A Case Presentation of An Adult With Gestational Diabetes Mellitus

Republic of the Philippines
CENTRAL MINDANAO UNIVERSITY

COLLEGE OF NURSING
University Town, Musuan, Maramag, Bukidnon

E-mail: [email protected]
A Case Presentation of an Adult

with Gestational Diabetes Mellitus
A Case Study Presented to the Faculty of the College of Nursing,
Central Mindanao University
In Partial Fulfillment of the Requirements in

NCM 66.1: MATERNAL AND CHILD AT RISK OR WITH PROBLEMS
(ACUTE AND CHRONIC)
BSN2- B
GROUP 2
Santos, Lea Marie Khristine, I.
Orate, Eula Marie Victoria, V.
Sabornido, Jastine Nicole, B.
Dominguez, Ann Mariz, U.
Gauran, Rogelen May, A.
Tulang, Ana Domini, B.
Manlangit, Kint, D.
Balcos, Andrea, A.
Andrada, Leah, S.
Chu, Aubrey Mia
CLINICAL INSTRUCTORS
Postrano, Fave Danielle, RN
Postrano, Lhara Mae, RN
Luceño, Hanely Mae, RN
Itable, Emvie Loyd, RN
MARCH 2021
Acknowledgement
The researchers would like to extend their deepest gratitude to the people
who contributed and supported this study to be promising and fruitful.
To their Clinical instructor, Ms. Fave Danielle V. Postrano, RN, for her valuable
time and effort in suggesting, corrections, and inputs for the development of the
case study;
To our former Clinical Instructor, Mr. Sean Dignadice, RN, for lending his time
and inputs for the enhancement of the case study;
To the Clinical Instructors of Central Mindanao University College of Nursing

for inputs, comments, and suggestions of the case study;
And to the Almighty God for blessing and giving the researchers strength to
conduct and finish the paper.
Researchers
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Table of Contents
Page
PRELIMINARIES
Acknowledgement 2
Table of Contents 3
INTRODUCTION 4
Definition 4
Clinical Pathway 5
Statistics 5
Objectives 6
HEALTH HISTORY 8
Biographical Data 8
Chief Complaint 8
OB History 8
Antenatal History 8
Family Genogram 9
General Health History 9
PHYSICAL ASSESSMENT 10
ANATOMY AND PHYSIOLOGY 13
CONCEPT MAP 19
A. Schematic Diagram 19
B. Narrative Discussion 22
a. Etiology 22
b. Pathophysiology 23
c. Symptomatology 25
d. Prognosis 26
LABORATORY AND DIAGNOSTIC TESTS 28
PHARMACOLOGIC STUDIES 35
A. Pharmacotherapy, Intravenous Fluids & Nursing 35
Responsibilities
B. Diet & Activity Management & Nursing Responsibilites 46
SUMMARY OF PHARMACOLOGIC STUDIES 47
A. Pharmacotherapeutics 47
B. Intravenous Fluids 47
NURSING CARE PLANS 48
REFERENCES 55
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Introduction
Pregnancy has been recognized for a long time as a diabetic state in which
insulin sensitivity decreases with advanced gestational age—those who cannot meet
the increased demand develop diabetes. Diabetes is the most common medical
complication of pregnancy.
A 40-year-old multigravida woman named Julia Salazar is in her third

pregnancy. She is at the clinic for prenatal care at the 30th-week gestation at the
nearest primary hospital. Her weight is 200 pounds, indicating obesity on her ideal
weight, and her blood pressure is 140/90 mmHg. Her family history reveals that her
mother has type 2 diabetes mellitus. Results showed that she has 3+ glycosuria and
she was diagnosed with Gestational Diabetes Mellitus.
Definition
Gestational diabetes mellitus (GDM) happens when a placenta hormone

prevents the body from using insulin effectively. Glucose accumulates in the blood
instead of being absorbed by cells. Unlike type 1 diabetes, it is gestational diabetes
not caused by a lack of insulin. It is caused by other hormones produced during
pregnancy that can make insulin less effective. A condition referred to as insulin
resistance. Women with GDM have decreased quality of life and increased risks of
cesarean section, gestational hypertension, preeclampsia, and type 2 diabetes.
Evidence showed that GDM poses a threat to adverse maternal and prenatal
outcomes due to maternal Hyperglycemia (Jiménez‐Moleón, 2000). According to the
study of Keshavarz 2005, hyperglycemia develops during pregnancy due to the
secretion of placental hormones, which causes resistance to insulin. Gestational
diabetes occurs in about 14% of pregnant women and increases their risk for
hypertensive disorders. Women who are considered at high risk of GDM and who
must undergo blood glucose tests at their first prenatal visit are those who have
marked obesity, a personal history of GDM, glycosuria, or a strong family history of
diabetes.
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Clinical Pathway
Preferred screening and diagnostic 2-step from Diabetes Canada's 2018

guidelines is endorsed. All pregnant women should be offered screening between
24-28 weeks using a standardized non-fasting 50-g glucose challenge screening test
(GCT) with plasma glucose (PG) measured 1 hour later. If the value is <7.8 mmol/L,
no further testing is required. If the value of the GCT is 7.8–11.0, a 3-hour 100-g
oral glucose tolerance test with fasting PG (FPG), 1-hour PG, 2-hour PG, and 3-hour
PG should be performed. Gestational diabetes mellitus is diagnosed if one value is
met or exceeded: (1) FPG ≥5.3 mmol/L (2) 1-hour PG ≥10.0 mmol/L (3) 2-hour PG
≥8.6 mmol/L (3) 3hour ≥7.8. If the value of the GCT is ≥11.1 mmol/L, gestational
diabetes mellitus is diagnosed.
The "alternative 1-step diagnostic" approach from Diabetes Canada's 2018

guidelines is acceptable. In this strategy, pregnant women should be offered testing
between 24-28 weeks using a standardized 3-hour 100-g oral glucose tolerance test
with fasting plasma glucose (FPG), 1-hour plasma glucose (PG), and 3-hour PG.
Gestational diabetes mellitus is diagnosed if one value is met or exceeded: (1) FPG
≥5.3 mmol/L (2) 1-h PG ≥10.0 mmol/L (3) 2-h PG ≥8.6 mmol/L (3) 3hour ≥7.8.
Statistics
Global
The study of Hood et al. (2013) indicates that the prevalence of high blood
glucose (hyperglycemia) in pregnant women increases rapidly with age and is the
highest in women over 45 years of age. An estimated 223 million women (20 to 79
years old) live with diabetes. This number expected to rise to 343 million by 2045.
Twenty million or 16% of live births had some form of hyperglycemia during
pregnancy. An estimated 84% was due to gestational diabetes.
Like type 2 diabetes mellitus, its occurrence is increasing, reaching a global

prevalence of 15% to 20% (Hu et al., 2018), while locally in the Philippines, it was
reported to be at 14% (Litonjua et al., 1996). It carries the risk of adverse maternal,
fetal, and neonatal outcomes, including increased birth weight above the 90th
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percentile and a higher incidence of neonatal hypoglycemia and primary cesarean
section, demonstrated in the large-scale multinational cohort study called The
Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study. It is estimated that
GDM affects approximately 7-10% of all pregnancies worldwide (Xiong et al., 2001).
However, prevalence is difficult to estimate since rates differ among studies due to
the majority of different risk factors in the population, such as maternal age and
BMI, the prevalence of diabetes, and ethnicity among women.
National
According to the Department of Health (DOH), the Philippines' diabetes
accounted for 6% (6%) of the total death of all ages. In 2017, out of more than 60
million Filipinos, almost four (4) million adult Filipinos have diabetes, or the
equivalent of 6% (6%) of the total population. The university's annual medical and
physical examination results in 2016 and 2017 showed that the number of
employees with diabetes increased from 10% (10%) to 14% (14%) in a single year.
Gestational diabetes (GDM) is predominant in the Philippines. Data published

by the Asian Federation of Endocrine Societies Study Group on Diabetes in
Pregnancy (ASGODIP) showed that the Philippines have a prevalence of GDM of
14% in 1203 pregnancies interviewed (Litonjua et al., 1996). Due to this high
prevalence rate, the Unite for Diabetes Clinical Practice Guideline (CPG)
recommends universal GDM screening for the Filipino population. Data from
ASGODIP revealed that around 40.4% of high-risk women were positive for GDM
when screening was performed after the 26th week of pregnancy (Litonjua et al.,
1996).
Although the cases of diabetes increase at both the regional and global levels,
interventions that promote a healthy diet, physical activity, and weight loss can help
prevent diabetes. A healthy diet for those diagnosed with diabetes or high blood
sugars includes low-calorie intake, replacement of saturated fats with unsaturated
fats or fiber-rich foods, and avoidance of sugar, tobacco, and alcohol.
Objectives
General objectives
The case study seeks to demonstrate the student’s knowledge regarding the
general health and disease condition with diagnosis, its disease process, possible
complications, treatment plan, medical and nursing intervention.
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Specific objectives
At the end of the 2-hour discussion of the case study presentation, the student
nurses gained extensive knowledge regarding Gestational Diabetes Mellitus and
accomplished a comprehensive analysis concerning the disease.
1. Systematically present the data pertinent to the case being gathered.
2. Provide an evidence-based overview of the case study.
3. Present accurate personal and clinical information of the client, which will
serve as the baseline information.
4. Formulate a narrative health assessment including the findings that is

specific, measurable, attainable, realistic, and time-bounded.
5. Understand the role of drug therapy in managing the client’s related to the
patient’s diagnosis.
6. Recognize the contributing factors associated with the development of the

diagnosis.
7. Understand the pathophysiology and etiology of GDM.
8. Efficiently provide an appropriate and proper nursing diagnosis in line with

the client’s medical condition and skillfully formulate nursing care plans for
the problems identified.
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Health History
A. Biographical Data
Name : JS Height: 5’5

Age : 40 y/o Weight: 200lbs
Sex : Female Blood Type: AB+
Civil Status : Married Vital Signs:
Husband’s income from BP: 140/90
Source of Income :
farming RR: 25cpm
Occupation : House help PR: 102bpm
Dx : Tachycardic & hypothermic Temp: 35.4°C
B. Chief Complaint
“Magpa prenatal raman unta ko pero nikalit lang ug kalain akong paminaw,
nalipong ko ug kalit.”
C. OB History
LMP : 06/15/2020 G : 3
EDD : 03/22/2021 P : 1
AOG : 30W (T : 1
Age of Menarche : 14y/o P : 0
Menstrual Cycle : 28-30 days A : 1
Duration : 3-5 days L) : 1
G1 : Blighted ovum @6W 5 years ago
G2 : F, @40W of gestation w/ good APGAR score via NSVD last June 2019.
The infant is doing well.
G3 : Currently @30W of gestation, EDD: 03/22/2021
D. Antenatal History
JS has no other reported diseases. She reported that she was able to complete
all of her immunization and she received a dose of tetanus toxoid from her in this
pregnancy last December 2020. She is due for her TT2 dose this month.
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E. Family Genogram
F. General Health History
JS is currently at her 30th week of gestation and when she was about to visit
the nearest primary hospital for her prenatal check-up, she suddenly felt sick and
dizzy. “Magpa prenatal raman unta ko pero nikalit lang ug kalain akong paminaw,
nalipong ko ug kalit,” verbalized by JS.
Her profile showed that she is a 40-year-old multigravida woman, married, and
works as a house help. Her husband’s source of income is farming. Her family’s
health history revealed that her mother has type 2 diabetes mellitus and on her
paternal side has hypertension and asthma.
Upon the physical examination, her results disclosed her height as she stands
5ft and 5in (165cm) and weighs 200lbs (90.72kg). Her blood pressure runs
140/90mmHg, respiratory rate of 25cpm, pulse rate of 102bpm and temperature of
35.4°C. Her blood type is AB+. She is hypothermic and tachycardic.
JS’ past obstetric history includes her first pregnancy with blighted ovum at 6
weeks 5 years ago. Her second pregnancy is a female infant at 40-week gestation,
with good APGAR score delivered via NSVD last June 2019, and reportedly the child
is doing well. She’s currently at 30 weeks of her third pregnancy and she’s expected
to give birth on March 22, 2021.
She had her menarche at 14 years of age. She had a regular menstruation which
falls from 28-30-day cycle lasting 3-5 days, in moderate to heavy flow. Her LMP was
on June 15, 2020.
She has no other reported diseases. She reported that she was able to complete
all of her immunization and she received a dose of tetanus toxoid from her in this
pregnancy last December 2020. She is due for her TT2 dose this month.
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Physical Assessment
Date: February 20, 2021
Time: 7:00 AM
SYSTEM/AREA FINDINGS IMPLICATIONS
GENERAL Patient looks tired and This may be attributed
SURVEY/MENTAL sleepy. Patient is to a growing baby
STATUS hypothermic and bump, exhaustion from
tachycardic. delivering a baby,
multitasking, or other
pregnancy symptoms.
This needs to be looked
at further to see if there
are any other issues.
VITAL SIGNS
BLOOD PRESSURE BP: 140/90 mmHg High blood pressure is
twice more likely to
strike a person with
diabetes than a person
without diabetes. If left
untreated, high blood
pressure can lead to
heart disease and
stroke.
TEMPERATURE Temp: 35.4 degrees Celsius Hypothermia is more
(hypothermia) frequent among
patients with diabetes.
Hypothermia is a
frequent sign of severe
hypoglycaemia in
patients with diabetes.
PULSE RATE PR: 102 bpm Conditions such as
(tachycardia) anemia and diabetes
can put a strain on the
heart or damages heart
tissues and can
increase your risk of
tachycardia.
RESPIRATORY RATE RR: 25 cpm Respiratory rate with 25
cpm could point to
tachypnea, anxiety or
other underlying
conditions.
WEIGHT Weight: 200lbs Obesity increases risk
(Obese) of other diseases and
health problems, such
as heart disease,
diabetes, and high
blood pressure.
INTEGUMENTARY
SKIN Fair color complexion. Pallor Pallor is caused by an
is and palmar erythema illness, emotional shock
noted. or stress, stimulant use,
or anemia, and a result
of a reduced amount of
oxyhaemoglobin. An
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estimated 4.1% of
patients who has
diabetes experiences
palmar erythema.
NAILS Capillary refill actively Normal findings.
returns to its normal color in Normal capillary refill
less than 2 seconds. time is usually less than
2 seconds.
SKULL Rounded, normocephalic Normal findings. The
and symmetrical. skull sounded,
normocephalic and
symmetrical, smooth
and has uniform
consistency.
EYES AND VISION
PUPILS Black and equal in size. Normal findings. Pupils
must be round and
equal in size.
NECK Neck veins are visible, and Normal findings. There
no enlargement is noted. should be no
Neck muscles are equal in enlargement of thyroids
size, no palpable nodules. and no palpable
nodules.
NOSE No presence of discharge or Normal findings. It
flaring, it is clear. shows absence of
infection or difficulty in
breathing.
FACE Mask of pregnancy is visible Normal findings. Mask
of pregnancy
(melasma) is normal
during pregnancy. It is
caused by a
melanocyte-stimulating
hormone.
ABDOMEN Globular and a faint linea Normal findings. Linea
nigra and stretch marks are nigra and stretch marks
still visibly noted. Abdomen are results of hormonal
has audible bowel sounds. influences during
pregnancy.
BREASTS Symmetric, no dimpling and Normal findings. During
discoloration noted, nipples pregnancy your nipples
and areolas are dark in and areolae may
color, according to the become darker and
patient her breast seems to larger, and then return
appear larger and firmer. to their normal color
later on.
THORAX AND LUNGS
LUNGS Lungs have normal breath Normal findings. Lungs
sounds without dyspnea. should have a normal
Clear to auscultation in all breath sounds with the
lobes. absence of dyspnea.
POSTERIOR THORAX Chest is symmetrical. Normal findings. The
normal chest is
symmetrical.
BREATHING Patient reported that once in Shortness of breath can
a while, difficulty of be a sign of a serious
breathing is experienced disease.
especially when she is lying
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flat on bed and doing
household activity.
LOWER EXTREMITIES No edema was noted. Good Normal findings.
range of motion, sometimes Dependent edema is
felt leg pain due to prolongnormal during third
standing at work and some trimester. Varicose
varicosities were noted. veins may also appear.
MUSCULOSKELETAL No pelvic girdle pain or back
Normal findings. Pelvic
pain was noted. girdle pain or back pain
can be experienced
during pregnancy.
RECTUM AND ANUS The patient is constipated, Normal findings.
hemorrhoids are present. Haemorrhoids usually
get bigger and more
uncomfortable during
pregnancy.
GENITOURINARY Urine dipstick result shows Glycosuria is a common
3+ glycosuria and negative symptom of both type 1
ketones. diabetes and type 2
diabetes. Glycosuria
can lead to excessive
water loss into urine
with resultant
dehydration.
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Anatomy and Physiology
THE ENDOCRINE SYSTEM
The organs composing the

endocrine system are called glands;
they are small and unimpressive
compared to the other organs present
in the human body's different organ
systems. Though the glands are small
in size, their function, however,
impacts the body significantly. The
endocrine system is responsible for the
body's water equilibrium, heart rate
and blood pressure management,
immune system control, growth, metabolism, and tissue maturation, reproductive
function controls, blood glucose regulation, uterine contraction and milk release, ion
management, second messenger system, and direct gene activation.
HYPOTHALAMUS
The hypothalamus is a component of the nervous system and is one of the

significant endocrine glands - it secretes several hormones needed by the body to
operate appropriately. The hypothalamus is an essential part of the autonomic
nervous system and an endocrine control center of the brain situated inferior to the
thalamus.
PITUITARY GLAND
The pituitary gland is thin and oval, approximately the size of a pea. It is
situated behind the nose, close to the underside of the brain. It is attached to the
hypothalamus by a stalk-like structure. It consists of two functional lobes: the
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anterior pituitary, sometimes referred to as the glandular tissue and the posterior
pituitary, also called the nervous tissue. The pituitary gland's anterior lobe consists
of many different cell types that generate and expel various hormones. The
posterior lobe of the pituitary gland excretes hormones as well. These hormones
are usually formed in the hypothalamus and processed in the posterior lobe before
they are produced.
THYROID GLAND
The thyroid gland is placed at

the bottom of the throat, where it
can be effortlessly felt and palpated
during a physical examination. It
has two lobes connected by a mass
or isthmus. The internal
composition of a thyroid gland
comprises hollow structures coined
as follicles, which stores sticky
colloidal material.
The thyroid- produce hormone is known as the body’s primary metabolic

hormone. These major metabolic hormones are specifically called thyroxine (T4)
and triiodothyronine (T3). Both these hormones are active and are iodine-
containing. Thyroxine is the main hormone excreted by the thyroid follicles, while
triiodothyronine is formed at the target tissues upon conversion of thyroxine into
triiodothyronine.
The hormones produced by the thyroid controls the rate at which glucose is
being digested and is converted to body heat and chemical energy, used for cell
growth and repair.
PARATHYROID
The parathyroid glands are

four tiny masses of epithelial tissue
that are found in the connective
tissue capsule on the back of the
thyroid. They are parathyroid
glands, and they emit parathyroid
or parathormone. Parathyroid
hormone is an essential blood
calcium regulator. The hormone is produced regarding insufficient calcium levels in
the blood, which has the effect of increasing its levels.
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ADRENAL GLAND
Adrenal glands, also

identified as suprarenal glands, are
small, triangular glands found on
the top of both kidneys. Adrenal
glands manufacture hormones that
help control the metabolism,
immune response, blood pressure
level, response to stress, and other
vital functions. Human adrenal glands are made of two parts; the cortex and the
medulla, each of which is important for creating various hormones used in the body.
PANCREAS
The pancreas is an
elongated, tapered organ
situated around the back of the
stomach. The right side of the
organ, called the head, is the
most comprehensive section of
the organ and sits in the
duodenum curve, the first
section of the small intestine.
The tapered left-hand stretches
gently upward—called the
pancreas' body—and stops at the spleen— referred to as the tail.
The pancreas comprises two kinds of glands: the exocrine gland, which
excretes the enzymes used for digestion, and the endocrine gland consists of the
Islets of Langerhans, which expels hormones into the blood.
Enzymes produced by the exocrine gland in the pancreas tend to break down
carbohydrates, fats, proteins, and acids in the duodenum. These enzymes pass
down the pancreatic duct to the bile duct in an inactive state. The enzymes become
active as it enters the duodenum. The exocrine tissue also secretes bicarbonate to
neutralize digestive acids in the duodenum. The principal hormone produced by the
endocrine gland in the pancreas is insulin and glucagon, which control blood glucose
levels and somatostatin, which inhibit insulin and glucagon release.
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PINEAL GLAND
The pineal gland is also termed the pineal body. It is found below the corpus
callosum that is located in the middle part of the brain. The pineal gland is
responsible for bringing about the melatonin hormone—the hormone levels of
melatonin change throughout the day and night. The body's melatonin level is at its
peak levels during the night, which then triggers sleepiness.
THYMUS GLAND
The thymus is found in the

upper part of the chest and
contains white blood cells that
combat infection and kill
defective cells. This gland
appears to be more prominent in
infants and decreases in size as
the individual matures. The
thymus gland produces a hormone called thymosin that tends to be necessary for
the average production of a specific group of white blood cells (T-lymphocytes or
T-cells) and the body’s immune response.
FEMALE GONAD
The female gonads are referred to as

“ovaries,” which are found on both sides of
the uterus in the pelvic cavity. Aside from
producing female sex hormones, the ovaries
also excrete a couple of hormones called
estrogen and progesterone.
The estrogen is in charge of the growth

and maturation of female sex characteristics upon puberty. Estrogen functions with
progesterone in stimulating breast development and preparing the uterine lining for
menstruation. Progesterone aids in preparing the uterus during pregnancy to avoid
miscarriage and prepares the breasts for lactose formation.
PLACENTA
The placenta is not a permanent organ; it is

only formed during gestation and serves as the fetus’
system for respiration, excretory, and nutrition
delivery. It also induces proteins and steroid hormones
that aid in pregnancy and preparation for delivery.
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Gestational diabetes mellitus (GDM) is a complication in which the placenta's
hormone stops the body from taking insulin efficiently. Glucose ends up in the blood
instead of being ingested by the cells. Dissimilar from type 1 diabetes, gestational
diabetes is not caused by insulin deficiency but by other hormones released during
conception that can cause insulin to be less effective- a condition termed insulin
resistance. Gestational diabetes can be diagnosed during the second trimester-
around 24 to 28 weeks. Gestational diabetes is essentially similar to diabetes
mellitus type 2, in which hyperglycemia and insulin problems can be experienced.
The pancreas plays a vital role in discussing gestational diabetes mellitus

since it is the gland responsible for producing insulin. During pregnancy, there is
what we call Beta-cell hyperplasia. B-cell is present in the pancreas, which is mainly
the cell that produces insulin. And B-cell hyperplasia means an increase in the
number of b-cells.
When a pregnant woman takes in food, her blood glucose level increases-
this is called hyperglycemia. Hyperglycemia stimulates the b-cells found in the
pancreas to release insulin into the circulation. The released insulin will circulate the
body while targeting cells; as this happens, the cells take up the glucose found in
the bloodstream to reduce blood glucose levels present in the maternal tissue. This
process aside, there is still enough glucose left to aid the fetus’ growth and
development in the womb.
During pregnancy, insulin sensitivity decreases- effects of insulin in maternal

tissue are reduced, resulting in more glucose in the blood. Due to a decrease in
insulin sensitivity in the maternal tissue, b-cell hyperplasia occurs, resulting from
the fetal hormones signaling the maternal body to feed it.
In gestational diabetes, instead of having a slight decrease in insulin

sensitivity in the maternal tissue, there is a lot of insulin sensitivity decrease, thus
resulting in insulin resistance. Blood glucose is not taken up by the maternal tissue
as efficiently, resulting in hyperglycemia- which also travels to the fetal circulation.
Hyperglycemia in the fetal tissue results in an increase in fetal blood glucose level.
Which then triggers the fetal pancreas to produce its insulin. As a result, the fetal
tissue will take up more available insulin, causing the fetus to increase in size,
leading to macrosomia.
Maternal hyperglycemia causes the maternal tissue to experience and show

symptoms of diabetes. Often, these symptoms are called the 3 P’s: (1) Polyuria-
which is the frequent passage of large urine volumes. (2) Polyphagia- extreme
hunger, and (3) Polydipsia- excessive thirst.
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A significant decrease in insulin sensitivity and the development of insulin
resistance in gestational diabetes is thought to be caused by the placental hormones
being produced during pregnancy. These hormones are the growth hormones,
corticotropin-releasing hormones (CRH), and placental lactogen. Placental
hormones cause a decrease in insulin sensitivity to signal the mother to feed the
fetus with more glucose.
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Concept Map
(Etiology, Pathophysiology, Symptomatology & Prognosis)
A. Schematic Diagram
Biographical Data
Pt. JS is a 40-year-old
patient G3 P1 30 weeks AOG
Predisposing Factors Precipitating Factors

Etiology
Age Obesity
Family History of Diabetes Mellitus Reduced insulin secretion, increased insulin Sedentary Lifestyle
Ethnicity degradation, increased secretion of hormones Diet
Hypertension in current pregnancy with an anti-insulin effect, reduced tissue
Insulin-resistant conditions sensitivity to insulin, or a combination of two or
more of these mechanisms.
High risk for pregnancy induced glucose

tolerance
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Symptomatology Pancreatic beta cells work
Normal metabolic changes
Obesity and Polyphagia overtime to keep up with the
during pregnancy
increasing insulin demands
Diagnostic Test
BMI Calculation
Pancreatic beta cells “tire Placenta releases

out” and are unable to keep High fetal demands
hormones that are
up with insulin demands after 15-week
diabetogenic (Growth
gestation
Medical Management hormone, human
placental lactogen,
 Diet
progesterone,
 Exercise
Increase in corticotropin releasing
 Lifestyle changes
carbohydrate hormone)
Plasma glucose rises intake
Nursing Diagnosis
Obesity related to high
frequency of restaurant or
fried food Increase in High insulin
insulin resistance
requirements
Gestational Diabetes
Mellitus
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Medical Management
Advise client to rest
Symptomatology Prognosis
Pharmacological
Fatigue
Management
Oral antihyperglycemic agents Diagnostic Test
such as metformin and
None
glyburide
Nursing Diagnosis If Treated:
Fatigue r/t decreased Normoglycemia will usually occur after birth
metabolic energy production and mother is at risk of nongestational diabetes
within 5 to 16 years after the index pregnancy.
However, a study by Langer, et. al revealed that
Pharmacological Symptomatology 18% of those with treated GDM still had adverse
Management neonatal outcome such as stillbirth, neonatal
Vaginal yeast macrosomia/LGA, neonatal hypoglycemia,
Treatment with antifungal infection erythrocytosis, and hyperbilirubinemia.
medications (e.g. miconazole)
Diagnostic Test
Nursing Diagnosis
Urinalysis
Risk for infection r/t yeast
colonization in the vagina
If left untreated:
Pharmacological Mother will have increased incidence of
Management Caesarean section and gestational hypertension.
Study by Langer, et. al revealed that 58% of the
Initiation of insulin Symptomatology respondents with untreated GDM had a higher risk
Polydipsia, Polyuria, of adverse neonatal outcome such as stillbirth,
Nursing Diagnosis
and Glycosuria, neonatal macrosomia/LGA, neonatal hypoglycemia,
Deficient fluid volume related erythrocytosis, and hyperbilirubinemia.
to compromised endocrine Diagnostic Test
regulatory mechanism
Urinalysis
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B. NARRATIVE DISCUSSION
a. Etiology
Julia is a 40-year-old pregnant woman. Gravida 3, preterm 1 and is at 30th-

week gestation. She is diagnosed with Gestational Diabetes Mellitus (GDM). GDM is
a disease in which the placenta produces a hormone that prevents the body from
efficiently utilizing insulin. Instead of being consumed by the cells, glucose builds
up in the blood. It is a serious pregnancy complication, in which women without
previously diagnosed diabetes develop chronic hyperglycemia during gestation. In
most cases, this hyperglycemia is the result of impaired glucose tolerance due to
pancreatic β-cell dysfunction on a background of chronic insulin resistance. The
glomerular filtration of glucose is elevated, and the glomerular excretion threshold
is lowered that causes slight glycosuria. Glycosuria defines the presence of reducing
sugars in the urine, such as glucose, galactose, lactose, fructose, etc. This is
typically caused by an underlying condition that affects your blood sugar level, such
as diabetes. The rate of insulin secretion is increased, and the fasting blood sugar
level is lowered.
The predisposing factors are composed of the patient’s age, Family History
of Diabetes Mellitus, Ethnicity, Hypertension in the current pregnancy, Insulin-
resistant conditions, and obesity. Nevertheless, the precipitating factors are
composed of the patient’s Obesity, Sedentary lifestyle, Diet, and Glycosuria.
Predisposing Present Absent Implication

Factors
Age / Pregnant women over the age of 25 are

more likely to develop gestational
diabetes than younger women.
Family History of / People with a moderate to high family

Diabetes Mellitus risk of diabetes were more likely than
those with a low risk to confirm a
diabetes diagnosis.
Ethnicity / Asian and Filipina women had a

prevalence of GDM of 9.9 and 8.5%. It
was relatively high than other ethnic
groups.
Hypertension in / Gestational diabetes increases the risk

current pregnancy of high blood pressure and
preeclampsia, a severe pregnancy
complication that causes high blood
pressure and other symptoms that can
endanger both the mother and the
baby's lives.
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Insulin-resistant / This was not seen in the patient.
conditions Women with PCOS have a higher risk of
(Polycistic Ovary gestational diabetes mellitus than
Syndrome or women without PCOS. Both gestational
PCOS) diabetes mellitus and polycystic ovary
syndrome have negative effects on
pregnant women. Preeclampsia,
pregnancy-induced hypertension, and
neonatal hypoglycemia are all linked to
each other, increasing the risk of
preeclampsia, pregnancy-induced
hypertension, and neonatal
hypoglycemia.
Precipitating Present Absent Implication

Factors
Obesity / Obese women are even more likely to

develop the metabolic syndrome of
pregnancy.' They are more likely to
develop glucose sensitivity (GDM).
Sedentary lifestyle / Lack of physical activity raises the risk

of preterm birth and low birth weight
the weight of the baby at birth. In
addition, exercising is one way to
reduce blood glucose levels. Our
muscles take in more glucose as we
exercise. When this effect wears off, our
muscles stay insulin-sensitive for a while
longer.
Diet / In gestational diabetes it is important to

keep your blood sugar levels in check,
you will need to keep track of your
carbohydrate intake. This will involve
limiting the sugary food consumption in
your diet.
Glycosuria / Glucose can be found in the urine of up
to half of pregnant women at some
stage. Glucose in the urine could
indicate that a woman is suffering from
gestational diabetes.
b. Pathophysiology
Controlling the balance between insulin and blood glucose levels to avoid
hyperglycemia or hypoglycemia is the primary concern for any woman with these
disorders. Both conditions are risky during pregnancy, not just because of the long-
term impact on the woman's health, but also because normal fetal development is
jeopardized. Babies born to mothers who have uncontrolled diabetes are five times
more likely to be born big for gestational age or with birth defects.
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Previously, gestational diabetes mellitus (GDM) was defined as any degree
of glucose intolerance that begins or is first recognized during pregnancy.
Imprecision hampered the definition. Type diabetes has been diagnosed in women
diagnosed with diabetes in the first trimester. GDM is a type of diabetes that is
diagnosed in the second or third trimester of pregnancy but is not overt. Insulin
requirements rise during pregnancy due to the presence of insulin antagonists like
human placental lactogen or chorionic somatomammotropin, as well as cortisol,
which promotes lipolysis and lowers glucose consumption. GDM is becoming more
popular all over the world. Chronic insulin resistance and B-cell dysfunction are two
major metabolic disorders currently linked to the pathogenesis of GDM, but the
cellular mechanisms involved are unknown.
B-cells' main job is to store and secrete insulin in response to a glucose load.
B-cell dysfunction occurs when B-cells lose their ability to properly sense blood
glucose concentrations or release enough insulin in response. Long-term, excessive
insulin output in response to chronic fuel excess is thought to trigger B-cell
dysfunction. The exact mechanisms underlying B-cell dysfunction, on the other
hand, can be varied and complex. Effects can occur at any point in the process,
including proinsulin synthesis, post-translational modifications, granule storage,
blood glucose sensing, and the complex machinery that underpins granule
exocytosis.
Insulin sensitivity is an essential metabolic adaptation. Insulin sensitivity

changes during pregnancy, depending on the needs of the mother. Insulin
sensitivity rises during early pregnancy, encouraging glucose absorption into
adipose stores in preparation for the energy demands of later pregnancy. However,
as the pregnancy progresses, a release of local and placental hormones, such as
estrogen, progesterone, leptin, cortisol, placental lactogen, and placental growth
hormone, trigger insulin resistance. As a result, blood glucose levels rise slightly,
and this glucose is quickly transferred across the placenta to fuel the fetus's
development. This mild state of insulin resistance also encourages the development
of endogenous glucose and the breakdown of fat stores, leading to a rise in blood
glucose and free fatty acid (FFA) levels.
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Even prenatally, excessive fetal insulin production can stress developing
pancreatic B-cells, resulting in B-cell dysfunction and insulin resistance. Macrosomia
is often linked to shoulder dystocia, which is a form of obstructed labor. As a result,
babies born to women with GDM are usually delivered via cesarean section.
Glucose cannot be used by body cells if a woman's insulin output is

inadequate. The liver rapidly transforms stored glycogen into glucose to raise the
serum glucose level after the cells detect a need for glucose. However, since insulin
is still unavailable, the body cells are unable to use the glucose, causing the serum
glucose level to increase. In an attempt to reduce the level, the kidneys begin to
excrete large amounts of glucose in the urine (glycosuria). Huge amounts of urine
are excreted with urine.
As dehydration progresses, the blood serum becomes more concentrated,

and the total blood volume decreases as blood flow is reduced. Because cells don't
get enough oxygen, anaerobic metabolic reactions cause lactic acid to leak out of
muscles and into the bloodstream. Fat is mobilized from fat stores and metabolized
for energy to replace needed glucose, releasing large amounts of acidic ketone
bodies into the bloodstream.
c. Symptomatology
Gestational diabetes is a form of diabetes that develops during pregnancy
when the body's ability to produce or react to insulin is compromised. Because many
of the changes that occur during pregnancy are similar to those that occur during
gestational diabetes, there may be no obvious signs or symptoms. When the body
fails to react to insulin properly, high levels of sugar build up in the bloodstream,
resulting in diabetes symptoms.
Furthermore, these dangers to your wellbeing include fatigue, vaginal yeast

infection, polydipsia, polyuria, glycosuria, obesity, and polyphagia. Some pregnant
women are aware of the early warning signs of gestational diabetes. The signs and
symptoms are close to those of other diabetes types. However, since they are
common signs in all pregnant women, they are easy to overlook as a warning sign
that something is wrong. Both the pregnant woman and the fetus are at risk if the
mother has gestational diabetes.
Signs and Present Absent Implication

Symptoms
Fatigue / The client was showing signs of

exhaustion. Fatigue is normal in
pregnant women, particularly in the first
Page 25 of 56
12 weeks, due to hormonal changes;
however, it is also one of the positive
signs of GDM. Sugar remains in the
bloodstream rather than entering cells
to provide nutrition, causing fatigue.
Vaginal Yeast / This was seen in the client. Since a

Infection genital candida infection was discovered
in the client. It is one of the signs of
GDM is vaginal infection. An abnormally
high blood sugar level can prevent white
blood cells from reaching the infection
site, leaving the individual vulnerable to
infection.
Polydipsia / This was not reported by the client.

Polydipsia is excessive thirst or excess
drinking. It is a nonspecific symptom in
various medical disorders.
Polyuria / This was not reported by the client.

Polyuria is a condition where the body
urinates more than usual and passes
excessive or abnormally large amounts
of urine each time you urinate. Polyuria
is defined as the frequent passage of
large volumes of urine – more than 3
litres a day compared to the normal
daily urine output in adults of about 1 to
2 litres.
Glycosuria / The patient is experiencing this one.

Glycosuria is a term that defines the
presence of reducing sugars in the
urine, such as glucose, galactose,
lactose, fructose, etc. Glucosuria
connotes the presence of glucose in the
urine and is the most frequent type of
glycosuria and is the focus of this
review.
Obesity / There was an objective data reported to

this. The client is weighing above the
normal weight.
Polyphagia / This was not reported by the client.

Polyphagia is an excessive or extreme
hunger. It is different than having an
increased appetite after exercise or
other physical activity.
d. Prognosis
GDM (gestational diabetes mellitus) is linked to long-term maternal and fetal
complications. GDM has been linked to an increased risk of long-term maternal
Page 26 of 56
cardiovascular disease, chronic kidney disease, and cancer, according to new
research.
If treated, the patient will experience normoglycemia. This usually occurs

after birth and the mother is at risk of nongestational diabetes within 5 to 16 years
after the index pregnancy. However, a study by Langer, et. al revealed that 18% of
those with treated GDM still had adverse neonatal outcomes such as stillbirth,
neonatal macrosomia/LGA, neonatal hypoglycemia, erythrocytosis, and
hyperbilirubinemia.
If left untreated the mother will have an increased incidence of Caesarean

section and gestational hypertension. A study by Langer, et. al revealed that 58%
of the respondents with untreated GDM had a higher risk of adverse neonatal
outcomes such as stillbirth, neonatal macrosomia/LGA, neonatal hypoglycemia,
erythrocytosis, and hyperbilirubinemia.
Page 27 of 56
Laboratory and Diagnostic Tests
Laboratory &
Results/
Diagnostic Indications & Purposes Normal Values Nursing Responsibilities
Interpretation
Procedure
Complete Blood Count
 A complete blood count (CBC) test is performed to determine whether the pregnant mother has developed any health problems. It helps to
diagnose illnesses or infections in the expecting mother.
Parameters
WBC Used to screen for a variety of diseases 15.6/uL 5 - 10/uL  Encourage the patient to avoid
and conditions. Assist in the diagnosis of WBC is high; patient stress if possible because it can
infections, inflammatory processes, and shows positive for alter physiologic status
other diseases that affect the number of infection influences and changes normal
white blood cells (WBCs). hematologic values.
RBC The amount of red blood cells in the blood 4/uL 2.72 - 4.43/uL
that can imply her ability to bring oxygen Within the normal Explain to the patient:
to the fetus through blood. Can be used to range.  The test procedures.
help diagnose blood-related conditions,  That slight discomfort maybe
such as iron deficiency anemia. felt when skin is punctured
Hemoglobin The test may be used to screen for, 11g/dL 12.3 - 15.3 g/dL  That fasting (not eat solid foods
diagnose, or monitor a number of Hemoglobin is low, for 12 hours or so) is not
conditions and diseases that affect red patient shows positive necessary. Unless the patient is
blood cells (RBCs) and the amount for anemia. having other tests to be done at
of hemoglobin in blood. the same time that require it.
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Hematocrit The test for hematocrit measures the 45 28 - 39  The interpretation to the patient
volume of cells as a percentage of the Hematocrit is high, and patient’s family.
total volume of cells and plasma in whole patient shows risk for
blood. type 2 diabetes and  Apply manual pressure and
could mean dressing over puncture site
dehydration.  Monitor the puncture site for
MCV This measures the average size of the red 110fL 91-99 fL oozing or hematoma formation.
blood cells. MCV is high and can  Instruct to resume normal
be suggestive of folate activities and diet.
or B-12 vitamin
deficiency
MCH MCH is the average weight of hemoglobin 39pg 27-32 pg
per red cell. MCH is high can be a
sign for macrocytic
anemia
MCHC MCHC is the average concentration of 33g/dL 33-37 g/dL
hemoglobin per erythrocyte. Within the normal
range.
RDW A quantitative estimate of the uniformity 14 11.4 - 16.6
of individual cell size. Within the normal
range.
Platelets The platelet count is a test that 275/uL 146 - 429/uL
determines the number of platelets in your Within the normal
sample of blood. High or low platelet range.
levels can be a sign of a severe condition.
Neutrophils Can provide the doctor with important 4/uL 3.9 - 13.1/uL
clues about the health of the patient. Within the normal
Having a high percentage range.
of neutrophils in the blood is called
Page 29 of 56
neutrophilia. This is a sign that the body
has an infection.
Lymphocytes The levels of the main types of white blood 3/uL 1- 3.6/uL
cells in the body are measured. Within the normal
High lymphocyte blood levels indicate the range.
body is dealing with an infection or other
inflammatory condition.
Monocytes Help in diagnosing infection. Low levels 8 2-8
can indicate the existence of chronic Within the normal
infections or an autoimmune disease, range.
while high levels can indicate the presence
of chronic infections or a bone marrow
issue.
Eos A blood test that counts the number of 2 1–4
eosinophils, a form of white blood cell. Within the normal
range.
Basophil Tests to help diagnose certain health 1 0.5-1
problems such as allergic reaction if the Within the normal
basophil level is low. range.
Urinalysis
 Used to detect and manage a wide range of disorders, such as urinary tract infections, bladder infection, kidney disease and diabetes by measuring
the levels of sugar, protein, bacteria, or other substances in the urine.
Parameters
Appearance Can help a doctor determine whether a Cloudy Clear Educate the patient to:
person has certain health condition. The diagnosis of  Wash her hand before collecting
gestational diabetes the sample.
mellitus may be the  Collect a midstream urine
underlying cause of the sample.
cloudy appearance.
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Specific Gravity Urine specific gravity is a measure of urine 1.010 1.005-1.025 o Firstly, pass a small amount
concentration. This test simply indicates Within normal range of urine into the toilet and
how concentrated the urine is. then start collecting the
pH The pH level indicates the amount of acid 6.0 4.5-8 pH urine into the container—do
in urine. Abnormal pH levels may indicate Within normal range not touch the inside of the
a kidney or urinary tract disorder. container.
Glucose To check for abnormally high levels Negative 0-trace o Firmly screw down the lid of
of glucose in your urine. Normal Result the container and place it
Bilirubin Helps indicate liver damage or disease. Negative 0-trace into the biohazard bag
This test screens for bilirubin in the urine. Normal Result for return to the laboratory.
Bilirubin is not present in the urine of
normal, healthy individuals. Explain to the patient:
Ketone The test measures ketone levels in Negative 0-trace  The need to increase the
your urine. Normal Result patient’s fluid intake to promote
Occult Blood To screen any presence of blood in the 2+ 0-3 RBC's renal blood flow and to flush
urine called hematuria. bacteria from the urinary tract.
Protein The protein test pad provides a rough 3+ 0-trace  To avoid urinary irritants such as
estimate of the amount of albumin in the High amount of protein coffee, tea, colas, and alcohol.
urine. in the urine is  The interpretation to the patient
considered as and patient’s family.
proteinuria may be due
to infection. Protein in
the urine with raised
blood pressure
indicates preeclampsia
Leukocyte Leukocyte esterase is a 1+ 0-trace
Esterase screening test used to detect a substance Leukocyte esterase is
that suggests there are white blood cells positive, it could be a
in the urine. This may mean you have sign of a urinary tract
a urinary tract infection. infection (UTI).
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WBC When WBC count in urine is high, it may 30-50/HPF 2-5 /hpf or less per
indicate that there is inflammation in WBC is high making the
the urinary tract or kidneys. leukocyte esterase
positive it may indicate
urinary tract infection
(UTI).
RBC The presence of RBC is usually a sign of 15-30/HPF 0-5/ HPF
an underlying health issue, such as RBC is high that can
an infection or irritation of the tissues of indicate urinary tract
your urinary tract. infection (UTI).
Squamous To know if the sample is contaminated or 8-10 0-2 hpf
Epithelial not. If there are squamous epithelial cells Squamous epithelial
in your urine, it may mean your sample cells are present which
was contaminated. means the sample was
contaminated.
Bacteria To know if there are any bacteria. TNTC 0-trace
Bacteria are detected
and too many to count.
This indicates infection
OGTT and FBS
OGTT OGTT a test that is used to diagnose 125mg/dL <95.49 mg/dl Educate the patient:
gestational diabetes which can develop 1 hour post-prandial: • 1 hour after  That managing her blood glucose
during pregnancy. The test measures 200mg/dL <140.542 mg/dl level throughput the rest of her
your body's ability to maintain a normal 2 hours post- 2 hours after <120.72 pregnancy is a must, to avoid any
blood glucose (sugar) level prandial:170 mg/dl mg/dl complications.
The results are higher  To fast before the test, any liquid
than normal, the and kinds of food should not be
patient shows positive ingested. Even in b
for gestational  That she will be asked to drink a
diabetes. pure glucose juice dissolved in a
Page 32 of 56
500mL water, aware her that the
taste would not be that good,
must still she is required to finish
to complete the test.
 Instruct the patient that a blood

will be drawn before drinking the
liquid and again two more times
in every 60 minutes after
drinking.
o No liquid or any solid food
should be ingested in
between the first to third
collection of blood or until
the test is done.
o Educate the patient that
ingestion of food must be
avoided until the test is
done, so that test results
won’t be altered.
FBS Fasting blood sugar (FBS) measures 7mmol/L ≤ 5.6 mmol/L  Instruct the patient to fast for at
blood glucose after you have not eaten for The result is high; least 6-8 hours before specimen
at least 8 hours. It is often the first test patient shows positive collection for the fasting glucose
done to check for pre-diabetes and for diabetes. test and not to consume any
diabetes. caffeinated products or chew
any type of gum before
specimen collection as these
factors are known to elevate
glucose levels.
Biophysical Scoring
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Biophysical Test that measures the health of the fetus FHR: 138 bpm Score of 8-10  Explain the test procedures.
Scoring during pregnancy. A BPP test may include Within normal range  Explain the interpretation to the
a non-stress test with electronic fetal Amniotic Fluid index: patient and patient’s family.
heart monitoring and a fetal ultrasound. 2.87 Average  Inform the patient that before
The BPP measures the fetus’ heart rate, Estimated Fetal the test, she might be asked to
muscle tone, movement, breathing, and Weight: 2845 grams drink water or other liquids,
the amount of amniotic fluid around the Fetus is large for especially if the patient is
fetus. gestational age smoking.
Placenta Grade: 2
BPP = 8/8
Normal Result
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Pharmacologic Studies
A. Pharmacotherapy, Intravenous Fluids & Nursing Responsibilities
Drug Study: PLR

Dr. Chua ordered: PLR 1L at 100mL/hour x 2
Drug Mechanism of Action Indications or Contraindications Side Effects Adverse Nursing Responsibilities
Purpose Reactions
Generic Name: Lactated Ringer's is a Lactated Ringer's Contraindicated in patients Side effects Adverse effects • Monitor patient’s
PLR sterile solution for is used for with liver dysfunction. Most include chest include severe electrolytes.
fluid and electrolyte balancing fluid of the lactate is metabolized pain, redness and • Monitor IV infusion site and
Brand Name: replenishment. It and electrolytes in the liver, and any abnormal itching, regional access – check for signs of
N/A restores fluid and and as an dysfunction there will be an heart rate, cellulitis. infiltration, redness, pain,
electrolyte balances, alkalizing agent. accumulation of lactate. decreased swelling, and discomfort.
Classification: produces diuresis, This can confuse blood • Be attentive to the amount
Intravenous Fluid and acts as alkalizing interpretation of lactate pressure, of volume infused.
agent (reduces levels, with cerebral edema cough, • Advise patient to report any
Dose, Route & acidity). requiring osmotic therapy sneezing, signs of side and adverse
Timing: should avoid all hypotonic or rash, itching effects.
100mL/hour x 2 isotonic fluid.
Page 35 of 56
Drug Study: METOCLOPRAMIDE
Dr. Chua ordered: Metoclopramide 1 amp IVTT STAT then 1 amp IVTT PRN
Drug Mechanism of Indications or Contraindications Side Effects Adverse Nursing Responsibilities

Action Purpose Reactions
Generic Name: Metoclopramide works Indicated for Metoclopramide should not Side effects Adverse effects  Monitor blood pressure
Metoclopramide by blocking a natural active vomiting. be used in those patients include include regularly
substance (dopamine) Metoclopramide with hypersensitivity to the drowsiness, depression or  Monitor for extrapyramidal
Brand Name: which can cause injection is used drug or its components. weakness, suicide, reactions, if present, notify
Metozolv, Regans nausea and vomiting. to relieve Chronic use (e.g., greater headache, neuroleptic the physician right away.
It also speeds up symptoms caused than 12 weeks) should be diarrhea, malignant  Inform patient to avoid use
Classification: stomach emptying by slow stomach avoided due to the nausea, syndrome, tardive of alcohol, sleep remedies,
Prokinetic agent and movement of the emptying in increased risk for the breast dyskinesia, and sedatives
upper intestines. people who have development of movement enlargement, Parkinsonism,  Inform patient to report to
Dose, Route & diabetes. disorders such as tardive frequent hyperprolactinemi the nurse immediately if
Timing: dyskinesia. Metoclopramide urination, foot a, hallucinations, involuntary movement of
Dose: 10 mg has been used off-label as tapping, hypersensitivity the face, eyes, or limbs,
Route: an adjunct, based on risk- difficulty to reactions, blood severe depression and
Intravenously benefit ratios, for the sleep, disorders, diarrhea are experienced.
Timing: Once treatment of severe flushing, fever galactorrhea,
nausea/vomiting of hypotension
pregnancy (e.g.,
hyperemesis gravidarium)
not responding to standard
treatments.
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Drug Study: FERROUS SULFATE + FOLIC ACID
Dr. Roa ordered: Ferrous sulfate + folic acid 1-tab PO daily

Generic Name: Ferrous sulfate is a This medication is Contraindicated to patients Side effects Adverse effects • Inform patient to swallow
Ferrous sulfate + type of iron. an iron with hemolytic anemia, include include severe the drug without crushing or
folic acid Hemoglobin carries supplement used porphyria, and thalassemia. constipation, allergic reaction – chewing.
oxygen through your to treat or diarrhea, and rashes, itching, • Inform patient that there
Brand Name: blood to tissues and prevent low blood upset dizziness, are certain foods that may
N/A organs. Myoglobin levels of iron stomach. difficulty in inhibit absorption, for
helps your muscle (such as those breathing example, milk, eggs, and
Classification: cells store oxygen. caused by anemia caffeine.
Vitamin Folic acid helps your or during • Inform patient to notify the
body produce and pregnancy). nurse once constipation or
Dose, Route & maintain new cells, Ascorbic acid diarrhea has occurred.
Timing: and also helps (vitamin C) • Monitor patient’s bowel
1 tab PO daily prevent changes to improves the movement to identify
DNA that may lead to absorption of iron constipation or diarrhea.
cancer. from the
stomach.
Page 37 of 56
Drug Study: TETANUS TOXOID
Dr. Chua ordered: 1 vial single dose

Generic Name: It is protective The purpose of Contraindicated for patients Side effects Adverse effects • Inform the patient that
Tetanus Toxoid against effects from a giving the vaccine with hypersensitivity to any include include pregnancy is not a
gram-positive to women of component of the vaccine redness, anaphylaxis or contraindication of the
Brand Name: bacillus, Clostridium childbearing age including thimerosal or any warmth, anaphylactic vaccine.
Bio-TT tetani. This bacteria and to pregnant history of systemic allergic edema, shock, brachial • Inform patient on how the
produces a women is to reaction. induration neuritis, injury, vaccine works and what it is
Classification: neurotoxin called protect them with or cochlear lesion, for.
Vaccine tetanospasmin, which from tetanus and without paralysis of the • Monitor the injection site –
blocks the release of to protect their tenderness as radial nerve. check for redness or
Dose, Route & an inhibitory newborn infants well as swelling.
Timing: neurotransmitter and against NT and urticaria, and  Inform patient to notify the
1 vial, leads to unopposed prevent newborn rash. Malaise, nurse if any of the side and
Intramuscularly, muscle contractions from whooping transient adverse effects has
single dose and spasms. cough. fever, pain, occurred.
hypotension,
nausea and
arthralgia
may develop
in some
patients after
the injection.
Page 38 of 56
Drug Study: VITAMIN C
Dr. Roa ordered: Vitamin C 1-tab PO daily

Generic Name: In humans, an During Contraindicated to patients Side effects Adverse effects  Return the medication ticket
Vitamin C exogenous source of pregnancy, with blood disorders- include include acute on the right box for the next
ascorbic acid is vitamin C is vital thalassemia, G6PD nausea, hemolytic anemia, timing.
Brand Name: required for collagen for both mom and deficiency sickle cell vomiting, insomnia,  Inform patient what the
Poten-cee, formation and tissue baby. It is needed disease, and diarrhea, urethritis, dysuria, vitamin is for and that this
Kirkland repair by acting as a for tissue repair hemochromatosis. heartburn, hyperoxaluria, or vitamin increases the
cofactor in the post and wound stomach hyperuricemia. absorption of iron when
Classification: transitional formation healing, and it cramps, taken with iron-rich foods.
Vitamin of 4-hydroxyproline in helps the baby’s bloating,  Monitor patient for possible
–Xaa-Pro-Gly- bones and teeth headache. side and adverse effects.
Dose, Route & sequences in develop. Vitamin  Inform patient to report any
Timing: collagens and other C also aids in the side and adverse effects
1 tab PO daily proteins. Ascorbic body’s production that has occurred.
acid is reversibly of collagen, helps
oxidized to bolster immunity
dehydroascorbic acid and, on top of it
in the body. all, improves your
ability to absorb
iron.
Page 39 of 56
Drug Study: VITAMIN D
Dr. Chua ordered: 1 cap PO daily

Generic Name: Adequate nutritional Vitamin D Contraindicated in patients Side effects Adverse effects • Assess patient’s condition
Vitamin D vitamin D status supplementation with sarcoidosis, high include include serious that may be contraindicated
during pregnancy is during pregnancy amount of phosphate in nausea, allergic reactions, with the medication.
Brand Name: important for fetal improves blood, high amount of vomiting, arrythmias, • Determine baseline and
Fern-D skeletal development, maternal vitamin calcium in blood, kidney constipation, hypercalcemia, periodic values for serum
tooth enamel D status and may stones, decreased kidney loss of lethargy calcium, phosphorus,
Classification: formation, and reduce the risk of function appetite, magnesium, and alkaline
Vitamin perhaps general fetal pre-eclampsia, thirst, phosphatase.
growth and low birthweight unusual • Inform patient to notify the
Dose, Route & development. There and preterm tiredness nurse if any of the side and
Timing: also is mounting birth. It needs for adverse effects has
1 cap PO daily evidence to suggest building and occurred.
that vitamin D maintaining  Monitor for hypercalcemia.
deficiency impacts on healthy bones
the immune function, and absorb
not only of the calcium, the
mother, but also of primary
the neonate and component of
infant through the bone.
first year of life.
Page 40 of 56
Drug Study: MICONAZOLE
Dr. Chua ordered: Miconazole 1-tab PO daily x 7 days
Drug Mechanism of Action Indications or Contraindication Side Effects Adverse Nursing Responsibilities
Purpose s Reactions
Generic Name: Miconazole is an azole Miconazole is Contraindicated to Side effects Adverse effects • Assess for any cautions and
Miconazole antifungal used to treat a indicated for the local hypersensitivity to include include dysgeusia, contraindications to prevent
variety of conditions, treatment of miconazole and milk diarrhea, pharyngeal pain, any untoward
Brand Name: including those caused by oropharyngeal protein allergy. nausea, anemia, complications.
Oravig Candida overgrowth. candidiasis in adult headache, lymphopenia, • Monitor patient response to
Unique among the azoles, patients. It is vomiting, fatigue, pruritus the drug.
Classification: miconazole is thought to indicated for the upper • Instruct patient for correct
Antifungal act through three main treatment of itchiness abdominal method of administration,
mechanisms. The primary at genital area, pain depending on route.
Dose, Route & mechanism of action is vaginal reddening, • Monitor for any side and
Timing: through inhibition of the and genital candida adverse effect and inform
Dose: 50 mg CYP450 14α-lanosterol infection. client to report any effects
Route: Orally demethylase enzyme, experienced.
Timing: Daily for 7 which results in altered • Instruct patient to notify the
days ergosterol production and prescriber if the condition
impaired cell membrane worsen.
composition and
permeability, which in
turn leads to cation,
phosphate, and low
molecular weight protein
leakage.
Page 41 of 56
Drug Study: PNSS
Dr. Chang ordered: 1L at 100mL/hr x 2
Purpose s Reactions
Generic Name: Normal saline solution has Indicated for Contraindicated for Side effects Adverse effects • Obtain history of the
Plain Normal an osmolality. Because replacement of patients with heart include include febrile patient’s fluid and
Saline Solution the osmolality is entirely extracellular fluid. failure, pulmonary hypotension. response, electrolyte status before
contributed by edema, renal infection at IV therapy.
Brand Name: electrolytes, the solution impairment, sodium site, venous • Check the fluid for a safe
N/A remains within the ECF, retention thrombosis, administration.
does not cause red blood extravasation, • Monitor patient frequently
Classification: cells to shrink or swell. hypervolemia. for any signs of infiltration,
Isotonic Isotonic fluids expand the phlebitis, and condition of
Intravenous Fluid ECF volume. the skin
• Inform patient to notify the
Dose, Route & nurse if any side and
Timing: adverse effects has
100mL/hr x 2 occurred.
Page 42 of 56
Drug Study: INSULIN LISPRO
Dr. Roa ordered: 10 units SQ TID pre-meals
Purpose s Reactions
Generic Name: Insulins lower blood Whether the Insulin lispro use is Side effects Adverse effects • Ensure uniform dispersion
Insulin Lispro glucose by stimulating pregnancy is contraindicated in include include low blood of insulin suspensions by
peripheral glucose uptake classified as patients during headache, sugar, rolling the vial gently
Brand Name: by skeletal muscle and pregestational episodes of nausea, lipodystrophy, between hands; avoid
Humalog fat, and by inhibiting diabetes (occurring in hypoglycemia. hunger, pruritus, rash vigorous shaking.
hepatic glucose women who have confusion, • Give maintenance doses
Classification: production. Insulins been diagnosed with drowsiness, subcutaneously, rotating
Human Insulin inhibit lipolysis and type 1 or type 2 weakness, injection sites regularly to
proteolysis, and enhance diabetes before sweating, decrease incidence of
Dose, Route & protein synthesis. pregnancy) or as redness of the lipodystrophy
Timing: gestational diabetes injection site, • Carefully monitor patients
10 units, mellitus (GDM, swelling or being switched from one
subcutaneously, occurring when a itching of the type of insulin to another
TID pre-meals nondiabetic woman site • Monitor urine or serum
develops diabetes glucose levels frequently to
only during determine effectiveness of
pregnancy), the goal drug and dosage.
of treatment is to • Advise patient to inform the
maintain maternal nurse if any of the side and
glucose levels as near adverse effects has
to normal as possible occurred.
throughout the
pregnancy.
Page 43 of 56
Drug Study: INSULIN LEVIMIR
Dr. Roa ordered: 10 units SQ BID pre-meals
Purpose Reactions
Generic Name: Insulin detemir, a long- Insulin detemir is Contraindicated to Side effects Adverse effects • Follow order to administer
Insulin Detemir acting insulin, exerts its effective as a insulin detemir or include include low blood before meals.
action by binding to glucose-lowering cresol, diabetic weight gain, sugar, low • Monitor patient’s weight.
Brand Name: insulin receptors. agent, with glycemic ketoacidosis, coma, swelling of potassium levels, • Notify the prescriber of any
Levemir Receptor-bound insulin control equivalent to hypoglycemia. hands and fluid retention of the following: fever,
lowers blood glucose by that of NPH insulin. feet, infection, trauma, diarrhea,
Classification: facilitating cellular uptake thickening or nausea, or vomiting.
Human Insulin of glucose into skeletal hallowing of • Rotate injection sites and
muscle and fat, and the injection never inject into an area
Dose, Route & inhibiting the output of site, with redness, swelling,
Timing: glucose from the liver. dizziness, itching, or dimpling.
10 units, hunger, • Inform patient not to take
subcutaneously, slurred any other medication unless
BID pre-meals speech, approved by physician.
headache,
shakiness
Page 44 of 56
Drug Study: PARACETAMOL
Dr. Roa ordered: Paracetamol 500mg/tab 1 tab q4 PRN
Purpose Reactions
Generic Name: Decreases fever by a Indicated for Contraindications to the use Side effects Adverse effects  Encourage patient to take it
Paracetamol hypothalamic effect fever and of acetaminophen include include include with food or drink to
leading to sweating headache. hypersensitivity to nausea, methemoglobine minimize GI upset.
Brand Name: and vasodilation, acetaminophen, severe stomach pain, mia, hemolytic  Instruct patient to report if
Biogesic, Tylenol inhibits pyrogen hepatic impairment, or loss of anemia, cyanosis, shortness of
effect on the severe active hepatic appetite, neutropenia, breath, and abdominal pain
Classification: hypothalamic-heat- disease. itching, rash, thrombocytopenia has occurred.
Analgesic, regulating centers, headache, , leukopenia,  Inform patient to notify
Antipyretic inhibits CNS dark urine, jaundice. prescriber if paleness,
prostaglandin drowsiness. weakness, jaundice,
Dose, Route & synthesis with itchiness, and dark urine are
Timing: minimal effects on present.
Dose: 500 mg peripheral  Monitor patient if pain
Route: Orally prostaglandin persists for more than 3-5
Timing: q4 PRN synthesis days.
 Monitor patient’s response to
the therapy.
Page 45 of 56
B. Diet & Activity Management & Nursing Responsibilities
Type of Diet/Activity General Description Indication or Purposes Restricted Nursing Responsibilities

Foods/Activities
Eating the healthiest foods Manage the blood glucose • Fried foods and other • Discuss glucose monitoring at
in moderate amounts and levels. Achieve target blood foods high in saturated home with the patient
sticking to regular lipid (fat) levels. Maintain a fat and trans fat according to individual
mealtimes. A healthy-eating healthy blood pressure. • Foods high in salt, also parameters to identify and
Diabetes Diet plan that's naturally rich in Maintain a healthy body called sodium manage glucose variations.
nutrients and low in fat and weight. • Sweets, such as baked • Explain to the client to
calories. Key elements are goods, candy, and ice identify foods and drinks with
fruits, vegetables and whole cream high sugar content.
grains. • Beverages with added • Instruct the client to follow
sugars, such as juice, the nutritional plan and report
regular soda, and any related problems
regular sports or energy • Instruct the client to measure
drinks and record the waist
circumference, height and
weight accurately.
Usually orders given This particular diet is given Foods that is intolerable to • Discuss to the client the
regarding dietary restrictions when client can now tolerate ingest by the patient like importance of following any
after a medical procedure. any food she desires that is highly processed foods, restrictions of the food to
Diet as Tolerated (DAT) This means that a person nutritious, if this will not lead trans fat, added sugar and avoid any complications.
should be careful of what to any complications and if salts refined grains and • Explain to the client to
they eat. the client needs further alcohol. identify foods and drinks that
monitoring for lab test. is difficult to ingest, in order
to avoid ingesting it.
Page 46 of 56
Summary of Pharmacologic Studies
A. Pharmacotherapeutics
Date & Medication Classification Dosage Route

Time
02/20/2021 Metoclopramide Prokinetic Agent 1 tab Orally
– 8:00AM (10mg)
02/20/2021 Ferrous sulfate Vitamin 1 tab Orally
+ folic acid
02/20/2021 Vitamin C Vitamin 1 tab Orally
(100mg)
02/20/2021 Vitamin D Vitamin 1 cap Orally
(5000IU)
02/20/2021 Tetanus Toxoid Vaccine 1 vial Intramuscularly
02/20/2021 Miconazole Antifungal 1 tab Orally
– 12:00NN (50mg)
02/21/2021 Insulin Lispro Human Insulin 10 units Subcutaneously
– 5:30AM
02/21/2020 Insulin Detemir Human Insulin 10 units Subcutaneously
02/21/2020 Paracetamol Antipyretic, 1 tab Orally
– 5:00PM analgesic (500mg)
B. Intravenous Fluids
Date & Bottle Type of IV Fluid & Rate Incorporation

Time No. Volume
02/20/2021 Lactated Ringer’s 25 gtts/min. None
– 8:00AM Solution (PRN)
02/20/2021 Plain Normal Saline 25 gtts/min. None
– 4:00PM Solution
Page 47 of 56
Nursing Care Plan
A. Problem List (Summary)
Cues Nursing Diagnosis Definition

Patient stated Hypothermia related to Core body temperature below
“magpaprenatal decrease metabolic rate the normal diurnal range due
raman unta ko pero as evidenced by cold to failure of
nikalit lng og lain clammy skin and thermoregulation.
akong paminaw, temperature.
nalipong ko og kalit.”
“Ok ra kaha ko Anxiety related to threat Vague, uneasy feeling of
maam? Ang baby to current status as discomfort or dread
nako ok ra kaha cya? evidenced by fear, accompanied by an
mahadlok ko nga increase in wariness, high autonomic response (the
mahitabo sa ako blood pressure, increase source is often nonspecific or
utro ang nahitabo sa in heart rate, and unknown to the individual); a
ako sauna katong increase in respiratory feeling of apprehension
permiro nako nga pag rate. caused by anticipation of
buntis…” As danger. It is an alerting sign
verbalized by the that warns of impending
patient. danger and enables the
individual to take measures
to deal with that threat.
Client says she is able Obesity related to high A condition in which an
to digest food but frequency of restaurant individual accumulates
likely to consume fried or fried food as evidence excessive fat for age and
chicken from known by moreover optimum gender that exceeds
food chain and body weight and overweight.
seldom eats green- excessive fat.
leafy vegetables.
Page 48 of 56
Nursing Care Plan
Patient’s Code: JS Age: 40-year-old Sex: Female Civil Status: Married Religion: Roman Catholic Date & Time of Admission: 02/21/2021
8:00 am Room: 144 Attending Physician: Dr. Chua Chief Complaints: Dizziness
Nursing Diagnosis (PES): Actual – Hypothermia related to decrease metabolic rate as evidenced by cold clammy skin and temperature
Definition: Core body temperature below the normal diurnal range due to failure of thermoregulation.
Assessment/ Cues Planning Interventions Rationale Evaluation
(Subjective/ Objective) (Goals and Objectives)
Subjective Data Short-term Goals: Independent • Within 8 hours of
• Patient stated “magpaprenatal • Within 8hrs of nursing  Monitor vital signs • Serve as baseline data. nursing
raman unta ko pero nikalit lng interventions, patient  Monitor body temperature at • Regular temperature interventions the
og lain akong paminaw, will maintain body regular intervals. monitoring will identify patient maintained
nalipong ko og kalit.” temperature within adequate or inadequate body temperature
the normal range. thermoregulation. within the normal
Objective Data • Blood glucose will be  Regulate the environment • Provide for a more range as
 (+) Pallor controlled. temperature or relocate patient to gradual warming of the manifested by
 (+) Cold clammy skin a warmer setting. body. body temperature
 BP: 140/90mmHg Long-term Goals:  Promote surface cooling by means • To promote heat loss of 35.4°C.
 CR/PR: 102 bpm • After 2 weeks of of undressing cool environment, by radiation, conduction, • Patient verbalized
 T: 35.4°C nursing intervention and or fans, cool/tepid sponge convection, evaporation, and understood
patient will be able to baths or immersion of local ice and to decrease the specific
verbalize packs especially in the groin or temperature of areas intervention to
understanding specific axillae. with high blood flow. prevent
intervention to  Perform Capillary blood glucose • To rapidly test blood hypothermia.
prevent hypothermia. testing. glucose level before
administering insulin in
order to identify those at
Page 49 of 56
Objectives: highest risk for hypo-and
• Demonstrate behaviors hyperglycemia.
to monitor and promote
normothermia.  Maintain bed rest • To reduce metabolic
demands/oxygen
consumption.
Dependent
• Administer insulin as indicated by the • To control blood sugar
physician. of patient.
Collaborative
 Refer to physician for consultation. • Help to improved
patients outcome.
References: Eds. (2017). NANDA International Nursing Diagnoses: Definitions & Classification 2018-2020. Thieme.
Page 50 of 56
Nursing Care Plan
Patient’s Code: JS Age: 40-year-old Sex: Female Civil Status: Married Religion: Roman Catholic Date & Time of Admission: February 20,
2021 @ 8:00 AM Room: 144 Attending Physician: Dr. Chua
Chief Complaints: “Ok ra kaha ko maam? Ang baby nako ok ra kaha cya? mahadlok ko nga mahitabo sa ako utro ang nahitabo sa ako sauna katong permiro
nako nga pag buntis…”
Nursing Diagnosis (PES): Anxiety related to threat to current status as evidenced by fear, increase in wariness, high blood pressure, increase in heart
rate, and increase in respiratory rate.
Definition: Vague, uneasy feeling of discomfort or dread accompanied by an autonomic response (the source is often nonspecific or unknown to the
individual); a feeling of apprehension caused by anticipation of danger. It is an alerting sign that warns of impending danger and enables the individual to
take measures to deal with that threat.
Subjective Data Short-term Goals: Independent After 1-2 weeks of
• “Ok ra kaha ko maam? Ang • After 1-2 weeks of • Monitor the patient’s blood  Monitoring vital signs nursing intervention,
baby nako ok ra kaha cya? nursing intervention, pressure, respiratory and heart help alleviate risks for the goals were met:
mahadlok ko nga mahitabo sa the patient will be able rate. further complications.
ako utro ang nahitabo sa ako to show/verbalize  The patient was
sauna katong permiro nako nga decrease of worry and • Monitor fetal vital signs.  Fetal monitoring able to
pag buntis…” As verbalized by concerns regarding avoids fetal show/verbalize
the patient. the possible problems complications. decrease of
of her pregnancy. • Explain to/educate the patient  Making the patient concerns and
Objective Data • After 1-2 weeks, along about her feeling of being anxious. understand her worry. The
• BP: 140/90 mmHg with the patient’s feelings promotes patient’s vital signs
• PR: 102 bpm wariness, the patient’s better intervention. were back to
• RR: 25 cpm vital signs will be back
Page 51 of 56
to its normal range for • Recognize awareness of the  Acknowledgment of normal ranges for
pregnant women on patient’s anxiety. the patient’s feelings her current status.
their 3rd trimester. validates the feelings
and communicates
Long-term Goals: acceptance of those Long-term goal was
• The patient will be feelings. partially met:
able to maintain  Patient is still doing
having positive her maximum best
outlook regarding her • Accept patient’s defenses; do not  The patient may feel to manage her
pregnancy. dare, argue, or debate. secure and protected outlook about her
enough to look at pregnancy.
behavior.
• Help patient determine precipitants  Obtaining insight
of anxiety that may indicate allows the patient to
interventions. reevaluate the threat
or identify new ways
to deal with it.
Dependent
 Refer to a psych consult for better  Psych consults know
anxiety management and for best on how to
possible drugs to be used. manage anxiety.
Collaborative
 Collaborate with patient and her  Family collaboration
family on ways to manage anxiety. is one factor of a
good patient care and
intervention.
References: Herdman, T.H. & Kamitsumu, S. (2018). NANDA International Inc. Nursing Diagnosis. 2018 NANDA International
Page 52 of 56
Nursing Care Plan
Patient’s Code: JS Age: 40 Sex: Female Civil Status: Married Religion: Roman Catholic Date & Time of Admission: February 21, 2021
;8:00 AM Room: 144 Attending Physician: Dr. Chua Chief Complaints: Sudden dizziness and not feeling well.
Nursing Diagnosis (PES): Obesity related to high frequency of restaurant or fried food as evidence by moreover optimum body weight and excessive fat.
Definition: A condition in which an individual accumulates excessive fat for age and gender that exceeds overweight.

Subjective Data Short Term Independent The planned care was
 Client says she is able At the end of my 8 hours of nursing  Assess weight and blood pressure  To monitor the met as evidence by:
to digest food but care, the patient will be able to: every week. weight and provides
likely to consume fried  Verbalize consequences related information about the  Verbalization of
chicken from known to eating friend food and not effectiveness of the consequences
food chain and seldom green leafy vegetables that therapy about her eating
eats green-leafy resulted to obesity.  Discuss to the client about the  Provides opportunity habits and choices
vegetables. a. Gestational diabetes, proper foods and meals to eat and to focus and of foods.
cesarean delivery and teach her to keep a food dairy to internalize a realistic  Demonstration of
Objective Data preeclampsia. tract and change her eating habits. picture of the amount appropriate
 Wt: 200 lbs.  Demonstrate appropriate of food and kinds of selection of meals
 Ht: 5 ft. and 5 inches selection of meals towards the food to be ingested. and foods.
 BMI: 33.3 goal of weight reduction.  Identification of
 OGTT Fasting:  Identify behavior modification  Discuss the importance of exercise  Engaging into behavior
125mg/dL strategy to avoid frequent like walking, lifestyle and behavior exercise helps the modification
o 1 hr post-prandial: eating of unhealthy foods like in maintaining optimal health for client’s loss weight strategy to avoid
200mg/dL having a food diary. her pregnancy. and a lifestyle and eating unhealthy
o 2 hr post-prandial: behavior has a big foods.
170mg/dL factor for the goals
Page 53 of 56
 Would be able to understand and plans to be  Demonstrate
the importance of proper realistic and changes in
weight during pregnancy. achieved. lifestyle and
Dependent behavior.
Long Term  Administer medication as  To help the client
 After 1 month of nursing prescribed by the physician. improve her overall Some planned care
intervention the patient would metabolic health and was partially met as
be able to: reduce the risk of any evidence by:
 Display weight loss with optimal known adverse  Weight loss but
maintenance of health, prevent pregnancy outcomes. not yet ideal for
further weight gain and a long- her high and
term weight maintenance. Collaborative condition.
 Display lifestyle and behavior,  Consult to a dietician to determine  A dietician is more
modification strategies to caloric and nutrients required for knowledgeable
promote successful weight loss the client’s weight loss. regarding diet plan
and control like walking and appropriate for the
eating healthy foods.  Formulate an eating plan with a client.
 Displays improvement of bad dietician that corresponds to the  To help the client
eating habits and wrong eating client’s condition and situation. about what food
habits. should and should not
be ingested.
References: Heather, H., & Shigemi, K. (n.d.). NANDA International, Inc. Nursing Diagnoses (2018-2020 Eleventh ed.). New York, NY 10001 USA +1 800
782 3488,: Thieme New York.
Page 54 of 56
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Page 56 of 56

A Case Presentation of An Adult With Gestational Diabetes Mellitus

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Republic of the Philippines

CENTRAL MINDANAO UNIVERSITY

University Town, Musuan, Maramag, Bukidnon

A Case Presentation of an Adult

In Partial Fulfillment of the Requirements in

To the Clinical Instructors of Central Mindanao University College of Nursing

A 40-year-old multigravida woman named Julia Salazar is in her third

Gestational diabetes mellitus (GDM) happens when a placenta hormone

Preferred screening and diagnostic 2-step from Diabetes Canada's 2018

The "alternative 1-step diagnostic" approach from Diabetes Canada's 2018

Like type 2 diabetes mellitus, its occurrence is increasing, reaching a global

Gestational diabetes (GDM) is predominant in the Philippines. Data published

1. Systematically present the data pertinent to the case being gathered.

2. Provide an evidence-based overview of the case study.

4. Formulate a narrative health assessment including the findings that is

6. Recognize the contributing factors associated with the development of the

7. Understand the pathophysiology and etiology of GDM.

8. Efficiently provide an appropriate and proper nursing diagnosis in line with

Name : JS Height: 5’5

G1 : Blighted ovum @6W 5 years ago

G3 : Currently @30W of gestation, EDD: 03/22/2021

F. General Health History

THE ENDOCRINE SYSTEM

The organs composing the

The hypothalamus is a component of the nervous system and is one of the

The thyroid gland is placed at

The thyroid- produce hormone is known as the body’s primary metabolic

The parathyroid glands are

Adrenal glands, also

The thymus is found in the

The female gonads are referred to as

The estrogen is in charge of the growth

The placenta is not a permanent organ; it is

The pancreas plays a vital role in discussing gestational diabetes mellitus

During pregnancy, insulin sensitivity decreases- effects of insulin in maternal

In gestational diabetes, instead of having a slight decrease in insulin

Maternal hyperglycemia causes the maternal tissue to experience and show

Predisposing Factors Precipitating Factors

High risk for pregnancy induced glucose

Pancreatic beta cells “tire Placenta releases

Julia is a 40-year-old pregnant woman. Gravida 3, preterm 1 and is at 30th-

Predisposing Present Absent Implication

Age / Pregnant women over the age of 25 are

Family History of / People with a moderate to high family

Ethnicity / Asian and Filipina women had a

Hypertension in / Gestational diabetes increases the risk

Precipitating Present Absent Implication

Obesity / Obese women are even more likely to

Sedentary lifestyle / Lack of physical activity raises the risk

Diet / In gestational diabetes it is important to

Insulin sensitivity is an essential metabolic adaptation. Insulin sensitivity

Glucose cannot be used by body cells if a woman's insulin output is

As dehydration progresses, the blood serum becomes more concentrated,

Furthermore, these dangers to your wellbeing include fatigue, vaginal yeast

Signs and Present Absent Implication

Fatigue / The client was showing signs of

Vaginal Yeast / This was seen in the client. Since a

Polydipsia / This was not reported by the client.

Polyuria / This was not reported by the client.

Glycosuria / The patient is experiencing this one.

Obesity / There was an objective data reported to