College of Nursing

NURSING CASE STUDY

GESTATIONAL DIABETES MILETUS (LTCS)

Submitted By:
LAGARAS, RICH-ANNE M.

Submitted To:
Doc. Ina G. Ragotero

Submitted On:
October 22, 2019

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 TABLE OF CONTENTS
CONTENTS PAGE

TABLE OF CONTENTS 2
I. ADMISSION OR FINAL DIAGNOSIS 3
II. HEALTH HISTORY AND PHYSICAL EXAMINATION
A. Demographic
B. Source and Reliability of Information
C. Reasons for seeking care or chief complaints
D. History of present illness/ Or present Health
E. Past Medical History/ or Past Health 3-4
a. Pediatric/Cildhood/ Adult Illnesses
b. Injuries/Accidents
c. Hospitalization and Operations
d. Reproductive History
e. Immunizations
f. Allergies
g. Medications
F. Family History 4-5
G. Socio-Economic 5
H. Psychosocial Assessment 5
I. Functional Assessment 5-6
J. Review of Systems 6-8
III. LABORATORY STUDIES AND DIAGNOSTICS 8-17

IV. MEDICAL SURGICAL MANAGEMENT

A. Procedures 17-21
B. Pharmacotherapeutics/Medicines 22-24
V. NURSING CARE PLAN 24-26
III. PROGRESS NOTES 27-30

IV. DISCHARGE HEALTH TEACHING PLAN 31-32

V. REFENCE 32

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 NURSING HEALTH HISTORY

I. ADMISSION or FINAL DIAGNOSIS

Prior to admission, the patient felt a decrease in fetal movement. Pt. M.P’s was
diagnosed with an OB score of G4P3 (3003). She was in her 37-38 weeks
pregnancy uterine and has an overt Diabetes Miletus that was uncontrolled and
an Intrauterine Growth Restriction.

II. HEALTH HISTORY AND PHYSICAL EXAMINATION

A. Demographic (Biographical Data)

1. Client’s initials: M.P

2. Gender: F
3. Age, Birthdate and Birthplace: 30 | June 26, 1989 | Camarines Sur
4. Marital (Civil) Status: Single
5. Nationality: Filipino
6. Religion: Catholic
7. Address and Telephone Number: Pasong Lawin Baranggay Zone 4,
Dasmariñas Cavite | 0930546****
8. Educational Background: First year High School
9. Occupation (usual and present): “Tindera sa palengke”
10. Usual Source of Medical Care: Health Center or Pagamutan ng Dasmariñas

B. Source and Reliability of Information

Pt. M.P was competent to provide information. She was able to speak clearly;
conscious and coherent; oriented to time, person and place.

C. Chief Complaints (Preferably Top 3)

“Masakit yung balikat ko kasi nagtatrabaho ako sa palengke, madami at

mabibigat ang mga binubuhat”
“Mataas ang sugar ko”
“Malapit na ako manganak pero ang baby ko di ganoon kalakas sumipa”

D. History of Present Illness or Present Health

Two months prior to admission, the patient was diagnosed with Gestational
Diabetes Miletus during her pregnancy. The patient however addresses her
diagnosis as an increase in sugar level and she did not seem to worry about it that
much. In addition, she feels pain on her abdomen area due to her cesarean section
and rated it as 6/10 using a pain scale. Also, she verbalized that she feels pain on
both her shoulders at rest and when moving.

E. Past Medical History or Past Health

a. Pediatric / Childhood / Adult Illnesses

The patient verbalized that she did not have any illnesses during her
pediatric, childhood and adult stages.

b. Injuries or Accidents

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 The patient verbalized that she was not involved in any kinds of accidents
and that she never had any injuries as far as she can remember.

c. Hospitalization and Operations

The patient verbalized that she was only hospitalized thrice because she
gave birth to their 3 other children and nothing else. She also said that this
was her first cesarean birth and the rest was normal birth. She also had
undergone bilateral tubal ligation together with the low transverse cesarean
section surgery for prevention of having more children.

d. Reproductive History

The patient had her menstrual menarche at the age of 13 years old and
her normal cycle was 5 days a week every month. Her last menstrual
period was on December 27, 2018 and she gave birth to her baby girl on
October 1, 2019. She was found to have an Overt Diabetes Miletus the day
she was admitted. Her OB score is now G4P4 (4004). Lastly, after her CS
surgery, she also had undergone a bilateral tubal ligation surgery.

e. Immunizations
BCG: // At Birth // School Entrance
DPT: // 1st Dose // 2nd dose //3rd dose
OPV: // 1st Dose // 2nd dose //3rd dose
AMV: //
TT: // 1st Dose // 2nd dose //3rd dose // 4th dose // 5th
dose
HBV: // 1st Dose // 2nd dose //3rd dose
Others:_____________________________________

f. Allergies
// Food, please specify: _N/A________________________
// Drugs or medications, please specify: _______N/A_________________
// Chemicals, please specify: __________N/A_______________
// Other environmental allergens, please specify:
________N/A______________

g. Medications

The patient said that she did not take any kinds of medications prior to
hospital admission. However, after her cesarean section , she was
prescribed to take three medications for her recovery; Cefuroxime (Zinacef)
500mg/cap, 1 capsule 2x a day for treatment and prevention of numbers of
bacterial infections, Mefenamic Acid (Ponstel) 500mg/cap, 1 capsule 3x a
day for pain on full stomach, and Ferrous Sulfate (Feosol) 325mg/tab, 1
tablet once a day, used to prevent or treat low levels of iron in the blood.

F. Family History

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 From the maternal side of the patient, both grandparents of the patient have
died. The grandmother died due to an asthma attack and the grandfather
died due to an unrecalled cause. Both died at an unrecalled age. The
mother of the patient has 4 siblings, all of which, the patient does not recall
their ages and if they have any illnesses. Her mother’s age is 53 and she is
alive and well. However, her father died at the age of 27 because he was
stabbed. After the patient’s father died, she has lost contact with her father’s
family which is why she does not know if her grandparents are still alive,
how old they are and if they are doing well. The patient does not also know
how many her father’s siblings are, how old they are, and if they are doing
well. Moreover, the patient has 7 siblings and 6 of them are alive and well.
While the only boy has died at the age of 26 due to an unrecalled cause.
Lastly, the patient also mentioned that she has a twin sister.

G. Socio-Economic History

FAMILY MEMBER / MONTHLY

OCCUPATION /
RELATIONSHIP TO INCOME
SOURCE OF INCOME
PATIENT (optional)

Eduardo Babas Jr. (partner) Plumber at the City Hall (-)

Matet Pantilla Tindera sa palengke (-)

The patient lives with her partner and their 4 children only. Both of them provides
for their family and does not get any financial support from other people or
relatives.

H. Psychosocial Assessment

Patient Age: 30
Developmental stage: Middle Aged Adult
Developmental task: Generativity vs. Stagnation

The patient acts according to her developmental stage. She knows that she is
contributing to the people who buys food from her at the wet market where she
works at. She feels fulfilled that she is able to provide for her children and partner.

I. Functional Assessment

1. Health-Perception-Health Management Pattern

The patient stated that she noticed the changes in her body before, during
and after pregnancy. She also said that she in high in sugar level and she
controls her food, limiting sugar intake, to decrease the sugar level in her
body.

2. Nutritional-Metabolic Pattern

The patient always drinks a cup of water that is 145mL. She drinks atleast 8
of it per day which is 1,160mL. She stated that she has no problems in the
condition of her skin, hair, nails and mucous membranes, body temperature
and height. However, she worries about her weight loss after her pregnancy.

3. Elimination Pattern

The patients usually make 3 bowel movements a day. She noticed that her
stool is color black when she was pregnant, but it changed to yellowish brown
after she gave birth.

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 4. Activity-Exercise Pattern

The patient considers walking and lifting heavy boxes filled with vegetables,
fruits, etc., that she is selling at the wet market as her exercise every day.

5. Sleep-Rest Pattern

The patient sleeps 8 hours a day. Usually at 10pm-6am or she verbalized

“depende kung inaantok na ako pagkauwi galling palengke, edi matutulog na
ako”.

6. Cognitive-Perceptual Pattern

The patient does not have any problems with her senses. She only finished
first year of high school. She feels pain on her abdomen area due to the
cesarean section done to her to deliver her baby. She rated the pain 6/10
using a pain scale.

7. Self-Perception-Self Concept Pattern

The patient said that “namayat ako” and she said that she noticed only little
changes on her body appearance before, during and after pregnancy.

8. Role Relationship Pattern

The patient does not look up on anyone as her role models. She lives with her
partner which supports her every day. She believes that working at the wet
market is better than feeding your family from dirty money by doing dirty jobs.
She believes that being a mother is a tough but a precious gift to anyone and
she is thankful for her 4 children.

9. Sexuality-Reproductive Pattern

The patient verbalized that she had undergone a bilateral tubal ligation due
to not wanting anymore children.

10. Coping-Stress Tolerance Pattern

The patient verbalized “tahimik lang ako pag may problema para walang
gulo”.

J. Review of Systems
SYSTEM R.O.S. P.E
“parang namayat ako” Weight (before pregnancy) : 45
1. General kg
Weight (after pregnancy): 48 kg
“wala naman akong (-) rashes
pantal patal” (-) itchiness
“di naman ako (+) hair fall
nangangati” (-) nail changes
2. Integument (Skin,
“naglalagas buhok ko (-) pain
Hair, Nails)
dahil sa shampoo” (-) redness
“wala naman akong (+) skin is warm to touch
napansing kakaiba sa (-) bugs @ hair
mga kuko ko” (+) clean hairl, skin, and nails
“di naman sumasakit (-) headache
3. Head ulo ko” (-) dizziness
“di naman ako nahihilo”

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 “di naman malabo mga (-) blurry vision
mata ko” (-) glasses
4. Eyes “di ako nagsasalamin o (-) contact lens
contact lens” (-) conjunctivitis
(-) pain
“okay naman pandinig (-) discharge
ko” (-) pain
“cotton buds ginagamit (+) cleanliness
5. Ears ko panlinis ng tainga
ko”
“tuwing makadalawa
ako naglilinis ng tainga”
“wala naman akong (-) colds
sipon” (-) pain
6. Nose and Sinuses
(-) redness

“di naman ako inuubo” (-) cough

“di naman masakit (-) pain
lalamunan ko” (-) sore throat
7. Mouth and Throat (-) mouth sores
(+) uvula movement
(-) abnormal masses
(-) redness
“wala naman akong (-) pain
nakakapang bukol” (+) full ROM
“di namn rin sya (-) redness
8. Neck sumasakit” (-) rashes
“nagagalaw ko naman (-) abnormal masses
sya ng maayos” (+) warm to touch

“sumasakit dede ko pag (+) pain during breast feeding

nagpapadede” (-) abnormal masses @ bilateral
9. Breast and Axilla “wala naman akong boobs and underarms
nakakapang bukol sa
dede at kilikili ko”
“di naman ako ako (-) DOB
10. Respiratory nahihirapan huminga”
“wala naman akong (-) pain
sakit sa puso” (-) palpitations
11. Cardiac
“di naman naninikip
dibdib ko”
“tatlong beses ako sa (+) 3 BM/day
isang araw dumudumi” (-) trouble pooping
“dati black kulay ng tae (-) constipation
ko bago manganak (-)diarrhea
12. Gastrointestinal tapos ngayon greenish
brown na”
“di naman ako
nahihirapan sa pag
dumi”
“di ako nahihirapan (-) UTI
umihi” (-) pain
“di naman mahapdi
13. Urinary
umihi”
“kulay yellow yung ihi
ko”
“wala namang amoy ari (-) foul odor
14. Genitalia ko” (+) regular menstrual cycle
(-) masses
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 “wala naman ako akong (-) discharge
napapansing kakaiba
sa ari ko”
“7 days a week ako
kung reglahin pero
every month naman
iyon”
“walang naman akong (-) varicose veins
ugat ugat sa binti” (-) numbness of extremities
15. Peripheral Vascular
“di naman namamanhid
mga kasukasuhan ko”
“masakit yung balikat (+) pain during movement and at
ko” rest of both shoulders
16. Musculoskeletal (-) crepitus sounds
(-) full ROM

“di naman ako (-) dizziness

17. Neurologic madaling mahilo” (-) pain
“di naman ako ulyanin”
“di naman ako mabilis (-) bruises
18. Hematologic magkapasa”
“di naman ako anemic”
“mataas daw sugar ko” (+) GDM
19. Endocrine

“madalas akong (+) lack of concentration

20. Psychiatric nakatulala” (+) lack of attention span

III. LABORATORY STUDIES AND DIAGNOSTICS

Nursing
Procedure/ Normal Values / Actual Findings and
Indications Responsibilities
Date Findings Interpretation
(pre,intra,post)

Complete evaluates the Hemoglobin: 120-150 Hemoglobin: 140 g/L 1. Explain test
Blood cells that g/L procedure. Explain
Hematocrit: 0.42 that slight discomfort
Count| circulate in blood
Hematocrit: 0.37-0.47 may be felt when the
10/02/19 WBC Count:6.8x 103/L
skin is punctured.
WBC Count: 5-
Segmenters: 0.74 2. Encourage to avoid
10x103/L stress if possible
Lymphocytes: 0.22 because altered
Segmenters: 0.50-0.70
physiologic status
Monocytes: 0.04
Lymphocytes: 0.20- influences and
0.40 Eosinophils:________ changes normal
hematologic values.
Monocytes: 0.03-0.07 Stab cells:__________ 3. Explain that fasting is
not necessary.
Eosinophils: 0.00-0.05 Platelet count: However, fatty meals
ADEQUATE may alter some test
Stab cells: 0.03-0.05
results as a result of
ESR:__________
Platelet count: 150- lipidemia.
400x 103/L INTERPRETATION: 4. Apply manual
pressure and
ESR: 1-25mm/hr Findings are within dressings over
normal range except puncture site on
for segmenters which is removal of dinner.
.02 greater than the 5. Monitor the puncture
normal range. site for oozing or
hematoma
formation.

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 6. Instruct to resume
normal activities and
diet.

Urinalysis| screen for the Macroscopic Findings: Macroscopic Findings: 1. Instruct the patient to
10/02/19 presence of void directly into a
Color: Pale Yellow- Color: Light Yellow clean, dry container.
glucose (sugar)
Yellow Sterile, disposable
and/or protein. Transparency: Clear
containers are
Transparency: Clear
WBC: 0-2/HPF recommended.
WBC: Negative Women should
RBC: 0-1/HPF always have a clean-
RBC: 0-2/ HPF catch specimen if a
Epithelial cells: Few
microscopic
Epithelial cells: FEW examination is
Amorphous Crystals:
Amorphous Crystals: Occasional ordered. Feces,
FEW discharges, vaginal
Mucus Threads:______ secretions and
Mucus Threads: FEW menstrual blood will
Bacteria: Occasional contaminate the
Bacteria: 0-5/HPF urine specimen.
Others:_____________
2. Collect specimens
Others:_____________ form infants and
Urine Chemistry:
Urine Chemistry: young children into a
Glucose: 3+ disposable collection
Glucose: Negative apparatus consisting
Albumin: Negative of a plastic bag with
Albumin: Negative an adhesive backing
Reaction: Acidic
Reaction: Acidic around the opening
pH: 6.5 that can be fastened
pH: 5-6.5 to the perineal area
Specific Gravity: 1.005 or around the penis
Specific Gravity: 1.002- to permit voiding
1.030 directly to the bag.
INTREPRETATION: Depending on
hospital policy, the
Results are within collected urine can
normal range except be transferred to an
that there is a presence appropriate
of 3+ glucose in the specimen container.
urine and an 3. Cover all specimens
occasional presence of tightly, label properly
bacteria and send
immediately to the
laboratory.
4. If a urine sample is
obtained from an
indwelling catheter, it
may be necessary to
clamp the catheter
for about 15-30
minutes before
obtaining the
sample. Clean the
specimen port with
antiseptic before
aspirating the urine
sample with a needle
and a syringe.
5. Observe standard
precautions when
handling urine
specimens.

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 6. If the specimen
cannot be delivered
to the laboratory or
tested within an hour,
it should be
refrigerated or have
an appropriate
preservative added.

HIV for detection of Nonreactive Syphilis: Nonreactive

1. Promote skin
Screening HIV antigen (p24)
Test| and/or integrity. Patients are
8/15/19 HIV antibodies in INTERPRETATION: encouraged to avoid
the blood
Results are within scratching; to
normal range
use nonabrasive,
nondrying soaps and
apply nonperfumed
moisturizers; to perform
regular oral care; and to
clean the perianal area
after each bowel
movement with
nonabrasive soap and
water.

2. Promote usual bowel

patterns. The nurse
should monitor for
frequency and
consistency of stools and
the patient’s reports of
abdominal pain or
cramping.

3. Prevent infection. The

patient and the
caregivers should
monitor for signs of
infection and laboratory
test results that indicate
infection.

4. Improve activity
intolerance. Assist the
patient in planning daily

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routines that maintain a
balance between activity
and rest.

5. Maintain thought
processes. Family and
support network
members are instructed
to speak to the patient in
simple, clear language
and give the patient
sufficient time to respond
to questions.

6. Improve airway
clearance. Coughing,
deep breathing, postural
drainage, percussion and
vibration is provided for
as often as every 2 hours
to prevent stasis of
secretions and to
promote airway
clearance.

7. Relieve pain and

discomfort. Use of soft
cushions and foam pads
may increase comfort as
well as administration
of NSAIDS and opioids.

8. Improve nutritional
status. The patient is
encouraged to eat foods
that are easy to swallow
and to avoid rough,
spicy, and sticky food
items.

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OGTT| To evaluate System International: System International: • Have the client eat a
8/12/19 blood glucose diet high in
Fasting: 3.9-5.8mmol/l Fasting: 8.91 mmol/l carbohydrates for 3 days
levels to assist in
diagnosing 1 Hour: <11.1mmol/l 1 Hour: 18.90 mmol/l before the test.
diabetes.
2 Hours: <7.8 mmol/l 2 Hours: 18 mmol/l • If possible, discontinue
drugs that may interfere
Conventional: Conventional: with test results for 3
days before the test:
Fasting: 70-105 mg/dl Fasting: 160.54 mg/dl
1 hour: 200 mg/dl 1 hour: 340.54 mg/dl a. Corticosteroids
b. Oral contraceptives
2 Hours: <140 mg/dl 2 Hours: 324.32 mg/dl c. Synthetic estrogens
d. Phenytoin (Dilantin)
e. Vitamin C
INTERPRETATION: f. Aspirin
g. Thiazide diuretics
The results are far h. Nicotinic acid
more greater than the
normal range • Keep the client NPO
except for water for 10
hours before the
test.

• The client is given a

specified amount of
glucose (either 75 g or
100 g) as a lemon-flavor
or glucola liquid after
fasting blood and
urine samples are taken.
• Blood and urine
samples are taken after
the glucose is ingested
at 30 minutes, 1 hour,
and 2 hours. In some
instances, the test
may continue for up to 5
hours.

• Observe the client for

symptoms of
hyperglycemia and
hypoglycemia.

Client and Family

Teaching:

• The procedure for the

test.

• Foods that are high in

carbohydrates.

• For 10 hours before the

test and during the test,
the following
are not allowed: food,
tea, coffee, or alcohol.
Smoking is not permitted
during the test.

• Nausea, weakness,
dizziness, and sweating
may be experienced

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 during the test; these
symptoms often
disappear, but report
them to the nurse as
soon as they occur.

• Limit activity because

increased activity may
change the test results.

Metabolic/ To assist in the < 4-6 % (FIA) 11.6 SAME AS OGTT

Endocrine diagnosis of NURSING
Test diabetes and to RESPOSIBILITIES
evaluate INTERPRETATION:
disorders of
carbohydrate The result is far more
metabolism such greater than the normal
as malabsorption range
syndrome.

Chemistry To assist in FBS 3.89-5.83 mmol/L 4.91

To prevent and aid early
identifying the
presence of detection of type 2
fasting blood INTERPRETATION: diabetes you should be
sugar for early
detection of The result is within able to:
diabetes miletus normal range
 describe the risk
factors for type 2
diabetes
 explain the
importance of
prevention or delay
of onset of type 2
diabetes in
individuals at risk
 explain the role that
exercise plays in the
prevention of, or
delay in progression
to, type 2 diabetes
 explain the
importance of
weight control and
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 the role that diet
plays in the
prevention of, or
delay in progression
to, type 2 diabetes.

Promoting self-care

In order to support the

patient to self-care their
diabetes you should be
able to:

 support the patient

and help them
develop their own
self-care with
guidance from a
registered nurse
 observe and report
any concerns that
you may have about
a patient that would
affect their ability to
self-care
 encourage patients
to use their
personalized care
plans.

Mental health

To care for someone with

diabetes and mental
illness you should be able
to:

 have an
understanding and
awareness of how
mental health
issues, such as
depression and
anxiety, can affect
people with diabetes
 report any changes
that you notice in
the patient’s normal
mental health, to a
registered nurse or
doctor. This could
include changes in
medications
adherence, mood
and appearance and
also anxiety.

Nutrition

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To meet your patient’s
individual nutritional
needs you should be able
to:

 identify foods and

drinks with high
sugar content
 follow the nutritional
plan and report any
related problems
 measure and record
the waist
circumference,
height and weight of
your patient
accurately
 report if meals are
not eaten, especially
carbohydrates, if the
patient is using
insulin or blood
glucose lowering
therapies.

Urine monitoring

For the safe use of urine

glucose or ketone
monitoring and
associated equipment
you should be able to:

 perform the test

according to the
manufacturers’
instructions and
local guidelines
 perform the test
unsupervised at the
request of a
registered nurse
 document and
report the results
following local
guidelines and
procedures.

Blood glucose
monitoring

For the safe use of blood

glucose monitoring and

15
associated equipment
you should be able to:

 perform the test

according to
manufacturers’
instructions and
local guidelines
 perform the test
unsupervised, at the
request of a
registered nurse
 document and
report the result
according to local
guidelines and
procedures
 recognize and follow
local quality
assurance
procedure, including
disposal of sharps
 recognize hypo
glycaemia and be
able to administer
glucose
 Understand the
normal range of
glycaemia and
report any readings
outside this range to
the appropriate
person.

Injectable therapies

For the safe

administration and use of
insulin and GLP-1
receptor agonists you
should be able to:

 describe the effect

of insulin on blood
glucose levels
 be aware of local
sharps disposal
policy
 show and
understanding of the
on-going nature of
the therapy
 administer insulin
competently where
supported by local
policy

16
  report identified
problems
appropriately
 all nursing staff who
handle prescribe or
administer insulin
should undertake a
training course.

IV. MEDICAL SURGICAL MANAGEMENT

A. Procedures (USN, lavage/ gavage/CPT, Surgery etc.)

Procedure/ Date Indications Nursing Responsibilities (pre,intra,post)

Low Transverse Due to small pelvic

Cesarean Section | outlet to prevent
Preoperative Measures
10/01/19 complications of GDM
Preoperatively, there are measures that
should be taken to ensure the woman’s
safety during surgery.

 Securing the informed consent

from the patient.
 It is everyone’s responsibility to
see to it that the consent is
obtained, and witnesses might be
asked to witness the woman’s
signature.
 The consent must be informed,
and the risks and benefits of the
procedure must be explained in a
language that the woman
understands.
 Upon admission, the woman is
provided with a clean hospital
gown and her hair is pulled into a
ponytail.
 The woman’s nails should be free
from nail polish or any acrylic
fingernails because nails are used
to assess capillary refill.
 To decrease stomach secretions,
a gastric emptying agent is used
before surgery, because the
woman would be lying on her back
during surgery which makes
esophageal reflux
and aspiration highly possible.
 To ensure that the woman is fully
hydrated, an intravenous solution
such as Ringer’s can be started as
prescribed.
 Only a minimum of preoperative
medications is given to prevent
compromising the fetal blood

17
 supply and make sure that the
newborn is wide awake at birth
and respirations are initiated
spontaneously.
 Documentation of nursing care up
until the woman leaves the
hospital must be complete and
factual.
 Upon transport to surgery, ensure
that the woman is lying on her left
side to
prevent supine hypotension.
 Ensure that the side rails are up,
and the woman is covered with a
blanket.
 A support person may be needed
during cesarean birth, and they
also need encouragement to
watch the birth live.

Intraoperative Measures

 While anesthesia is being

administered, a surgical nurse will
assist the woman first to move
from the transport stretcher to the
operating table.
 The anesthesia of choice is
usually a regional block.
 Encourage the woman to remain
on her side or insert a pillow under
her right hip to keep her body
slightly tilted to the side to prevent
supine hypotension.
 Epidural anesthesia is
administered while the woman is
lying on her side, and it has an
effect that lasts for 24 hours, so
continuous pulse oximetry must
be used 24 hours post surgery to
detect respiratory depression.
 For the skin preparation, shaving
away abdominal hair and washing
the skin over the incision site with
soap and water could reduce the
bacteria on the skin.
 The woman is then positioned with
a towel under her right hip to move
abdominal contents away from the
surgical field and lift her uterus
away from the vena cava.
 The woman would be covered by
a sterile drape to block the flow of
the bacteria from her respiratory
tract to the incision site and also
block the woman’s and support
person’s lines of sight from the
incision site.

18
  The incision area is scrubbed by
an antiseptic, and additional
drapes are placed around the area
so that only a small area of the
skin is exposed.
 Prepare the woman and the
support person for the sights they
might see.
 It is less likely that LTCS type of
incision would rupture during
labor, so it is possible for the
woman to have VBAC in the
future.
 It results in less blood loss, easier
to suture, decreases puerperal
infections and less likely to
cause postpartum gastrointestinal
complications.

Postpartal Care

 After surgery, the woman would

be transferred by stretcher to the
post anesthesia care unit.
 Pain control is a major problem
after birth because it was so
intense that it interfered with the
woman’s ability to move and deep
breathe.
 Use a pain rating scale to allow a
woman to rate her pain.
 Some women may need patient
controlled analgesia or continued
epidural injections to relieve the
pain.
 Supplement the analgesics with
comfort measures such as change
in position or straightening of bed
linen.
 Instruct the woman to ambulate
because this is the most effective
method to relieve gas pain.
 Inform the woman that she should
not take acetylsalicylic acid
or aspirin because this can
interfere with blood clotting and
healing.
 Instruct the woman to place a
pillow on her lap as she feeds the
infant to deflect the weight of the
infant from the suture line and
lessen the pain.
 Football hold for breast feeding is
a way to keep the infant’s weight
off the mother’s incision.
 Note carefully the woman’s first
bowel movement after surgery
because if no bowel movement
has been observed, the physician

19
 may order a stool softener, a
suppository, or an enema to
facilitate stool evacuation.
 Teach the woman to eat a diet
high in roughage and fluid and to
attempt to move her bowels at
least every other day to
avoid constipation.
 Incisional pain may interfere with
the woman’s ability to use her
abdominal muscles effectively, so
the physician may prescribe a
stool softener.
 Caution the woman not to strain to
pass stools because this puts
pressure on their incision.
 Advice the woman to keep their
water pitcher full as a reminder for
her to drink fluids.
 Reassure the woman that it is
normal not to have bowel
movements for 3 to 4 days
postoperatively, especially if there
is enema administered before
surgery.

Bilateral Tubal Ligation For prevention of Pre operative measure

(Fimbriectomy)| pregnancy  Discuss the components of client
10/01/19 preparation for surgery.
o Pre-operative assessment
and screening
o Pre-operative and post-
operative instructions
o Review of what to expect
during the procedure
o Identify client conditions
suitable for female
sterilization using the WHO
Medical Eligibility Criteria.
o Adequate preparation of
clients for BTL/MLLA
diminishes client discomfort
and is an important factor for
success of the procedure.

Intra operative Measure

 Tell patient that:
o Performing other procedures
and requesting for additional
tests, other than
recommended, may cause
barriers to using these
methods.
o Additional tests performed
may be for the reason of
investigating other medical
conditions but not for
determining the client’s

20
 suitability for using his/her
chosen contraceptive method.
o Discuss recommendations for
BTL as presented by the
table.

Post operative care

1. Instruct patient to rest for one or two
days at home. Patient will probably be
able to resume most of their normal
activities within three to five days.
2. Instruct patient to avoid void heavy work
or lifting for one week. This will help the
wound heal.
3. Do not let the bandage get wet for one
or two days.
4. Take the medicine provided by the
clinic.
5. You may have sex as soon as it is
comfortable for you. This is usually
about one week after the operation.
6. Avoid pulling, scratching, or irritating the
wound.
7. It is important for you to know what is
normal following your surgery. There will
probably be some pain and swelling
around the wound. This is normal and
should not worry you.
8. Return to the clinic and notify the doctor
or health worker if you have any of the
following, or if you notice any unusual
body changes:
- Fever within one week of the
operation
- A pain in your belly that does
not go away or that becomes
worse
- Bleeding or pus coming from
the wound
- Signs that you may be
pregnant
 a missed period,
stomach pains, or dark
or spotty bleeding
between periods
(Watch for these signs
at any time after the
operation. They may
mean that the
operation has f

21
B. Pharmacotherapeutics / Medicines (IV fluidS, Frequecy)
Indications (client-
Generic name (brand
specific) Nursing
name) Classification
Dosage Responsibilities
Stoke Dose
Frequency
Cefuroxime (Zinocef) 500mg/cap, 1 cap 2x a 1. Assess patient for signs

day | Treatment of the and symptoms of infection

following infections prior to and throughout

caused by susceptible therapy.

organisms: Respiratory 2. Before initiating therapy,

tract infections, Skin obtain a history to determine

and skin structure previous use of and reactions

infections, Bone and to penicillins or

joint infections (not cephalosporins. Persons with

cefaclor or cefprozil), a negative history of penicillin

Meningitis, gynecologic sensitivity may still have an

infections, and Lyme allergic response.

disease 3. Observe patient for signs

and symptoms of anaphylaxis

(rash, pruritus, laryngeal

edema, wheezing).

Discontinue the drug and

notify physician or other

health care professional

immediately if these

symptoms occur. Keep

thromepinephrine, an

antihistamine, and

resuscitation equipment close

by in the event of an

anaphylactic reaction.

22
 4. Instruct patient to report

signs of hypersensitivity.

Mefenamic Acid (Ponstel) 500g/cap, 1 cap 3x a day | Assessment & Drug

- For relief of mild to Effects

moderate pain in patients 1. Assess patients who

≥ 14 years of age, when develop severe diarrhea and

therapy will not exceed vomiting for dehydration and

one week (7 days). electrolyte imbalance.

- For treatment of 2. Lab tests: With long-term

primary therapy (not recommended)

dysmenorrhea. obtain periodic complete

blood counts, Hct and Hgb,

and kidney function tests.

Patient & Family

Education

1. Discontinue drug promptly

if diarrhea, dark stools,

hematemesis, ecchymoses,

epistaxis, or rash occur and

do not use again. Contact

physician.

2. Notify physician if

persistent GI discomfort, sore

throat, fever, or malaise

occur.

3. Do not drive or engage in

potentially hazardous

activities until response to

23
 drug is known. It may cause

dizziness and drowsiness.

4. Monitor blood glucose for

loss of glycemic control if

diabetic.

5. Do not breast feed while

taking this drug without

consulting physician.

Ferrous Sulfate (Feosol) 325mg/tab, 1 tab once a 1. May cause seizures,

day | prevention and hypotension, constipation,

treatment of iron- epigastric pain, diarrhea, skin

deficiency anemia staining, anaphylaxis

2. Assess nutritional status,

bowel function

3. Monitor hemoglobin,

hematocrit, iron levels

4. May cause elevated liver

enzymes

5. Take on an empty stomach

to increase

absorption/vitamin c helps

with absorption

6. Use z-track for IM

injections

V. NURSING CARE PLAN

ASSESSMENT NURSING OBJECTIVES PLAN OF

RATIONALE
CUES DIAGNOSIS OF CARE INTERVENTIONS

1. Subjective : - Acute pain due - Using the pain - monitor V/S - To reduce the
to CS scale, the patient pain that the
24
“masakit yung - Knowledge should feel less - Health patient is feeling
tahi ko dahil CS deficit r/t proper pain after nursing Education on on her abdomen
ako” body mechanics intervention proper positioning due to cesarean
and proper - The patient and body section
Objective: positioning would be able to mechanics - Established
V/S: - Risk for execute proper - encourage mechanisms
BP- 110/80 infection r/t CS body mechanics patient to walk designed to
T- 34.7 surgery and proper - execute doctors prevent infection.
PR- 92 positioning while pain management - May be given
RR- 19 laying down and prescription with prophylactically
while walking nurse’s on duty’s for suspected
Using a pain and CI’s consent infection or
scale, the patient - Adhere to facility contamination.
rated her pain to infection control,
be 6/10 sterilization, and
aseptic policies
and procedures.
- Administer
antibiotics as
indicated.

2. Subjective: - Impaired - Using the pain - inform the nurse - To reduce the
“ masakit po ang comfort r/t lack of scale, the patient on duty about the pain that the
balikat ko” knowledge on should not feel patient’s concern patient is feeling
proper posture, any pain at her - monitor V/S on her shoulders
Objective: noninvasive pain shoulders at all - educate patient
V/S: relief method and after nursing about proper
BP- 110/80 proper body intervention positioning while
T- 34.7 mechanics. lying on the bed
PR- 92
RR- 19

Using a pain
scale, the patient
rated her
shoulder pain to
be 3/10.
3. Subjective: -Knowledge - Patient will - monitor V/S - Facilitates
“mataas lang deficit r/t lack of verbalize - Assess patient’s planning of
sugar ko, di exposure to understanding of level of preoperative
naman to information the procedures, understanding. teaching
diabetes” evidenced by laboratory tests, -Assess client’s program,
statement of and activities and/or couple’s identifies content
Objective: misconception of involved in knowledge of the needs.
V/S: condition. controlling disease condition - When there is
BP- 110/80 diabetes. and treatment, a clear
T- 34.7 - Patient will including understanding of
PR- 92 participate in the relationships both the disease
RR- 19 management of between condition and
diabetes during diet, exercise, rationale for each
According to her pregnancy. stress, illness, management
OGTT result, the - Patient will and insulin helps the client
patient has an demonstrate requirements. and/or couple
increased sugar proficiency in -Review make informed
while she was self-monitoring hematocrit and decisions.
pregnant up to and insulin hemoglobin -Anemia is a
now and administration, levels. Provide concern for
because of this, dietary diabetic clients
she was also instructions on because
the importance of elevated glucose
25
diagnosed with intake iron-rich levels replace
GDM foods. oxygen in the Hb
- Provide molecule which
information can result in
regarding the reduced oxygen-
impact of carrying capacity
pregnancy on the causing more
diabetic condition problems.
and future - Sufficient
expectations. knowledge can
condition decrease
the fear of the
unknown, may
increase the
likelihood of
participation and
may help reduce
fetal/maternal
complications.

26
 Highlights and Insights

10/03/19

Today is the very first day of my hospital duty at Pagamutan ng Dasmariñas and

I was very excited as I am about to go in the OB ward and meet my patients. However,

I was so surprised as I was assigned to take care of an additional 2 mothers and 2 babies

as my first patients were about to get discharged. On the very first day on my duty, I felt

challenged and overwhelmed already. It was a toxic day for me, however it was such a

fulfilling experience as I hear my patients thanking me for taking care of them and for

teaching them additional information about the things I felt that was a problem to them.

Although all I did was check and monitor the mothers’ and newborns’ vital signs, check

their comfortability, I&O, I was still thanked by them. Today, is definitely a day to

remember and I hope I could encounter more patients and help them the best that I

could.

27
 Highlights and Insights

10/04/19

Another day of duty and I am still tired from last night’s. But I need to fight for my future!

As I come in on my second day, I have more to learn. I wanted to have more experience

when it comes to IV regulation, removal of IFC, and many more. Because I already

handles 3 mothers and 3 babies yesterday, I was only given 1 mother and 1 baby to

monitor today which made me more relaxed. I was able to do better and was able to

perform my tasks smoother than yesterday’s as I was still adjusting to the setting.

28
 Highlights and Insights

10/10/19

A week has already past and here we our down to our last week of duty. Today is a chill

day however it was also hectic at the same time due to the nurse’s complaints about the

results of the patients’ vital signs. I have a new patient again and I have to adjust again.

The new patient was a challenge for me because she was not very cooperative during

the first time we met. She didn’t seem to care at all. She was just sleeping all day that

looked like she does not want to be bothered at all. However, since I am a student nurse

who needs information from her, I kept going back to her and asking her about her life.

As soon as she felt like opening up, it was a lot easier for me. Also, there was also a

patient that has the same name as I am and she was expressing her emotions to me as

well. Even though she wasn’t my patient, I felt the need to keep her comfortable as well

because she is a patient in Pagamutan ng Dasmariñas. I felt more attached with her.

29
 Highlights and Insights
10/11/19

Today marks the last day of the second rotation in the OB ward here in Pagamutan ng

Dasmariñas. As we do our rounds for our last patients, I felt sad that I am not able to see

them anymore. Both my patient the patient with the same name as I am got discharged

today. It felt great the both of them expressed their gratitude towards me and I can’t help

but put a big smile of my face as they both leave the hospital. I even heard that the

patient with the same name as I am which is not really my patient, got attached to me as

well. I felt fulfilled and great to hear that and that gave me motivation to become a better

student nurse to my next patients.

30
 HEALTH EDUCATION PRIOR TO DISCHARGE
Mga Epekto ng Gestational Diabetes at Mga Tips para Dito
Ang pagbubuntis ay isang mahalaga ngunit maselang yugto
sa buhay ng isang babae. Maaaring magkaroon ito ng mga
komplikasyon gaya ng gestational diabetes dahil sa pagtaas
ng blood sugar level sa mga nagdadalangtao. Dahil dito,
dapat ipasuri agad ang mga posibleng diabetes symptoms
gaya ng madalas na pagka-uhaw, madalas na pag-ihi lalo na
sa gabi, pagkahapo, yeast infection at panlalabo ng paningin.

Ang gestational diabetes ay karaniwang nangyayari sa ika-24 hanggang 28 na linggo ng

pagbubuntis at nawawala naman din ito pagkatapos ipanganak ang sanggol.
Gayunpaman, ang mga babaeng nagkakaroon ng gestational diabetes ay mas prone
magkaroon ng type 2 diabetes pagkatapos ng kanilang pagbubuntis.

Mga Epekto ng Gestational Diabetes

Karamihan ng mga buntis na mayroong gestational diabetes ay nagsisilang ng mga
malulusog na sanggol. Gayunpaman, kapag hindi nabigyan ng atensyon ang sakit na
ito, maaari itong magdulot ng sobrang taas na blood sugar level at puwede itong
makaapekto sa pagbubuntis.

Ito ang mga komplikasyon ng gestational diabetes na nakakaapekto sa sanggol at ina:

 Labis na timbang pagkapanganak - Nangyayari ito dahil tumataas din ang blood sugar
ng sanggol at nasosobrahan ito sa nutrisyon. Dahil dito, nagiging balisa ang pakiramdam
ng ina sa mga huling buwan ng kanyang pagbubuntis.

 Maaaring kailanganin ang Caesarean section delivery dahil sa sobrang laki ng sanggol.
Posible ring magkaroon ng shoulder dystocia ang sanggol dahil sa matinding puwersa
sa mga balikat nito habang ipangangak. Mas mahirap din ang paggaling ng sugat para
sa inang nagdaan ng C-section.

 Maaga o pre-mature na panganganak ng ina - Ito ay puwedeng magdulot ng ibang mga

komplikasyon sa bagong-silang gaya ng paninilaw ng balat (jaundice) at hirap na
paghinga (respiratory distress)

 Mababang blood sugar (hypoglycaemia) ng sanggol kung kaya’t mahalaga rin ang pag-
monitor ng blood sugar para maagapan ang mga posibleng komplikasyon sa bata.

Type 2 diabetes - Kadalasang nawawala ang

gestational diabetes pagkapanganak subalit
nangyayari ang type 2 diabetes kapag hindi pa rin
nawala ang kondisyon matapos manganak.
Kung minsan, kahit mawala ang diabetes ng babae
ay nandoon pa rin ang posibilidad na maulit ang
gestational diabetes kapag siya ay muling
nagdalangtao. Dahil dito, mahalagang
pangalagaan ang kalusugan bago, habang at
pagkatapos ng pagbubuntis upang maiwasan ang
mga komplikasyon nito.

 Depresyon - Maaari itong magdulot ng pagkahapo lalo na dahil sa labis na pag-aalala

ng ina sa kanyang sarili at dinadala. Mahalagang maging positibo ang pag-iisip habang
nagbubuntis dahil nakabubuti rin ito sa sanggol.

 Pagkalaglag o miscarriage lalo na sa unang 23 linggo ng pagbubuntis.

 Preeclampsia o mataas na high blood pressure - Mapapansin ito kapag namamaga ang
mga daliri sa paa at kamay ng nagdadalangtao. Ang pagtaas ng presyon ng isang buntis
ay kailangan ng maagap na atensyon dahil maaari itong magdulot ng stroke sa ina sa

31
 kanyang panganganak. Ang kondisyong ito ay kritikal at maaari ding maging dahilan ng
pagkamatay ng sanggol sa pagsilang nito.

Mga Payo Para sa mga Mayroong Gestational Diabetes

Hindi madaling iwasan ang gestational diabetes ngunit
maaaring mabawasan ang mga epekto nito. Ito ang ilang
mga payo:
Kumain ng masusustansyang pagkain - Ito ang
pinakamabisang paraan para makontrol ang blood sugar
at maiwasan ang pagtaas ng timbang. Kumain ng mga
pagkaing mataas sa fiber at mababa sa taba. Limitahan
ang pagkonsumo ng mga matatamis na pagkain. Mas
makatutulong ang pagkonsulta sa iyong doktor o dietitian
upang malaman ang tamang uri ng diet sa iyong
kalagayan.
 Magkaroon ng sapat na ehersisyo - Ang mga gawaing
pisikal ay nakapagpapababa ng blood sugar at
nakatutulong sa pagbalanse ng pagkain. Maaaring
maglaan ng 30 minutong pag-eehersisyo sa loob ng 5
araw kada linggo tulad ng paglalakad at paglangoy.
Iwasan ang mga ehersisyo na maaaring makasakit sa
iyong tiyan. Sumangguni sa iyong doktor upang matukoy ang wastong ehersisyo para
sa iyong kalagayan.

 I-check at i-monitor ang blood sugar gamit ang glucometer - Mabilis ang pagbabago ng
blood sugar sa isang nagdadalangtao kung kaya’t mahalaga ang pagmonitor dito.

 Gumamit ng insulin kung ito ay ipinayo ng iyong doktor - Mas

makatutulong ang insulin sa pagkontrol ng blood sugar.

 Magpa-check kung ikaw ay mayroon pa ring diabetes pagkatapos

ng pagbubuntis - Gawin ito 6 hanggang 12 na linggo matapos
manganak.

Importante ring ipaalam sa iyong pediatrician na ikaw ay nagkaroon ng gestational

diabetes upang maalagaan nang husto ang iyong anak.
Seryoso mang sakit ang gestational diabetes, kaya itong makontrol. Kailangan lamang
magkaroon ng tamang diet, mas aktibong pamumuhay at regular na pagpapa-checkup
sa doktor. Sa pamamagitan ng mga ito ay masisigurado ang kaligtasan ng iyo

REFERENCE

Ritemed (2019). “Mga Epekto ng Gestational Diabetes at Mga Tips para Dito” Retrieved

from: https://www.ritemed.com.ph/articles/mga-epekto-ng-gestational-diabetes-at-mga-

tips-para-dito

Carpentino-Moyet (2017). “Nursing Care Plan: Transitional Patient & Family Centered

Care”. 7th Edition. Philadelphia:Wolters Kluwer Health (2017).

Carpentino-Moyet (2010). “ Handbook of Nursing Diagnosis”. 13th Edition. Lippincott

Williams and Wilkins

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