
 Frequent infections, including those of the bladder, vagina,
and skin
 Increased thirst
 Increased urination
 Nausea and vomiting
 Weight loss despite increased appetite
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7. 8 min To discuss the Screening- Discussion Ppt Students
screening for method discussed the
gestational screening
diabetes. procedure for
gestational
diabetes

Lecture
method Ppt

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8. 3min To discuss Effects Of Diabetes On Pregnancy- Lecture cum Black Students
the effect of discussion board, ppt discussed the
When diabetes is well controlled, its effect on pregnancy is minimal.
diabetes on method effects of
If the control is inadequate, there may be complications.
pregnancy. diabetes on
 Increased incidence of macrosomia and birth trauma pregnancy
 Perinatal mortality rate among infants of diabetic mothers is
markedly increased.
 More prone to urinary tract infections and greater
susceptibility to candida albicans.

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 9. 2 mins To describe Effects Of Pregnancy On Diabetes- Lecture cum ppt Students
the effect of In the early stages diabetic control may be complicated by nausea discussion understood the
pregnancy and vomiting. As the fetus grows, the mother needs more method. effects of
on diabetes. carbohydrate and ketosis is induced more easily, particularly in later pregnancy on
stages of pregnancy. The diabetic who is controlled by diet may diabetes.
become dependent on insulin.

10. 2mins To explain Effect On The Fetus - Lecture ppt Students

the effect on Severe maternal ketosis can cause intrauterine death. Neural tube method explained the
the fetus defects are twice as common amongst babies of diabetic mothers effect of
and defects in the kidney and heart are seen. gestational
diabetes on
fetus.
11. 10 min To explain Management- Lecture cum Ppt and Students
the discussion black described the
management Pre conceptional counseling method board management of
of Pregnancy may lead to a deterioration of the diabetes and hence the gestational
gestational woman must be carefully examined for the presence of renal, diabetes.
diabetes cardiovascular or retinal changes before becoming pregnant. The
woman will need to continue using some form of contraception
while improving control of her diabetes.
Principles Of Management-
 Careful antenatal supervision and control of diabetes, to
maintain the glucose level as near to physiological level as
possible.
 To find out the optimum time and method of delivery.
 To make arrangements for the care of the newborn.
Medical management- Target glucose values-
 Fasting PG below 5.3 mmol/L
 1h postprandial below 7.8 mmol/L
 2h postprandial below 6.7 mmol/L
Non pharmacological management-
Pharmacological management-If women do not achieve glycemic

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targets within 2 weeks from nutritional therapy alone, insulin
therapy should be initiated
Rapid-acting bolus analog insulin may be used over regular insulin
for postprandial glucose control although perinatal outcomes are
similar.For women who are non-adherent to or who refuse insulin,
glyburide or metformin may be used as alternative agents for
glycemic control. Use of oral agents in pregnancy is off-label and
this should be discussed with the patient.
Nursing Responsibilities-
Antenatal care
 Antenatal supervision should be at monthly intervals up to
20th week and thereafter at two weeks interval up to 30th
week.
 The daily calorie requirement is about 30-35kcal per kg of
bodyweight and an additional 200kcal for the need of the
fetus. Fat may be reduced if the woman is obese.
 Fiber containing food items are increased and a four-meal
regimen with a bedtime snack is usually advised. Oral
hypoglycemic agents are changed to insulin.
 Frequent blood glucose estimation is required.
 Assessment of the fetal well-being is to be made from 32nd
week onwards.
Labour And Delivery-
Induction of labor is done is in the presence of following
indications:
 Multipara with good obstetrical history
 Young primigravida without any obstetric abnormality.
 Presence of congenital malformation of the fetus
Induction is done by low rupture of membranes and simultaneous
oxytocin drip. Discussion Ppt
Cesarean section is indicated in the following conditions: method
 Elderly primigravidae
 Multigravida with bad obstetrical history
 Diabetes difficult to control.
 Obstetrical complications like pre-eclampsia,
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  polyhydramnios and malpresentation
 Presence of large baby.
Spontaneous onset of labour at term and vaginal delivery are
awaited in the following conditions:
 Young primigravidae or multiparae with good obstetrical
history.
 Diabetes well controlled either by diet, insulin or both or
without any obstetrical complications.
During labour, control of blood glucose is achieved through
administration of IV dextrose and soluble insulin with hourly
estimation of blood glucose.(4.0 and 7.0 mmol/L) Epidural
anaesthesia is preferred than strong analgesics as they might depress
the fetal respiratory center.
The nurse should monitor fetal condition throughout labour using
electronic fetal monitoring.
A pediatrician should be present during the delivery especially if
labour has been induced as a baby with premature lungs may require
resuscitation.
Postnatal Care-
A diabetic mother who is breastfeeding should be encouraged to
increase her carbohydrate intake by 50mg a day because of the
increased nutritional demands.
The diabetic women are more prone to infection and delayed
healing. Antibiotics are given prophylactically to minimize
infection.
Women should be screened with a 75g OGTT between 6 weeks
and 6 months postpartum to detect prediabetes and diabetes.
12 2min To conclude Conclusion- gestational diabetes is an important topic to be
the topic concerned in the aspect of nurses as nurses can prevent maternal and
fetal complications by early diagnosing of gestational diabetes,
proper antenatal, intarnatal and postnatal care.
13 1 min To Today we discussed about-
summarise Introduction of gestational diabetes
the topic Definition
Carbohydrate metabolism in pregnancy
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 Potential cases
Clinical manifestations
Screening
Effects of diabetes on pregnancy
Effects of pregnancy on diabetes
Effects on fetus
Management-
Medical and nursing responsibilities.
Conclusion.

14 3mins To 1. Define gestational diabetes Discussion Students

recaptualize 2. Who are more prone cases for gestational diabetes? method understood the
the topic 3. Explain carbohydrate metabolism in pregnancy. topic
4. Explain mana Gement of gestational diabetes during labour

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