Nursing Care Plan

Gestational Diabetes Mellitus

In Partial Fulfilment of the

Requirements in NCM-209 RLE
DELIVERY NURSING ROTATION

Submitted to:
Trina Domanais, RN, MAN
Clinical Instructor

Submitted by:
Janiel Kayyi D. Torralba, St.N.
BSN 2E GROUP 2

May 30, 2021

Name of Patient: Mary Grace Te Age: 35 years old Sex: Female Attending Physician: Dr. Garado Ward: St. Lorenzo Bed#: 253-6

Chief Complaint: Labor Pains Diagnosis: Gestational Diabetes Mellitus GPA: G4 P3 A1 TPAL: T3 P0 A1 L2 AOG: 39 weeks and 2 day

DATE NURSING PATIENTS IMPLE

& CUES NEEDS DIAGNOSIS OUTCOME INTERVENTIONS MENTA EVALUATION
TIME TIONS
M  “Ngano taas gihapon C Deficient Knowledge Within the 6-hour 1. Establish Rapport. May 8, 2021
A ako blood pressure O related to inability to span of care the 1 @ 1PM
R: Promotes a therapeutic
Y ug blood sugar bisan G fully grasp and patient will be
ga tuman man ko sa N understand condition able to: relationship that supports Goals met at the
8, tambal?” I as evidenced by end of my 6-hour
a. Verbalize patient self-reflection. care the patient
 “Sige man kog T questions and
2 ehersisyo aron I statements of understandin Recognizing problems was able to:
0 mubaba akong O misconception. g of
2 Gestational through sharing feelings is a. Verbalize
timbang.” N
1  “Gutomon ko maong - Rationale: Patients Diabetes best achieved with a warm understanding
mubawi jud kog P with low health Mellitus, of Gestational
7AM literacy are at risk in Insulin and trustworthy Diabetes
kaon pagkahuman E
nakog ehersisyo.” R medicine dosing Injection, atmosphere. Mellitus, Insulin
 “Naay mga panahon C errors, forgetfulness, Oral Glucose Injection, Oral
na wala ko ga E and unable to Tolerance 2 Glucose
injection kay maayo P comprehend Test, Serum 2. Identify and analyze Tolerance Test,
akoang pamati.” T information regarding Glucose Serum Glucose
the patient’s Social
(As verbalized by the U their condition; thus, Level Level
patient) A risking their illness to monitoring, Determinants of monitoring, and
L be placed at a and Lifestyle Lifestyle
Health.
Objective: worsened state Modifications Modifications
 Vitals Signs: P (Ciaglia, 2017). The such as R: Communicating with such as Walking
o BP: 160/95 mmHg A lack of knowledge Walking and and Diet plans
the patient to understand
T such as incorrect Diet plans involved in
o HR: 134 bpm
T decisions and actions involved in the social determinants controlling the
o RR: 36 cpm
E done to relieve a controlling condition.
 35 years old that affects their health
R condition pose the condition.  “Dapat diay
 HGT test result of N unknowingly can greatly increase na
210 mg/dL detrimental effects b. Recognize balibalihon
the labor and patient understanding,
 Multigravid unto one’s self. This kung aha
 Fatigue could then yield preoperative health, and wellness. nako gina
 Exhausted and dreadful outcomes, care such as inject ang
Blood Social determinants of
stressed which could have insulin.”
 High school been treated Glucose health such as education,  “Pagkahuma
graduate immediately and Monitoring, n nako
Glycated poverty, unemployment,
easily with adequate manganak
knowledge Hemoglobin food insecurity, and kay dapat pa
(Unintended A1c nako e
Checking, unstable housing have
Consequences, monitor ako
2019). General been factors that increase blood sugar.”
Preoperative  “Di dapat ko
Assessment, the rates and severity of
mag banat
Reduce conditions that may lead to ug kaon
Insulin human
Therapy, greater morbidity and 3
ehersisyo
Maintain well mortality. kay mas
Hydrated, gapadaghan
and 3. Assess the patient’s
ug blood
Discontinuing readiness and sugar na dili
Oral nako ma
Regimens willingness to learn
control.”
such as before carrying out  “Dapat ang
Secretagogu mga
es and the education plan.
ehersisyo na
Metformin. R: Patients diagnosed akoang
with GDM often go buhaton dili
c. Express kayo
proper through various stages bughat…
communicati mas maayo
on and and providing reassurance
kung mag
 listening that these feelings are lakaw lakaw
skills. rako sa
normal help with the 4 balay.”
d. Restate grieving process.  “Dapat dili
potential risks nako
that could undangan
develop after 4. Assess the patient’s ang tambal
pregnancy bisan maayo
fears and major
such as Type ako
2 Diabetes. concerns about GDM. paminaw”
R: Encourage discussing (Vebalized by
e. Apply patient)
relaxation fears and feelings related
and breathing b. Recognize the
to the complications
techniques. labor and
brought by GDM. Provide preoperative
understandable and direct care such as
Blood Glucose
information to clear out 5
Monitoring,
any misconceptions about Glycated
Hemoglobin A1c
the condition. General
Checking,
Preoperative
5. Assess skills and Assessment,
self-health care Reduce Insulin
Therapy,
behaviors done to Maintain well
alleviate condition. Hydrated, and
Discontinuing
R: Patient’s that have Oral Regimens.
diabetes often make errors  “Kay naa man
koy diabetes
in self-care, reassessment
must be done to determine angay lang na
naa silay mga
their competency in health
test o
care and preventive 6 examination
na buhaton
measures to preclude
nako bago sa
complications. ako
operasyon.”
 “Salamat, kay
6. Educate the patient naka
on medications used himundom ko
na naay mga
to treat GDM; tambal na
specifically insulin, undangan
bago sa ako
as well as medication operasyun ug
to avoid for ibaba ang
dosage sa
treatment. ako insulin”
R: Insulin is the drug of  “Dili dapat
kayo taas ako
choice when it comes to blood sugar
controlling blood sugar bago ang
operasyon.”
during pregnancy since it (Vebalized by
is the most effective for patient)

fine-tuning blood sugar c. Express proper

and it does not cross the communication
and listening
placenta; hence, safe for skills by
the baby. While, oral exhibiting trust
and effective
hypoglycemic agent is not responses.
7  “Salamat sa
recommended to be taken
pagpasabut
during pregnancy because usab sa
akoang
it crosses the placenta,
sakit…naka
that can potentially can hibaw nako
na di jud
harm the fetus.
dapat ko mag
salig.”
7. Provide substantial (Vebalized by
patient)
information about
GDM and its possible d. Identify potential
risks that could
complications such develop after
as developing Type 2 pregnancy such
as Type 2
Diabetes. Diabetes.
R: Sufficient knowledge  “Di dapat ko
mag salig kay
can decrease the fear of nay
the unknown, increase the 8 posibilidad na
maka
likelihood of participation, “develop”
increase knowledge about pako ug
diabetes.
the condition, and help (Vebalized by
reduce fetal/maternal patient)

complications. e. Apply relaxation

and breathing
techniques
8. Provide information
 regarding the use during her labor.
 “Salamat
and action of insulin.
nurse ug mas
Demonstrate on how makaya na
nakog antos
to administer
ang
medication (by paghugtong
sa ako tiyan
injection, nasal spray
karon.”
or an insulin pump) (Vebalized by
patient)
as well as the
importance of
injection site rotation. Janiel Kayyi D.
R: Prenatal metabolic Torralba, St,N.
changes cause insulin
requirement to change. In
the first trimester, insulin
requirements are lower,
but they double or
quadruple during the
second and third trimester.
Insulin is best
administered
subcutaneously in the 9
abdomen, upper arm,
buttocks hip, and thigh;
site rotation must be done
to prevent fat tissue build
up lipohypertrophy that
can cause poor insulin
absorption.

9. Teach serum glucose

monitoring at home
using a glucometer,
and the need to
record readings at
least 2-4 times/day.
R: Recording blood 10
glucose measurements
enables the client to
closely monitor and
control sugar levels
while seeing first-hand
the impact of her diet
and exercise on serum
blood glucose levels.
10. Encourage exercises
that can aid in
maintaining healthy
weight and achieve
target blood glucose
levels.
R: Exercising is beneficial
11
to improve glucose serum
levels and lower chance of
developing Type 2
diabetes. It is
recommended to do both
aerobic and resistance
exercises at a moderate
intensity; a minimum of
three times a week for 30-
60 minutes.

11. Educate patient to

follow a diet that is
low in simple sugars,
low in fat, high in
 fiber, and whole
12
grains.
R: A low fat and high fiber
diet helps control
cholesterol and
triglycerides. Daily meals
thrice a day and snacks is
recommended. Intake of
refined and simple sugars 13
should be reduced while
complex carbohydrates
should be increased.

12. Explain that blood

sugar should be
monitored for 6-12
weeks after delivery.
R: This is to find out if the
client has developed Type
2 Diabetes.

13. Encourage
maintaining a diary of
 home assessment of
serum glucose levels,
insulin dosage,
16
reactions, general
well-being, diet,
exercise and other
thoughts related to
the disease
condition.
R: The use of a diary can
aid and guide health care
provider to evaluate and
alter the therapy provided 17
as indicated.

Preoperative Care:
14. Inform patient that a
General Preoperative
Assessment will be
performed.
R: One quarter of diabetic
patients are unaware of
their disease and mortality
rate from heart disease is
2-4 times greater in
14
diabetic patients.

15. Inform patient that

Glycated Hemoglobin
A1c will be checked.
R: Elevated HbA1c before
surgery may provide
insight that a patient is at
risk for postoperative
diabetic-related 15

complications, a value of
less than 6% would be
ideal for the operation to
go through.

16. Inform patient the

need to reduce
Insulin Therapy.
R: Insulin therapy should
be typically reduced by 20-
25% the evening before
the operation to prevent
hypoglycemia while in nil
per os (NPO).

18
17. Advise patient that
Oral Regimens such
as Secretagogues
(Sulfonylureas) and
Metformin are to be
discontinued.
R: Secretagogues have a 19
potential to cause
hypoglycemia,
Sulfonylureas may
interfere with ischemic
myocardial
preconditioning, and
Metformin may develop
lactic acidosis.

18. Encourage patient to

Maintain Well
 Hydrated.
R: Maintain physiological
electrolyte and fluid
balance.

Labor Care:
19. Demonstrate
Relaxation and
Breathing
Techniques.
R: Preparing patient
physically and emotionally
will compose mind and
body for labor. Moreover,
the uterus can effectively
function if there is
adequate oxygen supply
and the patient can endure
hours of labor if they
distract themselves with
breathing techniques.
BIBLIOGRAPHY

Diabetes NSW & ACT (2021). Safe exercise for gestational diabetes. Retrieved on May 14, 2021 from https://diabetesnsw.com.au/gestational-
diabetes/safe-exercise/#:~:text=It's%20recommended%20to%20do%3A,day%20off%20in%20between%20sessions)

Martin, P. (2019). 4 Gestational Diabetes Mellitus Nursing Care Plans. Retrieved on May 13, 2021 from https://nurseslabs.com/gestational-diabetes-
mellitus-nursing-care-plans/#deficient_knowledge

Morris, S. (2020). Insulin Injection Sites: Where and How to Inject. Retrieved on May 25, 2021 from
https://www.healthline.com/health/diabetes/insulin-injection

Our Moment of Truth (2017). Gestational Diabetes: What Happens After My Baby Is Born? Retrieved on May 25, 2021 from
http://ourmomentoftruth.com/pregnancy/gestational-diabetes-what-happens-after-my-baby-is-born/
Unintended Consequences (2019). Acquiring Ignorance. Retrieved on May 14, 2021 from https://unintendedconsequenc.es/acquiring-ignorance/

Vera, M. (2021). 17 Diabetes Mellitus Nursing Care Plans. Retrieved on May 13, 2021 from https://nurseslabs.com/diabetes-mellitus-nursing-care-
plans/2/

SickKids Staff (2016). Selecting the injection site. Retrieved on May 25, 2021 from
 https://www.aboutkidshealth.ca/Article?contentid=1735&language=English#:~:text=You%20should%20always%20rotate%20injection,bumps
%20that%20absorb%20insulin%20poorly.

Wayne, G. (2019). Knowledge Deficit Nursing Care Plan. Retrieved on May 14, 2021 from https://nurseslabs.com/deficient-knowledge/