NORTHWESTERN UNIVERSITY COLLEGE OF Related Learning Experience Plan

1nd Semester 2022-2023

NURSING
CASE NUMBER 4 Nursing Care of a Mother with Gestational Diabetes Mellitus

Presented by: Group 4

(Galleta,Olicia, Cabigao, Caoile)

Prepared by:
Mrs. Lucylyn M. Quejarro
Instructor
Course Title: NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (ACUTE AND CHRONIC)
(ACUTE AND CHRONIC)

CASE NUMBER 4 Nursing Care of a Mother with Gestational Diabetes Mellitus

Case study: Levi a 40 y/o Prim gravida in her 3rd trimester admitted in the hospital with a chief complaint of
bipedal edema, with high glucose level ranging from 200 to 300mg/dl. She is always thirsty and hungry and
experience increased in urinating. BP 160/100, RR 24, PR 75.
• Was given 10 “u” of regular insulin SQ
• Nifedipine 10mg SL now was ordered.
• Metformin (glumetza) 500mg once a day taken in the evening with meal
She was diagnosed having GESTATIONAL DIABETES MELLITUS

1.What are the major problems you would address for Levi during her hospital stay?
i.Hyperglycemia
ii.Hypertension
 2. What is the classification of the medications prescribed for Levi? How do
the medications work and what are the side effects?

b.The Classification of the 1st Medication which is the Metformin (Glumetza) is a Anti-diabetes and Biguanides it works by
decreasing blood glucose levels by decreasing hepatic glucose production, decreasing intestinal insulin sensitivity by
increasing peripheral glucose uptake and utilization. The side effects are
• Asthenia
• Diarrhea
• Stomach ache
• Ageusia (taste disorder)
• Diaphoresis
c. The classification of the 2nd medication which is Nifediphine is Antihypertensive that is used to treat High blood pressure
and also This medication is for Antianginals which is to control Chest pain and lastly Nifediphine is a Calcium Channel
Blocker. The side effects are
• Dizziness
• fever
• peripheral edema
• muscle cramps
3. Levi’s health condition improves and schedule for discharge. Her doctor orders continuation of
Insulin as drug treatment. What should be monitored for this medication?

• In taking Insulin there are Adverse effects that need to be monitored like Hypoglycemia and
Hypokalemia. In Hypoglycemia it happens when the Client is taking too much Insulin, not eating
enough Carbs for how much insulin you take and also the timing of taking the insulin. Next is the
Hypokalemia which happens when insulin takes the Potassium back in the Cells, which causes the
potassium to decrease. So proper monitoring should be implemented for patients taking Insulin.

4. Develop a discharge teaching plan for Levi.

-Proper nutrition specially taking carbohydrates that should match the dose of insulin
-Exercise like walking or swimming to prevent excessive weight
-Healthy sleeping habits, because sleep deprivation causes aggravation of insulin resistance,
hypertension, hyperglycemia, and dyslipidemia and increases inflammatory cytokines.
-Safety of medications
-Blood sugar monitoring
 Formulate a 1 nursing care plan based on the prioritized nursing
problem. Use the provided format in the example given
ASSESMENT PLANNIING INTERVENTION/IMPLEMENTATION RATIONALE EVALUATION

Problem: Hyperglycemia Short Term Goal Independent • To assess risk or contributing factors. Short Term
 Determine individual factors that may contribute • Insulin needs for the day can be The goal is MET. After
to unstable glucose adjusted based on periodic serum
Objective Data: After 4 hours of nursing Glucose readings. 4 hours of nursing
 Teach and demonstrate to the client how to
intervention, the monitor blood glucose levels using a finger-stick • Eating very frequent small meals intervention, the
 High glucose level patient will be able to method. improves insulin function. patient was able to
ranging from 200 to identify factors that  Teaching the importance of regularity of meals and • Keeping track of the carbs in the meals identify factors that
300 mg/dl may lead to unstable snacks when taking insulin. can help you match your activity level may lead to unstable
 Advise the patient to monitor her carbohydrate and medicines to the food you eat.
blood glucose levels and • Division of insulin dosage considers blood glucose levels
intake to make her blood sugar level stable.
 Excessive thirst a decrease of glucose  Discuss the type of insulin, dosage, and schedule. basal maternal needs and mealtime and a decrease of
 UrinaryFrequency level, from 200-300  Monitor serum blood glucose levels (fasting blood insulin-to-food ratio and allows more glucose level, from
 Bipedal Edema mg/dl to 1- sugar, 1-hour postprandial) on the first visit, and freedom in meal-scheduling. 200-300 mg/dl to 1-
then as indicated by the client’s condition. • The client should obtain fasting and 1-
hourpostprandial of no hourpostprandial of no
Dependent hour postprandial values four times a
V/S higherthan 140 mg/dl. day, and goals include fasting numbers higherthan 140 mg/dl.
Administer medication as prescribed.10 “u” Insulin,
BP:160/100 of 90 mg/dL and below and
SQNifedipine 10mg SLMetformin (glumetza) 500mg
PR: 75 Long Term Goal Collaborative: Referred to a Registered dietician postprandial values less than 140 Long Term
RR: 24 to Individualized diet and Counsel Regarding mg/dL. To treat underlying causes The goal is MET> After
Diet specification is necessary to
After 1-2 days of Dietary questions.Refer to an OB/GYNE for
maintain Normoglycemia and to obtain
1-2 days of
NURSING DIAGNOSIS: appropriate nursing consultation in regards to her 3rd trimester appropriate nursing
pregnancy. desired weight gain. To monitor the
Risk for Unstable Blood intervention, the condition of the baby. intervention, the
Glucose related to insulin patient will be able Collaborative patientestablished a
resistance, pregnancy toestablish a normal • To treat underlying causes normal urine output
urine output with the  1.Referred to a Registered dietician to • 1.Diet specification is necessary to with the absence of
absence of glucose, Individualized diet and Counsel Regarding maintain Normoglycemia and to obtain glucose, absence of
absence of thirst, and Dietary questions. desired weight gain. thirst, and maintained
maintain blood glucose  2.Refer to an OB/GYNE for consultation in blood glucose levels
levels within normal • To monitor the condition of the baby. within normal range.
regards to her 3rd trimester pregnancy.
range.
Name of the Drug Classification Indications Side Effects NursingImplications
Glumetza
Antidiabetes and Prevention of type 2 diabetes in patient Asthenia Restrict environmental stimuli, especially during
Generic name Buguanides with prediabetes, those younger than 60 Diarrhea planned times for Rest and sleep
Metformin years old and women with prior history of Stomach ache Correct electrolyte imbalances
Mechanism ofAction Gestational Diabetes or Polycystic ovary Ageusia (taste disorder Increase fluid intake
Dosage:Metformin syndrome Diaphoresis For taste disorder Give Zinc supplement to the
500 mg once a day Client
taken in the evening Metformin decreases
w/ meal. blood glucose levels by Contraindications Administer IV hydration if needed.
decreasing hepatic AdverseEffects
glucose production, • Contraindicated in patients
decreasing intestinal hypersensitive to drugs and in • Accidental injury
those with hepatic disease or • Infection
insulin sensitivity by
increasing peripheral metabolic acidosis or lactic
glucose uptake and acidosis. not indicated for use in
utilization. patients with Type 1 Diabetes
mellitus or diabetes
ketoacidosis.
Name of the Drug Classification Indications Side Effects NursingImplications

Generic name Anti-hypertensive, Antiginals, indicated to treat Dizziness Monitor vital signs
Calcium Channel Blocker vasospastic angina and Fever Tepid Bath
Nifedipine chronic stable angina Peripheral edema encourage low-sodium
Mechanism of Action and hypertension. muscle cramps diet
Dosage Nifedipine blocks voltage gated
apply what or cold
L-type Calcium Channels in Contraindications AdverseEffects compress
Nifedipine 10mg vascular smooth muscle and provide safety
SL myocardial cells. This blockage Contraindicated in difficulty in balance provide heating
prevents the entry of Calcium patients hypersensitive chills blankets
ions into cells during to drug, in those taking
depolarization, reducing strong Rifampin and in
peripheral arterial vascular patient with
resistance and dilating coronary Cardiogenic shock
artery. These action reduces
blood and increases the suplly of
oxygen to the heart, alleviating
angina
 NORTHWESTERN UNIVERSITY COLLEGE OF Related Learning Experience Plan
1nd Semester
2022-2023
NURSING

Prepared by:
Mrs. Lucylyn M. Quejarro
Instructor