Republic of the Philippines

TARLAC STATE UNIVERSITY

COLLEGE OF SCIENCE
NURSING DEPARTMENT
Villa Lucinda Campus, Brgy. Binauganan, Tarlac City Philippines 2300
Tel. No.: (045) 493-1865 Fax: (045) 982-0110 website: www/tsu.edu

A Clinical Case Study presented to the Faculty of Tarlac State University

College of Science, Department of Nursing

In Partial Fulfillment of the Requirements of the Subject

NCM 109 RLE (OPD)

Gestational
Diabetes Mellitus
Presented by:

Viacel G. Gamboa
Marron Jane A. Ganotice
Hailyne Jade Mamuad
Trixie T. Mercado
Kiesha R. Ocampo

Presented to:
Miriam Thea Consuelo C. Damasco, RN, MAN

May 2023
Demographic Data

Name: M.E.F.
Age: 34 years old
Sex: Female
Civil Status: Married
Religion: Roman Catholic
Occupation: Housewife
Position in the Family: Mother
Address: Tarlac City
Date of Birth: September 14, 1988
Place of Birth: Tarlac City
Nationality: Filipino

OB History
LMP: July 20, 2022
EDD: April 27, 2023
Menarche: June 2001
GTPLA: 32002
Last Prenatal Checkup: January 27, 2023

Environmental Status

Patient M is currently residing at Tarlac City together with her daughter and
parents. Their house is a one-storey, two-bedroom structure, with concrete walls and
metal roofs; has one living room, one kitchen, one dining area, and one bathroom.
Their house is located on the edge of the town near the rice fields. They have windows
in every room for ample ventilation, are surrounded by trees, and away from pollutants.

Lifestyle

Patient M is a 34-year-old female. She is a G3P2. She goes to bed around 9:00
PM and gets up at 5:00 AM. She has no known food or drug allergies. She had no
prior medical conditions, illnesses, or surgeries from her childhood. The patient also
indicates that she had all of her immunizations performed when she was a baby. The
patient states that her typical nutrition intake includes frequent substantial meals,
usually three times a day, that are mostly composed of fats, protein, and
carbohydrates. She does not have a regular exercise routine; she spends her days
on household chores, and napping or sleeping. And they usually purchase mineral
water from water stations as their drinking water.
FAMILY HISTORY OF HEALTH AND ILLNESS

Patient MEF’s grandparents on both sides are already deceased due to old age,
while her mother is still alive with a history of asthma acquired from her grandfather.
She has three siblings, the oldest died of an unknown cause, while her two siblings are
alive and well, as is their father. Patient MEF did not inherit asthma from her mother’s
side.

HISTORY OF PAST ILLNESS/PREGNANCY

Patient MEF indicated that she had common illnesses such as cough, cold, and
fever in some instances of her life, but she managed them with over-the-counter
medications such as Solmux for cough, Neozep for runny nose, and Paracetamol for
fever.

The patient had no past serious medical conditions and operations. She stated
that she was 13 years old when she got her first menstruation, it lasted 4-5 days and
she uses 4 pads per day. She has no allergies to any medications or foods. All of her
previous deliveries have undergone NSD with no known complications and
abnormalities. She also stated that she completed all of her prenatal checkups and
medication intake before.

HISTORY OF PRESENT ILLNESS/PREGNANCY

 During her 14th week of pregnancy, the patient had a prenatal checkup with chief
complaints of having a fever, nausea and vomiting, and abdominal cramps. She had
undergone multiple laboratory tests (CBC, Hbsag screening, HIV, FBS, urine analysis,
and VDRL syphylis) where she was diagnosed with UTI and was prescribed with
Cefalexin for this condition.

On December 20, 2022, she tested positive for yeast infection and was
prescribed Neo Penotran Forte. She returned to the clinic after a week, complaining of
frequent urination, exhaustion, nausea, and vomiting. She performed an oral glucose
tolerance test after being suspected of having gestational diabetes and was directed to
Dr. Mary Rose Tonggol, an endocrinologist. She had glucose monitoring and was told to
limit her calories to 1800 kilocalories per day and switch from Enfamama to Ensure with
the same quantity per day. Her next follow up checkup is on February 17, 2023.
LABORATORY AND DIAGNOSTIC PROCEDURES

DIAGNOSTIC/ LABORATORY DATE PURPOSE OF THE RESULTS INTERPRETATION NURSING

PROCEDURE PERFORMED PROCEDURE AND ANALYSIS OF RESPONSIBILITIES
THE RESULTS (PRIOR, DURING
AND AFTER)
COMPLETE BLOOD COUNT January 21, A complete blood count Hemoglobin The results are PRIOR
(CBC) 2023 (CBC) will assist in Result: 140 g/dl regarded as  Explain to the
determining the amount of (normal) normal because patient the
blood loss and whether Normal: 120/160 they fall within the purpose of CBC
anemia is present. If the g/dl reference range. and its
hemoglobin and significance.
hematocrit levels are low MCV
and the patient is Result: 85 fL DURING
symptomatic, transfusions (normal)  Appropriate
are recommended. The Normal: 80-90 fL recommendation
CBC will also offer and assistance
indications of an infection, WBC to medical
which would result in an Result: technologists as
elevated white blood cell 5.5x1000/nm3 needed.
count and a left shift on (normal)
differential. Normal: 4.5 – AFTER
11x1000/mm3  Keep an eye on
the puncture site
PLATELET for any signs of
Result: 318,000 blood clot
mcL (normal) formation.
 Normal:  Record the
150,000– details of the
400,000 mcL procedure in the
patient's record.
HEPATITIS B SURFACE September The A1C test—also Result: The negative or PRIOR:
ANTIGEN (HBsAG) TEST 25, 2022 known as the hemoglobin Negative/ nonreactive result  Explain to the
 A1C or HbA1c test—is a Nonreactive is known to be patient what
simple blood test that (normal) normal. HBsAg
measures your average Normal: screening is,
why it is
blood sugar levels over Negative/Nonreac
important, and
the past 3 months. It's tive how the test is
one of the commonly performed.
used tests to diagnose
prediabetes and diabetes DURING:
and is also the main test  Obtain blood
to help the health care sample from the
team manage your patient and label
it properly to be
diabetes. transported to
the laboratory.

AFTER:
 Document all
aspects of care
related to
HBsAG
screening.
Human Immunodeficiency September 25, An antigen/antibody test Result: 0.31 The result falls PRIOR:
Virus (HIV) Test 2022 performed by a lab on (normal) within the normal  Explain to the
blood from a vein can Normal: less than range, thus, it is patient what HIV
usually detect HIV 18 to 1.0 considered to be screening is,
why it is
45 days after exposure. normal.
important, and
how the test is
performed.

AFTER:
  Administer
antiretroviral
medication/s to
the patient. If
indicated.
Fasting Blood Sugar (FBS) September 25, Fasting blood sugar Result: 80 mg/dL The result is PRIOR:
2022 (FBS) measures blood (normal) regarded as  Explain to the
Normal: 70 mg/dL normal because it patient what
glucose after you have fasting blood
not eaten for at least 8 (3.9 mmol/L) to 99 is within the
sugar screening
mg/dL (5.5 expected range.
hours. It is often the first is, why it is
mmol/L) important, and
test done to check for
how the test is
prediabetes and diabetes.
performed.
 Instruct the
patient to fast for
at least 8 hr
before specimen
collection for the
fasting glucose
test and not to
consume any
caffeinated
products or chew
any type of gum
before specimen
collection; these
factors are
known to elevate
glucose levels.

DURING:
 Ensure safe and
 sanitary
precautions
when procedure
is being done.

AFTER:
 Properly cleanse
the equipment
used and
document the
procedure.
Urinalysis September 25, A urine test is used to Result: An elevated result PRIOR:
2022 screen for high levels of RBC- 2-3 of WBC,  Explain to the
sugars, proteins, ketones, (normal) Amorphous patient what
and bacteria in order to Urates, and urinalysis is, why
WBC- 5-6
diagnose bladder or Bacteria indicates it is important,
kidney infections, (elevated) a Urinary Tract and how the test
diabetes, dehydration, Amorphous Infection. is performed.
and Preeclampsia. Urates- Moderate Women with  Instruct the client
(elevated) diabetes are at to observe
Bacteria- increased risk of proper sanitation
Moderate developing a UTI and hygiene.
since the sugar in Patient should
(elevated)
their urine may clean the vaginal
Mucous Thread- cause bacteria to area with
Moderate multiply proprietary
(elevated) (Government of sterile wipes in a
Normal: South Australia, downward
RBC- 0-3 2021). motion, front to
WBC- 0-5 back.
Amorphous
Urates- Few
 Bacteria- Few DURING:
Mucous Thread-  Instruct the
Few patient to pass a
small amount of
urine into the
toilet and then
collect a
midstream
specimen into
the sterile
container, and
then finish
passing urine
into the toilet.

AFTER:
 Emphasize
maintenance of
proper sanitation
and hygiene.
Venereal Disease Research September 25, The VDRL test is Result: Negative The blood sample PRIOR:
Laboratory (VDRL) Test 2022 a screening test for (normal) is considered  Explain to the
syphilis. It measures Normal: No normal if there are patient what
substances (proteins), antibodies to no identified VDRL test is,
why it is
called antibodies, which syphilis have been syphilis antibodies
important, and
your body may produce if seen in the blood in it or if the how the test is
you have come in contact sample results are performed.
with the bacteria that (Negative). negative. Hence,
cause syphilis. the result is DURING:
normal.  Ensure safe and
sanitary
precautions
 when procedure
is being done.

AFTER:
 Properly
document the
procedure.
Oral Glucose Tolerance Test December 27, The oral glucose Result: Gestational PRIOR:
(OGTT) 2022 tolerance test (OGTT) is  Fasting: 103.16 Diabetes Mellitus  Explain to the
one method of evaluating mg/dL (elevated) (GDM) can be patient what
an individual's apparent  1 hour: 299.93 identified if two or OGTT is, why it
is important, and
insulin sensitivity and mg/dL (elevated) more elevated
how the test is
insulin resistance.   2 hours: 133.07 results are performed.
mg/dL (normal) obtained. The  Instruct the
results are patient to fast for
Normal: elevated during at least 8 hr
 Fasting: equal to fasting and after before specimen
or less than 92 one hour after collection for the
mg/dL (5.1 fasting glucose
drinking the
mmol/L) test and not to
glucose solution, consume any
 1 hour: equal to or
therefore, GDM is caffeinated
less than 180
evident. products or chew
mg/dL (10.0
any type of gum
mmol/L)
before specimen
 2 hours: equal to
collection; these
or less than 153 factors are
mg/dL (8.5 known to elevate
mmol/L) glucose levels.

DURING:
  Inform the
patient that he or
she may feel a
slight discomfort
from the needle
punctures and
the pressure of
the tourniquet.
However,
reassure him or
her that
collecting blood
sample only
takes less than 3
minutes.

AFTER:
 Properly cleanse
the equipment
used and
document the
procedure.
Hemoglobin A1c (Hba1c) Test February 03, A hemoglobin A1C  Result: 6.0 % High A1C levels PRIOR:
2023 (HbA1C) test is a blood (elevated) are a sign of high  Explain to the
test that shows what your Normal: 4% and blood glucose patient what
average blood HBA1C test is,
5.6% from diabetes
sugar (glucose) level was why it is
over the past two to three (National Library
important, and
months. of Medicine, how the test is
2022).  performed.

Several studies DURING:

reported that  Ensure safe and
women with sanitary
elevated HbA1c precautions
during early when procedure
is being done.
pregnancy have
a higher risk for AFTER:
gestational  Keep an eye on
diabetes mellitus the puncture site
(GDM) for any signs of
manifestation blood clot
and/or adverse formation.
 Record the
pregnancy
details of the
outcomes procedure in the
(Bozkurt, et.al., patient's record.
2020).
PATHOPHYSIOLOGY
Book-based Pathophysiology

A variety of threat including obesity, physical inactivity, sedentary lifestyle,

condition where blood sugar levels are above normal, and Polycystic Syndrome aging,
race, are among the reasons of gestational diabetes mellitus. Another cause of
gestational diabetes may be history of diabetes in the family. There is also a chance of
reoccurrence if mother had GDM or delivery of 9 pounds (4.1kg) baby during her
previous pregnancy.
The hormone human chorionic somatomammotropin and elevated levels of
cortisol, estrogen, progesterone, and catecholamines are likely responsible for the
phenomenon where all pregnant women appear to develop insulin resistance or insulin
does not seem to be as effective. Insulin degradation or breakdown may be accelerated
by placental insulinase. In a typical pregnancy, this insulin resistance or degradation
helps keep the blood glucose from decreasing to unsafe levels. Despite the fact that
insulin secretion is enhanced. It is challenging for a diabetic pregnant woman to raise
her insulin dosage starting around week 24 of pregnancy in order to prevent
hyperglycemia.
This is further worse by the low maternal amount of glucogenic amino acids.
During the second and third trimesters, most likely, a woman can get ketoacidotic
disease from the breakdown of stored fat between meals. At least 25% of diabetic
mothers have an increase in amniotic fluid, most likely as a result of the fetus's
hyperglycemia, which increases urine production. If the situation worsens,
amniocentesis may be necessary to reduce the amount of amniotic fluid. Unfortunately,
because amniotic fluid is constantly being produced, this only serves as a temporary
solution and exposes the woman to infection and the possibility of preterm labor. The
likelihood of fetal growth limitation, asphyxia, stillbirth, and pregnancy-induced
hypertension in the mother increases noticeably in women who already have kidney
illness.
Patient-based Pathophysiology
Prioritization of Nursing Diagnosis

PRIORITIZATION
Ranking Diagnosis Justification
1st Readiness for enhanced This is the last among the
knowledge regarding actual problems. Using
diabetic condition, Maslow’s Hierarchy of
prognosis, and self-care needs, cognitive needs,
treatment needs as such as knowledge and
manifested by desire to understanding, curiosity,
enhance learning exploration, and need for
meaning and
predictability, is under the
growth need that is a key
in achieving
contentedness or self-
actualization. The need for
knowledge enhances
cognitive processes like
sound decision making
and understanding. This
will promote optimal
health by letting the
patient comply with the
treatment regimen.
2nd Readiness for enhanced This is the last among the
nutrition related to altered actual problems. Using
blood glucose levels as Maslow’s Hierarchy of
manifested by adherence needs, self-actualization
to prescribed dietary needs, such as realizing
modifications personal potential, self-
fulfillment, and seeking
personal growth, is under
the growth need that is a
key in achieving
contentedness or self-
actualization. The
treatment regimen under
nutrition will help the
patient and the infant cope
with the consequences of
the disease. Complying
with dietary modifications
with lessen the probability
of maternal and fetal
complications.
3rd Risk for fetal injury related Using Maslow’s Hierarchy
to elevated maternal of needs, safety needs,
serum blood glucose levels such as security of body,
of employment, of
resources, of morality, and
of health, is the second
key stage in achieving
contentedness or self-
actualization. Risk for fetal
injury can be heightened
because of elevated blood
glucose levels. One key
risk factor is macrosomia,
or large baby. This can
lead to birth injuries or
malformation as the
progress of fetal
maturation becomes
abnormal.
NCP 1

Nursing
Assessment Planning Nursing Intervention Rationale Evaluation
Diagnosis
Subjective: Readiness for Within an hour of Independent: Independent: - After an hour of
“Bakit po ba enhanced proper nursing ● Assist the client to ● This helps to nursing
nagkakaroon ng knowledge intervention, the identify learning frame or focus intervention, the
diabetes kapag regarding diabetic patient will exhibit goals. content to be patient exhibited
buntis? Ano po condition, responsibility for learned and responsibility for
kaya ang pwede prognosis, and her own learning by provides a her own learning
kong gawin self-care seeking answers to measure to by seeking
para hindi na treatment needs questions. evaluate the answers to
lumala ang as manifested by ● Support the client in learning process. questions.
kondisyon ko?” desire to enhance making health- -
as verbalized by learning related decisions ● To foster self- Goal met.
the patient. and pursuing self- esteem and
Scientific care practices that support positive
Objective: Explanation: promote health
self-concept.
● (+) Conscious Patient education such as keeping all
and coherent has been shown follow-up visits and
● to improve quality doing exercises
of life, contribute such as aerobic
to better and resistance
compliance, and exercises at a
reduce moderate intensity.
complications and
healthcare costs. ● Provide accurate
While the factors and relevant
facilitating GDM information ● To let the client
self-management regarding current incorporate it into
included: thinking and future needs self-care plans
about the baby such as a dietary while minimizing
and psychological plan that includes problems
support from food like: associated with
partners and ˗ Lean proteins change.
families. such as white
fish and chicken
breast.
˗ Complex
carbohydrates
such as dried
beans, nuts,
and whole grain
breads, cereals,
or pasta.
˗ Fresh fruits and
vegetables.
˗ Low-fat dairy
products.
˗ Healthy fats.

● Assist the client to

identify ways to
● The ability to apply
integrate and use
information in all or use information
applicable areas increases the
(e.g., situational, desire to learn and
environmental, retain information.
personal).

● Encourage the
● This provides an
client to journal,
keep a log, or graph opportunity for
as appropriate. self-evaluation of
the effects of
learning, such as
better
management of
chronic conditions,
reduction of risk
factors, and
acquisition of new
skills.
NCP 2

Nursing
Assessment Planning Nursing Intervention Rationale Evaluation
Diagnosis
Subjective: Readiness for Within 30 minutes Independent: Independent: - After 30 minutes of
“Malakas po enhanced of proper nursing ● Advise the patient ● An increase in proper nursing
ako kumain ng nutrition related to intervention, the to self-monitor and weight can be an intervention, the
matatamis saka altered blood patient will express record her weight at indicator of a patient expressed
kanin. Pero sabi glucose levels as understanding of home. required calorie understanding of
po nila doc manifested by the treatment adjustment. the treatment
kailangan ko na adherence to management management
‘yon bawasan prescribed dietary process and the ● Educate the client ● Eating very process and the
dahil modifications necessity of regular and family frequent small necessity of
makakasama sa self-assessment. members about the meals improves regular self-
akin at sa bata” Scientific importance of assessment.
insulin function.
as verbalized by Explanation: regular meals and -
the patient. During snacks when taking Goal met.
pregnancy, the insulin.
Objective: body makes more ● Visuals of portion
● (+) Conscious hormones and ● Encourage the size and use of
and coherent goes through client on the use of household
other changes, T-shaped plate containers as
BMI – 30 such as weight model to make
measures of food
gain. These nutrition counseling
Fasting changes cause more effective. quantity are
Blood the body’s cells to practical and easy
Sugar - use insulin less teaching tools to
103.16 effectively, a help improve
1st Hour - condition called adherence to the
299.93 insulin resistance. quantity of food
2nd Hour - Insulin resistance
consumed. 
133.07 increases the
body’s need for
● HBA1C result – insulin. All ● Instruct the client ● Carbohydrate
6.0% pregnant women about proper restriction remains
● have some insulin carbohydrate the most common
resistance during restriction.
approach for
late pregnancy.
However, some medical nutrition
women have therapy in GDM to
insulin resistance control blood
even before they sugar level.
get pregnant.
They start ● Encourage the ● Dietary fiber
pregnancy with an client to include decreases
increased need fiber and reduce
postprandial
for insulin and are saturated fats and
more likely to cholesterol in her hyperglycemia
have gestational diet. and lowers insulin
diabetes. requirements.
Increased
consumption of
saturated and total
fats could worsen
insulin
requirements.
NCP 3

Nursing
Assessment Planning Nursing Intervention Rationale Evaluation
Diagnosis
Subjective: Risk for fetal injury Short term: Independent: Independent: Short term:
N/A related to elevated Within 15 minutes of  Educate the client  To help the client After 15 minutes of
maternal serum proper nursing about the possible make informed proper nursing
Objective: blood glucose intervention, the effects of GDM on decisions about intervention, the
● (+) Conscious levels client will verbalize fetal growth and managing client verbalized
and coherent understanding of development. regimens and may understanding of
Scientific GDM and its effect increase GDM and its effect
BMI – 30 Explanation: on fetal growth and cooperation. on fetal growth and
Infants of women development, and  Educate the client development, and
Fasting with diabetes tend importance of about home blood  To ensure lower importance of
Blood to be large abiding with glucose monitoring perinatal mortality abiding with
Sugar - because the treatment regimens. and diabetic tendency for a treatment regimens.
103.16 increased insulin management. diabetic pregnancy
1st Hour - the fetus must when glucose Goal met.
299.93 produce to concentrations are
2nd Hour - counteract the kept in check for
133.07 overload of glucose normal or abnormal
they receive acts results.
● HBA1C result – as a growth
6.0% stimulant. A  Educate the client  To check for the
● macrosomic infant about the lung maturity as it
may create birth importance of is in different rate
problems at the amniocentesis. with pregnancies
end of the affected by
pregnancy because diabetes.
of cephalopelvic
disproportion or an  Emphasize the need  To avoid high
increased risk for to comply with levels of blood
shoulder dystocia.
 dietary glucose and
modifications. abnormal BMI.

DRUG STUDY

Name of the Route of Mechanism of Indication Contraindication Side Effects and Nursing
Drug Administration, Action Adverse Effects Responsibilities
Dosage, and
Frequency
Drug Name: Route: Oral Iron combines with It is indicated for If a person has Side Effects: PRIOR:
Ferrous Sulfate porphyrin and globin treating iron experienced an allergic  Upset stomach  Educate the
Dosage: 200 chains to form deficiency anemia reaction to iron or vomiting client that milk,
mg/tablet hemoglobin, which is which is mainly supplements,  Constipation eggs, or caffeine
Brand Name: critical for oxygen caused by hemochromatosis (iron beverages
Frequency: OD delivery from the  Diarrhea
Ferron pregnancy. overload disease), should be
lungs to other hemosiderosis (iron in the  Black stools
avoided when
Classification: tissues. lungs), or any sort of taken with iron
anemia not caused by Adverse Effects: preparation.
Iron Supplement
iron deficiency, these  Dyspnea
medications should not  Flushing DURING:
Pregnancy be taken.  Take medication
 Dizziness
Category: between meals
 Black, tarry, or with orange juice
A
bloody stools or a vitamin C
supplement.
Image:
AFTER:
 Instruct the client
to remain upright
for at least 30
minutes after
administration
Drug Name: Route: An exogenous source When the baby is Folic acid is Side effects: Prior:
Folic Acid Oral of folate is required developing early contraindicated for use in  Nausea ● Instruct client not
for nucleoprotein during pregnancy, patients with folic acid  Loss of to drink alcohol
Brand Name: Dosage: synthesis and the folic acid helps form hypersensitivity. Folic appetite during the
Folart 5mg/capsule maintenance of the neural tube. Folic acid should be used with  Bloating, gas, duration of folic
normal acid is very important extreme caution in stomach pain acid
Classification: Frequency: erythropoiesis. Folic because it can help patients with  Bitter or supplementation.
Water-soluble OD acid, whether given prevent some major undiagnosed anemia. unpleasant
vitamin by mouth or birth defects of the taste in the After:
parenterally, baby's brain mouth ● Monitor for
Pregnancy stimulates the (anencephaly) and hypersensitivity
 Confusion,
Category: A production of red spine (spina bifida).  reactions.
trouble
blood cells, white concentrating
blood cells, and  Sleep problems
Image: platelets in persons
 Depression
suffering from certain
 Feeling excited
megaloblastic
or irritable
anemias.
Adverse effects:
 Skin rash
 Wheezing
 Tightness in
the chest or
throat
 Trouble
breathing or
talking
Drug Name: Route: Vitamins, minerals, A multivitamin is This product is Side effects: Prior:
Multivitamins Oral and fatty acids are indicated to fill in contraindicated in  Constipation ● Teach the patient
important building nutritional gaps and patients with a known  Diarrhea about the risks of
Brand Name: Dosage: blocks of the body that provides only a hint of hypersensitivity to any of  Upset stomach excessive
PrimaCare One 1 capsule help keep a person in the vast array of the ingredients.  Nausea supplementation.
good health. healthful nutrients ● Avoid taking
Classification: Frequency: and chemicals  Vomiting antacids, dairy
Iron Products: OD naturally found in products, tea, or
Vitamin and food needed for a Adverse effects: coffee within 2
Mineral healthy pregnancy.  Hives hours before or
Combination  Difficulty after this
breathing medication.
Pregnancy  Swelling of the
Category: A face, lips, DURING:
tongue, or  Instruct the client
throat to take vitamins
Image: with food to
 Easy bruising
 Unusual promote
bleeding absorption.
 Rash
After:
 Itching
● Store vitamins in
 Severe a light-resistant
dizzinness container.
Drug Name: Route: It reduces parathyroid During pregnancy, a Calcium carbonate use is Side effects: Prior:
Calcium Oral release and sufficient amount of contraindicated in cases  Constipation ● Ensure that the
Carbonate intracellular calcium Calcium is very of hypersensitivity, renal  Upset stomach patient did not
Dosage: and so reduces important as it can calculus, high urine have a high-fiber
Brand Name: 500mg/tablet smooth muscle help prevent losing calcium levels, elevated Adverse effects: meal before
Calcisaph contractility. By this bone density as the serum calcium, low  Hives taking the
Frequency: mechanism, calcium baby also requires serum phosphate,  Difficulty supplement.
Classification: OD supplementation calcium for his/her achlorhydria, or breathing ● Advise the
Calcium reduces uterine own bone growth. suspected digoxin  Swelling of the patient not to
supplement, smooth muscle Calcium carbonate is toxicity. face, lips, smoke cigarettes
antacid, contractility and a dietary supplement tongue, or or drink alcohol
phosphate prevents preterm used when the throat or large amounts
binder labor and delivery. amount of calcium of caffeine.
 Nausea
taken in the diet is not  Vomiting
Pregnancy enough. DURING:
Category: C  Loss of
 appetite  Calcium
 Unusual weight supplements are
loss best taken with
Image:  Mental or mood meals to ensure
changes optimal
 Bone or muscle absorption.
pain
 Headache After:
 Increased thirst Monitor for adverse
or urination effects.
 Weakness
 Unusual
tiredness
 Rash
 Itching
 Severe
dizziness
Drug Name: Route: Neo Penotran Forte Treatment of vaginal This product is Side effects: Prior:
Neo Penotran Vaginal contains miconazole candidiasis due to contraindicated in  Vaginal ● Educate the
Forte suppository nitrate for antifungal Candida albicans, patients with a known irritation client that the
effect and bacterial vaginitis due hypersensitivity to any of  Abdominal pain medication is not
Brand Name: Dosage: metronidazole for to anaerobic bacteria the ingredients.  Stomach to be taken by
Embil 3 doses antibacterial and and Gardnerella cramps other routes.
antitrichomonal vaginalis, trichomonal  Constipation
Classification: Frequency: effects, and also vaginitis due to DURING:
 Diarrhea
Antifungal Agent Every other lidocaine for local Trichomonas  Instruct the client
 Loss of
night anesthetic effect. vaginalis, and mixed to lie down when
Pregnancy appetite
vaginal infections. It administering the
Category: B  Nausea
is used to treat yeast medication.
 Vomiting
infection.
Image:  Headache After:
 Dizziness  Instruct the
 Skin rash patient to not
stand up for half
an hour after
administering the
suppository.