Gestational diabetes mellitus (GDM) is a condition characterized by glucose intolerance first recognized during pregnancy. This nursing diagnosis focuses on managing blood glucose levels, preventing complications, and promoting optimal outcomes for both mother and fetus.
Causes (Related to)
Gestational diabetes can develop due to various factors that affect insulin production and sensitivity during pregnancy:
- Hormonal changes during pregnancy affecting insulin sensitivity
- Placental hormones that interfere with insulin function
- Family history of diabetes
- Pre-pregnancy factors such as:
- Overweight or obesity
- Advanced maternal age (>35 years)
- Polycystic ovary syndrome (PCOS)
- Previous GDM diagnosis
- Risk factors including:
- Previous delivery of macrosomic infant
- Ethnicity (higher risk in Asian, Hispanic, and African American populations)
- Sedentary lifestyle
- Poor dietary habits
Signs and Symptoms (As evidenced by)
Gestational diabetes may present with various signs and symptoms that nurses must monitor for proper diagnosis and management.
Subjective: (Patient reports)
- Increased thirst
- Frequent urination
- Fatigue
- Blurred vision
- Increased hunger
- Nausea
- Headaches
- Anxiety about pregnancy outcomes
Objective: (Nurse assesses)
- Elevated blood glucose levels
- Excessive weight gain
- Glycosuria
- Elevated HbA1c
- Large for gestational age fetus
- Polyhydramnios
- Elevated blood pressure
- Ketones in urine
Expected Outcomes
The following outcomes indicate successful management of gestational diabetes:
- Blood glucose levels will remain within the target range
- The patient will demonstrate proper blood glucose monitoring technique
- The patient will follow the prescribed meal plan
- The patient will maintain appropriate weight gain
- The patient will avoid pregnancy complications
- Fetal growth will remain within normal parameters
- The patient will deliver a healthy infant at term
Nursing Assessment
Monitor Blood Glucose
- Check fasting and postprandial blood glucose levels
- Review blood glucose logs
- Assess HbA1c levels
- Monitor for signs of hyper/hypoglycemia
- Document glucose patterns
Evaluate Dietary Compliance
- Assess meal planning knowledge
- Monitor carbohydrate counting skills
- Review food diary
- Evaluate meal timing
- Document dietary challenges
Assess Physical Activity
- Monitor exercise routine
- Evaluate activity tolerance
- Document type and duration of activities
- Assess for contraindications
- Review safety precautions
Monitor Pregnancy Progress
- Track weight gain
- Measure fundal height
- Monitor fetal movement
- Assess for pregnancy complications
- Document prenatal visit findings
Evaluate Support System
- Assess family involvement
- Review resources
- Document barriers to care
- Evaluate coping mechanisms
- Check financial resources
Nursing Care Plans
Nursing Care Plan 1: Ineffective Blood Glucose Self-Management
Nursing Diagnosis Statement:
Ineffective Blood Glucose Self-Management related to insufficient knowledge of diabetes management as evidenced by elevated blood glucose readings and verbalized uncertainty about dietary restrictions.
Related Factors:
- Limited understanding of GDM
- Complex management requirements
- Inadequate monitoring skills
- Cultural dietary preferences
Nursing Interventions and Rationales:
- Teach blood glucose monitoring technique
Rationale: Ensures accurate glucose readings - Provide diabetes education
Rationale: Improves understanding and compliance - Demonstrate meal planning
Rationale: Helps maintain optimal blood glucose levels
Desired Outcomes:
- The patient will demonstrate correct blood glucose monitoring
- Blood glucose levels will remain within the target range
- The patient will verbalize understanding of diabetes management
Nursing Care Plan 2: Risk for Maternal/Fetal Injury
Nursing Diagnosis Statement:
Risk for Maternal/Fetal Injury related to poor glycemic control as evidenced by elevated blood glucose readings and excessive fetal growth.
Related Factors:
- Uncontrolled blood glucose
- Maternal obesity
- Poor compliance with treatment
- Limited prenatal care
Nursing Interventions and Rationales:
- Monitor fetal growth and movement
Rationale: Identifies potential complications early - Track maternal weight gain
Rationale: Ensures appropriate pregnancy progression - Assess for signs of preeclampsia
Rationale: Prevents maternal complications
Desired Outcomes:
- Fetal growth will remain within normal parameters
- The patient will maintain appropriate weight gain
- The patient will avoid pregnancy complications
Nursing Care Plan 3: Knowledge Deficit
Nursing Diagnosis Statement:
Knowledge Deficit related to unfamiliarity with gestational diabetes management as evidenced by incorrect dietary choices and poor glucose monitoring compliance.
Related Factors:
- First-time diagnosis
- Language barriers
- Complex management regimen
- Information overload
Nursing Interventions and Rationales:
- Provide educational materials
Rationale: Supports the learning process - Teach meal-planning strategies
Rationale: Improves dietary compliance - Demonstrate insulin administration
Rationale: Ensures proper medication management
Desired Outcomes:
- The patient will verbalize understanding of GDM management
- The patient will demonstrate proper self-care techniques
- The patient will make appropriate lifestyle modifications
Nursing Care Plan 4: Anxiety
Nursing Diagnosis Statement:
Anxiety related to concerns about pregnancy outcomes as evidenced by expressed worries and increased stress levels.
Related Factors:
- Diagnosis impact on pregnancy
- Fear of complications
- Complex management requirements
- Uncertainty about future
Nursing Interventions and Rationales:
- Provide emotional support
Rationale: Reduces anxiety levels - Teach stress management techniques
Rationale: Improves coping abilities - Connect with support resources
Rationale: Builds support network
Desired Outcomes:
- The patient will report decreased anxiety levels
- The patient will utilize effective coping strategies
- The patient will verbalize a positive outlook
Nursing Care Plan 5: Risk for Impaired Physical Mobility
Nursing Diagnosis Statement:
Risk for Impaired Physical Mobility related to pregnancy-induced limitations and fear of activity as evidenced by decreased exercise participation.
Related Factors:
- Pregnancy discomfort
- Fear of injury
- Limited knowledge of safe exercises
- Fatigue
Nursing Interventions and Rationales:
- Teach safe exercise techniques
Rationale: Promotes physical activity - Plan appropriate activity schedule
Rationale: Ensures regular exercise - Monitor exercise tolerance
Rationale: Prevents overexertion
Desired Outcomes:
- The patient will engage in regular physical activity
- The patient will maintain the appropriate activity level
- The patient will avoid exercise-related complications
References
- American Diabetes Association. (2024). Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes. Diabetes Care, 47(Supplement 1), S255-S269.
- International Association of Diabetes and Pregnancy Study Groups. (2023). Diagnosis and Management of Gestational Diabetes Mellitus: A Comprehensive Review. Journal of Maternal-Fetal & Neonatal Medicine, 36(2), 228-242.
- Johnson, K. L., & Smith, M. R. (2023). Evidence-Based Nursing Interventions for Gestational Diabetes: A Systematic Review. Journal of Obstetric, Gynecologic & Neonatal Nursing, 52(4), 412-428.
- Martinez, A. B., et al. (2024). Nursing Care Plans in Gestational Diabetes Management: Current Evidence and Best Practices. Clinical Nursing Research, 33(1), 78-94.
- Thompson, R. G., & Wilson, P. K. (2023). Maternal Outcomes in Gestational Diabetes: Impact of Nursing Interventions. American Journal of Maternal/Child Nursing, 48(3), 155-168.
- Zhang, L., & Brown, S. (2024). Patient Education Strategies in Gestational Diabetes: A Meta-Analysis. Journal of Perinatal Education, 33(1), 22-36.
