gestational diabetes

Gestational Diabetes Nursing Diagnosis Interventions and Care Plans

Gestational Diabetes NCLEX Review Care Plans

Nursing Study Guide on Gestational Diabetes

      Gestational Diabetes is a pregnancy-related type of diabetes. It causes elevated blood sugar level which can be detrimental to both the mother and baby’s health during pregnancy.

Like any other complications of pregnancy, gestational diabetes is seemingly alarming but risks may be reduced by controlling the blood sugar level of the mother.

This can be achieved by modifying diet and appropriate exercise.

Medications are likely needed if these interventions are not enough. It is essential to keep blood sugar at normal level to ensure healthy pregnancy and safe delivery.

Gestational diabetes usually disappears after giving birth. However, women who have had gestational diabetes are at risk for recurrence in next pregnancies and even developing Type 2 diabetes in the near future.

A regular blood sugar level check is necessary to note any changes.

Signs and Symptoms of Gestational Diabetes

  • Polydipsia – increased thirst
  • Polyuria – increased urinary frequency
  • mouth dryness
  • fatigue or tiredness

The mother can be asymptomatic and the condition can only be diagnosed when she goes to her prenatal visits.

Causes of Gestational Diabetes

The exact cause of gestations diabetes is still unknown.

However, the risk factors that contribute to its development include: being overweight or obese, previous gestational diabetes or prediabetes, a lack of physical activity, diabetes in an immediate family member,  polycystic ovary syndrome (PCOS), and previously delivering a baby weighing more than 9 pounds (4.1 kilograms).

In addition to these, women who are Black, Hispanic, American Indian and Asian American have a higher risk of developing gestational diabetes.

Complications of Gestational Diabetes

Failure to manage gestational diabetes may cause elevation in blood sugar levels which can greatly affect the mother and her baby.

It may also increase the likelihood of delivering thru Cesarean section.

The fetus may be at risk for having the following conditions:

  1. Fetal macrosomia. This term used for excessive birth weight, typically weighs 9 pounds or more which makes them at risk for birth injuries. It also increases the need for surgical delivery
  2. Early preterm birth. High blood sugar level may precipitate early labor and delivery prior to the expected delivery date
  3. Serious breathing disorders such as newborn respiratory distress syndrome (NRDS) which are common in preterm newborns
  4. Hypoglycemia. Low blood sugar after birth and risk for having type 2 diabetes and obesity later in life
  5. Stillbirth or fetal death before or shortly after delivery

The mother may be at risk for having the following conditions:

  1. Hypertension. Elevated blood pressure can lead to a serious complication such as preeclampsia that may put the mother and the baby’s life at risk.
  2. Delivery via C-Section. Macrosomia can cause the baby to become wedged in the birth canal causing difficulty in vaginal delivery.
  3. Diabetes. It can be either developed on the next pregnancy or as the mother gets older.

Diagnosis of Gestational Diabetes

  • Screening tests – usually done during the second trimester which is between 24- and 28-weeks of pregnancy and during the prenatal visit for those who are at high risk.
  • Initial glucose challenge test- a blood sugar below 140 mg/dL (7.8 mmol/L) can be considered normal
  • Follow-up glucose tolerance testing

Treatment of Gestational Diabetes

The following may help in prevention and treatment of gestational diabetes:

  1. Blood sugar monitoring. Gestational diabetes can be treated through lifestyle modification. Blood sugar monitoring (one in the morning and after meals) also helps in managing blood sugar levels. An individual’s lifestyle plays an important role in maintaining their blood sugar at a normal level. The mother’s food choices and daily activities can improve or negatively affect her blood sugar. It’s important to set a pregnancy weight gain goal with the dietitian.
  2. Proper Nutrition. It’s important to get the daily nutrition by consuming foods that are high in nutrients such as fruits, vegetables, whole grains and lean protein. Foods that are high in fat and highly refined sugars should be avoided. A meal plan based on one’s preference, food habits and blood sugar can be of great help.
  3. Regular Exercise. Exercise not only relieves pregnancy discomfort but also helps a lot in lowering blood sugar. Everyday activities such as walking, doing household chores and gardening are also beneficial.
  4. Insulin administration. If the lifestyle modifications are inadequate then insulin injections may be incorporated in the management. Close monitoring of the baby’s condition thru ultrasounds and other diagnostics will be done throughout the pregnancy.
https://youtu.be/r3Bcu08av_Q

Nursing Care Plans for Gestational Diabetes

Diabetes is a medical condition that involves excessive glucose (sugar) levels in the blood due to the little or no production of the hormone insulin, or the presence of insulin resistance.

Despite not having a cure, diabetes can be controlled by effective medical and nursing management, as well as the patient’s strict adherence to prescribed medication, lifestyle changes, and blood sugar monitoring.

The following nursing care plans can be used to assess, plan, manage, and monitor the symptoms and effects of diabetes to a patient.

  1. Nursing Diagnosis: Deficient Knowledge related to new diagnosis of gestational diabetes as evidenced by patient’s verbalization of “I want to know more about my new diagnosis and care”

Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of gestational diabetes and its management.

InterventionsRationales
Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g. denial of diagnosis or poor lifestyle habits)To address the patient’s cognition and mental status towards the new diagnosis of diabetes and to help the patient overcome blocks to learning.
Explain what diabetes is, its types (specifically gestational diabetes), and how it affects the vital organs and potential harm to the baby. Avoid using medical jargons and explain in layman’s terms.To provide information on diabetes and its pathophysiology in the simplest way possible.
Educate the patient about hyperglycemia and hypoglycemia.  Inform her the target range for her blood sugar levels to be classified as “well-controlled”.To give the patient enough information on the risks of blood sugar control (e.g. too much insulin dose may result to hypoglycemia, while too little insulin dose may lead to hyperglycemia). It is important to inform the patient the desired range for blood glucose level because this helps the patient and healthcare provider decide on the appropriate insulin dosage.  
Demonstrate how to perform blood sugar monitoring.To empower patient to monitor her blood sugar levels at home.  
Inform the patient the details about the prescribed medications (e.g. drug class, use, benefits, side effects, and risks) to control blood sugar levels, and explain how to properly self-administer each of them. Ask the patient to repeat or demonstrate the self-administration details to you.To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and self-administration details.
Use open-ended questions to explore the patient’s lifestyle choices and behaviors that can be linked to the development of diabetes. Teach the patient on how to modify these risk factors (e.g. high sodium and/or cholesterol diet, obesity, sedentary lifestyle, etc). Educated the patient about proper nutrition suitable for pregnancy with gestational diabetes.To assist the patient in identifying and managing modifiable risk factors related to diabetes.
  1. Nursing Diagnosis: Fatigue related to decreased metabolic energy production as evidenced by overwhelming lack of energy, verbalization of tiredness, generalized weakness, blood sugar level of  210 mg/dL, and shortness of breath upon exertion

Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.

InterventionsRationales
Assess the patient’s degree of fatigability by asking to rate her fatigue level (mild, moderate, or severe). Explore activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that she used to do or wants to try.To create a baseline of activity levels, degree of fatigability, and mental status related to fatigue and activity intolerance.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with rest and sleep.To gradually increase the patient’s tolerance to physical activity.
Teach deep breathing exercises and relaxation techniques.   Provide adequate ventilation in the room.To allow the patient to relax while at rest. To allow enough oxygenation in the room.
Refer the patient to physiotherapy team as required.To provide a more specialized care for the patient in terms of helping her build confidence in increasing daily physical activity.

Other nursing diagnoses:

  • Fatigue
  • Risk for Imbalanced Nutrition
  • Risk for Maternal/Fetal Injury

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures. The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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