Case Scenario: GDM 3

K.C. is 34 years old. She is a gravida 2, para 0. Her first pregnancy ended in a stillbirth. At her
first prenatal visit, her diabetes screening was negative. However, in her second semester, she is
diagnosed with gestational diabetes. She is the normal weight for her height, and her weight gain
has followed the recommended pattern thus far in pregnancy.
1. What risk factors does K.C. have for gestational diabetes?
The risk factors that K.C. has are age since she is 34 years old and her history of
having stillbirths. It is also noted that she is in her second trimester where GDM
diagnosis among pregnant usually appears.

2. What test was probably used to diagnose K.C’s diabetes?

The test that will be used to diagnose K.C’s diabetes would be the Oral Glucose
Tolerance Test (OGTT). This test identifies abnormalities in the way one’s body handles
glucose after a meal — often before ones fasting blood glucose level becomes abnormal.
A sample of your blood will be tested, then you will be given a glucose drink. Another
sample of blood will then be taken every half an hour for two hours, to see how your
body is dealing with the glucose.

3. K.C. has been advised to return in one month for another three-hour oral glucose
tolerance test. What should the nurse teach her about preparing for this test?
For the three-hour test the nurse will advice K.C. on the following
 K.C. will be asked to come to the test fasting — not having had anything to eat or drink
for the previous eight hours. A fasting blood sugar will be obtained.
 The morning of the test, the person should not consume caffeine or smoke.
 She will have to drink about 8 ounces (237 milliliters) of a glucose solution containing
3.5 ounces (100 grams) of sugar.
 Your blood glucose level will be tested again one, two and three hours after you drink the
solution.
 After drinking the glucose solution, the client will need to remain in the doctor's office or
lab while you're waiting for the blood glucose level to be tested.

4. Why do you think K.C.’s blood glucose was normal on her first prenatal visit, but became
abnormal during her second trimester?
Gestational Diabetes is usually diagnosed in late pregnancy like the case of K.C.
who is in her second trimester. This is a normal physiological change during pregnancy.
This is because the hormones estrogen, cortisol, and human placental lactogen can
block insulin. When insulin is blocked, it's called insulin resistance. Glucose can't go into
the body's cells. The glucose stays in the blood and makes the blood sugar levels go up.

Critical Thinking Exercise: PIH/Pre-eclampsia-3

S.J. is a 38-year-old primigravida at 32 weeks gestation. She is a single mother, living with her
parents and 2 sisters. She has a high-stress sales job, being paid by commission only. She admits
that she doesn’t “eat right.” She says she doesn’t have time to prepare meals and eats mostly fast
foods and “junk food.” Her mother does cook for the family, but the meals are high in fat and
sodium. S.J. is 5 ft. 2in. tall and her pre-pregnant weight was 180 lbs. S.J. has edema of the feet,
ankles, and hands/
1. What risk factors does S.J. have for pregnancy-induced hypertension?
The risk factors for PIH/Pre-eclampsia that S.J. has are having a high stress sales
job that doesn’t allow her to have a proper diet especially for pregnant women. Her meals
mostly consist of fast foods and junk foods and her mother also prepares meals that are
high in fat and sodium. She has edema on her feet, ankles and hands which may be an
indication of eclampsia. She is also 38 years old which poses a high risk because blood
vessels at this age become atherosclerotic. She is also a single mother and this can be a
source of stress. Lastly, her BMI and pre-pregnancy weight of 180 lbs is also quite
alarming.

2. What vital sign is the most important for the nurse to assess at this time?
The most important vital sign that the nurse should assess is her blood pressure an
increase of 15mmHg from the baseline is alarming. The client should also be screened for
proteinuria since there is presence of edema in the hands (laboratory test). The nurse
should also monitor her other vital signs to make sure that no other disorders are present.

3. What should the nurse ask S.J. in order to assess her edema further?
The nurse should ask whether the edema on her feet, ankles and hands goes away
with elevation or when resting. The nurse should also closely assess the clients face if
there is presence of “moonface”. If she is wearing rings especially when the nurse notices
that the ring is wounded tightly, she should check if the rings could be removed. The
nurse should also ask more information about her weight gain and her diet to confirm
whether she has PIH. Questions regarding her urine output like how long she urinates, the
odor and color should be asked or if there are any signs of proteinuria. Lastly, since she
working in a high-stress sales job the nurse should ask if she wears compression
stockings or restrictive clothing.

4. S.J.’s blood pressure is 146/90. Her health problem will be managed on an outpatient
basis. After being taught to check her blood pressure and to check her urine for protein,
she is asked to keep a record of her weight, urine protein, BP, and fetal movement count.
What other advice should the nurse provide?
 The nurse should provide health teaching regarding the client’s diet and
encourage her to have a low salt and high protein diet.
 Teach her to monitor her intake and output (MIO).
 Encourage her to take frequent rests from her high stress job since she is
pregnant and it is not good for the baby. She should monitor the activity or
 movement of the baby, if she notices that the baby is not moving, she
should immediately go to the doctor.
 The nurse should also provide health education on the danger signs in
pregnancy and signs that can indicate that her condition is worsening.
Such as when she is experiencing headache or blurring of vision, she
should immediately go to her doctor.
 The nurse should also advice that S.J. should take more frequent health
check-ups especially when she is close to full term to monitor her
condition and the baby’s condition.