Gestational Diabetes Nursing Care Plans Diagnosis and Interventions
Gestational Diabetes NCLEX Review and Nursing Care Plans
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:
- 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
- Early preterm birth. High blood sugar level may precipitate early labor and delivery prior to the expected delivery date
- Serious breathing disorders such as newborn respiratory distress syndrome (NRDS) which are common in preterm newborns
- Hypoglycemia. Low blood sugar after birth and risk for having type 2 diabetes and obesity later in life
- Stillbirth or fetal death before or shortly after delivery
The mother may be at risk for having the following conditions:
- 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.
- Delivery via C-Section. Macrosomia can cause the baby to become wedged in the birth canal causing difficulty in vaginal delivery.
- 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:
- 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.
- 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.
- 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.
- 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.
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.
Gestational Diabetes Nursing Care Plan 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.
|Gestational Diabetes Nursing Interventions||Rationales|
|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.|
Gestational Diabetes Nursing Care Plan 2
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.
|Gestational Diabetes Nursing Interventions||Rationales|
|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.|
Gestational Diabetes Nursing Care Plan 3
Risk for Imbalanced Nutrition: Less than Body Requirements
Nursing Diagnosis: Risk for Imbalanced Nutrition: Less than Body Requirements related to lack of ability to make use of nutrients appropriately secondary to gestational diabetes.
- The patient will express an understanding of the treatment management process and the necessity of regular self-assessment.
- The patient will attain the required fasting blood sugar levels, between 60 to 100 mg/dl, and no higher than 140 mg/dl after meals.
- The patient will increase body weight by at least 24 to 30 pounds prenatally or according to the recommended pre-pregnancy weight.
- The patient will not develop diabetic ketoacidosis and signs and symptoms such as weakness, fruity-scented breath, excessive thirst, frequent urination, confusion, and complications.
|Gestational Diabetes Nursing Interventions||Rationale|
|Monitor and record patient’s dietary pattern and intake of calories within a 24-hour period.||To assist in assessing the patient’s perception and continuance to a rigid dietary plan.|
|Evaluate the patient’s thoughts on the effect of stress and how is it related to diabetes. Educate the patient about relaxation techniques and strategies on how to cope with stress.||Based on studies, stress directly affects blood sugar levels by increasing its level. During times of stress, blood sugar levels may be more difficult to control. Thus, an adjustment in the treatment plan is required.|
|Take the patient’s weight every prenatal visit. Also, advised the patient to self-monitor and record her weight at home.||An increase in weight can be an indicator of a required calorie adjustment.|
|Watch out for the presence of nausea and vomiting, mostly in the first trimester of pregnancy.||Feeling nauseous than what is normal during pregnancy is a sign of the presence of ketones and also an early sign of diabetes. In diabetes, the sugar remained stuck in the bloodstream and the body is unable to use it for energy. As the result, fat is broken down and used instead as a source of energy. This process will end up in a by-product called ketones that stay in the blood and urine.|
|Have a regular meal plan, especially when taking insulin. Discuss the importance of having a regular meal per day, including snacks in controlling blood sugar.||It is proven that eating a small portion of food, more frequently improves the function of insulin.|
|Teach clients how to use a glucometer to monitor their blood sugar levels.||The Daily required amount of insulin can be adjusted with the use of periodic serum glucose readings. Take note that the results taken by reflectance meters can be 10-15% be lower or higher than the plasma level.|
|Discuss the information related to any changes needed in managing diabetes. Examples are the usage of human insulin, switching from oral antihyperglycemic drugs to insulin, daily monitoring of blood sugar level at least two times a day, and decreasing the amount of carbohydrates intake.||During pregnancy, the metabolic and maternal/ fetal needs vary, requiring close observation and adjustment. According to research, antibodies opposing insulin may cross the placenta, resulting in undesirable fetal weight gain. Treating its with human insulin will decrease the progress of these antibodies. In meal planning, decreasing carbohydrates to less than 40% of the caloric intake lessen the degree of a meal peak of hyperglycemia. For the reason, that pregnancy results in extreme glucose intolerance in the morning, the first meal of the day must be in small amount, with the minimum level of carbohydrates.|
|Educate the patient about the difference between hyperglycemia and hypoglycemia and its signs and symptoms,||Providing accurate information about the signs and symptoms will prompt the patient to be careful and observant with what they will experience. Hypoglycemia is more severe and sudden to appear during the first trimester. May require an increase in usage of glucose and glycogen both by the mother and her developing fetus. Meanwhile, Ketoacidosis is more frequent to happen during the second and third trimesters, primarily due to insulin resistance and high HPL levels. The intermittent pulse of hyperglycemia is both mutagenic and teratogenic for the fetus during the first 3 months. Also, it may cause fetal hyperinsulinemia, macrosomia, slow down lung maturity, and risk of irreversible neurologic damage,|
|Balance the diet and insulin treatment to meet daily required calories and insulin.||Metabolic needs vary throughout the trimesters of pregnancy, and adjustments are identified by weight gain and results of laboratory tests.|
|Consult a registered dietician for individual diet plans and counsel with patient’s dietary concerns and questions.||Diet varies on individual needs, so it is important to have an individual diet plan. Comprehensive teachings provide enough information on patients’ individual needs and correct misconceptions.|
Gestational Diabetes Nursing Care Plan 4
Risk for Maternal Injury
Nursing Diagnosis: Risk for Maternal Injury related to changes in diabetic control secondary to gestational diabetes.
- The patient will maintain a normal blood sugar level.
- The patient will be free of signs and symptoms of maternal injury related to gestational diabetes.
|Gestational Diabetes Nursing Interventions||Rationale|
|Evaluate the patient for vaginal bleeding and abdominal tenderness.||Changes in the circulatory system related to diabetes may bring the patient at risk for placental abruption.|
|Identify the nature of any vaginal discharge.||The presence of glucose in the urine may develop a fungal infection called monilial vulvovaginitis, by the causative agent Candida albicans. This more likely lead to oral thrush among newborn.|
|Evaluate for any signs and symptoms of urinary tract infection.||Patients with diabetes are at higher risk of developing UTIs since increased blood sugar level gives a favorable environment for bacterial growth. Early detection and treatment are highly important to avoid the occurrence of complications like pyelonephritis and premature labor.|
|Check and monitor for signs of edema.||A person with diabetes is also prone to developing excess fluid retention and pregnancy-induced hypertension. This is because of changes in vascularity. The extremity of vascular changes before pregnancy affects the extent and time of onset of pregnancy-induced hypertension.|
|Find out for the fundal height; Examine for edema of extremities and difficulty breathing.||Pregnant diabetic patients are at risk of developing Hydramnios, by 6% to 25%. Excessive amniotic fluid can be related to the increased fetal contribution because hyperglycemia rises fetal urine output.|
|Check for episodes of hyperglycemia.||To achieve a normal blood sugar level, a proper diet and regulated insulin level are necessary, especially during the second and third trimesters. Because during these periods, the insulin requirements are usually doubled.|
|Check for episodes of hypoglycemia.||Episodes of hypoglycemia happen most frequently during the first trimester, due to fetal insufficiency on serum glucose and amino acids, as well as low levels of human placental lactogen. In hypoglycemia, vomiting may result in ketosis.|
|Observe for signs and symptoms of preterm labor. An excessive amount of amniotic fluid will make the client susceptible to early labor.||Excessive distension of the uterus is caused by a newborn’s excessive birth weight.|
|Guide the patient in learning blood glucose monitoring at home. It can be done a minimum of 4 times a day.||It provides greater accuracy rather than urine testing because during pregnancy the renal threshold for glucose is much lower. A blood glucose test makes it easier to control sugar levels.|
|Check for urine ketones daily.||The presence of ketones in urine implies a starvation state, which may have negative effects on the development of the fetus.|
|Monitor blood count on the initial visit, then on the second trimester and during full term. Particularly, check the Hematocrit and hemoglobin levels.||Because of vascular changes, Anemia is possible to occur.|
|Check HbA1c usually every 2 to 4 weeks, or as ordered by the physician.||It provides more exact results to assess glucose control for the past 2 months.|
|Obtain another blood test such as protein excretion, creatinine clearance, BUN, and uric acid levels.||Continuous vascular changes may reduce renal functions, mostly among severe or long-standing diabetes.|
|13. Check for a urine test. If vaginal discharge is present, obtain urine culture.||Early detection may prevent kidney infection.|
|Schedule for ultrasonography, usually at 8, 12, 18, 16, and 36 to 38 weeks or as indicated.||Ultrasonography determines fetal size using the biparietal diameter, femur length, and estimated fetal weight. On-time schedule of ultrasonography detects anomalies in fetal structures, macrosomia, and hydramnios.|
|Provide health teaching among family members||Assess their understanding of Gestational diabetes and explain to them its effects on the mother and fetus. They can help in monitoring the patient and assist with the client’s needs. They can also support the client by motivating them to be compliant with the treatment.|
Gestational Diabetes Nursing Care Plan 5
Risk for Fetal Injury
Nursing Diagnosis: Risk for Fetal Injury related to elevated maternal serum blood glucose levels secondary to gestational diabetes.
- The fetus will remain safe and pregnancy is maintained until it reaches maturity.
- The fetus will display a reactive normal stress test, a negative result in OCT and CST.
|Gestational Diabetes Nursing Interventions||Rationale|
|Identify White’s classification for diabetes. Discuss classification and significance to the client or couple.||White classification A, B, or C indicates that the fetus is at less risk. Client with classification DD, E, or F who have an advanced kidney problem, acidotic problems, or pregnancy-induced hypertension is at high risk. To identify the prognosis of the perinatal outcome, White’s classification has been used in connecting with the evaluation of diabetes control or insufficient control, and the presence or absence of Pedersen’s prognostically bad signs of pregnancy, including acidosis, mild to severe toxemia, and pyelonephritis.|
|Identify the client’s diabetic control before pregnancy.||Constant normal HbA1c levels before pregnancy help prevent the risk of fetal death and congenital anomalies and abnormalities.|
|Observe for any signs of pregnancy-induced hypertension. These include edema, hypertension, and proteinuria.||PIH has negative effects on placental perfusion and fetal status. About 12-13% of pregnant with diabetes also develop hypertensive disorders resulting from cardiovascular changes related to diabetes.|
|Check the fundal height each visit.||This is effective in determining abnormal growth patterns like microsomia, or IUGR, small or large gestational age.|
|Monitor fetal movement and fetal heart rate every visit as indicated. Advised the patient to record each fetal movement periodically, starting about 18 weeks, then every day from 34 weeks until delivery.||The occurrence of placental insufficiency and maternal ketosis harms fetal movement and fetal heart rate. Check for the presence of ketones in the urine. Take note of fruity breath.||Maternal ketonemia can lead to irreversible damage to the fetus’s central nervous system and the worst is fetal death. Especially in the third trimester.|
|Give information with regards to the possible effects of diabetes on fetal growth and development.||The patient will be guided in decision-making about regimen, and treatment management. Also, it may increase cooperation and compliance.|
|Discuss the details and support procedure for home monitoring of blood glucose and diabetic management.||Regular monitoring of blood sugar levels is important to reduce the occurrence of fetal hypoglycemia or hyperglycemia. Reduced fetal and newborn deaths and morbidity complications and congenital anomalies are connected with desirable FBS levels between 70 to 96mg/dl, and a 2-hour post-meal glucose level of less than 120 mg/dl|
|Check for HbA1c every 2 to 4 weeks, as indicated.||There’s an increase Incidence of congenital malformed infants in mothers with increased HbA1c levels (greater than 8.5%) in the early stage of pregnancy or before conception.|
|After 30 weeks of gestation, Check sequential serum or 24-hr urinary specimen for estriol levels.||Lowering levels of estriols may denote the decreased function of the placenta, may result in possible intrauterine growth restriction and stillbirth.|
|Schedule for ultrasonography at 8, 12, 18, 28, and 36 to 38 weeks of gestation, as indicated.||This procedure is useful in the confirmation of gestation date and helps in the evaluation of intrauterine growth restriction (IUGR)|
|Obtain creatinine clearance levels periodically.||There is a slight correlation between the damage in renal vascularity and damage in the uterine blood flow.|
|Help the patient with the preparation for delivery, vaginally or surgically if the test result shows placental aging and insufficiency.||Helps in ensuring a positive outcome for the newborn. The incidents of stillbirths have a significant increase with more than 36 weeks of gestation. Macrosomia usually results in dystocia with cephalopelvic disproportion.|
|Perform nonstress test and oxytocin-challenge test or contraction stress test as indicated.||These procedures assess fetal well-being and adequate placental perfusion.|
|Confirm the alpha-fetoprotein (AFP) levels during 14 to 16 weeks of gestation.||AFP screening is recommended for both diabetic and non-diabetic, but it is especially significant among diabetic clients since the defect in the neural tube is greater among diabetics. Specifically, if the condition is poorly controlled.|
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