Gestational Diabetes Mellitus (GDM)
Lab tests
1 hour oral glucose screen at 24-28 weeks gestation
3 hour oral glucose tolerance test following positive 1 hour test
negative result ,140 mg/dL
Patient's result 158 mg/dL This shows that patient may be either resistant to insulin or not producing sufficient insulin.
positive results are 2 or more of the following values met or exceeded: fasting 95 mg/dL, 1 hour 180 mg/dL, 2 hour 155 mg/dL, 3 hour 140 mg/dL
Patient's results were positive: fasting 112, 1 hour 198, 2 hour 162, 3 hour 143
Medications
Referral to a registed dietitian
No medications prescribed at this time, but the patient may need glyburide (2.5-5 mg PO daily 1 hour before meals) or insulin.
Nursing Diagnoses
- Obesity R/T portion sizes larger than recommended AEB BMI of 30.2 and patient report of eating habits.
- Deficient knowledge R/T gestational diabetes AEB the patient's questions and concerns.
- Risk for complications of hypoglycemia or hyperglycemia
- Anxiety R/T concern over fetal wellbeing AEB verbal expressions from the patient
Short term-Patient will be able to list risk factors associated with GDM and their potential effects on the fetus. She was given a pamphlet on GDM which listed risk factors and how they can affect her and her baby.
Long term-Patient will be able to identify sources of anxiety and report feeling less anxious. She listed four sources of anxiety and is working on dealing with them.
Provide education as the patient best receives it. To correct misconceptions and relieve unnecessary anxiety.
Short term-Patient will be able to explain GDM and ways to manage it. Patient explained GDM and how she plans to manage her blood glucose levels.
Long term-Patient will follow exercise and diet plan and maintain blood glucose levels within normal limits.
Promote therapeutic communication. To promote trust and allow for educational opportunities.
Encourage patient to share her concerns with the health care team. To allow for better collaboration in her care.
Listen to patient's feelings and concerns. To learn of misconceptions that may be contributing to anxiety.
Long term-Patient will gain between 11-20 pounds during her pregnancy. Patient gained between 11-20 pounds by the end of her pregnancy.
Short term-Patient will commit to 3 changes in food choices to begin eating healthier. Patient committed to 3 specific changes in her diet starting today.
Provide patient teaching on nutrient dense foods and "empty calories". To promote understanding of better food choices.
Short term-Patient will begin walking 5 days a week for at least 30 minutes per day with a local mom's walking group. Patient was put on contact with a member of a local walking group.
Discuss the negative effects of excess weight that she feels. To help motivate her to desire to change.
Encourage the patient to list cues that trigger eating. To help patient avoid situations that encourage over-eating.
Discuss a typical day of eating and help her see how to make better choices. To encourage open communication and healthier eating.
Explain GDM and the effects on her and her fetus. To promote her compliance with the suggested treatment plan.
Teach the signs of hypo/hyperglycemia and the interventions for each. To promote recognition of a problem and self-management of the disease.
Assess her current knowledge of GDM. To allow for needed further teaching.
Explain the principles of a diabetic diet and give examples of meals that follow her suggested diet. To encourage understanding of and compliance with the suggested diet.
Long term-Patient and baby will experience no long term affects of hypo/hyperglycemia. Patient was taught how to monitor her blood glucose levels.
Teach the signs of hypo/hyperglycemia and the interventions for each. To promote recognition of a problem and self-management of the disease.
Explain risks of hypo/hyperglycemia. To encourage compliance with diet and monitoring.
Test A1C at each prenatal visit. To assess compliance with blood glucose control.
Encourage journaling of food eaten and blood glucose results. Helps with understanding of what is actually eaten and how different foods affect blood glucose levels.