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GESTATIONAL DIABETES MELLITUS (PATHOPHYSIOLOGY (Control of DM is difficult…
GESTATIONAL DIABETES MELLITUS
DEFINATION
It is DM that is diagnose first time in pregnacy,
Assessment is done to check glucose tolarence
Glucose intolerance may be due to altered carbohydrate, proteins and fat metabolism
A woman's body may fail to secrete and produce insulin or has developed resistence to insulin
this predisposes a woman to hyperglycaemia
PATHOPHYSIOLOGY
Control of DM is difficult due to increase placental hormones
Oestrogen and cortisol (which are insulin antagonist)
These hormones constantly increase as the pregnancy progresses
And placental function increases
There is also loss of glucose in the urine throughout pregnancy period...
due to increased glomerular infiltration
In early pregnancy insulin requirements may drop
Thd early morning nausea and vomiting( hyperemesis gravidarum)...
which could lead to hypoglyaemia
There are reduced insulin and fasting blood glucose levels
Altered carbohydrate metabolism throughout pregnancy changes after labour
Insulin requirements drops drastically as soon as the placenta is delivered
Dosage must be reduced or hypoglycaemia coma will result
NURSING CARE PLAN
PROBLEM
Risk for maternal injury
SPECIFIC OUTCOME
Patient will remain normoglycema(normal levels of glucose)
NURSING INTERVENTION
Assess for signs and symptoms of UTI
Assess and monitor for signs of edema
determine fundal height, check for edema of extremities and dyspnea
NURSING CARE PLAN
PROBLEM
Risk of altered nutrition
SPECIFIC OUTCOME
Patient will be free of signs and symptoms of diabetic keteoacidosis
NURSING INTERVENTIONS
Assess and record diary pattern and caloric intake using a 24hour recall
Weigh the client every prenatal visit
NURSING MANAGEMENT
Health education related to health diet is important
Encourage the mother to comply with therapeatic regimen
Advise the patient to limit or avoid protein>100 and carbohydrate>200g and fats must be 60-89 g / day
Strictly monitor blood glucose levels in the patient
MEDICAL TREATMENT
INSULIN THERAPY
Short acting insulin= actrapid
intermediate insulin= monotard
SUITABLE DIET
Grass-fed beef
Eggs or egg white
vegetables (kate, spinach, broccoli, cauliflower)
Low-glycemic fruit (raspberries, blueberries, straberries)
COMPLICATIONS
Respiratory distress syndrom
jaundice
Obesity later in life
Diabetes later in life
Hypoglyceamia
SIGNS AND SYMPTOMS
Fatigue
Unusual thirst
Frequent urination (polyuria)
Blurred vision
Frequent vaginal, bladder and skin infection
Nausea
DIAGNOSTIC PROCEDURE
GLUCOSE TOLERANCE TEST
The Dr can prescribe 200mg/dl of oral sweet drink to raise blood sugar level.
An hour late patient will do blood test to see how the body handled all sugar
Patient will check blood glucose after going without food..
and having 3-hour test.
PREOPERATIVE CARE( CESAREAN SECTION)
Prepare and identify the patient precisely before she go to operating room
Relive anxiety
Ensure that consent is obtained and consent form signed
POST OPERATIVE CARE
Monitor vital signs
Assess for sign and symptoms of hemorrhages
Safety ( identify the patient)
Hydration and elimination ( urine output 4 hourly)
Wound care 9 done in line with hospital policy or doctor's order
Skin integrity ( assess for bruises , redness on heels and buttocks)
Medication (Note prescriptions and record accordingly) and also administer anti-diabetic medication precisely)
CAUSES
Hereditary
Obesity
poor or limited body activites
distorted physiology of pancreas
Diet
