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CASE PRESENTATION

CASE PRESENTATION. GESTATIONAL DIABETES. PREPARED BY: JYOTHIS JAMES. DEMOGRAPHIC DATA. CASE NO: 185… NAME: MS. M.A AGE: 19 YRS SEX: FEMALE Primigravida with pregnancy 40 wks by LMP DIAGNOSIS: GESTATIONAL DIABETES. PHYSICAL ASSESSMENT. GENERAL.

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CASE PRESENTATION

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  1. CASE PRESENTATION GESTATIONAL DIABETES PREPARED BY: JYOTHIS JAMES

  2. DEMOGRAPHIC DATA • CASE NO: 185… • NAME: MS. M.A • AGE: 19 YRS • SEX: FEMALE • Primigravida with pregnancy 40 wks by LMP • DIAGNOSIS: GESTATIONAL DIABETES

  3. PHYSICAL ASSESSMENT

  4. GENERAL • The patient is 19years of age, FEMALE, weighs 75 kg. • She is conscious, coherent, with the following Vital Signs: • BP= 112/60mmHg • PR=78bpm • RR= 20cpm • Temp=37.2 ⁰C • SPO²= 96%

  5. SKIN • Fair complexion • No palpable masses or lesions, moist, with good turgor

  6. HEAD • Maxillary, frontal, and ethmoid sinuses are not tender. • No palpable masses and lesions • No areas of deformity

  7. LEVEL OF CONSCIOUSNESS AND ORIENTATION • Awake and alert • Oriented to persons (knows some of our name) • Place ( she can tell where she is) • Time ( knows the day, date and always asking the time) • She knows the function of something like BP apparatus

  8. EYES • Pink conjunctivae and no dryness • Pupils equally round and reactive to light

  9. EARS • No usual discharges noted

  10. NOSE • Pink nasal mucosa • No unusual nasal discharges • No tenderness in sinuses

  11. MOUTH • Pale and dry oral mucosa and free of swelling and lesions

  12. NECK AND THROAT • No palpable lymph nodes • No masses and lesions seen

  13. CHEST AND LUNGS • Equal chest expansion • No retraction • Clear breath sounds

  14. HEART • Regular rhythm

  15. ABDOMEN • Globular abdomen • Leopold’s Maneuver done: fetus in cephalic presentation, head is round and hard, fetal back is facing left side, engaged

  16. GENITALS • No leaking per vagina

  17. EXREMITIES • Pulse full and equal • No lesions noted

  18. PATIENT HISTORY • No special past medical history

  19. PRESENT MEDICAL HISTORY • MEDICAL HISTORY: Primigravida with pregnancy 40 wks by LMP, GDM (Gestational Diabetes) on diet .No history of Diabetes at Pre-pregnancy state. • ON EXAMINATION: BP: 112/60mmHg, PR: 78 bpm, RR: 20 cpm, Temp=37 .2⁰C SPO²=96% . RBS =140 mg/dl

  20. PRESENT MEDICAL HISTORY • INVESTIGATION

  21. MEDICATION

  22. INTRODUCTION • INTRODUCTION • Gestational diabetes is a condition characterized by high blood sugar (glucose) levels that is first recognized during pregnancy • The condition occurs in approximately 4% of all pregnancies

  23. INTRODUCTION Causes, incidence, and risk factors • Pregnancy hormones can block insulin from doing its job. When this happens, glucose levels may increase in a pregnant woman's blood.

  24. INTRODUCTION RISK FACTORS • Are older than 25 when you are pregnant • Have a family history of diabetes • Gave birth to a baby that weighed more than 9 pounds or had a birth defect • Have high blood pressure • Have too much amniotic fluid • Have had an unexplained miscarriage or stillbirth • Were overweight before your pregnancy

  25. ANATOMY AND PHYSIOLOGY

  26. ETIOLOGY

  27. ETIOLOGY RISK FACTOR: Have a family history of diabetes Dietary Factor Obesity Increased sugar Level in the Blood of the mother Increased sugar Level in the Blood of the Baby Overweight of the Baby

  28. SIGNS & SYMPTOMS • Symptoms • Usually there are no symptoms, or the symptoms are mild and not life threatening to the pregnant woman. The blood sugar (glucose) level usually returns to normal after delivery. Symptoms may include: • Blurred vision • Fatigue • Frequent infections, including those of the bladder, vagina, and skin • Increased thirst • Increased urination • Nausea and vomiting • Weight loss despite increased appetite

  29. SIGNS & SYMPTOMS • Signs and tests • Gestational diabetes usually starts halfway through the pregnancy. All pregnant women should receive an oral glucose tolerance test between the 24th and 28th week of pregnancy to screen for the condition. • Women who have risk factors for gestational diabetes may have this test earlier in the pregnancy. • Once you are diagnosed with gestational diabetes, you can see how well you are doing by testing your glucose level at home. • The most common way involves pricking your finger and putting a drop of your blood on a machine that will give you a glucose reading.

  30. Oral Glucose Test Values (Fasting Plasma Glucose Values) for Pregnancy

  31. VIII. NURSING INTERVENTION • Improving Nutrition • Teaching about Insulin • Preventing Injury • Improving Activity tolerance • Providing information about medications • Maintaining Skin Integrity • Improving Coping Strategies • Reducing fear and anxiety

  32. STANDARDS OF CARE GUIDELINES • Assess level of knowledge of disease and ability to care for self • Assess adherence to diet therapy, monitoring procedures, medication treatment, and exercise regimen • Assess for signs of hyperglycemia: polyuria, polydipsia, polyphagia, weight loss, fatigue, blurred vision • Assess for signs of hypoglycemia: sweating, tremor, nervousness, tachycardia, light- headedness, confusion • Perform thorough skin and extremity assessment for peripheral neuropathy or peripheral vascular disease and any injury to the feet or lower extremities

  33. STANDARDS OF CARE GUIDELINES 6. Assess for trends in blood glucose and other laboratory results 7. Make sure that appropriate insulin dosage is given at the right time and in relation to meals and exercise 8. Make sure patient has adequate knowledge of diet, exercise, and medication treatment 9. Immediately report any signs of skin or soft tissue infection ( redness, swelling, warmth, tenderness, drainage) 10. Get help immediately for signs of hypoglycemia that do not respond to usual glucose replacement 11. Get help immediately for patient presenting with signs of either ketoacidosis or hyperosmolar hyperglycemic nonketotic syndrome

  34. TREATMENT • The goals of treatment are to keep blood sugar (glucose) levels within normal limits during the pregnancy, and to make sure that the growing baby is healthy.

  35. TREATMENT • WATCHING YOUR BABY • Your health care provider should closely check both you and your baby throughout the pregnancy. Fetal monitoring will check the size and health of the fetus. • A non stress test is a very simple, painless test for you and your baby. • A machine that hears and displays your baby's heartbeat (electronic fetal monitor) is placed on your abdomen. • Your health care provider can compare the pattern of your baby's heartbeat to movements and find out whether the baby is doing well.

  36. TREATMENT DIET AND EXERCISE • The best way to improve your diet is by eating a variety of healthy foods. You should learn how to read food labels, and check them when making food decisions. Talk to your doctor or dietitian if you are a vegetarian or on some other special diet. • In general, when you have gestational diabetes your diet should: • Be moderate in fat and protein • Provide your carbohydrates through foods that include fruits, vegetables, and complex carbohydrates (such as bread, cereal, pasta, and rice) • Be low in foods that contain a lot of sugar, such as soft drinks, fruit juices, and pastries • If managing your diet does not control blood sugar (glucose) levels, you may be prescribed diabetes medicine by mouth or insulin therapy. • Most women who develop gestational diabetes will not need diabetes medicines or insulin, but some will.

  37. COMPLICATIONS • Diabetes can affect the developing fetus throughout the pregnancy. In early pregnancy, a mother's diabetes can result in birth defects and an increased rate of miscarriage. Many of the birth defects that occur affect major organs such as the brain and heart. • During the second and third trimester, a mother's diabetes can lead to over-nutrition and excess growth of the baby. Having a large baby increases risks during labor and delivery. For example, large babies often require caesarean deliveries and if he or she is delivered vaginally, they are at increased risk for trauma to their shoulder.

  38. COMPLICATIONS • In addition, when fetal over-nutrition occurs and hyperinsulinemia results, the baby's blood sugar can drop very low after birth, since it won't be receiving the high blood sugar from the mother. • However, with proper treatment, you can deliver a healthy baby despite having diabetes.

  39. PRIORITIZATION OF NURSING PROBLEMS • Risk for ineffective tissue perfusion related to reduced vascular flow • Imbalanced nutrition, less than body requirements, related to inability to use glucose • Risk for fetal injury related to elevated maternal serum glucose level. • Knowledge Deficit : the diabetic condition, prognosis and the need for action • Deficient knowledge related to therapeutic regimen necessary during pregnancy • Risk for ineffective coping related to required change in lifestyle • Risk for infection related to impaired healing accompanying condition • Deficient fluid volume related to polyuria accompanying disorder • Deficient knowledge related to difficult and complex health problem • Health- seeking behaviors related to voiced need to learn home glucose monitoring

  40. NURSING HEALTH TEACHING • The nurse working with patients who are diagnosed with gestational diabetes mellitus is often responsible for teaching the patient how to self-monitor and record glucose and ketones at home. In addition, the nurse can teach patients about proper diet and safe exercise during pregnancy. • During prenatal visits, the nurse reviews the blood glucose and diet logs to make recommendations about monitoring, medication administration, and diet. Patients may also need to learn how to self-administer insulin. The nurse should make sure the patient can comfortably and appropriately check blood glucose levels and administer insulin by requesting a return demonstration.

  41. NURSING HEALTH TEACHING • It is imperative that the nurse teach patients with gestational diabetes the signs and symptoms of hypoglycemia. These signs and symptoms include shakiness, anxiety, headache, hunger, cold, clammy skin, and tingling around the mouth. The patient should be taught to closely monitor for hypoglycemia and to notify their healthcare provider immediately if signs and symptoms are noted. The patient can drink milk or juice or eat fruit to correct hypoglycemia (Leifer, 2007). • Since the potential for developing diabetes is significant in patients with gestational diabetes, it is important that patients understand the need for follow-up evaluation after delivery. Patients should continue to watch for signs and symptoms of hypoglycemia and notify their healthcare provider if seen.

  42. CONCLUSION • This is a case of a 19 y/o Primigravida with pregnancy 40 wks by LMP, GDM (Gestational Diabetes) on diet .No history of Diabetes at Pre-pregnancy state. Patient was advised for expectant management. • Gestational diabetes is a condition characterized by high blood sugar (glucose) levels that is first recognized during pregnancy.

  43. CONCLUSION • The condition occurs in approximately 4% of all pregnancies • Criteria which are fulfilled by the patient, conservative management rendered such as investigations, nonstress test, diet and exercise. • The goals of treatment are to keep blood sugar (glucose) levels within normal limits during the pregnancy, and to make sure that the growing baby is healthy.

  44. BIBLIOGRAPHY • 5th Edition Maternal & Child Health Nursing “care of the Childbearing & Childrearing Family” pp. 378-382 • Fischbach, F. (2004). A manual of laboratory and diagnostic tests (7th ed.) Philadelphia: Lippincott Williams & Wilkins • Lippincott Manual of Nursing practice 9th Edition pp. 960-963 • http://www.nursingceu.com/courses/345/index_nceu.html

  45. Thank you!! 

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