Question

besides ffrom risk of infection please make a NCP from this

For Group 3 Mrs. GH, is a 35-year-old G2P0, from Batangas City. Her personal history was unremarkable. The patient is a non-smoker and non-alcoholic beverage drinker. Her Pregestational body weight was 62 kg and BMI 26.7. An OGTT test with 75 g. of glucose was performed at 26 weeks AOG Results reveled the following FBS-105 mg/dl: 1 hour = 200 mg/dl: 2 hours 180 mg/dl: She was diagnosed with GDM and was advised self-monitoring of blood glucose with nutritional and lifestyle recommendations She was started on insulin On her 36th week of pregnancy she gave birth by CS to a live baby boy, with a birthweight of 8.2 pounds

make an NCP for GDM

Answer 1

Two nursing diagnosis applicable to the given case scenerio are

Risk for unstable blood glucose

Related to: hormonal changes post-delivery, lack of adherence to diabetes management, inadequate blood glucose monitoring practices, alteration in physical activity level, stress

As evidenced by: blood glucose levels below or above normal levels

Desired Outcome
– Client will demonstrate understanding of factors that may lead to unstable blood glucose levels
– Client verbalizes understanding of balancing body and energy needs
– Client verbalizes need to modify factors (diet, exercise, drugs) to prevent shifts in glucose level
– Client maintains blood glucose levels within the normal range

Nursing Interventions	Rationale
Assess risks and contributing factors to unstable blood glucose levels. Determine the client’s factors that may contribute to unstable blood glucose levels.	Certain risk factors like a family history of diabetes, history of poor glucose control in pregnancy, poor exercise habits, eating disorders, and failure to recognize changes in glucose needs can result in blood glucose stability problems post-delivery too.
Determine the influence of client’s cultural and religious factors affecting dietary practices and taking responsibility for own care in post-partum period	These factors need to be addressed in creating a client’s healthcare plan to ensure acceptance and adherence to plan.
Determine the client’s ability to take responsibility of for own health care	Age, developmental stage, maturity level, and current health status affect the client’s ability to adhere to treatment plans
Assist client in creating preventive strategies for unstable blood glucose level by ensuring that client is knowledgeable about using his own blood glucose monitoring device.	The blood glucose monitoring device is a handy and accurate way of assessing blood glucose levels. Proper usage of this device is essential in detecting unstable blood glucose levels.
Educate about balancing food intake with physical activities. Encourage gradual resumption of activities and to adhere to exercise plan as suggested.	Vital in preventing a sudden increase or decrease in blood glucose levels.
Educate about adjusting home glucose monitoring frequency depending on the client’s risk factors like stress and poor diet.	To quickly identify fluctuating blood glucose levels for immediate correction.
Review and discuss the client’s carbohydrate intake.	Blood glucose levels greatly depend on carbohydrate intake. It should be monitored and controlled closely when stabilizing high blood glucose levels.
Refer the client to a dietitian to plan specific dietary needs based on complicated situations like pregnancy, growth spurt and change in activity level following an injury	To balance dietary intake with altered body needs after delivery.
Review client’s risk factors and provide information on how to avoid complications.	Ensures prevention of unstable blood glucose levels in the future.
Provide information about community resources, support groups and diabetic educators.	For client’s access to additional resources for diabetes management.

Deficient Knowledge

Related to: lack of recall, lack of exposure to information, misinterpretation, misinformation, unfamiliarity with information resources.

As evidenced by: verbal statements, request for information, misconception, inaccurate follow-through of instructions, development of preventable complications.

Desired Outcomes

Client will verbalize understanding of the monitoring of blood sugar, dietary modifications and activities involved in controlling diabetes.

Client will participate in the management of diabetes postpartum.

Client will demonstrate proficiency in self-monitoring and insulin administration

Nursing Interventions	Rationale
Assess client’s and/or couple’s knowledge of the disease condition and treatment, including relationships between diet, exercise, stress, illness, and insulin requirements and impact of delivery on it. Help the client and significant others to understand the risk of recurrence of GDM in future pregnancies and overt diabetes in later life and measures required for early diagnosis and to prevent complications.	When there is a clear understanding of both the disease condition and rationale for each management helps the client and/or couple make informed decisions. It decrease fear of the unknown. Gestational diabetes mellitus improves and blood sugar returns to normal postdelivery. Sufficient knowledge can decrease the fear of the unknown, may increase the likelihood of participation
Teach the client to have a serum glucose monitoring at home using a glucometer, and the need to record readings (usually at least 2-4 times/day).	Recording blood glucose measurements at home allow the client to see the impact of her diet and exercise on serum blood glucose levels and to closely control of sugar levels
Discuss how the client’s anti-diabetic medications work. Emphasize the importance of inspecting client’s own insulin medication. Discuss the different types of insulin as well as each type’s administration method. Check injection sites.	Essential in ensuring the client’s understanding of his treatment regimen to ensure his compliance and adherence. It is important to regularly check for the expiry date, cloudiness/clearness and storage of insulin to ensure drug efficacy. Knowing and following proper administration method is important in ensuring drug’s efficiency. Insulin absorption is affected by the integrity of injection sites.
Discuss the reasons why oral hypoglycaemic agents avoided during pregnancy and now why they are safe post-delivery.	The oral hypoglycaemic agent is not recommended to be taken during pregnancy because it crosses the placenta, that can potentially can harm the foetus.
Discuss risk of infection of cs wound, urinary tract infection, vaginal infections post-delivery , how they can recognize signs of infection. Caution against self-medication.	Important to seek medical help early to avoid further complications. Self-treatment may be inappropriate/mask infection
Encourage the client to maintain a diary of home assessment of serum glucose levels, insulin dosage, reactions, general well-being, diet, exercise and other activities after discharge.	The use of a diary can help the health care provider to evaluate and alter the therapy provided as indicated.