Question

GROUP 1 CASE STUDY: Gestational Diabetes
Casey is a 23-year-old primigravida woman who presents at the clinic for suspected pregnancy.  Pregnancy test is positive and there is a positive amniotic sack with growing embryo noted on ultrasound.  Casey has a history of type I diabetes since the age of 10.  She is 5 foot 1 inch and weighs 175 pounds making her BMI 33, and her last fasting A1C was 7.4.  Casey reports that her job keeps her sedentary behind a desk daily, she consumes whatever she wants and lets her insulin pump do the work of caring for her daily insulin needs, but she only drinks water with fresh lemon and sweetner
PEER RESPONSE:
#2.         Address the nursing process for care of this patient with gestational diabetes.  Assess and assign a nursing diagnosis to her or the fetus.  Provide an intervention and rationale for the chosen diagnosis.  How are we going to care for this mom and fetus during antepartum, intrapartum, and postpartum (include risks for both mom and baby).  When you to respond to peers add additional data and discuss Casey further as she has developed some additional complications that require her to have additional high-risk pregnancy testing:  Amniotic fluid volume analysis and a Biophysical Profile (do not forget the role of the RN in addressing these tests). 

Answer 1

Some times abnormal glucose metabolism arises during pregnancy. This is what we called gestational diabetes mellitus. This condition usually returns to normal after delivery. Sometimes this condition turns to type 2 diabetes.

Nursing Care:

First we have to collect the disease condition, need of administration of insulin, maintaining normal sugar levels, food control and evaluate the patient and fetal well-being. We have to evaluate risk-factors involved in the patient/fetal. Risk factors include altered nutrition, maternal injury, fetal injury and patient's understanding.

Nursing Interventions	Rationale
Assess and record diet of patient and caloric intake using a 24-hour.	Patient will understand strict dietary regimen
Weigh of the patient every prenatal visit. Encourage periodically monitor weight at home between visits.	This will indicate caloric adjustment.
Nausea and vomiting during the first trimester.	deficiency in carbohydrates
Importance of regular of meals.	frequent small meals improves insulin function.
Adjust diet or insulin	This will change throughout the trimester
Monitor blood glucose levels (Fasting blood sugar, preprandial 1 and two hr postprandial)	fetal abnormalities is decreased when fasting glucose level between 60 and 100 mg/dl, preprandial levels between 60 and 105 mg/dl, 1-hr postprandial remains below 140 mg/dl, and 2-hr postprandial is less than 120 mg/dl.
Monitor HbA1c every 2-4weeks.	We can get average serum glucose control during the preceding 60 days.
Hospitalization if serum blood glucose is not controlled	Infant morbidity. Maternal hyperglycemia-induced fetal hyperinsulinemia.
vaginal bleeding and abdominal tenderness	risk for abruptio placenta.
vaginal discharge.	likely to develop monilial vulvovaginitis, cause oral thrush in newborn.
symptoms of UTI.	contribute to premature labor
episodes of hyperglycemia	Diet and/or insulin regulation
episodes of hypoglycemia	In the presence of hypoglycemia, vomiting may lead to ketosis
preterm labor	Overdistention of the uterus, it will cause macrosomia
Teach patient to have a glucose level monitoring at home using a glucometer	Note blood glucose measurements at home. So we can evaluate sugar levels and manage diet and excercise

In these type of any condition threaten patient life, Abruptio placentae, BPP score between 0 and 2 is abnormal, Fetal death, Placenta previa. In these condition RN keep attention.  

Amniotic fluid:  An Amniotic fluid index between 8-18 is considered normal. This will measure via ultrasound.  

Biophysical Profile : A score of 10 out of 10 or 8 out of 10 with normal fluid is considered normal and 4 and less than 4 is considered as abnormal.