Gestational Diabetes Case Study

Subjective

State the patient’s chief complaint, reason for visit and/or the problem for which you are providing follow-up.

The client is a 30-year-old 27 weeks pregnant Hispanic-American woman in her third pregnancy. The client is married and has two children living at home and no history of miscarriage.

All symptoms related to the problem are described using the following cue descriptive categories:

Precipitating/alleviating factors (including prescribed and/or self-remedies and their effect on the problem).

The client denies any attempted self-remedies for her gestational diabetes mellitus (GDM), which is defined as experiencing intolerance to glucose that is initially identified during pregnancy (Jafari-Shobeiri & Ghojazadeh, 2015).

2) Associated symptoms

The client reports frequent urination and being thirsty much of the time which are both consistent with a diagnosis of GDM (Mcgill, 2015).

3) Quality of all reported symptoms including the effect on the patient’s lifestyle

The client reports no significant adverse effects as a result of GDM.

4) Temporal factors (date of onset, frequency, duration, sequence of events)

The client was first diagnosed with a glucose tolerance test for GDM during this pregnancy.

5) Location (localized or generalized? does it radiate?)

NA

6) Sequelae (complications, impact on patient and/or significant other)

Beyond the increased thirst and frequency of urination, the client reports no discernible impact on herself or her family.

7) Severity of the symptoms

The client reports no discernible symptoms besides the aforementioned increased thirst and frequency of urination.

b. Pertinent Past Medical History including Pregnancy, Prenatal. Postnatal, Immunizations, Tests, Dental Care, Allergies, Accidents, Childhood illnesses, Operations, Hospitalizations.

Although the client has two previous uneventful pregnancies, she but was not tested for GDM at those times.

c. Family History includes family members, family health history, social history to include, residence, financial situation, outside assistance, family interrelationships, school experiences that are relevant to the problem are stated.

The client is a slightly obese, career homemaker and her husband is currently employed as a factory worker in an automobile parts enterprise which provides full coverage health insurance. The client reports struggling financially on occasion due to their support of an extended family which lives nearby. In addition, the client reports a family history of GDM which is one of the potential causes of GDM, which also include: (a) gestational age, (b) history of gestational diabetes, (c) body mass index, (d) abortions and parity, and (g) a history of macrosomia (Jafari-Shobeiri & Ghojazadeh, 2015). Some evidence also exists that certain environmental factors that cause sustained inflammation may contribute to the onset of GDM (Malmqvist & Jakobsson, 2015). In addition, although the precise cause of GDM remains unclear, LIberatore (2009) reports that, “It is possible that hormones from the mother’s placenta block the action of insulin in her body” (p. 68).

d. The Review of Systems relevant to the chief complaint/presenting problem is included.

The client denies any discernible symptoms besides increased thirst and frequency of urination which is consistent with the majority of cases of GDM (Mcgill, 2015).

e. Habits to include development and personality

NA

f. If appropriate, subjective date is obtained from or corroborated with parent or caregiver of child or other members of health care team

NA

g. Interview pursues all cues presented by the patient/parent/caregiver.

The results of the screening test and assessment are consistent with a diagnosis of GDM.

2. Objective

a. Using inspection, palpation, percussion, and auscultation, the examiner evaluates all systems associated with the subjective complaint including all systems which may be causing the problem or which manifest or may potentially manifest complications and records positive and pertinent negative findings

NA

b. Performs appropriate diagnostic studies if equipment is available

The results of a 100-g 3-hour oral glucose tolerance test were positive for a diagnosis of gestational diabetes (Jafari-Shobeiri & Ghojazadeh, 2015).

3. Assessment

a. Diagnosis/es is (are) derived from the Subjective and Objective data

See 7g above.

4. Plan includes:

a. Appropriate diagnostic studies with rationale

A follow-up glucose tolerance test should be performed during the client’s next regularly scheduled clinic appointment (Sederstrom, 2013). In addition, the client should receive a BMI test to evaluate her body mass to determine if an exercise and diet regimen are appropriate during and post-pregnancy (Sederstrom, 2013).

b. Therapeutic treatment plan with rationale

The client should self-monitor and record her blood glucose level on a schedule determined by her physician (Sederstrom, 2015). In addition, the client should also be referred to a nutritionist for counseling concerning changes in her diet and lifestyle that can help manage GDM and weight during and post-pregnancy including restricted sugar and carbohydrate intake (Sederstrom 2013). If the dietary changes are not sufficient to manage the client’s GDM, she should be prescribed insulin which is regarded as safe for mother and fetus (Sederstrom, 2013). In this regard, Sederstrom advises, “[Insulin] is a naturally occurring hormone that your body makes anyway, so there’s no risk to the fetus, other than hypoglycemia in the mother” (p. 166). Many clients resist changes in the diet and lifestyle, though, so it will also be important to educate the client concerning the importance of managing her GDM given the potential harm the condition can cause the fetus, including the need for a caesarian section due to the larger size of the baby (Sederstrom, 2013).

References

Jafari-Shobeiri, M. & Ghojazadeh, M. (2015, August). Prevalence and risk factors of gestational diabetes in Iran: A systematic review and meta-analysis. Iranian Journal of Public Health, 44(8), 1036-1041.

Liberatore, S. (2009, September). Q: What causes diabetes, and how does it affect a person’s health? The Science Teacher, 76(6), 68.

Malmqvist, E. & Jakobsson, K. (2013, April). Gestational diabetes and preeclampsia in association with air pollution at levels below current air quality guidelines. Environmental Health Perspectives, 121(4), 488-491.

McGill, N. (2015, March). Gestational diabetes: A risk during pregnancy. The Nation’s Health, 45(2), 20.

Sederstrom, J. (2013, November). Treating two: Effective management of gestational diabetes. Drug Topics, 157(11), 16S-169.