A Case Presentation of an Adult with Gestational Diabetes Mellitus

A Case Presentation of an Adult with Gestational Diabetes Mellitus A Case Study Presented to the Faculty of the College of Nursing, Central Mindanao University In Partial Fulfillment of the Requirements in NCM 66.1: MATERNAL AND CHILD AT RISK OR WITH PROBLEMS (ACUTE AND CHRONIC) Acknowledgement The researchers would like to extend their deepest gratitude to the people who contributed and supported this study to be promising and fruitful. To their Clinical instructor, Ms. Fave Danielle V. Postrano, RN, for her valuable time and effort in suggesting, corrections, and inputs for the development of the case study; To the Clinical Instructors of Central Mindanao University College of Nursing for inputs, comments, and suggestions of the case study; And to the Almighty God for the blessing and giving the researchers the strength to conduct and finish the paper. Table of Contents Researchers Page PRELIMINARIES Acknowledgement 2 Table of Contents 3 I. INTRODUCTION 4 II. HEALTH HISTORY 8 III. PHYSICAL ASSESSMENT 10 IV. ANATOMY AND PHYSIOLOGY 12 V. CONCEPT MAP 18 VI. LABORATORY AND DIAGNOSTIC TESTS 27 VII. PHARMACOLOGIC STUDIES 34 VIII. NURSING CARE PLANS 47 IX. REFERENCES 54 Introduction Pregnancy has been recognized for a long time as a diabetic state in which insulin sensitivity decreases with advanced gestational age— those who cannot meet the increased demand develop diabetes. Diabetes is the most common medical complication of pregnancy. A 40-year-old multigravida woman named Julia Salazar is in her third pregnancy. She is at the clinic for prenatal care at the 30th-week gestation at the nearest primary hospital. Her weight is 200 pounds, indicating obesity on her ideal weight, and her blood pressure is 140/90 mmHg. Her family history reveals that her mother has type 2 diabetes mellitus. Results show that she has 3+ glycosuria and was diagnosed with Gestational Diabetes Mellitus. Gestational diabetes mellitus (GDM) happens when a placenta hormone prevents the body from using insulin effectively. Glucose accumulates in the blood instead of being absorbed by cells. Unlike type 1 diabetes, it is gestational diabetes not caused by a lack of insulin. It is caused by other hormones produced during pregnancy that can make insulin less effective. A condition referred to as insulin resistance. Women with GDM have decreased quality of life and increased risks of cesarean section, gestational hypertension, preeclampsia, and type 2 diabetes. Evidence showed that GDM poses a threat to adverse maternal and prenatal outcomes due to maternal Hyperglycemia (JIMÉNEZ‐ MOLEÓN, 2000). According to the study of Keshavarz 2005, hyperglycemia develops during pregnancy due to the secretion of placental hormones, which causes resistance to insulin. Gestational diabetes occurs in about 14% of pregnant women and increases their risk for hypertensive disorders. Women who are considered at high risk of GDM and who must undergo blood glucose tests at their first prenatal visit are those who have marked obesity, a personal history of GDM, glycosuria, or a strong family history of diabetes. Figure 1. Clinical Pathway Preferred screening and diagnostic 2-step from Diabetes Canada's 2018 guidelines is endorsed. All pregnant women should be offered screening between 24-28 weeks using a standardized non-fasting 50-g glucose challenge screening test (GCT) with plasma glucose (PG) measured 1 hour later. If the value is 7.8 mmol/L, no further testing is required. If the value of the GCT is 7.8–11.0, a 3-hour 100-g oral glucose tolerance test with fasting PG (FPG), 1-hour PG, 2-hour PG, and 3-hour PG should be performed. Gestational diabetes mellitus is diagnosed if one value is met or exceeded: (1) FPG ≥5.3 mmol/L (2) 1-hour PG ≥10.0 mmol/L (3) 2-hour PG ≥8.6 mmol/L (3) 3hour ≥7.8. If the value of the GCT is ≥11.1 mmol/L, gestational diabetes mellitus is diagnosed. The "alternative 1-step diagnostic" approach from Diabetes Canada's 2018 guidelines is acceptable. In this strategy, pregnant women should be offered testing between 24-28 weeks using a standardized 3-hour 100-g oral glucose tolerance test with fasting plasma glucose (FPG), 1-hour plasma glucose (PG), and 3-hour PG. Gestational diabetes mellitus is diagnosed if one value is met or exceeded: (1) FPG ≥5.3 mmol/L (2) 1-h PG ≥10.0 mmol/L (3) 2-h PG ≥8.6 mmol/L (3) 3hour ≥7.8.