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Case Study: Debora - Coggle Diagram
Case Study: Debora
Now What?
Discuss the possibility of a vaginal delivery. A vaginal delivery will allow for less of a chance of infection, shorter hospital stay, and more maternal/infant bonding time.
Develop a plan of care with the patient to continue to monitor blood glucose and the size of the baby throughout pregnancy.
Patient should be given a dietician referral, prescription for glucometer with supplies, education on how to use glucometer with parameters, and more detailed instructions on foods prior to her dietician visit.
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The provider should explore the patient's wishes for family planning and work with her to fulfill these.
What?
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Patient brought up "ugly lump" on gums. Her concern was ignored and she was not given a referral for prenatal dental care.
Told to expect a C-section due to baby's size because patient has been diagnosed with gestational diabetes.
Told to avoid chips, pop, and fried food without any further instruction aside from a dietetics referral. (Assumptions made about dietary habits and restrictive orders placed without dietary consultation)
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So What?
While pain and fatigue are normal in pregnancy, they should always be evaluated further to assure there are not more serious problems occurring.
It is common practice to do a 1 hour and 3 hour GTT to confirm a diagnosis of diabetes. Patient was immediately prescribed medication without proper diet teaching, gestational diabetes education or glucometer training.
Patient should receive more in depth education with a dietician, but she also needed to receive more education regarding weight and diet while at her visit. Gaining too much weight during pregnancy leaves the mother at a higher risk for maternal obesity. Maternal obesity leads to risk of unsuccessful breastfeeding due to reduced initiation, early cessation, and delayed lactogenesis. Maternal obesity also leaves the baby at higher risk for macrosomia, hypoglycemia, and hyperbilirubinemia.
Patient was told to expect a C-section (much more invasive procedure) due to baby's size, but not all mother's with gestational diabetes have large babies, and they do not all require C-section. Patient had two uncomplicated vaginal deliveries previously. The patient is at less risk of post-delivery complications if she is able to have a vaginal delivery.
Provider should have given some education regarding her dental health. It is common for women to have gingivitis, bleeding gums, and gum tissue overgrowth during pregnancy. Patient also should have been given a dental referral. The benefit of treating oral diseases during pregnancy outweighs the risk it could cause to the pregnancy.
The comment the resident made was insensitive. He assumed the patient would want her tubes tied after this pregnancy, but there was no conversation had with the patient regarding her wishes to possibly continue her family.