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Gestational Diabetes and Pregnancy Fairooz Jalill

Maternity Nursing PNR 203

Instructor Sandra Raine August 6, 2013

ABSTRACT

Gestational diabetes develops in pregnant women who did not have diabetes before pregnancy. When diabetes develops in a pregnant woman who didnt have the condition before pregnancy, it is called gestational diabetes. Diabetes is a condition in which the levels of blood sugar or glucose are not regulated. It is the result of metabolic changes in hormones (insulin in particular) during pregnancy. You are at a greater risk for gestational diabetes if you have a family history of diabetes, have had a previous pregnancy & developed the condition, are 25 years or older or over weight/obese. It is more common in African American, American Indian, Asian American, Hispanic/Latino or Pacific Islander women. There are several forms of treatment and can be controlled with proper teaching during pregnancy. Although the cause of gestational diabetes is not known, there are some theories as to why the condition occurs. The placenta supplies a growing fetus with nutrients and water, as well as produces a variety of hormones to maintain the pregnancy. Some of these hormones (estrogen, cortisol, and human placental lactogen) can have a blocking effect on insulin, which usuallybeginsabout20 to 24 weeks into the pregnancy.

SCENARIO

A 38 year old, 22 week pregnant Native American named Ahyoka James, presents at the Health clinic complaining of excessive and uncontrollable thirst. I am thirsty all the time and urinate all day long, it is affecting my daily life, is there something wrong with me. On examination, and while taking her medical history, she tells the nurse that cannot control her thirst, and subsequently excessive urination, making it difficult to sleep at night as she has to go to the bathroom numerous times. She further states that she is tired all time, on waking in the morning and throughout the day. Mrs. James also tells the nurse that she is concerned about her weight gain; she weighed 150 pounds before pregnancy, is only in her 22th week but has gained 30 pounds as she stays hungry and eats all the time. Mrs James is worried about her complications as this is her first baby and even though she is aware of the risk due to her age, she wants to do everything possible to have a healthy pregnancy. After doing the assessment and diagnosis, it is established that Mrs, James has Gestational Diabetes.

OBJECTIVES FOR TEACHING OBJECTIVE ANSWER

Knowledge Deficit: Promoting Optimal Glucose Control

At each visit, review the blood glucose levels, including any laboratory tests and self-monitoring results.

Reinforce the need to perform blood glucose monitoring at home before meals and at bed time and to keep a record of the results.

Assess the techniques patient use for monitoring blood glucose levels at home

Altered Nutrition: Eat Healthy Food and Stay Active Encourage client to work with a dietician, diabetes educator or buy books giving advice on how to develop a healthy meal plan and keep glucose levels under control. Stay active to keep blood sugar under control. Light moderate exercise, such as walking brisk walking 30 minutes, 5 days a week is good goal. Eating a variety of healthy foods, learn how to read food labels, and check them when making food decisions. Eat fat and protein in moderation. Provide your carbohydrates through foods that include fruits, vegetables, and complex carbohydrates (such as bread, cereal, pasta, and rice) Be low in foods that contain a lot of sugar, such as soft drinks, fruit juices, and pastries

METHOD OF TEACHING

Assess client knowledge of diabetes and pregnancy to establish a baseline from which to develop an individualized teaching plan.

Review the underlying problems associated with diabetes and how pregnancy affects glucose control to provide client with a firm knowledge base for decision making.

Review signs and symptoms of hypoglycemia and hyperglycemia and prevention and management measures to ensure client can deal with them.

Provide written material describing diabetes and care needed for control to provide opportunity for client review and promote retention of learning.

Explain food pyramid to patient and promote teaching of using simple menus to plan meals.

Observe client administering self-glucose testing for technique and offer suggestions for improvement if needed to ensure adequate self-care ability.

Teach home treatment for symptomatic hypoglycemia to minimize risk to client and fetus.

Outline acute and chronic diabetes complications for reinforce the importance of glucose control.

EVALUATION

Evaluation is a continuous process, determining what the patient has learned. If there is a behavior change related to the learning activities. Has the teaching helped in promoting the health of the patient. Does the patient understand what they have to do. I will evaluate by doing the following: Verbal questioning Observation Return demonstration Written follow-up

I feel the teaching lesson will be effective and goals will be met if the patients follows the teaching plan.

REFERENCES

Screening for gestational diabetes mellitus: Recommendation statement. Rockville, MD. US Preventive Services Task Force. Ann Intern Med. 2008; 148:759-765] Serlin DC, Lash RW. Diagnosis and management of gestational diabetes mellitus. Am Fam Physician. 2009 Jul 1;80(1):57-62] American Diabetes Association. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2008;31:S61-S78. Benjamin TD, Pridijan G. Update on gestational diabetes. Obstetrics and Gynecology Clinics. 2010 June;27(2):255-267 eMedicineHealth: Practical Guide to Health, Diabetes Causes. Retrieved on December 1, 2008. http://www.emedicinehealth.com/diabetes/page2_em.htm