Nursing Care Plan for Patient Suffering from gestational diabetes mellitus
Christine is a thirty-three-year-old Caucasian lady who has had her pregnancy for the last eight months and two weeks. The lady is experiencing her early stages of labor, which is an indication that the lady is about to deliver her child. However, the lady seems to be fatigued excessively, even though fatigue is a familiar feeling when expecting a child. The fact that
the lady appears to be exhausted most of the time and uncomfortable is a clear sign of the need for assessment.
Based on the earlier indication of the need for concern on the patient’s wellness, several characteristics were obtained or observed from the patient.
Characteristics obtained directly from the patient include,
Complains of prolonged pain during the day and at night.
Indicates feeling fatigued almost throughout the day despite being in the early stages of labor.
She feels thirsty most of the time, prompting her to drink lots of fluids, in most cases, water.
Frequently feels the urge to urinate.
Characteristics obtained from the observer
The patient seems uncomfortable, although all necessary conditions for comfort are put in place.
The patient seems exhausted as early as six in the morning after waking up, although she has been inactive through the night. The rest of the day is exhibited by similar signs of fatigue
and discomfort. Therefore, the patient may not be resting well since she appears tired throughout the day and night.
The patient also takes in a lot of fluids, more so water, even when the weather is not very warm or hot.
The patient frequents the washrooms many times, which may not seem familiar, indicating that something is not okay.
From close family member/ primary caregiver, the patient increased urge for fluids has developed as the labor progressed. Before pregnancy, the patient did not seem tired or in constant use of the washroom.
Data Analysis and Organization
High levels of plasma were detected in the lady after screening. The serum glucose levels were also deemed relatively high for the lady. The glucose levels were established at 192 mg/dL, indicating that the patient might be suffering from gestational diabetes mellitus. The body temperature was slightly above average for the patient that is at 37.4 degrees Celsius. Blood pressure levels were recorded at 132/80 mmHg, which is also outside the normality bounds for blood pressure level. The two initial assessment findings indicate that the patient is suffering hence prompting for further assessment. The patient also showcases signs of restlessness and discomfort. The patient also seems very tired, although she is not exposed to any tasks having in mind that she is pregnant (Amiri, 2019).
Polydipsia is excessive thirst. The patient showcases an increased appetite for fluids such as water, which she takes on numerous occasions. Although any individual needs to stay hydrated, the patient’s fluid intake levels are highly abnormal. The fluid intake may account
for the frequent visits to the washrooms by the patient. High sugar levels and dry mouth is an indication of the need for a diagnosis. Polyphagia, that is, the patient showcases an increased appetite for food, although she appears weak and tired.
Polyuria is the abnormal and excessive urination accompanied by high amounts of urine by the patient (Craig, Sims, Glasziou, & Thomas, 2020). The patient also appears anxious and nervous, which may be expected for an expectant mother. The patient also complains of occasional headaches even though they are not persistent. Blurred vision and confusion for the patient may be associated with occasional headaches. The patient also experiences episodes of nauseated feeling.
Gestational diabetes has increased its prevalence among women who have attained childbearing age and suffer from obesity and overweight (Kampmann et al., 2015). Gestational diabetes threatens the welfare of newborns in cases where expectant mothers are suffering from the ailment. Diagnosis of the disease is essential to ensure early and proper management hence guaranteeing the welfare of both the yet to be born child and its mother. Screening is the first step that precedes the gestational diabetes diagnosis of an expectant mother. Screening aids in the early detection and diagnosis of the ailment to take note of women at risk of developing the disease.
Measurement of fasting glucose helps in diagnosing gestational diabetes among young women. Ladies of a younger age are at risk of having undiagnosed gestational diabetes (Craig, Sims, Glasziou, & Thomas, 2020). However, screening and measurement of the glucose level are methods that are not globally accepted. Glucose tests are used to diagnose the ailment, although it is normal for pregnant women to have a low glucose level. The low
glucose level brings in other symptoms, including fatigue and unusual thirst. The symptoms can assist in correctly diagnosing a patient of gestational diabetes. Frequent urination and blurred vision are among other symptoms that help in the diagnosis.
Monitoring and managing blood sugar levels would be the highest priority when dealing with the disease. The blood sugar should be stable, and in case it gets too high, medication such as insulin ought to be provided. Gestational diabetes provides room for insulin resistance hence the need for insulin intake. The compensation for insulin is also needed because a pregnant woman secrets a lot of insulin to maintain a euglycemic state. Insulin also aids in maintaining normal glucose levels in both the woman and the fetus. It is usual for glucose to exchange between the expectant mother and the fetus. However, in cases where the mother already has gestational diabetes, there is an excess transfer of glucose from the placenta.
Insulin helps in compensating for the excess glucose that exists in the placenta (Amiri, 2019). The glucose levels in the fetus are therefore also restored, and its welfare guaranteed. Another priority would be to perform a screening process to confirm the disease’s presence to lower the risk imposed on the mother and child. Actions such as exercising and dieting, would be recommended to reduce the risk of the ailment if declared absent after screening. Dietary counseling is vital in the self-restoration of blood glucose for both the expectant mother and her child.
Establishing goals and desired outcomes
Goals and desired outcomes are geared at motivating both the primary care provider and the patient. Gestational diabetes can harm the expectant mother and her child’s lives, hence the need to prepare a care plan guided and motivated by establishing goals. The primary care provider’s ultimate goal is to improve the quality of life for the expectant mother. To achieve that, the primary care provider should focus on an effective treatment plan that will guide the patient’s journey to recovery. Normalizing the glucose levels, which should be less than 180 mg/dL for the patient, is another desired goal for both the patient and the care provider. The goal can be achieved through insulin intake, which also establishes the insulin levels for the patient. The patient should also work towards attaining normal weight levels. Obesity and excess weight can threaten the lives of the expectant mother and her child. The patient should, therefore, establish a daily workout and exercising plan to achieve that goal. However, the plan should not be tiresome and stressful to reduce risking the life of the expected child. A perfect dietary plan is also crucial to achieving average weight goals. Maintaining normal insulin, blood sugar, and glucose levels are all desired outcomes that will protect the patient and her child from complications brought about by gestational diabetes.
Nursing interventions and Rationale
Assessing for signs of hyperglycemia, which is commonly referred to as high blood sugar. High levels of glucose bring about hyperglycemia compared to insulin levels. High glucose levels lead to symptoms such as increased thirst and incidences of urination. Hunger, fatigue, and blurred vision are also brought about by the patient’s rise in glucose levels. Blood glucose
levels should also be assessed to ensure that they balance between 140 and 180 mg/dL. The assessment should be conducted before meals and during the patient’s bedtime.
If the patient is non-intensive, the blood glucose levels should be below 140 mg/dL before having meals (Plows, Stanley, Baker, Reynolds, & Vickers, 2018).
Assessment of the blood glucose levels for the past two months, also identified as HbA1c-glycosylated hemoglobin, is essential. The blood glucose levels should balance between six to seven percent, which is the desired level. Assessing symptoms of hypoglycemia, which is low blood sugar, is also vital. Low blood sugar is characterized by symptoms such as seizures and loss of speech. Anxiety and loss of consciousness are also a sign of hypoglycemia which can be life-threatening.
Temperature assessment and pulse determination should also be considered to assure the patient of wellness. Abnormal temperature and pulse are clear signs of unwellness of a particular individual. Reports of nausea and abdominal pain would also signify a threat to the patient’s quality of life and the unborn child. The reports are vital in determining the treatment method to be applied to the patient. Assessing the patient’s physical activity, such as exercising, is crucial. Physical activity assists in lowering the blood glucose levels that are a clear indication for gestational diabetes. Physical activity is essential in managing diabetes and preventing cardiovascular complications.
Administering insulin is vital to maintain safe glucose levels in the patient. Insulin intake also compensates for excess loss of glucose used by the unborn child in the placenta. The patient and the primary care provider should look out for hyperglycemia that occurs in the morning. A rise in the glucose levels in the morning is dealt with through the administration of insulin in the morning. Assessing blood pressure levels is essential because it should be lower than 160 mmHg (Plows, Stanley, Baker, Reynolds, & Vickers, 2018). High blood pressure can lead to hypertension, a complication that is often associated with
gestational diabetes. Hypoglycemic medications should be taken orally to assure the patient of quality life. Sulfonylureas assists in stimulating the secretion of insulin from the placenta. Biguanides, among other drugs, are useful in normalizing the levels of glucose in the patient.
The patient should have normal levels of glucose after some time. After that, symptoms such as increased urination and thirst ought to subside. Just as in typical pregnancy situations, the patient should increase her insulin secretion aided by the medication. The patient should also report normal body temperature and pulse levels and an indication of the individual’s health wellness. The normal blood sugar levels for the patient will also be assured. Proper management of gestational diabetes will ensure the patient’s wellness and that of her child. The patient should be able to self-administer insulin and maintain the necessary blood sugar levels to avoid complications. Christine’s safety and her unborn child will be guaranteed through personal safety and care as directed by the primary care provider.
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