Case Analysis GDM Final

Cotabato Medical Foundation College, Inc
Quezon Ave. Poblacion 8, Midsayap, Cotabato

Tel: 064-229-8207
CLINICAL
CASE ANALYSIS WORKSHEET
Submitted by
Abbas, Ayessah Fatima A.

Baterna, Adonis Charles D.
Cabasag, Mary Grace M.
Bernabe, Mayfer M.
Alamada, Ashlea A.
Anso, Bai Rejan B.
Adam, Bailailah N.
Abubakar, Aisa T.
Aliman, Nortaliza
Aling, Jenylyn P.
Cane, Valerie C.
1
Tel: 064-229-8207
Date Presented:
Date Submitted: April 30, 2021
2nd Semester SY 2021
TABLE OF CONTENTS
Page
COVER PAGE
Introduction (Includes the Background and Rationale of the analysis) . . . . . . . . .3-4
Scenario (if presented in a virtual progressive scenario, write the summary) . . …5
Phenomenon (Series of incidents leading to the occurrence
of the main (health) problem) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Concept Map (brief but concise graphical presentation of the phenomena) . . . . . 7
Learning Objectives (SMART; includes the main parts of the Clinical
Case Analysis Worksheet; Nursing Process – Approached) . . . . . . 8
Clinical Case Analysis Worksheet
Patient’s Personal Data
I. Family Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
II. Developmental Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
III. Chief Complaints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
IV. Health History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
V. Complete Diagnosis of the case chosen . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
a. Definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Etiology………………………………………………………………………..12-13
c. Symptomatology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
d. Anatomy and Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
e. Pathophysiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15-18
VI. Medical Management
a. Laboratory Interpretation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . …20-27
b. Drug Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-30
Nursing Management
a. Nursing Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..31
b. Nursing Care Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32-37
VII. Evaluation and Implication of the case to:
a. Nursing Practice (What might the case mean for other nurses?) . . . . . .38
b. Nursing Education (What might the case contribute to education).. . …..38
c. Nursing Theory (applicable nursing theory in the care of the case) . . . ..39
d. Nursing Research (any related issues that may need investigation) . ….39
VIII. Recommendations/Referrals/ Follow – ups . . . . . . . . . . . . . . . . . . . . . . . . 40-41
IX. Journal Reading Related to the Case (EBP Readings) . . . . . . . . . . . . . . . 42-43
X. REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44-45
APPENDIX (Any relevant documentation as long as it will
not violate the Intellectual Property Rights) . . . . . . . . . . . . . . . . . . . . . . ….46
2
Tel: 064-229-8207
INTRODUCTION
Inconveniences of pregnancy are medical issues that happen during pregnancy. They
can include the mother's wellbeing, the infant's wellbeing or both. A few ladies have medical
conditions that emerge during pregnancy and different ladies have medical issues before they
become pregnant that could prompt entanglements. It is vital for ladies to get medical services
previously and during pregnancy to diminish the danger of pregnancy difficulties.
In the United States, about 1% to 2% of pregnant women have type 1 or type 2 diabetes
and about 6% to 9% of pregnant women develop gestational diabetes. Diabetes during
pregnancy has increased in recent years. Recent studies found that from 2000 to 2010, the
percentage of pregnant women with gestational diabetes increased 56% and the percentage of
women with type 1 or type 2 diabetes before pregnancy increased 37%.
The gestational diabetes mellitus is defined as any degree of glucose intolerance with
onset or first recognition during pregnancy reported to have a prevalence of 14% in the
Philippines and 7.5% at the University of Santo Tomas Hospital, a tertiary hospital in Manila. In
postpartum glucose intolerance among Filipino women with GDM is high. Implement
compliance to postpartum glucose testing must be formulated to increase rates of follow-up
testing among these women.
A good nutrition and diet are so important in pregnancy, this case analysis presents,
L.Y. 28 years old gravid woman, 26th weeks of pregnancy and is a primigravida. Her pre-
pregnancy body mass index is 25. She is concerned about her gestational diabetes mellitus
and her diet history that is high in noodles and rice with little protein and her lactose intolerant.
This case analysis focuses in promoting proper diet in a pregnant woman and to elevate
the readers awareness of healthy diet for nutrition in the pregnant woman. Eating a balanced,
3
Tel: 064-229-8207
healthy diet can help you manage gestational diabetes mellitus and a walking exercise the
easiest type of exercise for pregnant woman, it's prevented complications during pregnancy
period. In gestational diabetes mellitus the possible complications are raises your risk of high
blood pressure, as well as preeclampsia a serious complication of pregnancy that causes high
blood pressure and other symptoms that can threaten the lives of both mother and baby.
In this case analysis, it is useful in promoting optimum healthy diet in pregnant woman
and to discuss and evaluate the clinical case occurring to the patient who has gestational
diabetes mellitus.
4
Tel: 064-229-8207
SCENARIO
GESTATIONAL DIABETES MELLITUS
L.Y., a 28-year-old gravid woman, arrives for her regularly scheduled obstetric appointment.
She is in her 26th week of pregnancy and is a primigravida. After physical examination the
patient, L.Y. is scheduled for a glucose challenge test. Chart review reveals that she is 5 feet,
3 inches and weighs 143 pounds; her pre-pregnancy body mass index (BMI) is 25. Her father
has type 2 diabetes mellitus (DM), and both paternal grandparents had type 2 DM.
Chart View
Time of Test Value Normal Range

0730 109 mg/dL Under 95 mg/Dl
0830 213 mg/dL Under 180 mg/dL
0930 162 mg/dL Under 153 mg/dL
She is treated with medical nutrition therapy as the primary treatment for the management of GDM.
Because treatment must begin immediately, the dietitian to come see L.Y. Other members of the DM
management team were also met later in the week.
During the meeting with the dietitian, L.Y. gives a diet history that is high in noodles and rice with little
protein. She informs the dietitian she is lactose intolerant but can have dairy products occasionally in
small portions.
Further, L.Y. is monitored for her fasting blood glucose first thing in the morning and 2 hours
after every meal, complete ketone testing using the first-voided urine in the morning.
L. Y. asks, “Will my baby be hurt?”
Metformin 500mg OD h is prescribed for L.Y. with supplemental insulin if the glycemic level is not
maintained. If postprandial blood glucose concentrations are high, rapid-acting insulin analogs (aspart)
5
Tel: 064-229-8207
is given before meals at a dose calculated to be 1.5 units per 10 g carbohydrate in the breakfast meal and
1 unit per 10 g carbohydrate in the lunch and dinner meals.
PHENOMENON
L.Y, 28 years old, 26 weeks pregnant primigravida.
During OBSTETRIC APPOINTMENT:
Family Assessment
-father has type 2 DM.
-both paternal grandparents have type 2 DM.
Client Assessment:
Ht: 5 feet, 3 inches and 143 pounds.
Wt: 143 lbs.
BMI: 25
Laboratory:
-glucose challenge test
-Complete ketone testing in urine
-fasting blood sugar
Management
-metformin 500mg OD
6
Tel: 064-229-8207
-medical nutrition therapy
-supplemental insulin if glycemic level is not maintained.
Diet History
High in noodles and rice and little protein
7
Tel: 064-229-8207
CONCEPT MAP
L.Y 28 y/o, 26th Diet history

week AOG, -high in noodles and
primigravida rice w little protein
-Dairy products
Family Client
Laboratory
Assessment Assessment
Father : type 2 Ht- 5 feet, 3

DM -Glucose
inches challenge test
Both paternal Wt-143 pounds
grand parent has -Ketone testing
type 2 DM BMI is 25 in urine
-FBS
Management/Tr
eatment:
-medical
nutrition therapy
-metformin 500
mg OD
- supplemental
LEARNING OBJECTIVES
insulin if
glycemic level
not maintained
8
Tel: 064-229-8207
After completing the clinical case analysis, the nursing student will be able to understand the
nature of the problem based on the diagnoses and its relation to family history. Specifically, the
students will;
1. obtain the health history of the patient.
2. identify the series of incidents leading to the occurrence of main problem.
3. present the concept map through a brief but concise graphical presentation.
4. discuss the developmental task/psycho-social according to Erik Ericson theory.
5. identify the chief complaint made by the client
6. discuss the basic symptomatology and etiology.
7. review the anatomy and physiology of the system and organ involved.
8. discuss the result of the laboratory interpretation.
9. explain the nursing management applicable to the health problem of the patient
10. formulate the accurate nursing diagnosis and develop a nursing care plan according to the
needs of the client.
11. explain the evaluation and implication of case to the nursing practice, nursing education,
nursing theory and nursing research.
12. present evidenced based information related to our case.
13. make recommendations, referrals or follow-ups for the future learners.
CLINICAL CASE ANALYSIS WORKSHEET
9
Tel: 064-229-8207
CONCEPT
PATIENT’S PERSONAL DATA:
Name (optional): L.Y., Age: 28 Sex: Female Civil Status: N/A
Religion: N/A Address: N/A
I. FAMILY BACKGROUND:
Occupation: N/A
Number of Siblings/Children: N/A
Obstetric history: Primigravida
Current Medical Status: G1, P0, 26-week AOG
Other Relevant Data
Father has T2 DM
Both paternal grandparents had T2 DM.
II. DEVELOPMENTAL DATA: Specify the Stage.
(Based on Havighurst’s and Erikson’s Life and Developmental Task/Psycho-Social).
A person chose’s a life partner, establish a family, take care of a home and established a
career. Erickson developmental task: (Intimacy vs. Isolation 18-40 years old) It is the sixth
stage of Erickson’s theory of psychosocial development, which happens after the
fifth stage of identity vs. role confusion. This stage takes place during young adulthood
between
10
Tel: 064-229-8207
the ages of approximately 19 and 40. Success at this age leads to fulfilling relationship.
According to him, intimacy is a loving relationship of any sort. It requires sharing yourself with
others. It can help you develop deeply personal connections. Isolation may prevent you from
developing healthy relationship. It may also be the result of relationship that fell apart and can
be a self-destructive cycle at this stage you have the choice to open yourself up to others and
share who you are and your experiences so that you can create lasting, strong connection
when you put yourself out there and have that trust returned you develop intimacy. If those
efforts are rebuked or you’re rejected in some way, you may withdraw fears of being
dismissed, spumed or hurt may lead you to separate yourself from other.
In our case, patient L.Y a primigravida and 26 weeks pregnant goes to the hospital alone for
her regular prenatal checkup. Being alone with all the pregnancy, confusion and complications
of the situation It’s hard to cope up with the stressors knowing that you don’t have someone to
lean on. Someone who can comfort you in the trying times and console you when you are
afraid. Especially when you are not expose and familiar to your current situation. The patient,
L.Y would most likely to develop isolation, because she doesn’t have any support system,
intimacy and companionship of another person. She might be experiencing rejection which
causes her to withdraw herself from someone she hoped to be with especially now that she’s
pregnant. And these factors may increase the risk for her to become lonely and isolated.
Whatever is the cause it can have a detrimental impact in your life that would lead you to feel
loneliness and become depressed.
Reference: Kozier and Erbs, Fundamental of Nursing. Volume 18 TH Edition Chapter 21 Page
368.
11
Tel: 064-229-8207
CHIEF COMPLAINTS: Nutrition and Diet
III. HEALTH HISTORY:

Past Illness/Surgery:
-Lactose Intolerance
Inclusive Period of Hospitalization: N/A
Present Illness: Gestational Diabetes Mellitus
Diet History: high in noodle and rice and little protein.
IV. COMPLETE DIAGNOSIS OF THE CASE CHOSEN
a. Definition (at least 2 Definition with Bibliography)
Gestational Diabetes Mellitus
-is a condition of abnormal glucose metabolism that arises during pregnancy.
-possible signal of an increased risk for T2 diabetes mellitus later in life.
Type 2 DM
-a state that usually arises because of insulin resistance combined with a relative deficiency in
the production of insulin.
Impaired glucose homeostasis
-a state between “normal” and “diabetes” in which the body is no longer using and/or secreting
insulin properly.
Reference: Flagg, J., & Pillitteri, A. 2018 Nursing Care of a Family Experiencing a Pregnancy
Complication from a Preexisting or Newly Acquired Illness. Maternal & Child Health Nursing:
Care of the Childbearing & Childrearing Family. 8TH Edition Volume 1, Pg. 515
12
Tel: 064-229-8207
13
Tel: 064-229-8207
B.Etiology
List all the Basic Actual Etiology on the
Rationale (Include the reference as endnote)
Etiology Patient
 Obesity   . women with normal glucose tolerance, the underlying pathophysiology of GDM is present before
pregnancy. Those destined to develop GDM exhibit decreased insulin sensitivity, before pregnancy,
the latter likely to being overweight and obese (World Health Organization. Obesity: preventing and
management of a global epidemic. World Health Organization Technical Report Ser. 2000; 894, 1–
4. [Google Scholar])
 Insulin resistance  all women appears to develop an insulin resistance as pregnancy progress or insulin does not seem


as effective during pregnancy. a phenomenon that is probably caused by the presence of hormone
 Unhealthy eating human placental lactogen.
habits  due to excessive eating of foods that contain high in calories.

 Type2 diabetes
 happens due to family inherited. Because her father and grandparents have the history of type 2
 Pancreatitis diabetes.
 there is a possible happens when the pancreas is unable to produce enough insulin to manage blood
 Age over 28 years
sugar levels. (1 Ramin KD, Ramin SM, Richey SD, Cunningham FG (1995) Acute pancreatitis in
 pregnancy. Am J Obstet Gynecol 173:187–191.)
 Pcos
Maternal age is an established risk factor for gestational diabetes mellitus.

(https://www.hopkinsmedicine.org/health/conditions-and-diseases/diabetes/gestational-diabetes?
amp=true)
 women have an increased risk of glucose intolerance, leading to type 2 diabetes characterized by
chronic anovulation, insulin resistance and androgen excess.
(Lo JC, et al. Increased prevalence of gestational diabetes mellitus among women with diagnosed
14
Tel: 064-229-8207
polycystic ovary syndrome: A population-based study. Diabetes Care 2006;29:1915–7.)
 If you have a family health history of diabetes, You are also more likely to get type 2 diabetes if you
 family history have had gestational diabetes, are overweight or obese.
diabetes (https://www.cdc.gov/genomics/famhistory/famhist_tools_resources.htm)
Actual
List all the Basic
Symptomatology Rationale (Include the reference as endnote)
Symptomatology
on the Patient
15
Tel: 064-229-8207
 Skin infection  due to hormonal changes
 Fatigue  due to unhealthy lifestyle choices
 Polydipsia  caused by too much sugar (glucose) in your blood.
 Polyuria  High blood sugar levels force your kidney to go into overdrive to get rid of the extra sugar.
 Polyphagia  blood glucose levels remain abnormally high (hyperglycemia), glucose from the blood cannot
enter the cells – due to either a lack of insulin or insulin resistance – so the body can't convert
the food you eat into energy.
 due to insufficient insulin production. (Medically reviewed by Deborah Weatherspoon, Ph.D.,

 Hyperglycemia R.N., CRNA — Written by Valencia Higuera on February 26, 2019)
 weight gain  Eating more calories than the body needs will lead to excess glucose levels. If the cells do not
remove glucose from the blood, the body will store it in the tissues as fat. When a person
takes insulin as a therapy for diabetes, their body may absorb too much glucose from food,
resulting in weight gain (Medically reviewed by Alan Carter, Pharm.D. — Written by Jamie
 glycosuria Eske on May 31, 2019)
 in all pregnancy, the glomerular filtration of glucose is increased causing slight glycosuria
C. Symptomatology
16
Tel: 064-229-8207
d.Anatomy and Physiology (Organ or System Involved)
The Endocrine System
The endocrine system is a series of glands that produce and secrete hormones that the body
uses for a wide range of functions. These control many different bodily functions, including:
Respiration. Metabolism. Reproduction.
PANCREAS- your pancreas makes pancreatic juices called enzymes. These enzymes break
down sugars, fats, and starches. Your pancreas also helps your digestive system by making
hormones.
BILE DUCT- (from gall bladder) are drainage that carry bile from the liver to the
gallbladder and from the gallbladder to the small intestine. A variety of diseases can affect your
bile ducts.
COMMON BILE DUCT- A tube that carries bile from the liver and the gallbladder through the
17
Tel: 064-229-8207
pancreas and into the duodenum (the upper part of the small intestine). It is formed were the
ducts from the liver and gallbladder are joined.
DOUDENUM OF SMALL INTESTINE- is to complete the first phase of digestion. In this
section of the intestine, food from the stomach is mixed with enzymes from the pancreas and
bile from the gallbladder. The enzymes and bile help break down food.
PANCREATIC DUCT- is a duct joining the pancreas to the common bile duct. This supplies it
with pancreatic juice from the exocrine pancreas, which aids in digestion.
ACINAR CELLS SECRETE DIGESTIVE ENZYMES- its primary responsibility is the
production, storage and regulated secretion of the large amounts of enzymes necessary for
the proper digestion and absorption of food.
SPLENIC ARTERY- is responsible for supplying oxygenated blood to the spleen, but also has
several branches that deliver blood to the stomach and pancreas. The branches of the splenic
artery is the short gastric, the left gastroepiploic, the posterior gastric, and the branches to the
pancreas.
PANCREATIC ISLETS-ALPHA CELLS, BETA CELLS, EXOCRINE ACINUS SPLEEN- α
cells secrete glucagon (increase glucose in blood). β cells secrete insulin (decrease glucose in
blood).
18
Tel: 064-229-8207
The Anatomy of Placenta
Villus- The villi of the small intestine project into the intestinal cavity, greatly increasing the
surface area for food absorption and adding digestive secretions.
Maternal vessels- The in-flowing maternal arterial blood pushes deoxygenated blood into the
endometrial and then uterine veins back to the maternal circulation.
Stratum spongiosium- is the large middle layer. It contains the main portions of uterine glands
and accompanying blood vessels;
Placental septum-which transmit fetal blood and allow exchange of oxygen and nutrients with
the maternal blood.
Chorion- are to protect and nurture the embryo. The chorionic fluid protects the embryo from
19
Tel: 064-229-8207
shock, and the chorionic villi allow the exchange of nutrients, oxygen and waste products with
the mother.
Amnion- thus providing a cushion against mechanical injury. The amnion also provides
protection against fluid loss from the embryo itself and against tissue adhesions.
trophoblast-are cells that form the outer layer of a blastocyst, which provides nutrients to the
embryo, and then develop into a large part of the placenta.
umbilical arteries- carry deoxygenated blood from fetal circulation to the placenta.
umbilical vein-The vein carries oxygen and nutrients from the placenta (which connects to the
mother’s blood supply) to the baby.
umbilical cord- it carries the baby’s blood back and forth, between the baby and the placenta.
It delivers nutrients and oxygen to the baby and removes the baby’s waste products.
20
Tel: 064-229-8207
e. Pathophysiology (Schematic Diagram as applied to your patient)
Predisposing factors Precipitating factors

 Patient 28 years old Patient L.Y 28 y/o  unhealthy lifestyle
 Female  too much eating of
26th week AOG
 Family history w/type 2 carbohydrates
DM Primigravida  overweight (BMI:25)
 Primigravida
Breakdown of glucose
Stimulates pancreas to
release insulin
Insulin helps blood sugar to

enter body’s cell
Surge of placental hormone
Human placental lactogen blocks

effect of insulin
Insulin Resistance
Promotes Endogenous Glucose stays in the

glucose production maternal bloodstream
GDM/ HYPERGLYCOMA
S/S Pancreas keeps making more insulin to

Weight gain promote absorption of glucose
Maternal Fetus
If treated If not treated

If not treated
If treated
Fetal receives Fetal hypoglycemia
Pre-enclampsia
Healthy pregnancy adequate glucose 21
Fetal hyperinsulinemia
1st trimester
Normal Delivery of Normal fetal
miscarriage Neonatal macrosomia
the fetus growth
Increased maternal Birth Trauma
Tel: 064-229-8207
V. MEDICAL MANAGEMENT
a. Laboratory Interpretation
Basic Diagnostic
Result of the
Procedures Required Purpose / Rationale Clinical Significance Intervention
Patient
with Normal Values
 measures your body's  A blood sugar level below 140  Have the client eat a
1. Glucose response to sugar mg/dL (7.8 mmol/L) is diet high in
DONE
challenge test (glucose). The glucose carbohydrates for 3
considered normal.
challenge test is done 7:30-109mg/dL days before the test
during pregnancy to
 A blood sugar level of 140
 The client is given a
screen for gestational 8:30-213mg/dL specified amount of
diabetes that develops mg/dL (7.8 mmol/L) or higher glucose (either 75 g or
9:30-162mg/dL might indicate gestational
during pregnancy. 100 g) as a lemon-flavor
 is given to determine diabetes. or glucola liquid after
how quickly glucose is fasting blood and urine
cleared from the blood.  Low insulin levels, combined samples are taken.
The test is used with hormonal changes, can  Keep the client NPO
to test for diabetes, lead to insulin resistance. except for water for 10
insulin resistance, hours before the test
impaired beta cell  observe the client for
higher than normal glucose levels:
function, reactive symptoms of
hypoglycemia,  Kidney disease, hyperglycemia and
acromegaly, and other hypoglycemia
Hyperthyroidism
disorders of  perform the test
Pancreatitis, Pancreatic
carbohydrate according to
metabolism cancer
manufacturers’
 To evaluate blood lower than normal glucose levels: instructions and local
glucose levels to assist guidelines
 Hypothyroidism, Too much
in diagnosing diabetes.  Apply direct pressure to
insulin or other diabetes
the venipuncture site
medicine, Liver disease
22
Tel: 064-229-8207
 Normal: 3.9 to 5.4 mmols/l (70 until bleeding stops.

2. Fasting blood  Provide a balanced
sugar test DONE to 99 mg/dl) meal or a snack.
 Prediabetes or Impaired  Instruct the patient that
he may resume his
Glucose Tolerance: 5.5 to 6.9
 used to test the usual medications that
effectiveness of different mmol/l (100 to 125 mg/dl) were stopped before the
medication or dietary  Diagnosis of diabetes: 7.0 test.
changes on people  Note on the laboratory
mmol/l (126 mg/dl) or above results when the patient
already diagnosed as
diabetic.  The American Diabetes last ate, when the
sample was collected,
 useful to see how well Association reduced the level
and when the patient
the body is able to of diagnosis in this test from received the last pretest
manage blood sugar dose of insulin or oral
levels in the absence of 140 to 126 mg/dl in 1997.
antidiabetic drug (if
food. When we do not  High fasting blood sugar levels applicable).
eat for several hours, point to insulin  Explain to the patient
the body will that he may experience
resistance or diabetes, while
release glucose into slight discomfort from
the blood via the liver abnormally low fasting blood the tourniquet and
and, following this, the sugar could be due to diabetes
needle puncture.
body's insulin should
medications.
help to stabilise blood
glucose levels.
 Monitor vital signs
 Check blood sugars and
treat with insulin as
ordered
 A normal test result is
negative- no ketones were  Educate the patient on
23
Tel: 064-229-8207
found in your blood

the importance of
3. Ketone testing  high blood ketone levels-
DONE compliance with diabetic
you have diabetic
medications
ketoacidosis (DKA)
 test positive for blood  Educate the patient on
ketones. These include: the importance of follow
Eating up
disorders, malnutrition, and  Encourage patient to
other conditions where the quit smoking and
body does not take in abstain from
 A ketones in blood test enough calories, Alcohol.
is mostly used to check Pregnancy. Sometimes
for diabetic ketoacidosis pregnant women will
(DKA) in people with develop blood ketones. If
diabetes. DKA can high levels are found, it can
affect anyone with mean gestational diabetes,
diabetes, but it is most a type of diabetes that only
common for people with affects pregnant women.
type 1 diabetes. If you
have type 1 diabetes,
your body does not
make any insulin,
the hormone that
controls the amount of
glucose in your blood.
People with type 2  Encourage the patient to
diabetes can make drink plenty of water.
insulin, but their bodies  Explain oral glucose
don't use it properly. tolerance test (OGTT) to
 risk for cesarean delivery- the patient.
neonatal hypoglycemia  Instruct the patient to
4. Oral glucose  macrosomia maintain a high
tolerance test carbohydrate diet for 3
24
Tel: 064-229-8207
days.
(OGTT)
 Tell that patient that he
NOT DONE or she needs to fast for
10 to 16 hours before
the test as ordered by
the physician.
 Remind the patient not
to smoke, drink alcohol
and coffee, and not to
eat 8-12 hours before
the test or during the
 evaluates how the body test.
manages glucose after
a meal. Glucose is a
type of sugar produced
when the body breaks
down carbohydrates co
nsumed in food. Some
of the glucose will be
used for energy; the rest
will be stored for future
use.
 Explain test procedure.
Explain that slight
discomfort may be felt
when the skin is
punctured.
 Encourage to avoid
 severe anemia- can cause stress if possible
a fetus to receive too little because altered
5. Complete blood oxygen to support normal physiologic status
count development. influences and changes
25
Tel: 064-229-8207
 High number in RBC- low normal hematologic

oxygen tension in the blood values.
NOT DONE (congenital heart disease,  Explain that fasting is
COR pulmonale, pulmonary not necessary.
fibrosis). However, fatty meals
 Low RBC- anemia, may alter some test
hemorrhage, bone marrow results as a result of
failure, hemolysis, leukemia lipidemia.
and multiple myeloma.  Apply manual pressure
and dressings over
puncture site on
removal of dinner.
 provides valuable  Monitor the puncture
information about the site for oozing or
blood and to some hematoma formation.
extent the bone marrow,
which is the blood-
forming tissue.
 as a preoperative test to
ensure both adequate
oxygen carrying  Instruct the patient to
capacity and void directly into a
hemostasis clean, dry container.
 to identify persons who Sterile, disposable
may have an infection containers are
 White blood cells- sign of recommended. Women
infection either in the kidney should always have a
or urinary tract. clean-catch specimen if
 Glucose- a high-sugar a microscopic
content is a maker for examination is ordered.
6. Urinalysis diabetes  Collect specimens form
infants and young
26
Tel: 064-229-8207
 Protein- sign that kidneys children into a

aren’t working normal disposable collection
NOT DONE apparatus. Depending
 Nitrates- there is infection
which certain kinds of on hospital policy, the
bacteria. collected urine can be
transferred to an
appropriate specimen
container.
 Mild anemia- make the
pregnant feel tired and  Cover all specimens
weak tightly, label properly
and send immediately to
the laboratory.
 Observe standard
 Few red blood cells in precautions when
 this test gives valuable pregnancy cause anemia. handling urine
diagnostic information specimens.
and to evaluate the cell
that circulate in blood,
consist of the blood are  Educate about home
RBC, WBC, and glucose monitoring.
platelets.  Review factors in
 To identify and prevent glucose instability
problems done at the  Encourage client to read
beginning of pregnancy labels. The client must
and also during choose foods described
pregnancy. as having a low
 Normal: HbA1c below 5.7% glycemic index, higher
 Prediabetes: HbA1c fiber, and low-fat
content.
between 5.7% and 6.4%
 Educate client on the
 Diabetes: HbA1c of 6.5%
functions of his or her
or higher medications because
27
Tel: 064-229-8207
7. HEMOGLOBIN Increase level: there are combinations

A1C of drugs that work in
NOT DONE  Poorly controlled Diabetes different ways with
Mellitus (DM) different blood glucose
 Non-Diabetic control and side effects.
Hyperglycemia:  Emphasize
the importance of
Stress, Cushing Syndrome, checking expiration
Pheochromocytoma,
dates of medications,
Corticosteroid Therapy
inspecting insulin for
Decrease level: cloudiness if it is
normally clear, and
Renal failure, Blood loss,
Hemolytic anemia, Sickle cell monitoring proper
anemia storage and preparation
because these affect
insulin absorbability
 measures the amount
of blood sugar (glucose)
attached to hemoglobin.
Hemoglobin is the part
of your red blood cells
that carries oxygen from
your lungs to the rest of
your body. An HbA1c
test shows what the
average amount of
glucose attached to
hemoglobin has been
over the past three
months. It's a three-
month average because
28
Tel: 064-229-8207
that's typically how long

a red blood cell life.
29
Tel: 064-229-8207
b. Drug Study (All drugs Indicated for the Patient’s Illness

Generic Dosage and Pharmacolog
Name Classificatio Route of ic Effects / Indication and Nursing
Side Effects
(Brand n Administrati Mechanism Contraindication Responsibilities
Name) on of Action
30
Tel: 064-229-8207
Metformin Therapeutic Decreases Indication:

class: 500mg. OD hepatic  Obtain patient’s  Diarrhea, Anorexia  Observe 14 rights
Brand Antidiabetics HS. glucose eGFR before  Vomiting before
name: Pharmacologi production starting drugs.  Hypoglycemia administering the
Glucophage, c class: and intestinal  Give drug with  Dizziness, drug.
Fortamet, Biguanides absorption of meals. Maximum lightheadedness  Instruct the pt. to
Riomet glucose and doses may be better take metformin
improves tolerated if total dose with meals it can
Generic insulin is divided and given help prevent or
name: sensitivity in three doses with limit the effects.
Metformin (increases meals.  Recommend the
hydrochlorid peripheral Contraindications: pt. to temporarily
e glucose  Patients with stop the
uptake and hypersensitive to medication until
use). drug and in those vomiting subsides.
with hepatic  Instruct the pt. to
disease. follow a well-
 Not indicated for use balanced diet.
in patients with type  Encourage the pt.
1 DM or diabetic to take vit. B12
ketoacidosis. supplements. And
do not stop taking
metformin without
talking to your
doctor.
31
Tel: 064-229-8207
Generi Pharmacologi
c Name Dosage and Route of c Effects / Indication and
Classification Side Effects Nursing Responsibilities
(Brand Administration Mechanism of Contraindication
Name) Action
Rapid- Therapeutic  1.5 units per 10g Lowers blood Indication:  Hypoglycemia  Observe 14 rights
acting class: carbohydrate in glucose level by  Usually given in a  Seizures before administering
insulin Antidiabetics breakfast meal stimulating regimen that includes  Injection site the drug.
analogs Pharmacologic  1 unit per 10g peripheral an intermediate acting reaction  Monitor glucose level
(aspart class: carbohydrate in glucose uptake or a long-acting  Weight gain closely and adjust
) Insulins lunch and dinner. by binding insulin. insulin dosage as
To insulin  Don’t use if solution needed.
Brand receptors on id viscous or cloudy;  Advice pt. that
name: skeletal muscle use only if clear and seizures episodes can
Aspart and in fat cells colorless. impair the ability to
and by Contraindication: concentrate and react;
inhibiting  Don’t use during advice pt. to use
hepatic glucose pregnancy unless caution while driving
production; also potential benefit and operating
inhibits lipolysis justifies risk to the machinery.
and proteolysis, fetus.  Instruct pt. on self-
and enhances  Monitor blood management
protein glucose levels closely procedures, including
synthesis. in pregnant pt. in proper administration
women who have technique.
recently given birth,  Instruct pt. to maintain
and in breastfeeding eat healthy foods and
women; insulin regular exercise.
requirements may
change.
32
Tel: 064-229-8207
33
Tel: 064-229-8207
VI. NURSING MANAGEMENT
a. Nursing Diagnosis (Write five according to priority needs.)
1. Imbalanced Nutrition: more than body requirement related to food intake that
exceeds body needs as evidenced by BMI of 25.
2. Health seeking behavior r/t lack of knowledge as evidenced by pt verbalization
“will my baby be hurt?”
3. Risk for Ineffective peripheral tissue perfusion related to too much glucose in the
bloodstream.
4. Risk for Fetal Injury r/t Elevated Maternal blood glucose level.
5. Risk for infection r/t high glucose level.
34
Tel: 064-229-8207
Nursing Objective of Nursing Actions with Rationale

Date / Cues Needs Diagnosis Evaluation
Care (@ least 5 nursing interventions)
P -Imbalanced Nutrition: After 1 week of 1.Review the patient’s diet history. Goal met
H More than body nursing Rationale: To help identify the patient’s eating habits After 1 week of
Objective: Y Requirement related to interventions and lifestyle that could be incorporated to the meal nursing
S food intake that the patient will plan. Consider the patient’s food preferences, eating interventions the
Ht-5 feet and 3 I exceeds body needs be able to times, food values, special needs, ethnic and cultural patient was able to
inches O as reduce her BMI backgrounds. Explore the patient’s need for weight achieved the BMI
Weight- 143 pounds L evidenced by BMI is from 25 to 23. management (weight loss, weight gain, or weight of 23 from 25.
BMI- 25 O 25. maintenance).
Diet- high in calories G Partially met
I 2.Weigh daily or as ordered. After 1 week of
C Rationale: Rationale: Weighing serves as an assessment tool to nursing
A determine the adequacy of nutritional intake. interventions the
L Eating large amount of A variety of different exercises keep the patient patient partially
carbohydrates may interested and motivated to continue to exercise. achieved the target
result to overweight Different workouts provide a variety that keeps the range of BMI, 24
N and high glucose level. patient engaged long term. from 25.
E
E 3. Ascertain understanding of individual nutritional Not met
D needs. After 1 week of
S Rationale: To determine what information to be nursing
/ provided to client or SO. interventions the
N patient was not
U 3.Recommend the patient to engage in light exercises able to achieved
T such as walking, and yoga. the target goal of
R Rationale BMI which is 23
I A variety of different exercises keep the patient from 25.
T interested and motivated to continue to exercise. .
I Different workouts provide a variety that keeps the
O patient engaged long term.
N
35
Tel: 064-229-8207
5. Discuss eating habits and encourage a diabetic diet

(balanced diet) as prescribed by the doctor.
Rationale: To achieve health needs of the patient with
the proper food diet for his condition.
values, special needs, ethnic and cultural backgrounds.
Explore the patient’s need for weight management
(weight loss, weight gain, or weight maintenance).
b. Nursing Care Plan (Develop 3 NCP from the 5 Nursing Diagnosis)

Date / Cues Needs Evaluation
Diagnosis Care (@ least 5 nursing interventions)
L Health seeking After 2 hours of Goal Met
Subjective: E behavior r/t lack of nursing care 1. initiate health teachings regarding aspart’s
A knowledge as interventions pharmacodynamics. After 2 hour of
“will my baby be R evidenced by pt the pt will be Rationale nursing
hurt?” as verbalized N verbalization “will my able to acquire Deals with the relationship between drug, intervention the
by pt. I baby be hurt?” knowledge dosage or concentration in the body and its drug patient was able to
N related to the effects, both desirable and undesirable. acquire knowledge
Objective: G Rationale: effects of 2. Assess ability to learn or perform desired health- related to the
aspart to her related care. effects of aspart to
Lack of information Patient is anxious baby. Rationale her baby.
G1P0 N about the effect of her Cognitive impairments must be recognized so
Anxious E condition to the fetal an appropriate teaching plan can be outlined. Partially Met
E development. 3. Provide clear, thorough, and understandable
D explanations and demonstrations. After 2 hour of
S Rationale nursing
Patients are better able to ask questions when intervention the
they have basic information about what to patient partially
expect. acquire knowledge
4. Give information with the use of media. Use related to the
visual aids like diagrams, pictures, videotapes, effects of aspart to
36
Tel: 064-229-8207
audiotapes, and interactive Internet websites, her baby by

such as Nurseslabs. repeatedly asking
Rationale questions again
Different people take in information in different and again.
ways.
5. Check the availability of supplies and
equipment.
Rationale
Adequate preparation is especially important
when teaching in the home setting. Not Met
After 2 hour of
nursing
intervention the
patient was not
able to acquire
knowledge about
the effects of
aspart to her baby.

Date / Cues Needs Evaluation
Diagnosis Care (@ least 5 nursing interventions)
37
Tel: 064-229-8207
S Risk for ineffective After 2 hrs. of Goal met

A peripheral tissue nursing care 1.Identify the presence of high risk factors or conditions
F perfusion r/t too much intervention the (e.g,. smoking, uncontrolled hypertension, obesity, After 2hours of
Objective: E glucose in the blood pt will be able pregnancy, pelvic tumor, paralysis, hyper nursing care
High glucose level T stream. to demonstrate cholesterolemia, varicose veins, arthritis, sepsis) intervention the pt
Y behaviors and Rationale was able to
- Chart View lifestyle Replace client at greater risk for developing peripheral demonstrate
N changes to vascular disease (including the arterial blockage and behaviors and
Time of Test Value E Rationale: improve chronic venous insufficiency) with associated lifestyle changes to
Normal Range E circulation. complications. improve circulation
0730 109 mg/dL D High glucose level will . 2.Ascertain impact of condition on functioning and like eating healthy
Under 95 S increase the blood lifestyle. diet, and perform
mg/Dl viscosity which will Rationale light exercises.
0830 213 mg/dL / result to alteration of For example leg pain may restrict ambulation or person
Under 180 blood flow. may develop skin ulceration and healing problems that Partially met
mg/dL H seriously impact quality of life
0930 162 mg/dL E 3.Note clients nutritional and fluid status. After 2hours of
Under 153 A Rationale nursing care
mg/dL L Protein energy malnutrition and weight loss make intervention the pt
T ischemic tissues more prone to breakdown. partially
H Dehydration reduces blood volume and compromise demonstrate
peripheral circulation. behaviors and
4.Collaborate and treatment of underlying conditions, lifestyle changes.
such as diabetes, hypertension, cardio pulmonary Eating healthy diet
conditions, blood disorders, traumatic injury, without exercise.
hypovolemnia, hyposemia.
Rationale
To maximize systemic circulation and organ perfusion.
5.Administer fluids, electrolytes, nutrients and oxygen Not met
as indicated.
Rationale After 2 hrs. of
To promote optimal blood flow, organ perfusion, and nursing
function. intervention the pt
38
Tel: 064-229-8207
was not able to

demonstrate
behaviors and
lifestyle changes to
improve
circulation.
39
Tel: 064-229-8207
VII. EVALUATION AND IMPLICATION OF THE CASE TO:
a.Nursing Practice
The study will provide the student nurses with the nutrition advice about nutrition
knowledge, attitude and skills towards the management care of practice having deficient
knowledge about proper diet and provides important information for the nurses because
nurses play an important role in overall management of a gestational diabetes mellitus.
Also, give the higher quality care practice to the patient. The knowledge given by this
study will help to know the most frequent causes of gestational diabetes mellitus and
the effective nursing interventions to the patient.
b.Nursing Education
Focuses on educating health care people about effective ways to deliver the health care
to patients, it is also the preparation of nurses who use critical thinking skills to provide
comprehensive patient-centered care to a variety of clients. The nursing student should
have a descriptive Information or ideas about the gestational diabetes mellitus. Nurse
should create awareness about the prevention advice, using behavior change and
health coaching techniques screening, early detection of type 2 diabetes mellitus,
assessing and meeting the patient’s nutritional needs and promoting self-care. We
recommend to include the self-management, prevention and intervention to widen and
strengthen the knowledge of the learners about the GDM.
40
Tel: 064-229-8207
c.Nursing Theory
Theory of Self-care by Dorothea Orem’s is best suited for our case study and for
application of care to our gestational diabetes mellitus patient. According to Orem’s self-
care theory, defined as the act of assisting others in the provision and management of
self-care to maintain or improve human functioning at the home level of effectiveness.
Orem’s theory is focuses on each individual’s ability to perform self-care the practice of
activities that individuals initiate and perform on their own behalf in maintaining life,
health, and well-being. This theory is related to our case study because providing self-
care to emphasizes the active role of people in their own healthcare, not the passive.
Self-Care is effective, learned, informed and objective activities and behavior of a
person that are done in concrete situation of life. The aim of self- care is to regulate the
effective factors on growth and patient’s performance in relation to life, health, and well-
being.
d.Nursing Research
Pregnancy is critical period when women are at high risk from gestational diabetes
mellitus in the first pregnancy. Gestational diabetes is a type of diabetes that happens
during pregnancy must work in partnership with their health care team to improve both
maternal and fetal outcomes. The study provides decreases dramatically for women
who engage in interventions to lose weight postpartum, improve their nutrition and
increase their physical activity. Therefore, postpartum women with GDM should be
retested and reclassified at 6 weeks postpartum and strongly encouraged to lose weight
through proper nutrition and exercise. Although the researcher proved that one
41
Tel: 064-229-8207
significance findings is exercise is an important part of glucose control and decreases
blood glucose levels by increasing glucose transfer into the cells without insulin. The
ideal management and proper intervention are done in order to give a more holistic
approach and optimum care to client with GDM.
VIII.RECOMMENDATION/REFERRALS/FOLLOW-UPS
RECOMMENDATION
Recommendation regarding to pregnant women:
 Attend routine care appointments
 Avoid packaged food and “junk food”
 Replacing candy with fruit
 Eating more lean protein, such as fish and tofu, to stay fuller for longer
 Increasing fiber intake by eating plenty of vegetables and whole grains
Recommendation regarding to patient with GDM:
 Encourage the mother to exercise regularly
 Encouraged to return to a healthy diet
 Eat healthy foods
 Make cereals as breakfast instead of coffee and pantry so that you can get
enough supply of iron daily
 Choose complex carbohydrates (such as whole grains and beans) over simple
ones (like white
 Rice and white bread)
42
Tel: 064-229-8207
 Distribute your foods between three meals and two or three snacks each day
 Strictly limit sweets and desserts
 Stay away from added sugars
 Go to your prenatal checkups and take a daily prenatal vitamin
 Educate in wound care, insulin preparation, and glucose monitoring
Recommendation regarding to student’s nurses:
 Be honest
 Assisting your patient when they need help in bathing and eating etc.
 Charting involves recording all medical records including the patient’s condition,
treatment
 Plan, medication list, and symptoms
 Study your patient’s health condition
43
Tel: 064-229-8207
VIII. JOURNAL READINGS RELATED TO THE CASE

(Should be an Evidence-Based Practice (EBP) Reading: Attach the
photocopy of your journal reading)
“Comparative Study between Metformin and Insulin in
Controlling Gestational Diabetes Mellitus”
Summary:
Eha Mohamad et al discussed about the controversial issue between the Metformin and
Insulin in controlling Gestational Diabetes Mellitus. Gestational Diabetes can pose some
health risks for the mother and the baby, including the risk of a high birthweight,
jaundice, breathing problems for baby and increased changes of high blood pressure
and preeclampsia for the mother. According to the authors, this study aims to assess
the efficacy of metformin in controlling maternal blood glucose level compared to insulin
in woman with GDM. In Randomized control trial, 120 patients t with GDM were
recruited from the outpatient of the El Sayed Galal Hospital, Cairo, Egypt from March
2016 to September 2018 and all women attend to outpatient clinic were suggested to
Careful History Taking, Clinical Examination, Ultrasonography, and Screening. The
patient diagnosed to have GDM were subjective to Exclusion Criteria, Allocation and
Concealment, Randomization. Sealed envelope technique was suggested as a method
for randomization of subjects in both groups, group M including 58 women that received
Metformin and group I including 58 women that received Insulin. Concerning patient’s
characteristics in both groups, there were no significant differences between two groups
44
Tel: 064-229-8207
regarding maternal age, gravidity, parity, GA at a time of diagnosis, GA at beginning of
treatment, and BMI at a time of diagnosis.
Reaction:
This journal provides us a partial idea between Metformin and Insulin in controlling
GDM. We all know that Metformin and Insulin are used to treat Diabetes. But the
Metformin is used to treat only the Type 2 Diabetes Mellitus, while the Insulin may be
used to treat both Type 1 and Type 2 Diabetes Mellitus. The purpose and function of
Metformin is to lower the blood sugar level by improving the way the body handles
insulin, compared to the Insulin that help moves sugar from the blood into other body
tissues where it is used for energy, it also stops the liver from producing more sugar.
All my life I believed that Insulin really treats carefully who suffer Diabetes most
especially to those pregnant women who are under control. But this article increased my
understanding in terms of taking care of those Diabetes and GDM patients. I found out
that Metformin not only treat the Type 2 Diabetes Mellitus, Metformin also used to treat
polycystic ovaries, and weight gain due to medications used for treating psychoses.
Just stated from this article, evidenced from the Metformin in Gestational Diabetes
(MiG) trial showed that this Metformin was not associated with increased prenatal
complications although there was an increase spontaneous pre-term births compared
the Insulin therapy that requires a quiet multiple daily injection which may reduce patient
compliance.
45
Tel: 064-229-8207
In conclusion, Metformin is comparable with insulin in glycemic control and neonatal
outcome. It might be more suitable for women with mild GDM. And also, it has been
tested in other clinical studies and is safe to take for Gestational Diabetes. So, I will
highly agree and recommend this to all of us, for us to avoid any complications.
X.REFERENCES
Flagg, J., & Pillitteri, A. 2018 Nursing Care of a Family Experiencing a Pregnancy
Complication from a Preexisting or Newly Acquired Illness. Maternal & Child Health
Nursing: Care of the Childbearing & Childrearing Family. 8 TH Edition Volume 1, Pg. 515
Mohamad, E., Sedek, A,. et Al..(2019). Comparative Study between Metformin and
Insulin in Controlling Gestational Diabetes Mellitus”. Vol.74 (8), Page 1791-1798
Michael Dansinger, MD on November 06, 2020
Ana Maria Kausel, MD on updated July 27, 2020 Debra Manzella, RN January 05, 2021
Charles Patrick Davis, MD, PhD. Medical Definition of Fasting blood glucose
Kozier and Erbs, Fundamental of Nursing. Volume 18TH Edition Chapter 21 Page 368
Doenges, M., Moorhouse, M. & Murr, A. (2017). Diagnoses, Prioritized Interventions
and Rationales. Nurse's Pocket Guide. Edition 14 TH
Doenges, M., Moorhouse, M. & Murr, A. (2017). Diagnoses, Prioritized Interventions
and Rationales. Nurse's Pocket Guide. Edition 15TH
Doenges, M., Geissler, A., & Moorhouse, M. (1992). Orthopedic and Connective
Tissue Disorders:
Amputation. Nursing Care Plans: Guidely for Planning and Documenting Patient Care.
Edition 3 pg. 804-
805.
American Diabetes Association. 2. Classification and diagnosis of diabetes: Standards
of medical care in diabetes-2021. Diabetes Care. 2021;44(Suppl 1):S15-S33.
doi:10.2337/dc21-S002
American College of Obstetrics and Gynecology. AGOG Practice Bulletin No. 190:
Gestational Diabetes Mellitus.Gynecol Obstetrics. 2018;131(2):e49-e64.
doi:10.1097/AOG.0000000000002501
46
Tel: 064-229-8207
Centers for Disease Control and Prevention. National Diabetes Statistic Report, 2017:
Estimates of Diabetes and Its Burden in the United States. Atlanta, Georgia; 2017.
https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf
US National Library of Medicine and the National Institute of Health – Medline Plus
Encyclopedia of Surgery
Lippincott’s Review Series Pediatrics Nursing
image by: health.allrefer.com
https://www.hindawi.com/journals/jdr/2017/7058082/
https://courses.lumenlearning.com/ap2/chapter/the-endocrine-pancreas/
https://www.endocrineweb.com/
https://nurseslabs.com/
https://ncbi.com/
www.hormone.org
47
Tel: 064-229-8207
APPENDIX
48

Case Analysis GDM Final

Uploaded by

Copyright:

Available Formats

You might also like

Case Analysis GDM Final

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Case Analysis GDM Final

Uploaded by

Copyright:

Available Formats

Cotabato Medical Foundation College, Inc

Quezon Ave. Poblacion 8, Midsayap, Cotabato

Abbas, Ayessah Fatima A.

previously and during pregnancy to diminish the danger of pregnancy difficulties.

and about 6% to 9% of pregnant women develop gestational diabetes. Diabetes during

women with type 1 or type 2 diabetes before pregnancy increased 37%.

compliance to postpartum glucose testing must be formulated to increase rates of follow-up

testing among these women.

GESTATIONAL DIABETES MELLITUS

Time of Test Value Normal Range

management team were also met later in the week.

L. Y. asks, “Will my baby be hurt?”

1 unit per 10 g carbohydrate in the lunch and dinner meals.

L.Y, 28 years old, 26 weeks pregnant primigravida.

During OBSTETRIC APPOINTMENT:

-father has type 2 DM.

-both paternal grandparents have type 2 DM.

Ht: 5 feet, 3 inches and 143 pounds.

Wt: 143 lbs.

-glucose challenge test

-Complete ketone testing in urine

-fasting blood sugar

-medical nutrition therapy

-supplemental insulin if glycemic level is not maintained.

High in noodles and rice and little protein

L.Y 28 y/o, 26th Diet history

Father : type 2 Ht- 5 feet, 3

1. obtain the health history of the patient.

2. identify the series of incidents leading to the occurrence of main problem.

4. discuss the developmental task/psycho-social according to Erik Ericson theory.

5. identify the chief complaint made by the client

6. discuss the basic symptomatology and etiology.

8. discuss the result of the laboratory interpretation.

needs of the client.

nursing theory and nursing research.

12. present evidenced based information related to our case.

13. make recommendations, referrals or follow-ups for the future learners.

CLINICAL CASE ANALYSIS WORKSHEET

PATIENT’S PERSONAL DATA:

Name (optional): L.Y., Age: 28 Sex: Female Civil Status: N/A

Religion: N/A Address: N/A

Number of Siblings/Children: N/A

Obstetric history: Primigravida

Current Medical Status: G1, P0, 26-week AOG

Other Relevant Data

Both paternal grandparents had T2 DM.

II. DEVELOPMENTAL DATA: Specify the Stage.

(Based on Havighurst’s and Erikson’s Life and Developmental Task/Psycho-Social).

stage of Erickson’s theory of psychosocial development, which happens after the

loneliness and become depressed.

CHIEF COMPLAINTS: Nutrition and Diet

III. HEALTH HISTORY:

IV. COMPLETE DIAGNOSIS OF THE CASE CHOSEN

a. Definition (at least 2 Definition with Bibliography)

Gestational Diabetes Mellitus

-is a condition of abnormal glucose metabolism that arises during pregnancy.

-possible signal of an increased risk for T2 diabetes mellitus later in life.