BSN 2 1 Group 3 Revised Grand Case Paper GDM

A Case Study
Presented to
Manila Doctors’ College of Nursing
S.Y. 2021-2022
In Partial Fulfillment of the

Requirements for the
Subject
MATERNAL AND CHILD

NURSING
Submitted by:
BSN II - 01 | Group 3
Buenviaje, Lorraine Tuesday
Cruz, Kathrina
Dulay, Mia Nicole
Gotan, Christine Ann
Horca, Sophia Aldona
Lutap, Shyna Mitchelle
Ong, Maria Krzandra
Oreza, Erik Miguel
Rico, Anabelle
Sy, Maria Pauline Antoinette
Vicente Rey Roldan, RN, MAN
Clinical Instructor
.
Table of Contents
I. Case Abstract ……………...………………....……………………………………………………..……...………..….3

II. Nursing Health History ………………………………………………………………………...…..……...…….……..4
a. Biographic Data ………………………………………………………………………...…..……...…….………...4
b. Chief Complaint(s) ………………………………………………………………………...…..……...…….……...4
c. History of Present Illness ...………………………………………………………………………...….…….…......4
d. Past History ……….....…………..………………………………………………………….……...….….….…......4
e. Childhood Illness ………………………………………………………………………...…..……...…….……......4
f. Family History ………..……………………………………………………………………….….…………….…..5
Hetero-familial illnesses ………………………………………………………………….………………………...6
g. Developmental History ………………………………………………………………………...…………………..6
h. Environmental History ………………………………………………………………………...…..……...……….8
i. OB/Gyne History……………………………………………………………………………………...…………….8
III. Gordon’s Typology of Functional Health Pattern ………………………………………………………...………….9
a. Health Perception/Health Management Pattern …………………………………………………………………9
b. Nutritional/Metabolic Pattern …………………………………………………………..………..……….....…….9
c. Elimination Pattern ……………………………………………………………………………….………….…...10
d. Activity-Exercise Pattern ………………………………………………………………………….…...…….…...11
e. Sleep-Rest Pattern ………………………………………………………………..…………………………...…..12
IV. Physical Assessment ……………………………………………………………………………………….…………..13
a. General Survey ……………………………………………………………………………………………………13
b. Anthropometric Measurement ………………………………………………………………………...…..…......13
c. Vital Signs ………………………………………………………………………...…..……...…….………………13
d. Physical Examination …………………………………………………………………………………………......14
e. Neurologic Status ………………………………………………………………………………………………….27
V. Anatomy and Physiology ………………………………………………………………………………………….......28
VI. Pathophysiology ……………………………………………………………………………………………………….31
VII. Laboratory Results ………………………………………………………………………………………………...… 38
VIII. Drug Study …………………………………………………………………………………………………………..... 41
IX. List of Prioritized Problems …………………………………………………………………………………………. 43
X. Nursing Care Plan ………………………………………………………………………...…..……...…….………… 46
XI. Health Teaching Plan…………………………………………………………………………………………………. 57
XII. Discharge Plan ………………………………………………………………………………………………………... 63
XIII. References …………………………………………………………………………………………………………….. 65
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I. Case Abstract
Gestational Diabetes Mellitus (GDM) is defined as glucose intolerance due to increasing insulin resistance
commonly occuring during second to third trimester of pregnancy. GDM has 2 subgroups: GDM A1 and GDM A2. GDM
A1 is the type of diabetes that is controlled by diet alone. While GDM A2 is controlled by diet and insulin medications.
GDM usually develops at 24 - 28 weeks of pregnancy, therefore a routine screening occurs around this age of gestation.
The cardinal symptoms of GDM include elevated blood glucose level, polyphagia, polyuria, polydipsia, and glycosuria.
Some of the well known risk factors of GDM are obesity or being overweight, advanced maternal age, maternal nutrition,
family history of diabetes, previous history of GDM, ethnicity, and polycystic ovarian syndrome. Studies found that GDM
occurs in 2.2% - 8.8% of pregnancies worldwide (Cheung, N., 2019). And published data in the Philippines showed that
14% in 1, 203 pregnancies surveyed have GDM. Prevalence of GDM is continuously increasing worldwide causing
detrimental effects to women, unborn fetuses and children. Women who have been diagnosed with GDM are at risk for
developing Type 2 diabetes later in life. Moreover, GDM is also associated with several maternal complications such as
pre-eclampsia, cesarean section, infection, dehydration, and polyhydramnios. It is also related to development of fetal
complications such as fetal macrosomia, birth trauma, hyperbilirubinemia, respiratory distress syndrome, and
polycythemia.
Client Mrs. M.J. is a 42 years old G4P3 at her 28th week of pregnancy visited the hospital for a check-up and was
diagnosed with Gestational Diabetes Mellitus. Glucose tolerance test and hbA1c were performed and elevated results
revealed presence of hyperglycemia. The client also complains about the fatigue, frequent urination and excessive thirst
she experiences. She elaborated that she often feels weak and lacking in energy despite sleeping for 6 to 8 hours a day. As a
result, she is unable to fulfill her usual daily routines such as household chores and walking to and from work, thus her
husband and eldest son take over some of her responsibilities. To regain her energy, she mentioned that she usually takes
some naps in the afternoon and increases her food intake. The client also experiences frequent urination, stating that she
urinates at least 15 times a day, sometimes even more. The client also had mentioned that her water intake increased at the
beginning of her pregnancy, however at the past couple of weeks, she always feels thirsty which increased her water intake
to 3.5 liters from 1.5 liters daily. Through assessment, the client turned out to have a normal pre-pregnancy weight of 110
lbs with a BMI of 20, classified as normal. After 7 months, she gained 32 lbs, making her current weight 142 lbs. Gaining
32 lbs is still under the average recommended weight gain of 25 - 35 lbs for pregnant women during the entire course of
pregnancy. However, a weight gain of 32 lbs at 28 weeks of gestation is considered excessive. Moreover, according to
Pillitteri (2010), weight gain of more than 3 kg (6.6 lbs) a month during the second trimester is considered excessive.
Health education measures will be prepared for the client such as blood glucose monitoring, insulin use and
administration, strict nutritional practices, weight management, signs and symptoms of hyperglycemia and hypoglycemia,
and self monitoring of fetal well being. The client will also be encouraged to follow a strict diabetic diet composed of right
food choices divided into small frequent meals and a light to moderate exercise routine in order to have a good control and
regulation of blood glucose level. Moreover, the client will be encouraged to alternate daily activities with rest periods to
conserve energy and prevent further aggravation of overall feeling of weakness and lack of energy. Lastly, referral to
nutritionist and medical technologist will also be done to provide a comprehensive management plan for the client.
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II. Nursing Health History

a. Biographic Data
Patient’s Initial: M.J. Gender: F Age: 42 years old Date of Birth:

March 1, 1980
Educational Attainment: Occupation: Fish Vendor Place of Birth: Manila

High School Level
Date of Admission: N/A No. of days in hospital: Order of Admission: Source of Information:
N/A Ambulatory Patient
Date of prenatal visit: LMP: August 21, 2021 AOG: 28 weeks EDD: May 28, 2022
March 5, 2022
b. Chief Complaint(s)
Fatigue, Polydipsia, Polyphagia, and Polyuria
c. History of Present Illness

Mrs M.J, currently at her 28 weeks of gestation, is diagnosed with diabetes during her recent pregnancy. The
client started to experience fatigue and has frequency urination of at least 15 times a day or more with approximately
250mL urine output each since 3 months ago. She said that even though she urinates frequently, she replaces it by
drinking 3500 mL of water a day. Client M.J. gained weight from 110 lbs to 142 lbs during pregnancy. She mentioned
that she eats more to help her baby grow during pregnancy and to regain her energy back.
The client also reports fatigue despite sleeping 6-8 hrs a day which hinders in the performance of her normal
daily activities such as housework and walking to and from work; frequent urination at least 13 times a day or more, and
excessive thirst by consuming 3500mL from 1500 mL of water a day. The urine dipstick reveals 3+ glycosuria and no
ketones. The result of a routine glucose tolerance test was 200 mg/dl. A follow-up HbA1c test found that it was 7.6%.
d. Past History
According to the client, she already had her BCG, DPT, OPV, Hepatitis B, and Measles vaccinations. She also
had completed her COVID-19 vaccine as well as the booster shot six months after her second dose. She also had her TT1
and TT2 vaccinations. Client stated that she had Chicken Pox when she was 10 years old. Moreover, she stated that she
does not have any chronic diseases nor allergies to food and medications. Mrs. MJ underwent three spontaneous vaginal
births when she delivered her children 7 years, 6 years, and 3 ½ years ago. Client stated that she takes Folic Acid and
Vitamin C as prescribed by the physician for her pregnancy.
Childhood illness(es) Chicken Pox (1990)
Childhood/adult ● BCG (March 11, 1980)

immunization(s) ● DPT (1st dose: March 29, 1980), (2nd dose: April 26, 1980), (3rd dose: May
31 1980)
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● OPV (1st dose: March 29, 1980), (2nd dose: April 26, 1980), (3rd dose: May
31 1980)
● Hepatitis B (1st dose: May 31 1980), (2nd dose: July 5, 1980), (October 14,
1980)
● Measles (December 5, 1980)
● Sinovac Covid-19 Vaccine (1st dose July 17, 2021, 2nd dose August 15, 2021,
and booster shot (February 20, 2021)
● TT1 Vaccine
● TT2 Vaccine
Accidents and Injuries N/A
Previous NSD (June 8, 2014 - Manila Doctors Hospital)

hospitalization/surgery NSD (February 23. 2016 - Manila Doctors Hospital)
NSD (December 5, 2018 - Manila Doctors Hospital)
Medication prior to Folic Acid tablet 400 mg OD

confinement Vitamin C 500 mg OD
e. Family History
General Family Information:
Name Relation Age Gender Occupation Educational Diseases/Disorder
Attainment
M.M. Mother 63 F N/A High School Grad Diabetes
F.M. Father 65 M Househusband High School Grad None
M.L.J Mother-in-law 65 F Housewife High School Grad Hypertensive
F.L.J. Father-in-law 66 M Househusband High School Grad Hypertensive
A.J. Husband 43 M Carpenter High School None

Undergrad
F.C.J. Child 7 M Student Elementary None

Undergrad
S.C.J. Child 6 F Student Kindergarten None
T.C.J. Child 3 1/2 F N/A N/A None
Heredo-familial illnesses (use genogram): Please see attached for legend
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f. Developmental History
Theory Age Developmental Task Client Description Interpretation
Psychosexual 42 Genital Stage According to the client, The client is showing

y/o ● During this stage, the she and her husband are appropriate behavior to her
adolescent has overcome having sexual age as she shows that she
latency, formed gender intercourse 1-2 times a still seeks sexual pleasure
connections, and is now week before she was through sexual contact with
seeking pleasure through pregnant. Now, they her husband.
sexual contact with others. - only have intercourse
Sigmund Freud once a month due to her
pregnancy.
Psychosocial 42 Generativity vs. Stagnation According to the client, The client is showing
y/o ● Middle-aged persons she fetches her children behavior appropriate to her
attempt to build or nurture from school after lunch age as she shows actions that
things that will outlast time. She also said that nurture her children and her
them, often through the she is the one who family.
parenting of children or the prepares her family’s
promotion of beneficial meals and that she
social change. - Erik makes sure to eat
Erikson healthy foods such as
vegetables, fruits, and
meat. She mentioned
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that she does not allow

her children to buy food
from the sari-sari store.
Cognitive 42 Formal Operational The client stated that in The client shows appropriate
y/o ● The ability to create making decisions for behavior to her age as she
hypotheses and test them in their family, she and her makes decisions with her
order to find a solution to a husband decided husband that makes her more
problem - Jean Piaget together. According to confident with their solution.
the client, doing this However, she also makes her
makes her more own decision even without
confident on the her husband’s input.
outcomes of their
decision. However, on
some occasions, she
does not seek her
husband’s opinion.
Moral 42 Postconventional Morality The client pointed out The client shows appropriate
y/o ● The individual's perspective that it's better to sell fish behavior to her age as she
expands beyond that of his while pregnant than to knows her responsibilities
or her own civilization. stay in the house. She such as selling in order to
Morality is defined by said that their earnings attain their financial needs
abstract ideas and values are sufficient to cover and being a mother to her
that can be applied to any their daily costs. Aside children.
scenario or society. The from that, she stated that
person tries to see things being responsible to her
from everyone's point of children will not be a
view. -Lawrence Kohlbergs hindrance even though
she is exhausted due to
her fatigue.
Spiritual 42 “Conjunctive” Faith Client stated that Client shows appropriate

y/o (Mid-Life Crisis) whenever she prays at behavior to her age as she
● A person understands the night, all of her wishes has her own belief regarding
contradictions that come in life come true. She her practices to her faith.
with transcending values. also claimed that her
This causes the individual prayers are always
to move beyond any followed by hard work
religious traditions or and perseverance, since
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beliefs he may have she believes that prayer

inherited from prior stages does not work without
of development. When a the believer's actions.
person is able to hold a
multi-dimensional
perspective that recognises
"truth" as something that
cannot be stated through
any one profession of
religion, the tensions of this
stage are resolved.
g. Environmental History
Client MJ resides at Paranaque City in a single storey house and is currently living with her family. She mentioned
that the floor area is 60 sqm and is made of concrete. She lives together with her husband and their 3 children. “Bale dito
rin kami lahat nakain, nagluluto, natutulog, at naglalaro yung mga bata.” as verbalized by the client. She also mentioned
that they only have one window in their house and do not have proper ventilation adding that “minsan iniiwan naming
bukas yung pinto para may pumapasok na hangin.” The client described their house as generally clean as their family has a
routine of cleaning the house daily, however, there are times that she finds cockroaches and rats. In addition, the client has
mentioned that their house floods up until their heels, even in light rains. For their drinking water, the client has said that
they buy mineral water from a nearby water station. Their family shares a communal toilet with three nearby families and
their garbage is collected from their house daily. The client has also said that there are no other noises aside from the noise
of the jeeps and tricycles passing on their street. The client have mentioned that, “meron saming (sa amin) na health center
siguro mga limang minuto na lakad lang.”
h. OB/Gyne History
Menarche Age: 14 y/o Amount: max of 2 regular Characteristic: Bright red, regular
sized pads per day (fully
soaked)
Duration: 5 days Associated Symptom: Dysmenorrhea and lower back pain
Obstetric History G: T: P: A: L: M: Type of Delivery: (3) Normal Spontaneous

4 3 0 0 3 0 Delivery
Complications: None Exposure to Teratogenic Agents: None
Last Menstrual Period: August 21, 2021 Age of Gestation: 28 weeks EDD: May 28, 2022
Fundal Height: 28 cm (Normal for AOG)
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III. Gordon’s Typology of Functional Health Pattern
A. Health Perception / Health Management
In the past six months, the client described her general well-being by verbalizing “healthy”. She added
that she usually goes outside the house to fetch her 2 children at school and has been vaccinated for COVID-19.
The client doesn’t have any vices, instead she actively drinks her vitamins and sleeps early during the past 6
months. Client M.J. also follows personal hygiene practices on a daily basis, but becomes more frequent now
because of the pandemic. The client also added that her perception about healthy foods is eating meat, fruits, and
vegetables. She also prevents her children from buying food in the sari-sari store as she verbalized “Alam ko
kasing hindi healthy yung mga pagkain na binebenta sa sari-sari store so as much as possible gusto ko talagang
luto ko o ng asawa ko para sure na healthy yung kinakain nila.”
Presently, the client described her general well-being by verbalizing “Slightly healthy kasi lagi akong
nakakaexperience ng fatigue lately kahit maaga naman akong natutulog tas para akong laging gutom, uhaw, at ihi
nang ihi”. Client M.J. doesn’t have any allergies or beliefs, practices, and traditional concepts regarding health and
illnesses. Safety practices on food preparation and overall hygiene and health are strictly followed by the client and
the family. Current health protocols established by the national and local government unit like wearing face masks
and frequent handwashing are followed by the client and the family. The client’s perception about healthy foods is
still the same as her diet is still meat, vegetables, and fruits. She still doesn’t allow her children to buy food from
the sari-sari store.
Analysis
Fatigue is a common symptom of gestational diabetes mellitus due to high blood sugar levels with other
symptoms and complications of the condition (Weatherspoon, D., 2019). Fatigue happens because decreased
glucose uptake in cells due to insulin resistance, leading to inability of cells to use glucose for energy. Other
symptoms associated with gestational diabetes is polydipsia when blood sugar levels get too high that make a
person feel thirsty, regardless of how much water they drink that will further lead to excessive urination or polyuria
(Jewell, T., 2018).
Interpretation
NOT NORMAL - The client is experiencing fatigue, excessive thirst, increased appetite, and excessive
urination recently during her 3rd trimester. The client’s perception about healthy foods includes meat, fruits, and
vegetables. The client also understands that food being sold in the sari-sari store is not healthy as compared to the
homemade foods that are cooked by her or his husband.
B. Nutritional / Metabolic Pattern

For the last six months, the client stated that she cooks food that is healthy for their family. When asked to
elaborate, she said that, “usual na kinakain namin ay mga pagkain na may gulay at karne tapos naghahanda rin
ako ng mga prutas para sa meryenda ng mga bata. Di ko rin pinapayagan ang mga bata na bumili sa tindahan.”
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Presently, the client stated that their food at home is still the same: fruits, vegetables, and meat. She also
said that since she is pregnant, she started eating more because it will help the baby grow healthy and for her to
regain her energy back as she verbalized “Lately, dumami yung pagkain ko kasi para akong laging gutom. Tuwing
kumakain kami, halos kalahati ng plato ko ay kanin tapos yung kalahati ay yung ulam namin na gulay at karne.
Minsan nga nakakadalawang plato pa nga ako pero para sa aming dalawa naman ni baby ‘yun at para bumalik
na yung dati kong lakas. Sa meryenda, prutas kinakain namin. Minsan manga, minsan orange o kaya saging.”.
When asked to describe her food plate at home, she said that she fills almost half of the plate with rice and the
other half with the viand. Sometimes, she even goes for a second plate. During merienda, she eats a couple of
servings of fruits. Her usual selection is mangoes, oranges, and bananas. The client has also mentioned gaining
32lbs since her pregnancy started, making her weight at 28 weeks AOG 142lbs.
Analysis
A healthy lifestyle should be followed and maintained by a mother during pregnancy. This includes
appropriate weight gain, balanced diet, and appropriate vitamin and mineral supplementation. Each day, about 300
additional calories are required to support a healthy pregnancy. A balanced diet of protein, fruits, vegetables, and
whole grains should provide these calories. Sweets and fats should be consumed in moderation (Johns Hopkins
Medicine, 2019).
In diabetes blood glucose levels are higher than what is considered normal, but the glucose is not able to
enter and be utilized by the cells, either due to lack of insulin or insulin resistance. As the cells experience
starvation, the brain will be stimulated to feel hunger causing the person to eat. This will make the person feel
excessive hunger or an increased appetite which is also known as polyphagia (Diabetes.co.uk, 2019).
The normal weight gain in the entire course of pregnancy is 25-35lbs. During the first three months of
pregnancy, a pregnant woman should gain 2 to 4 pounds, and then 1 pound every week for the duration of the
pregnancy (Johnson, 2020).
Interpretation
NOT NORMAL - Client M.J. has an understanding of what foods are recommended for having a
balanced diet. However, she also has a skewed belief regarding the normal nutritional intake of a pregnant mother
as well as how the body is able to utilize food as energy. This belief caused the client to eat in excessive amounts
rather than following the actual recommended intake. Although within the suggested range of weight gain for the
entire course of pregnancy, the client has gained more than what is recommended at her AOG.
C. Elimination
For the last six months, client M.J. stated that she urinates around 11 times a day and has a regular bowel
movement. The client have mentioned that, “dati nakaka-1.5 L lang ako ng tubig namemeasure ko siya kasi yung
tubig ko nakalagay sa 1.5 L na bote.”
Presently, client M.J. have mentioned that she frequently urinates throughout the day by verbalizing
“Nakakailang beses ako mag-cr sa isang araw tapos may mga times din na nagigising ako sa gitna ng pagtulog
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para lang umihi.” She estimates that she urinates around 15 times a day with approximately 250mL because
“recently nakakahigit 2 bote ako halos, so 3.5L kada-araw ang naiinom ko.” As for her bowel movement, client
M.J, has mentioned that she sometimes feels constipated and finds it difficult to poop.
Analysis
Increase in urinary frequency is one of the common early symptoms of pregnancy as a result of the rise of
progesterone and human chorionic gonadotropin. In addition, during pregnancy, the body’s fluid levels increase
making the kidneys work harder in getting rid of the extra fluid, thus increasing the amount of urine the body
produces. During the third trimester, the growing size of the fetus puts pressure on the bladder causing a higher
frequency and urgency to urinate (Nall, 2016). In addition, increased urination is one of the manifestations of high
glucose build up in the blood as the kidneys work harder to filter and absorb the excess glucose. When the kidneys
can no longer keep up, the excess glucose will be expressed in the urine (Mayo Clinic, 2021).
Constipation is the struggle to eliminate or have a bowel movement. Constipation is usually felt by
pregnant mothers as early as the second or third month of the first trimester which is when their hormone levels
start to increase in relation to the pregnancy. The fetus putting pressure on the bowel of the mother can also be a
cause of constipation (Cleveland Clinic, 2021).
Interpretation
NOT NORMAL - Client M.J. experiences increased urinary frequency due to her uterus pressing down
her bladder and due to her increased water intake caused by her elevated blood glucose levels. She also
experiences constipation as her hormone levels increase and with the fetus putting pressure on her bowel.
D. Activity / Exercise Pattern

For the past six months, the client shared that she usually starts her day by preparing her children for their
school day. After she wakes them up, she will walk from her house to the public market where she works as a fish
vendor. The client has mentioned that walking to and from her house to the marketplace is her primary form of
exercise. Around midday, she will walk back home to do household chores, such as cleaning the house, doing the
laundry, and cooking food for the family. After doing the household chores, she fetches her children from school.
Presently, the client stated that she has started relying more on her husband in preparing their children for
school because she feels like she lacks energy, even if she just woke up as she verbalized “Kapag sinusundo ko
yung mga anak ko sa school parang nanghihina ako na walang energy kahit 6 to 8 hours naman yung tulog ko tas
kapag nakakaramdam ako ng ganito naidlip ako tuwing hapon”. As she feels tired easily, the client was not able to
walk to and from her house and marketplace as she opts to ride the tricycle. As for the household chores, she can
only sweep the floor for a while before she starts to feel her body get heavy and tired as she verbalized “Sa bahay
naman kapag nagwawalis ako siguro mga ilang minuto palang di ko na kaya tas uupo na ako agad”, hence her
eldest son has started helping her with some of the household chores, while her husband does the rest.
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Analysis:
Fatigue is common in early pregnancy which is usually caused by increased metabolic requirements in
relation to pregnancy. This causes the pregnant mother to feel the need to modify her customary routine from
typical activities, such as cooking dinner and doing household chores (Pilliteri p. 283, 2014). Doing household
chores during pregnancy is not prohibited as long as the mother observes precautionary measures (Wallach, 2015).
Pregnant mothers are at a higher risk for injury as there are changes in the woman’s hormones that affect their
ligaments and joints in the spine to accommodate the developing baby (CDC, 2019).
However, fatigue is also a result when the cells aren't able to have sufficient glucose supply. Glucose is the
energy source of the cells and with insufficient amounts of it will lead to the feeling of exhaustion or the overall
feeling of lack of energy (Fletcher, 2019).
Interpretation:
NOT NORMAL - There is an evident change in the client’s daily activity routine from the past six months
and recently. The client has started relying more on her husband and her eldest son in fulfilling her household
chores as she feels tired easily.
E. Sleep-Rest
For the past 6 months, the client usually has 7 hours of sleep and usually goes to sleep at 10:00 pm and
usually wakes up at 5:00am to prepare for her children’s class and for the family’s breakfast. She mentioned that
she does not have any trouble falling asleep and staying asleep. The client added that she does not sleep alone,
rather she sleeps together with her husband, 3 1⁄2-year-old, 6-year-old and 7-year-old children in one room. She
described her sleep as “malalim'' and “Mas madali makatulog, kahit anong position” as verbalized by the client.
After finishing the household chores and working at the market, she rests at home while watching television.
Presently, client M.J. sleeps for about 6 to 8 hours as she usually goes to bed at 9:00pm and wakes up at
5:00 am to help her children get ready for school. However, she mentioned that she sometimes wakes in the middle
of the night to urinate or to reposition herself because “nahihirapan ako humanap ng magandang posisyon habang
natutulog,” The client described her usual sleeping position which is on her left side with some pillows to support
herself. Furthermore, even if she just woke up, client M.J. said that she still feels tired and weak. The client has
elaborated that, “tinatry ko talaga mabuo yung tulog ko, minsan nakakaidlip ako sala kapag walang akong
ginagawa pero feeling ko pa rin na ang bigat ng katawan ko, nanghihina, at pagod.”
Analysis:
Feeling tired or exhausted is usual during pregnancy, especially in the first 12 weeks as hormones fluctuate
and increase. In the later weeks of pregnancy, feeling tired may be a result of the extra weight carried by the
mother or the difficulty of getting a good night sleep as lying down seems uncomfortable or needing to urinate in
the middle of the night (NHS, 2021).
Fatigue is a common result of high blood sugar levels and a symptom of gestational diabetes. For glucose
to be absorbed and used by the body cells as a source of energy, it needs insulin that is produced by the pancreas.
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However, due to the hormones released by the placenta during pregnancy, insulin resistance occurs. As the body
cells are not able to utilize glucose for energy, the glucose will build up in the bloodstream while there is nutrient
deficiency in the cells leading to cell starvation (Cherney, 2021).
Interpretation:
NOT NORMAL - Client M.J experiences fatigue due to the inability of her body cells to utilize glucose in
the bloodstream. Her inability to sleep continuously at night and the extra weight of pregnancy is also a factor to
be considered as to why she feels tired and weak.
IV. Physical Assessment

a. General Survey:
Body Built: Grooming/Hygiene: Posture & Gait: Relaxed, Body Odor and Breath
Endomorph Clean and groomed with Shoulders and back erect Odor:
appropriately, dress is when standing or sitting, Gait Absence of unpleasant body
clean and appropriate is rhythmic and coordinated and breath odor
for season with arms swinging at sides
Signs of Distress: Obvious Signs of Illness(es)

Weary Physical Weakness
Orientation: Level of Affect: Mood:

Patient is aware of the environment and is Consciousness: Euthymic Client is active and
responsive to questions asked by the student nurse Alert & oriented, participative with no
Time ✔ Person ✔ Place ✔ responds to questions sudden and extreme
and interact shift of emotions
appropriately
Quantity & Quality of Speech: Speech is clear, Organization of thoughts:

in moderate tone, with moderate pace, and Clear and relevant answers, expresses ideas and feelings clearly
without slur or stutter and concisely
b. Anthropometric Measurement
Height: 155 cm Weight: 110 lbs (pre-pregnancy) IBW/BMI: 20.81 (Normal)
Weight: 142 lbs (pregnant)
c. Vital Signs
Temperature: 36.8℃ Pulse Rate: 84 bpm Respiratory Rate: 18 bpm Blood Pressure: 110/70 mmHg
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FHR: 136 bpm
d. Physical Examination
Body Part Normal Findings (IPPA) Actual Findings (IPPA) Analysis & Interpretation
Skin Color is general to the whole Client is fair skinned and Analysis:
body, no unusual or prominent is uniform to the whole During the third trimester,
discolorations, no odor, no body. There is no presence dependent edema is normal.
lesions. Skin is warm to touch, of lesions. Skin is warm to
surfaces vary from moist to touch and is dry. Presence Striae/stretch marks are caused
dry depending on the area. of Linea Nigra in the lower by rapid gaining or losing
Skin is smooth and even, abdomen, and Striae weight.
mobile with elasticity and Gravidarum and
returns to its original shape discoloration in the under Linea Nigra is
quickly when pinched. No arms and abdomen. There hyperpigmentation that occurs
edema. is a good skin turgor that during pregnancy. It started to
Weber, J. Kelley, J. (2018). retracts less than .2 get darker and more visible by
Health Assessment in Nursing. seconds. There is presence the 2nd trimester
Pp. 258-262 of edema (+1) in the left
ankle .Presence of Stretch marks, acanthosis
chloasma in the upper nigricans, roughening and
cheek. darkening of skin in localized
areas, suggests diabetes
mellitus.
Decreased moisture of the skin

occurs with dehydration.
Weber, J. Kelley, J. (2018).
Health Assessment in Nursing.
Pp. 249-262
Diabetic patients are most

likely to have dry skin due to
high blood sugar.
Sabban, C. (n.d). Cutaneous
manifestations of diabetes
mellitus. American Academy of
Dermatology Association.
Interpretation: Normal
Discoloration, striae, stretch
14
.
marks and Linea Nigra found

on patients’ lower abdomen
and under arms.
Hair Natural hair color. Scalp is dry The client’s hair is black in Analysis:
and has visible dandruff. Hair color. Hair is smooth, thin, Growth of hair tends to
is smooth and firm, somewhat and brittle. Has various increase during pregnancy.
elastic. Varying amounts of amounts of hair in the Some women note excessive
terminal hair cover the scalp, scalp, axillary, body and oiliness or dryness of the scalp
axillary, body, and pubic areas. few on the pubic areas. and a softening and thinning of
Fine vellus hair covers the Fine vellus hair covers the the nails by the 6th week of
entire body except the soles, entire body except the gestation. Pregnancy hormones
palms, lips and nipples. soles, palms, lips and increase the growing phase of
nipples. Hair is free from the hair follicle and decrease
Weber, J. Kelley, J. (2018). infestations. the resting phase of the hair 27
Health Assessment in Nursing. follicle. During the postpartum
Pp. 262-263 period, hormone withdrawal
increases the resting phase of
the hair follicle and transient
hair loss is noticed.
Pp. 249
Analysis:
The primary cause of hair
thinning in people with
diabetes is uncontrolled blood
sugar levels.
Fletcher, J. (2018). Does
diabetes cause hair loss?
Medical News Today.
Patients’ hair is thin and brittle
due to high glucose level
15
.
Nails Nail bed is pinkish in color, Client’s nails are convex Analysis:
clean, and smooth to touch. and oval, fingernails and Softening and thinning of the
Surrounding tissues are intact. toenails are smooth and nails by 6th week of gestation.
Nails are hard and immobile. firm, nail beds are pinkish, Pregnancy hormones increase
Capillary refill in 3 seconds no presence of dirt under in growing phases of the hair
her nails, no presence of follicle and decrease the
Weber, J. Kelley, J. (2018). nail clubbing, capillary resting phase of hair follicle.
Health Assessment in Nursing. refill time is 1 second.
Pp. 264-265 Weber, J. Kelley, J. (2018).
Pp. 692
Nails tend to increase in
growth softening and thinning
is common for pregnant
women.
Head & Face Head is symmetric, round, Client head is symmetric Analysis:
erect, in midline, and with a round oval Head shape and shape vary.
appropriately related to body appearance. There was no Usually symmetric, round,
size (normocephalic). No swelling on nodules, erect, and in midline, and
lesions, or nodules. Face is masses and depressions appropriately related to body
symmetric with a round, The found. No presence of size. No lesions or abnormal
head is symmetric with a edema and hollowness, movements. The face is
round oval appearance. There Patient can smile, elevate symmetric with a round, oval,
was no swelling on nodules, her eyebrows, frown, close elongated, or square
masses and depressions found. his eyes tightly, puff her appearance. No abnormal
No presence of Analysis: cheeks and smile. Presence movements noted.
Smooth, nontender, small of chloasma in the upper Weber, J. Kelley, J. (2018).
cervical nodes may be cheek. Health Assessment in Nursing.
palpable. Slight enlargement Pp. 289-291
of the thyroid 28
oval-elongated, or square Interpretation: Normal
appearance. No abnormal The patient's head is
movements. Neck is symmetric,round, erect and in
symmetric, with the head in midline. No lesions. No
center and without bulging swelling and tenderness on
masses. Neck movements are nodules.
smooth and controlled.
Trachea is in midline. No
16
.
bruits sound during

auscultation. No swelling or
enlargement and no tenderness
of the lymph nodes
(preauricular, postauricular,
occipital, tonsillar,
submandibular, submental,
superficial cervical, posterior
cervical, deep cervical chain,
supraclavicular nodes.)

Pp. 289-296
Eyes The client should see the Clients’ eyeballs are Analysis:
examiner's finger at the same symmetric and aligned, Pupils are equal, round,
time the examiner sees it when eyelids have no swelling reactive to light, and
testing the visual fields. and redness. The client has accommodate
Eyelids should be without a 20/20 vision Pupil is
redness, swelling or lesions. reactive to light. Weber, J. Kelley, J. (2018).
Conjunctivas must be clear, Performed 6 cardinals of Health Assessment in Nursing.
smooth, and moist without gaze. Sclera is white in P. 3707
swelling, Sclera must be color. Eyeballs are
white. Corneal reflex usually symmetrically aligned Interpretation: Normal
is present and the cornea must with each other. Both The patient’s eye vision is
be moist. Pupils must be Palpebral conjunctiva is 20/20. The eyes are equal and
equally round and react to pale. Bulbar conjunctiva is round with no signs of
light and accommodation. clear and moist. Cornea is swelling or redness on the. The
transparent and no eyelids close easily and touch
Weber, J. Kelley, J. (2018). swelling of lacrimal glands when closed. The eyeballs are
Health Assessment in Nursing. was seen. Iris is round, flat symmetric and aligned. Both
Pp. 258-262 and evenly colored. There corneas and lenses . Palpebral
is also a positive conjunctiva is pale, free of
appearance of eye bags. swelling, foreign bodies, or
trauma as well as the external
eye structures. No swelling or
redness on the lacrimal gland.
Iris is round, flat and evenly
colored.
17
.
Ears Ears are bilaterally equal in Client has no exhibition of Analysis:

size. Earlobes may be free, exudates on both ears. The Pregnant women may report a
attached or soldered. Skin is client has equal and decrease in hearing a sense of
smooth, with no lesions, lumps bilaterally sized ears and. fullness in the ears, or earaches
or nodules. Auricle, tragus, Skin is smooth and no because increased vascularity
and mastoid processes are not tenderness upon palpation of the tympanic membrane and
tender. Small amount of in Auricle, Tragus and blockage of the eustachian
odorless cerumen (earwax) is mastoid process. There is tubes
the only discharge present. no unusual discharge and
Whisper Test: Able to foul smell. No cerumen Weber, J. Kelley, J. (2018).
correctly repeat the was present in the ears Health Assessment in Nursing.
two-syllable word as during Physical P.693
whispered. Weber's Test: Examination.
Vibrations are heard equally Interpretation:
well in both ears. No Whisper test: client was Normal
lateralization of sound to able to identify the words The patient's ears are both
either ear. Rinne's Test: Air whispered such as “hello” equal in size and are smooth,
conduction is normally heard and “apple” without any lesions or lumps.
more than bone conduction. There was minimal cerumen in
Weber’s: Vibrations was both ears but it had no foul
Weber, J. Kelley, J. (2018). heard on both ears Rinne’s odor. The patient has good
Health Assessment in Nursing. test: The AC is greater hearing in both ears.
Pp. 347-351 than the BC.
Nose Color is the same as the rest of Nose color is brown which Analysis:
the face; nasal structure is is uniform to the body. Nasal mucosal swelling and
smooth and symmetric; no Client's nasal structure is redness may result from
tenderness. Can breathe smooth and symmetric. increased estrogen production.
properly through both nares There is no tenderness in Epistaxis is a common
(one nares is occluded). Nasal the frontal and maxillary variation because of the
mucosa is dark pink, moist, sinuses upon palpation. increased vascular supply to
and free of exudate. Frontal Septum is located in the the nares during pregnancy
and maxillary sinuses are midline, Can breath in
non-tender upon palpation, no both nares without Weber, J. Kelley, J. (2018).
crepitus is evident. difficulty even if one is Health Assessment in Nursing.
occluded. Nasal mucosa is P.707
Weber, J. Kelley, J. (2018). dark pink, and moist. No
Health Assessment in Nursing. presence of bleeding, No Interpretation:
Pp. 373 crepitus is evident. Normal
18
.
The patient has no obstruction

in the nose and can sniff well
through each nostril while the
other is occluded. Nasal flaring
is not seen. Sense of smell is
present, letting the patient sniff
a cotton ball dipped in a lemon
scent. No tenderness or lesions
are present during palpation.
Even though nasal stuffiness
and epistaxis might occur,
there was no sign of this
throughout the patient’s
hospital stay.
Mouth & Pharynx Lips are smooth and moist Client's lips, tongue, Analysis:
without lesions or swelling. buccal mucosa, and gums Dry mouth despite drinking a
Teeth and gums must be clean are pink. No lesions or lot can be another sign of
as well as the tongue. Palates masses were seen during gestational diabetes.
must be moist. Frenulum and inspection. Mouth is dry. Barbara, E. (2022). What are
uvula must be at the midline Tongue is pink and is in the signs of gestational
and gag reflex is usually midline with moderate diabetes?. Riverside.
present. There should be no sizes of papillae present.
foul breath odor. Tonsils may No foul odor was noted. Interpretation: Abnormal
be present or absent. Uvula is in midline and not The Patient's mouth is dry.
Normally, pink and symmetric. swollen. Tonsils are
present, pink and
Weber, J. Kelley, J. (2018). symmetric. Gag reflex
Health Assessment in Nursing. present.
Pp. 367-372
Neck Neck is symmetric, with the Clients’ Neck movements Analysis:

head in center and without are smooth and done. Neck is smooth, nontender,
bulging masses. Neck Trachea in midline with no small cervical nodes may be
movements are smooth and bruit sound upon palpable. Slight enlargement of
controlled. Trachea is in auscultation Lymph Nodes the thyroid may be noted
midline. No bruits sound are not palpable. No during pregnancy.
during auscultation. No thyroid gland enlargement Weber, J. Kelley, J. (2018).
swelling or enlargement and upon inspection and Health Assessment in Nursing.
no tenderness of the lymph palpation. No distention p.707
nodes (preauricular, and it can be moved freely.
19
.
postauricular, occipital, Interpretation: Normal

tonsillar, submandibular, Neck is symmetric with head
submental, superficial centered and without bulging
cervical, posterior cervical, masses, trachea is midline, No
deep cervical chain, bruits sound.
supraclavicular nodes.)

Pp. 291-296
Spine Cervical and lumbar spines Spine is straight. There is Analysis:

should be concave and no tenderness in the Spine is straight. Nontender
thoracic is convex. Spine spinous process and it is spinous process. Flexion and
should be straight. Non-tender smooth. No muscle spasm. extension of the cervical spine
spinous process; firm and Able to flex and extend the is 45 degrees.) 70 degrees of
smooth. No muscle spasm. head without pain. rotation is normal (cervical:
Flexion and Extension of the Rotation of the head is head rotation). Full ROM
cervical spine is smooth and smooth and without pain. against resistance. Strength
without tenderness. Should be Cervical ROM is done 5/5.
able to bend 40 degrees to the with resistance; Strength
left and right side (lateral 5/5. No presence of back Weber, J. Kelley, J. (2018).
bending of cervical spine). 70 and leg pain. Health Assessment in Nursing.
degrees rotation of head p.543-544
should be smooth and without
pain. Cervical ROM is smooth Interpretation: Normal
with resistance (strength). There was no tenderness and
Flexion of the lumbar spine muscle spasm. Patient was
(70-90 degrees) should be able to flex and extend without
smooth with aligned spinal pain.
processes. Should be able to
bend 35 degrees to the left and
right side (lateral bending of
thoracic and lumbar spine);
hyperextension and rotation of
thoracic and lumbar spine
should be 30 degrees. There
should be no pain in the back
and legs. Legs should be equal
in length or have a difference
of only 1cm.
20
.

Pp. 543-545
Thorax/Lungs Manifested quiet rhythmic and Nasal flarings are not Analysis:
effortless respirations. observed.The patient does As the pregnancy progresses,
Percussion notes resonate, not use accessory muscles progesterone influences
except over scapula. Chest to assist breathing. relaxation of the ligaments and
wall intact, no tenderness, no Increased anteroposterior joints. This relaxation allows
masses. Full and symmetric thorax. There are no the rib cage to flare, thus
chest expansion. Bilateral reports of tenderness and increasing the anteroposterior
symmetry of vocal fremitus. no masses palpated. Chest and transverse diameters. This
No additional sounds heard expands 5 to 10 cm apart accommodation is necessary as
during auscultation. symmetrically. RR: 18 the pregnancy progresses and
cpm. Fremitus is heard the enlarged uterus pushes up
Weber, J. Kelley, J. (2018). symmetrically. Normal on the diaphragm. The client’s
Health Assessment in Nursing. breath sounds heard. respiratory pattern changes
Pp. 393-401 from abdominal to coastal.
Shortness of breath is a
common complaint during the
last trimester. The client may
be more aware of her breathing
pattern and of deep
respirations and more frequent
sighing. Oxygen requirements
increase during pregnancy
because of the additional
cellular growth of the body
and the fetus. Pulmonary
requirements increase, with
tidal volume increasing by
30% to 40%. All of these
changes are 32 normal and are
to be expected during the last
trimester.
Health Assessment in Nursing,
Fifth Edition, Kelley, Weber
p.3692
21
.
Patient's nasal flaring is not

observed during breathing, has
evenly colored skin, the patient
does not use accessory muscles
to assist breathing, no reported
tenderness and masses
palpated. The patient's chest
expanded 5 cm to 10 cm apart
symmetrically. No adventitious
sounds such as crackles or
wheezes are heard. Voice
transmission is soft, muffled,
and indistinct. The patient’s
voice is heard but the actual
phrases cannot be
distinguished sometimes
because of obvious signs of
fatigue.
Cardiovascular/Hear Jugular vein is not visible and S1 and S2 heard from all Analysis:
t
distended. No additional sound sites, and there are no During pregnancy, there is an
heard. Apical impulse may or visible pulsations or increase in cardiac output and
may not be visible. No heaves noted. Apical pulse maternal blood volume by
pulsations or vibrations are barely palpable. Jugular approximately 40% to 50%.
palpated in the areas of the vein is not visible and no Because the heart is required
apex, left sternal border or additional sound such as to pump much harder, it
base. Normally, no murmurs s3 and s4 was heard. CR: actually increases in size. Its
are heard. However, innocent 84 beats/min with a position is rotated up to the left
and physiologic midsystolic regular rhythm. approximately 1 to 1.5 cm.
murmurs may be present in a The heart rate may increase by
healthy heart. 10 to 15 beats/min and systolic
murmurs may be heard.
Health Assessment in Nursing. Weber, J. Kelley, J. (2018).
Pp. 446-452 Health Assessment in Nursing.
P.693
There were no visible
pulsations or vibrations in the
areas of the apex, left sternal
22
.
border, or base. Apical pulse

barely palpable because client
is overweight, no other sound
heard during auscultation. No
murmurs, and pulse volume is
symmetric
Breast & Axilla Smooth to touch, no edema. There is tenderness upon Analysis:
(Optional) Areolas vary from dark pink to palpation, breasts are firm, One of the primary reasons for
dark brown, depending on the nipples are both everted nipple scabs caused by
client's skin. They are round with a presence of scab on breastfeeding is simply that the
and may vary in size. Nipples the left side of the nipple. skin of your nipples are very
are nearly equal bilaterally in No masses and tender sensitive. They’re not used to
size and are in the same nodules were palpated. No the level of abrasion and
location on each breast. It discharge excreted on the stimulation that occurs when
should be usually erected, but nipple. breastfeeding. Darkening of
they may be inverted or flat. nipples are also the result of
No discharges should be hormones. They stimulate
present. Axillary, and pigment-producing cells.
supraclavicular lymph nodes
are not tender, has no masses Weber, J. Kelley, J. (2018).
or nodules Health Assessment in Nursing.
p.692
Health Assessment in Nursing. Interpretation: Normal
Pp. 420-424 Patient MJ’s nipples are dark
colored areola and both
everted and there is a presence
of scab noted on the left side
of the nipple.
Abdomen Unblemished skin and uniform Striae and Linea Nigra are Analysis:
in color and symmetric present on the lower Stretch marks (striae
contour. Abdomen is not abdomen during gravidarum) are lines on the
distended. Bowel sound is inspection. There is skin that may appear late in
heard. No bruit sound heard in abdominal distention pregnancy. They look like
the abdominal. No venous during assessment. there is slightly indented pink, red,
hum and friction rub heard. No no pain and tenderness dark, or white streaks,
tenderness, relaxed abdomen, during palpation of the depending on your skin color.
with smooth consistent abdomen. Bowel sounds Stretch marks are most
tension. No rebound heard all over the common on the belly, but they
23
.
tenderness is present quadrant. No friction rub can also develop on the breasts
heard at the spleen. No and thighs Linea Nigra is the
Weber, J. Kelley, J. (2018). venous hum heard in the dark line that runs from your
Health Assessment in Nursing. epigastric and umbilical navel to your pubic bone. This
Pp. 504-518 area. Fundal height: 28 is a line that may have always
cm. There is no rebound been there, but you may have
tenderness present. never noticed it before because
it was a light color.

P.444
Linear stretch marks may be

seen during and after
pregnancy or with significant
weight gain or loss.
P.406
There are visible striae/stretch
marks and linea nigra on the
lower abdomen of the patient
Musculoskeletal Shoulders should be Clients’ shoulders are Analysis:

symmetrically round; no symmetrical with no Shoulders are symmetrically
redness, deformity, or heat. redness or swelling. round; no redness, swelling, or
Scapulae and clavicles should Clavicles and scapula are deformity or heat. Clavicles
be symmetrical. No presence even and symmetric. and scapulae are even and
of tenderness. (Shoulders, Elbows are symmetric symmetric.
Arms, and Elbows ROM) without redness or
forward flexion and swelling; deformities. Elbows are symmetric, without
abduction,180 degrees; Nontender and no presence deformities, redness, or
hyperextension and adduction, of nodules. Pronation and swelling. 90 degrees; pronation
50 degrees. External and supination, 90 degrees. and supination. Wrists are
internal rotation should be 90 Wrists are symmetrical symmetric, without redness, or
degrees. Elbows should by without swelling; swelling. They are non-tender
symmetrical with no non-tender and free of and free of nodules.
24
.
deformities or swelling. nodules. Hands and fingers Weber, J. Kelley J. (2018).

Nontender without nodules. are symmetrical with no Health Assessment in Nursing.
(Elbows ROM) Flexion, 160 tenderness and nodules. p.546-549
degrees; Pronation and Knees are symmetrical,
supination, 90 degrees. Should hollows are present on Hands and fingers are
have full ROM against both patella, no swelling. symmetric, non-tender, and
resistance. Wrists are No tenderness and firm; no without nodules.
symmetrical and without nodules. Presence of (+1) Weber, J. Kelley, J. (2018).
redness and swelling; free of edema in the left ankle. Health Assessment in Nursing.
nodules. (Wrists ROM) p.552
Flexion, 90 degrees;
hyperextension, 70 degrees; Analysis: Knees symmetric,
ulnar deviation, 55 degrees; hollows present on both sides
radial deviation, 20 degrees. of the patella, no swelling or
Should have full ROM against deformities. Non-tender and
resistance. Hands and fingers cool. Muscles firm. No
should be symmetrical, nodules.
non-tender and without Weber, J. Kelley, J. (2018).
nodules. (Hands and Fingers Health Assessment in Nursing.
ROM) abduction, 20 degrees; p.555
full abduction of fingers;
flexion, 90 degrees; Interpretation: Normal
hyperextension, 30 degrees; Patient shoulders, elbows,
thumb flexion, 50 degrees. wrists, hands and fingers, and
Should have full ROM against knees are symmetrical and
resistance. Buttocks are without deformities. There’s a
equally sized; iliac crests are presence of (+1) edema in the
symmetric in height. Hips are left ankle.
stable, nontender, and without
crepitus. (Hips ROM) Flexion
with knee straight, 90 degrees;
hip flexion with knee bent,
120 degrees. Knees should by
symmetrical, present on both
sides of patella, no swelling or
deformities. Non-tender and
cool. Muscles firm, no
nodules. (Knees ROM)
Flexion, 120-130 degrees;
hyperextension, 0-15 degrees.
25
.
Should be full ROM with

resistance. No pain or clicking
sound. Toes usually point
forward and lie flat; however,
they may point in (pes varus)
or point out (pes valgus). No
pain, heat, swelling, and no
presence of nodules. (Ankles
and Feet ROM) dorsiflexion of
ankles, 20 degrees; plantar
flexion of ankle and foot, 45
degrees; eversion, 20 degrees;
inversion, 30 degrees;
abduction, 10 degrees;
adduction, 20 degrees; flexion
and extension, 40 degrees.
Should have full ROM against
resistance.

Pp. 546-559
Genitalia Pubic hair is distributed in an Pubic hair are present and Analysis:
inverted triangular pattern and well distributed in a Cervix should look pink,
there are no signs of triangular pattern. Cervix smooth, and healthy.
infestation. The labia majora is bluish, smooth and color The cervix may be palpated in
are equal in size, and free of is evenly distributed. the posterior vaginal vault. It
lesions, swelling, and Cervical length is 3.5 cm. should be long, thick, and
excoriation. A healed tear or Labia minora is symmetric closed. Cervical length should
episiotomy scar may be visible with dark pink in color and be approximately 2.3–3 cm.
on the perineum if the client without unpleasant odor. The uterus should feel about
has given birth. Labia minora the size of an orange at 10
appear symmetric, dark pink, weeks (palpable at the
and moist. No drainage on the suprapubic bone) and about the
urethral meatus. Cervical size of a grapefruit at 12
secretions are normally clear weeks.
or white and without
unpleasant odor. Weber, J. Kelley, J. (2018).
Weber, J. Kelley, J. (2018). Pp. 685-687
26
.
Health Assessment in Nursing. Interpretation: Normal

Pp. 685-687 There are no significant
findings in the patients
genitalia.
e. Neurologic Status
Cranial Nerves Reflexes Sensory Function
I - Normal IX - Normal Biceps Reflex Touch: Able to determine what

Client able to Client’s gag reflex Contracted upon contact with objects are at hand even with eyes
identify the scent is present. Uvula the reflex hammer. closed.
presented to each and soft palate rise (+2 Normal)
nostril. (Cotton bilaterally and
with alcohol) symmetrically on
phonation.
II - Normal X - Normal Triceps Reflex Pain: Client able to distinguish dull

Client has 20/20 Client can swallow Extension of the forearm and and sharp objects.
vision with snellen and speak without slight contraction of the
chart, both eyes difficulty. triceps upon contact with
reflex hammer
(+2 Normal)
III, IV,VI - Normal Brachioradialis Reflex Temperature: Client able to

Client’s pupils are equal, round, and There was a flexion of the differentiate hot and cold
reactive to light. Both eyes move in arm and supination of the temperatures over various body parts.
coordination towards the same direction as hand
the examiner’s penlight. (+2 Normal)
V - Normal XI - Normal Patellar Reflex Position: Client able to move the left
Client can feel touch Client can shrug Lower legs are dangling and and the right thumb up and down
on the forehead, shoulders and turn was able to extend with closed eye.
maxillary, and head side to side (+2 Normal)
mandibular areas of against resistance.
the face and can
chew without
difficulty. Eyelids
blink bilaterally.
VII - Normal XII - Normal Achilles Reflex Tactile Discrimination: Client can
27
.
Client can smile, Client’s tongue is at Plantarflexion of the foot was discriminate between soft and hard
raise eyebrows, puff midline and can present when in contact with objects. (Felt with the use of rock and
out cheeks, and close move without the reflex hammer. cotton)
eyes without difficulty. (+2 Normal)
difficulty. Client can
also distinguish
different tastes.
VIII - Normal Plantar/Babinski Reflex

Client hears whispered words. Vibration is Negative of fanning out
heard equally well in both ears. Air (+2 Normal)
conduction is twice as long as bone
conduction.
V. Anatomy and Physiology

● Placenta
The placenta is a disc-shaped organ that is formed from the development of the outer cells of the
blastocyst upon implantation, then eventually will develop in the uterine wall once the woman is pregnant.
Significantly, the umbilical cord, which transports nutrients and waste, connects the fetus's midsection to the
placenta. During the nine months of pregnancy, the placenta serves a critical and essential role, since it is
responsible for the transport of blood, nutrients, and oxygen to the developing fetus through the umbilical cord
and chorionic villi. Aside from that, the placenta contributes to insulin resistance throughout pregnancy by
cytokine production and the secretion of hormones, like chorionic gonadotropin, human placental lactogen, and
estrogen, which are necessary for the growth and metabolism of the fetus, as well as the labor itself. Some of
these hormones can inhibit insulin action. This is known as the contra-insulin effect, and it normally occurs
between 20 and 24 weeks of pregnancy. More of these hormones are secreted as the placenta develops, increasing
the risk of insulin resistance.
Diabetic Placenta
28
.
● Pancreas
The pancreas, a large gland roughly the size of palm, is positioned near the rear of the abdominal cavity.
It is in charge of producing, storing, and releasing a hormone called Insulin. The insulin hormone regulates
glucose utilization in the body. Bodily tissues require insulin for adequate glucose absorption. Gestational
Diabetes occurs when the pancreas fails to make or secretes an adequate quantity of insulin, resulting in increased
blood glucose levels during pregnancy. Body produces unique hormones and undergoes other changes during
pregnancy, such as weight gains. Because of these changes, the body's cells do not respond effectively to insulin,
a condition known as insulin resistance.
● β-Cell
The Beta cells are produced by the pancreas which manufactures, stores, and releases the hormone called
Insulin. Beta cells primary job is to process and secrete insulin in response to a glucose load. In Gestational
Diabetes Mellitus, since there is an insulin resistance, the β-Cell fails to balance out the demands of pregnancy,
which reduces its ability to control glucose level resulting in β-Cell dysfunction. β-Cell dysfunction occurs when
cells lose their capacity to effectively sense blood glucose concentrations or to release enough insulin in response.
Due to the body’s attempt to compensate through producing higher quantities of insulin over a long period of
time, this will eventually lead to beta cell turnover or beta cell burnout. With these, blood glucose, and insulin
sensitivity may return to normal or remain impaired, putting the person at risk of Gestational Diabetes Mellitus in
the future pregnancy (Belfiore et al., 2001).
● Kidney
The length of kidneys increases by 1 to 1.5 cm all throughout the pregnancy. Due to fluid retention, the
kidneys grow in size during pregnancy (Cheung, 2013). Tubular function, and water and electrolyte balance
management are affected, resulting in glycosuria. If blood glucose levels remain elevated for an extended length
of time, kidneys will try to remove some of the extra glucose from the blood and excrete it as urine, resulting in
frequent urination or polyuria. While the kidneys filter the blood in this manner, water is taken from the blood
and must be replenished. This is why, when blood glucose levels are excessively high, the mother has also
increased thirst, or also called polydipsia. To function effectively, the kidneys require an adequate amount of
water in the blood. As a result, persistent dehydration can impair the kidney's capacity to operate.
29
.
● Uterus
The Uterus also known as the ‘womb’, is part of the female reproductive system, which is inverted
pear-shaped muscular organ located between the bladder and the rectum. It nurtures the fertilized ovum which
develops into the fetus and holds it till the baby is mature enough for birth. The fertilized ovum develops into an
embryo, then into a fetus, and so on until childbirth. However, for the case of gestational diabetes mellitus where
the infant is at strong risk associated with a large-for-gestational-age infant or Fetal macrosomia, the uterus
expands larger than in the usual size of a normal pregnancy. Aside from that, the fetus, placenta, amniotic fluid,
and the expanded gravid uterus account for half of the weight gained during pregnancy. Fetal macrosomia also puts
the mother at risk of another complication called Polyhydramnios or too much amniotic fluid surrounding the baby,
which may also cause the enlargement of the uterus for a pregnant mother.
30
VI. Pathophysiology/Psychopathology (for NCM, RLE 105)
Theoretical Based
NON-MODIFIABLE FACTORS MODIFIABLE FACTORS
Family History of Diabetes (1 close

relative and 2 distant ones)
Family History of GDM Pregnancy
History of Macrosomia Obesity or Overweight
History of fetal loss Maternal Nutrition
History of GDM in previous Maternal Lifestyle
pregnancy Lack of Exercise
History of PCOS
Maternal Age: Over 25
Race: Native American, Hispanic,
Asian
2nd to 3rd Trimester
Fetus growing bigger
Nutritional needs of fetus increases
Fetal demand for glucose increases
Surge of local and placental hormones:

Human placental lactogen, placental
insulinase, estrogen, cortisol, &
progesterone
Lowers maternal insulin

sensitivity to fuel fetal growth
Maternal cells not

receptive to insulin
Insulin Resistance
Decrease entry of
glucose to maternal cells
Elevated maternal blood

glucose level
31
Pancreas compensate by increasing
size and number of beta cells
Beta cells pump out more insulin
Insulin resistance overwhelms the

compensatory action of pancreas
Elevated maternal blood glucose
Gestational Diabetes Mellitus
Maternal Complications Fetal Complications
Fatigue Cells failure to utilize Elevated maternal blood glucose

glucose for energy transported across the placenta
Nutrient deficiency in Fetal Hyperglycemia

cells
Fetal pancreas compensate by

Cell starvation producing more insulin
Fetal Hyperinsulinemia
More glucose uptake in cells Macrosomia
Fetal osmotic diuresis Possible birth

injuries
Increase urination
Increase amount of amniotic fluid Polyhydramnios
32
Cell starvation
Cell register its

glucose need
Kidney
Liver
Brain
Kidney tubules cannot
reabsorb all glucose that
enters in glomerular filtrate Glucagon stimulates
Stimulates hunger
conversion of stored
center
glycogen to glucose
Excretion of Glycosuria
Voracious appetite and glucose in urine
Polyphagia Insulin resistance = failed
intense desire for food
glucose entry to cells
Reduces fluid
Further increase of absorption
Further increase of
maternal blood glucose
blood glucose level
Send impulse to
posterior pituitary
Excess glucose
Weight gain Cells continue to starve
converted into fat
Release anti-
diuretic hormone Stimulate burning of:
Insulin resistance =
elevated blood glucose
Increase water Fat stores
reabsorption
Stimulate production of:
Activate
Fail to keep up with cellular lipase
Cortisol Growth Hormone elevated blood glucose
Release of fatty
acids in blood
Polyuria Large amount of
fluid loss in urine
Utilization of fatty
Fat stores depleted
acid for energy
Body tries to
Polydipsia compensate by
increasing thirst Large amount Amino acids used
response of ketone for energy
bodies in blood
Losing more fluid Deplete cells of

than taking in Metabolic functional elements
acidosis
Stimulate hypothalamus to
Dehydration secrete growth hormone
Deposition of new
Blood volume fall protein stores
Reduced blood flow muscle loss, Continous reliance

weight loss on protein stores
Oxygen deprivation
in cells Depletion of cells
functional elements
Cells inability
Cell death
to function
33
Lungs Cardiovascular
Extremely rapid Fatty materials build

breathing up in blood vessels
Blow off carbon Stiff and hard arteries Hypertension

dioxide
Fetal inability to Atherosclerosis

Severe acidosis
use oxygen
Fetal anoxia Degree of acidosis Block blood flow to

incompatible with life heart or brain
Fetal death
Coma Heart attack or Stroke
Multiple Organ Failure
Death
34
VI. Pathophysiology/Psychopathology (for NCM, RLE 105)
Case-based
NON-MODIFIABLE FACTORS MODIFIABLE FACTORS
Family History of Diabetes (1 close

relative) Pregnancy
Maternal Age: Over 25 Maternal Nutrition (Excessive Food
Intake)
3rd Trimester 28 weeks AOG
Fetus growing bigger
Nutritional needs of fetus increases
Fetal demand for glucose increases
Surge of local and placental hormones:

Human placental lactogen, placental
insulinase, estrogen, cortisol, &
progesterone
Lowers maternal insulin

sensitivity to fuel fetal growth
Maternal cells not

receptive to insulin
Insulin Resistance
Decrease entry of
glucose to maternal cells
Elevated maternal blood

glucose level
35
Pancreas compensate by increasing
size and number of beta cells
Beta cells pump out more insulin
Insulin resistance overwhelms the

compensatory action of pancreas
Routine glucose
tolerance test elevated at
Elevated maternal blood glucose
200 mg/dl & HbA1c
elevated at 7.6%
Gestational Diabetes Mellitus
Maternal Fetal
Cells failure to utilize Elevated maternal blood glucose

Fatigue transported across the placenta
glucose for energy
Nutrient deficiency in Fetal Hyperglycemia

cells
Fetal pancreas compensate by

Cell starvation producing more insulin
Fetal Hyperinsulinemia
More glucose uptake in cells At risk for Macrosomia:

Fundic Height of 28cm
Fetal osmotic diuresis
Increase urination
At risk for
Increase amount of amniotic fluid Polyhydramnios:
Fundic Height of 28cm
At risk for Pre

term labor
At risk for fetal

distress:
Reassuring
FHR of 136 bpm
36
Cell starvation
Cell register its

glucose need
Kidney
Liver
Brain
Kidney tubules cannot
reabsorb all glucose that
enters in glomerular filtrate Glucagon stimulates
Stimulates hunger
conversion of stored
center
glycogen to glucose
Urine
Excretion of dipstick
Voracious appetite and glucose in urine shows 3+
Polyphagia Insulin resistance = failed
intense desire for food glycosuria
glucose entry to cells
Reduces fluid
Further increase of absorption
Further increase of
maternal blood glucose
blood glucose level
Send impulse to
Excessive weight posterior pituitary
Excess glucose
gain of 32 lbs at 28 Cells continue to starve
converted into fat
weeks AOG
Release anti-
diuretic hormone
Insulin resistance = At risk for burning of fat
elevated blood glucose stores for energy
Increase water
reabsorption
At risk for large
Negative
amount of ketone
ketones
bodies in blood
Fail to keep up with
elevated blood glucose
Polyuria Large amount of

fluid loss in urine
Body tries to
Polydipsia compensate by
increasing thirst
response
37
.
VII. Laboratory Results
Oral Glucose Tolerance Test:
Laboratory Normal Values Result Analysis & Interpretation
Plasma Glucose (1hr) < 140mg/dl 200mg/dl Analysis:

or < 92 mg/dl (11.1mmol/l) ↑ Because diabetes is such a serious
(7.8mmol/l or pregnancy complication, all pregnant
5.1mmol/l) women should be checked for gestational
diabetes. Gestational diabetes mellitus
screening is typically performed during
24-28 weeks of gestation because this is
when placental hormone-induced insulin
resistance peaks (Rani, 2016). All pregnant
women should have a 50-g glucose
challenge test between 24 and 28 weeks
gestation to see if they are at risk for
gestational diabetes. If the result is ≥140
mg/dl, they will need to undergo a
three-hour glucose tolerance test (Flagg &
Pilliteri, (2017) Maternal and Child Health
Nursing: Care of the Childbearing and
Childrearing Family 8th Edition. p. 1137).
One step strategy:

The test is performed in the morning after an
overnight fast of 8 hours, 75g glucose is
given with plasma glucose measurement
fasting, 1-hour, and 2-hour. If the blood
glucose levels are equal to or higher than the
values it indicates gestational diabetes (Rani,
2016).
Two-step strategy:
Step one is performing a 50g glucose
challenge test. If the plasma glucose level
increases to or meets ≥140mg/dl
(7.8mmol/l) one hour after loading it
indicates that a 100g glucose OGTT is
required (Rani, 2016).
3138
.
However, a fasting plasma glucose greater

than or equal to 126 mg/dl or non-fasting
plasma glucose greater than or equal to 200
mg/dl meets the threshold for the diagnosis
of diabetes and does not need further
confirmation (Flagg & Pilliteri, (2017)
Maternal and Child Health Nursing: Care of
the Childbearing and Childrearing Family
8th Edition. p. 1137).
Increased: Gestational Diabetes

Decreased: none
(Flagg & Pilliteri, (2017) Maternal and
Child Health Nursing: Care of the
Childbearing and Childrearing Family 8th
Edition. p. 1137).
Interpretation: Abnormal
HbA1c Test
Glycosylated Hemoglobin 6% 7.6% Analysis:

125mg/dl 171mg/dl ↑ Following Gestational diabetes mellitus
screening, HbA1c is used to assess the
individual's level of glucose control or to
confirm glycemic control. HbA1c is an
important indicator of long-term glycemic
control because it can reflect the previous
two to three months' cumulative glycemic
history. Hemoglobin A1c (HbA1c) is a
reflection of the average blood sugar over
the previous three months and a sign of
overall glycemic control. The increased
percentage of glycated hemoglobin indicates
gestational diabetes (Diabetes.co.uk, 2020).
Increased: Increase levels of glycated

hemoglobin signals pre-diabetes or diabetes
Decreased: none
3239
.
(Berman et al., (2015) Kozier & Erb’s

Fundamentals of Nursing, 10th edition. p.
723).
Urine dipstick
Glucose Negative 0 to 15 +3 (1000 mg/dL) Analysis:

mg/dL ↑ Diabetes is never diagnosed using urine tests.
They can, however, be used to monitor a
person's urine ketones and glucose levels.
They are often used to ensure that diabetes is
properly managed. For the results, the
filtered glucose surpasses the tubular
system's capacity as plasma glucose
increases, resulting in glycosuria or glucose
in the urine, which indicates gestational
diabetes (ucsfhealth, 2020).
Increased: It is normal to occasionally have

a small amount of glucose in urine during
pregnancy. Increased levels, on the other
hand, suggest gestational diabetes and an
increased risk for infection. (Flagg &
Pilliteri, (2017) Maternal and Child Health
Nursing: Care of the Childbearing and
Childrearing Family 8th Edition. p. 1137).
Decreased: Normal
Ketones Negative Negative Analysis:

The value of the ketones found in urine is
within normal levels (ucsfhealth, 2020).
Increased: It indicates a lack of

carbohydrates in the body which results from
carbohydrates
starvation, fasting, or a result of diabetic
3340
.
ketoacidosis.
Decreased: Normal
(ucsfhealth, 2020)
Urine Culture
Urine Culture Negative Negative Analysis:

10,000 to <100,000 8,000 CFU/ml A urine culture is performed because an
CFU/ml increased glucose concentration in urine may
lead to increased infection and possible
Urinary tract infection. The urine culture is
negative due to its normal range for urine
culture of 10,000 to 100,000 CFU/ml and no
significant growth, which indicates that there
is no infection prevalent and no required
corrective action needed (Portea Medical,
2019).
Positive: A positive urine culture is defined
as one type of bacteria growing at high
colony counts with more than 100,000
colony forming units CFU/milliliter of one
type of bacteria usually indicate infection
Negative: Normal, A culture that shows no
growth of pathogenic bacteria after 24 or 48
hours means there is no infection
(Testing, 2021)
VIII. Drug Study

Drugs Indication Action Side Effects & Nursing
Adverse Effect Considerations/
Health Teachings
a. Brand Name: Novorapid is NovoRapid produces Side Effects: ● Instruct the client to
Novorapid indicated to treat high a more rapid onset of ● Headache eat meals 15 - 20
b. Generic Name: blood sugar levels in action compared to ● Pain at the minutes after
Insulin Aspart adults with type 1 soluble human injection site administering the
3441
.
c. Classification: diabetes, type 2 insulin, together with ● Drowsiness insulin to prevent

Fast-Acting diabetes, and a lower glucose ● Confusion hypoglycemia
Insulin gestational diabetes concentration, as ● Tingling of hands, ● Use the same type
d. Dose: assessed within the fee, lips or tongue and brand of
● 8 units (after first four hours after a ● Dizziness syringe; use the
breakfast) meal. NovoRapid has same type and
● 6 units (after a shorter duration of Adverse Effects: brand of insulin to
lunch) action compared to ● ↓ Blood glucose avoid dosage
● 8 units (after soluble human insulin level errors. Arrange for
dinner) after subcutaneous proper disposal of
e. Date ordered: injection. NovoRapid syringes.
March 05, 2022 is injected ● Rotate injection
subcutaneously, the sites regularly
onset of action will (keep a chart of
occur within 10 to 20 sites used) to
minutes of injection. prevent breakdown
The maximum effect at injection sites.
is exerted between 1 ● Dosage may vary
and 3 hours after with activities,
injection. The stress, diet. Monitor
duration of action is 3 blood or urine
to 5 hours. glucose levels, and
consult health care
providers if
problems arise.
● Assess activity
level, including
amount and degree
of exercise which
can alter serum
glucose levels and
need for these
drugs.
● Monitor the results
of laboratory tests,
including
urinalysis, for
evidence of
glucosuria
● Store insulin in a
3542
.
cool place away

from direct sunlight
to ensure
effectiveness.
● Educate the client
about the peak
time, on-set and
duration of the
insulin that was
prescribed.
IX. List of Prioritized problems (for NCM/RLE 101 - INP)

Cues Nursing Diagnosis Rank Justification
Subjective: Fatigue related to inadequate 1 Fatigue is a physical and/or mental

“Kapag sinusundo ko yung glucose uptake in cells secondary exhaustion that one experiences which
mga anak ko sa school to insulin resistance aeb causes interference in their usual daily
parang nanghihina ako na verbalization of overwhelming activities. This can be caused by a poor
walang energy kahit 6 to 8 lack of energy, inability to diet, lack of sleep, and too little or too
hours naman yung tulog ko maintain usual routines, and much physical exercise, or a symptom of a
tas kapag nakakaramdam weakness health condition such as hyperglycemia or
ako ng ganito naidlip ako elevated blood glucose levels.
tuwing hapon”
The client has cited instances that feeling
“Sa bahay naman kapag tired as if she does not have energy and
nagwawalis ako siguro physically weak have interfered with her
mga ilang minuto palang di usual daily routine resulting in her
ko na kaya tas uupo na ako reliance on her husband and eldest son.
agad” Due to fatigue, the client has started
missing out on instrumental activities of
daily living (iADLs) such as preparing
Objective: meals for her and the family, cleaning and
● Weary maintaining their home, and performing
● HbA1c - 7.6% her other responsibilities in the household.
● Glucose tolerance test: Moreover, her domestic activities of daily
200 mg/dl living (dADLs) are also affected as she is
unable to do her primary form of exercise
which is walking to and from the house to
the marketplace or school to fetch her
children, making her to ride the tricycle.
3643
.
Addressing the client’s fatigue is the first

priority as it has already affected her
activities of daily living, meaning her
everyday life has started to get affected by
her condition. Inability to complete basic
daily chores can lead to a poor quality of
life and at worse cases, may affect one
negatively in their health and
relationships. In addition, addressing the
client’s fatigue is in-line to the patient’s
goals of wanting to restore her energy
back to fulfill her roles and
responsibilities as well as it will improve
her overall physical health, specifically
high blood glucose levels.
Subjective: Imbalanced nutrition: more than 2 A pregnant mother is recommended to

“Lately, dumami yung body requirements related to consume an additional 452 calories from
pagkain ko kasi para akong excessive hunger and food intake the baseline 2000 kcal/day to maintain a
laging gutom. Tuwing secondary to elevated maternal well-balanced diet, and vitamin and
kumakain kami, halos blood glucose level aeb mineral supplementation. A daily caloric
kalahati ng plato ko ay verbalization of excess hunger intake that exceeds daily energy
kanin tapos yung kalahati and food intake, and weight gain expenditure, results in excessive weight
ay yung ulam namin na of 32 lbs at 28th weeks AOG gain.
gulay at karne. Minsan nga
nakakadalawang plato pa The client has verbalized that she has
nga ako pero para sa started eating more as she believed that it
aming dalawa naman ni will help the baby grow healthy and for
baby ‘yun at para bumalik her to have energy. From what the client
na yung dati kong lakas. Sa has answered, she has excessive food
meryenda, prutas kinakain intake which is way more than what her
namin. Minsan manga, body requires. However, due to the body
minsan orange o kaya being unable to utilize glucose into
saging.” energy, the body cells will continue to
starve which signals the brain to stimulate
“Dati kasi nakaka-1.5 L the mother to eat. Excessive eating, or
lang ako ng tubig, polyphagia, is a cardinal symptom of
namemeasure ko siya kasi gestational diabetes or just diabetes.
yung tubig ko nakalagay sa
1.5 L na bote tas recently This nursing diagnosis is the second
nakakahigit 2 bote ako, so priority as it will address the client’s
3744
.
halos 3.5 L kada-araw ang excessive food intake which worsens her
iniinom ko.” blood glucose levels. Understanding that
having a balanced diet and recommended
Objective: intake during pregnancy is essential to
● Pregnancy weight gain of have an appropriate weight gain and
32 lbs on 28th weeks appropriate amount of nutrients that will
AOG support the mother’s and fetus’ needs.
● Weight: 142 lbs Moreover, preventing any excessive
● BMI: 26.85 (overweight) weight gain and high blood glucose levels
● HbA1c - 7.6% can prevent progression to complications
● Glucose tolerance test: for both the mother and fetus, such as
200 mg/dl polyhydramnios, fetal macrosomia, and
● Urine dipstick others.
○ Glycosuria: 3+
○ Ketones: Negative
Subjective: Risk for fetal injury related to 3 Maternal hyperglycemia is a medical

N/A elevated maternal glucose serum condition resulting from either
levels pre-existing diabetes or insulin resistance
Objective: developed during pregnancy, a condition
● HbA1c - 7.6% known as gestational diabetes mellitus
● Glucose tolerance test: (GDM) which is defined as impaired
200 mg/dl glucose tolerance first recognized during
pregnancy. This leads to fetal
hyperglycemia since glucose is
transported freely across the placenta by
facilitated diffusion. This stimulates
insulin, insulin-like growth factors,
growth hormone, and other growth
factors, which, in turn, stimulate fetal
growth and deposition of fat and
glycogen. Fetal hyperinsulinemia
increases the uptake of glucose in the fetal
cells leading to fetal macrosomia, or a
newborn with an excessive birth weight or
greater than 4000g or 4500 g, (8lp 13 oz
or 9lb 15 oz) or greater than 90% for the
gestational age.
This risk nursing diagnosis is a priority as

large newborns, also known as
3845
.
macrosomic newborns, are at risk for birth

trauma for the newborn such as clavicular
fracture, brachial plexus injury, and, in
worse cases, still birth. Due to birth
trauma, the infant may have difficulty
establishing respirations, increased
pressure on the respiratory center causing
a decrease in respiratory function, and
increased intracranial pressure. If the
infant was born vaginally, a diaphragmatic
paralysis or broken clavicle, both of which
can prevent effective lung function, may
have occurred in order for the wide
shoulders to be born. If the infant was
born by cesarean birth, transient fluid can
remain in the lungs and can interfere with
effective gas exchange. Furthermore, the
mother is also at risk for prolonged labor,
birth canal lacerations for normal delivery,
cesarean delivery, postpartum
hemorrhage, and prolonged recovery.
X. Nursing Care Plan/Care Map/Peg
Nursing Diagnosis: Fatigue related to inadequate glucose uptake in cells secondary to insulin resistance aeb verbalization of
overwhelming lack of energy, inability to maintain usual routines, and weakness
Cues Nursing Rationale Goals & Interventions Rationale Evaluation

Diagnosis Objectives
Subjective: Fatigue related GDM → Insulin Short Term: Independent: Independent: Short term:
“Kapag to inadequate resistance → After 2 hours of ● Ask the ● To have a Goal Met.
sinusundo ko glucose uptake Maternal cells nursing patient about baseline data and After 2 hours of
yung mga in cells not receptive to intervention, the the onset, to assess the nursing
anak ko sa secondary to insulin → client will be duration, and duration and intervention the
school elevated Impaired compliant with frequency and frequency of the client was able
parang maternal blood glucose entry in the medication her patients fatigue to:
nanghihina glucose level cells → Cells as evidenced by: management which is helpful
ako na aeb unable to use of fatigue at to determine if ● Started
walang verbalization of glucose for ● Start home (number interventions Novorapid
3946
.
energy kahit overwhelming energy → Novorapid of days per possesses injection of 8

6 to 8 hours lack of energy, Fatigue r/t injection of 8 week and time improvements or units after
naman yung inability to inadequate units after of day) regression to the breakfast, 6
tulog ko tas maintain usual glucose uptake breakfast, 6 condition of the units after
kapag routines, and in cells units after patient. lunch, and 8
nakakaramd weakness secondary to lunch, and 8 Prolonged fatigue units after
am ako ng elevated units after could be a result dinner
ganito maternal blood dinner of a medical subcutaneous
naidlip ako glucose level subcutaneousl condition that ly
tuwing aeb y could further lead
hapon” verbalization of to complications Long term:
overwhelming Long term: where further Goal Met.
“Sa bahay lack of energy, After 3 days of referral is needed. After 3 days of
naman inability to nursing nursing
kapag maintain usual intervention, the ● Evaluate the ● Patient’s GDM or intervention,
nagwawalis routines, and client will no patient's hyperglycemia the client no
ako siguro weakness longer complain activity of manifest as the longer
mga ilang of fatigability daily living, as cause of her complains of
minuto In gestational and will be well as the fatigue. However, fatigability and
palang di ko diabetes compliant to actual and extreme activities is compliant to
na kaya tas mellitus, insulin medication as perceived leads to a more medication as
uupo na ako resistance makes evidenced by: limitation to severe type of evidenced by:
agad” the maternal physical fatigue due to
● Client able to
cells not activity lack of stored ● Client is now
perform usual
receptive to energy affecting able to
daily routines
Objective: insulin. These the usual routines perform usual
(household
● Weary changes cause of the patient in daily routines
chores,
● HbA1c - cell starvation as everyday life (household
walking to the
7.6% the use of chores,
market and
● Glucose glucose for ● Encourage the ● To prevent severe walking to
fetching her
tolerance energy is patient to fatigue that could the market
children in
test: 200 impaired leading alternate lead to and fetching
school)
mg/dl to Fatigue r/t activity with complications as her children
inadequate periods of rest well as to in school)
● Client feels
glucose uptake conserve the
rested and to
in cells energy of the ● Client feels
appear no
secondary to patient well-rested
signs of
elevated and appeared
weariness
maternal blood ● Educate about ● Conserving no signs of
glucose level energy energy will help weariness
40
47
.
aeb conservation the patient be

verbalization of techniques able to
overwhelming while accomplish more
lack of energy, performing tasks with a
inability to activities of decreased
maintain usual daily living expenditure of
routines, and energy
weakness
● Advise the ● Overexertion in
patient to performing
avoid physical activities
overexertion increases the use
in performing of energy than
activities normal making a
person feels tired
easily in which
fatigue takes
place due to lack
of energy stores
in the body
● Instruct the ● Deep breathing

patient to do exercise promotes
deep breathing relaxation to ease
exercises the patients
fatigue
● Educate the ● It is the right of

patient on the the patient to be
importance of informed about
using insulin the medication as
(Novorapid) insulin increases
glucose uptake in
the cell that could
further reduce or
eliminate the
fatigue level of
the patient
● Instruct the ● Educating about
4148
.
patient on self-administratio
how to n provides the
administer patient the
insulin knowledge to
injections at focus on injecting
home into the right
tissue space, at
the right time,
and in the right
way to ensure
optimal
absorption
Dependent Dependent
● Novorapid ● To improve
injection of 8 glycemic control
units after every meal for a
breakfast, 6 patient with
units after gestational
lunch, and 8 diabetes mellitus
units after
dinner
subcutaneousl
y as
prescribed by
the physician
Nursing Diagnosis: Imbalanced nutrition: more than body requirements related to excessive hunger and food intake secondary to
elevated maternal blood glucose level aeb verbalization of excess hunger and food intake, and weight gain of 32 lbs at 28th weeks
AOG

Subjective: Imbalanced GDM → Insulin Short Term: Independent: Independent: Short term:
“Lately, nutrition: more resistance → After 2 hours of ● Evaluate the ● To have a Goal Met.
dumami than body Maternal cells nursing patient daily baseline data if After 2 hours of
yung requirements not receptive to intervention, the food and fluid the type and nursing
pagkain ko related to insulin → client will be intake - type amount of foods intervention the
kasi para excessive Impaired compliant with and amount of and fluids are client was able
akong laging hunger and glucose entry in the medication food and fluid appropriate to to:
4249
.
gutom. food intake cells → cell as evidenced by: pregnant

Tuwing secondary to starvation → mothers with ● Started
kumakain elevated Cell registers its ● Start GDM in relation Novorapid
kami, halos maternal blood glucose need → Novorapid to their current injection of 8
kalahati ng glucose level Stimulate injection of 8 trimester units after
plato ko ay aeb hunger center to units after breakfast, 6
kanin tapos verbalization of increased breakfast, 6 ● Encourage the ● Weighing daily units after
yung excess hunger appetite and units after patient to is important to lunch, and 8
kalahati ay and food intake, desire for food lunch, and 8 monitor her monitor increase units after
yung ulam and weight gain → excessive units after weight daily or decrease in dinner
namin na of 32 lbs at 28th food intake → dinner every morning weight hence subcutaneous
gulay at weeks AOG Imbalanced subcutaneousl before breakfast further referral ly
karne. nutrition: more y and have a is needed to
Minsan nga than body weight diary for prevent ● Verbalized
nakakadala requirements r/t Long term: everyday record complication for understandin
wang plato excessive After 2 months both the mother g about the
pa nga ako hunger and food of nursing and the fetus need for a
pero para sa intake secondary intervention, the carbohydrate
aming to elevated client will be ● Advice to do ● To enhance the counting
dalawa maternal blood able to maintain mild to glucose uptake worksheet
naman ni glucose level a normal moderate by tissues to every meal
baby ‘yun at aeb pregnancy aerobic exercise prevent fatigue.
para verbalization of weight gain as and restrict Too high blood Long term:
bumalik na excess hunger evidenced by: exercise (i.e. glucose level Goal Met.
yung dati and food intake, brisk walking) could even lead After 3 months
kong lakas. and weight gain ● Compliance to when blood to the collapse of nursing
Sa of 32 lbs at 28th 2452 kcal/day sugars are more of the patient intervention the
meryenda, weeks AOG intake of food than 250 mg/dl client was able
prutas in the 3rd to:
kinakain In gestational trimester using ● Enumerate and ● Alternatives to
namin. diabetes MyPlate, provide a list of appropriate food ● Comply to
Minsan mellitus, insulin Calorie Count, low cost foods for GDM also 2452 kcal/day
manga, resistance makes and high in nutrition provide the intake of food
minsan the maternal Carbohydrate and alternatives nutritional needs in the 3rd
orange o cells not Counting to meat (i.e. of the patient in trimester
kaya receptive to the Worksheet beans, peas, and line with their using
saging.” effect of insulin. corns) budget MyPlate,
These changes ● Will maintain Calorie
“Dati kasi cause decreased a weight gain ● Advise the ● Exposure to Count, and
nakaka-1.5 L glucose entry in between 25 - patient to avoid direct sugars Carbohydrate
4350
.
lang ako ng cells leading to 35 lbs direct sugars could further Counting
tubig, starvation. The throughout the like sweets, lead to increase Worksheet
namemeasur cell will now entire sweetened milk, glucose. Proper
e ko siya register its pregnancy and oily foods education to the
kasi yung glucose need patient will help ● Maintained a
tubig ko and stimulates them to be weight gain
nakalagay sa hunger center in compliant with between 25 -
1.5 L na bote the brain to the interventions 35 lbs
tas recently increase appetite to prevent throughout
nakakahigit and desire for further the entire
2 bote ako, food leading to complications pregnancy
so halos 3.5 Imbalanced for both the
L kada-araw nutrition: more mother and the
ang iniinom than body fetus
ko.” requirements r/t
excessive ● Encourage the ● MyPlate
Objective: hunger and food patient to emphasizes the
● Pregnancy intake secondary measure, correct portion
weight to elevated document, and of five food
gain of 32 maternal blood plan food groups: fruits,
lbs on 28th glucose level regularly using vegetables,
weeks aeb MyPlate and grains, proteins,
AOG verbalization of Carbohydrate and dairy
● Weight: excess hunger Counting products.
142 lbs and food intake, Worksheet Measuring and
● BMI: and weight gain planning food
26.85 of 32 lbs at 28th intake regularly
(overweig weeks AOG alerts patient to
ht) normal portion
● HbA1c - sizes appropriate
7.6% for pregnant
● Glucose women in
tolerance relation to their
test: 200 current trimester
mg/dl
● Urine ● Encourage the ● To assess
dipstick patient to use a baseline glucose
○ Glycosur glucometer level before
ia: 3+ before eating eating and to
○ Ketones: and 2 hours help the patient
4451
.
Negative after eating understand how

using a blood glucose
finger-stick reacts to the
method food she eats. It
will also
determine if the
patient insulin
medication is in
the right dose
and if not further
referral is
needed
● Encourage the ● To prevent

patient to eat 3 further
small frequent discomfort of
meals with 3 pregnancy such
snacks as nausea, gas,
bloating,
constipation,
headaches, and
fatigue. The
final snack of
the day out of
the 3 snacks
should be rich in
protein for slow
digestion to
avoid
hypoglycemia
● Encourage ● Polyuria and

patient to polydipsia is one
increase water of the symptoms
intake of a patient with
GDM and an
increase in water
intake can help
prevent
dehydration in
4552
.
the patient
Dependent Dependent
lunch, and 8 diabetes
units after
dinner
subcutaneously
as prescribed by
the physician
Collaborative Collaborative
● Refer the ● To provide the
patient to a appropriate diet
nutritionist for the patient
with GDM and
alternative food
appropriate to
their budget
● Refer to ● To assess for

medical increase or
technologist for decrease in
glucose glucose
tolerance test, tolerance test
HbA1c, and and HbA1c and
urine dipstick to check for the
presence of
glucose and
ketones in the
urine
4653
.
Nursing Diagnosis: Risk for fetal injury related to elevated maternal glucose serum levels

Subjective: Risk for fetal GDM → Short Term: Independent: Independent Short term:
N/A injury related to Elevated After 2 hours of ● Assess the ● Monitoring the Goal Met.
elevated maternal blood nursing patient’s client’s fundal After 2 hours of
Objective: maternal glucose → high intervention, the fundal height height identifies nursing
● HbA1c - glucose serum maternal glucose client will be every visit abnormal growth intervention the
7.6% levels circulates in fetus compliant with of the fetus in the client was able
● Glucose across the the medication uterus to:
tolerance placenta → fetal as evidenced (macrosomia,
test: 200 hyperglycemia by: IUGR, SGA, and ● Started
mg/dl → fetal LGA) Novorapid
hyperinsulinemia ● Start injection of 8
→ Increased Novorapid ● Assess the ● Lack of interest units after
glucose entry in injection of 8 readiness to in the need for breakfast, 6
fetal cells → units after learn from the information can units after
growth stimulant breakfast, 6 patient before interfere with the lunch, and 8
→ Risk for fetal units after conducting readiness to learn. units after
injury r/t lunch, and 8 health Retention of dinner
elevated maternal units after teaching information is subcutaneous
glucose serum dinner reinforced when ly
levels subcutaneousl the patient is
y motivated and Long term:
In gestational ready to learn Goal Met.
diabetes mellitus, Long term: After 3 months
the elevated After 2 months ● Educate the ● To provide the of nursing
maternal blood of nursing client about patient intervention,
glucose will also intervention, the the possible knowledge and the client was
be transported in client will be complication increase able to maintain
fetal circulation able to maintain of elevated cooperation to a normal fundal
across the a normal fundal blood glucose help them make height and the
placenta causing height and the in the fetus informed fetus was able
fetal fetus will be decisions about to maintain a
hyperglycemia. able to maintain managing diet normal weight
The fetal a normal weight and taking and blood
pancreas will and blood medication glucose level
now try to glucose level after birth as
compensate by after birth as ● Encourage ● To prevent weight evidenced by:
increasing the evidenced by: light to gain and to
4754
.
production of moderate control serum ● Maintained a

insulin leading to ● Fundal height aerobic glucose elevation fundal height
increased glucose within -2 and exercises within -2 and
uptake in cells. +2 of the +2 of the
This increased in current ● Encourage the ● To help control current
glucose uptake gestational age patient to serum glucose gestational age
will serve as a adhere to the elevation to
growth stimulant ● Fetal weight prescribed prevent further
for fetus leading within 2.5 to dietary complication ● Maintained
to Risk for fetal 3.5 kg modification fetal weight
injury r/t for a patient within 2.5 to
elevated maternal ● Blood glucose with GDM 3.5 kg
blood glucose level of the
levels fetus between ● Provide ● To assess if
40 - 60 mg/dl information insulin ● Maintained
and reinforce medication is blood glucose
procedures for effective to level of the
home blood determine if they fetus is within
glucose are within the 40 - 60 mg/dl
monitoring normal range.
and diabetic Frequent
management monitoring is
important to
maintain this tight
range and to
reduce the
incidence of fetal
hypoglycemia or
hyperglycemia
● Provide ● Right to
patient with information,
guidelines in medication, and
self-administer dose are the
ing insulin as fundamental
well as the rights of the
importance of patient, and
adherence to providing them
the medication the information
will ease the
4855
.
patient to be
compliant with
the medication
since they know
the importance of
using the specific
medication
Dependent Dependent
lunch, and 8 diabetes
units after
dinner
subcutaneousl
y as prescribed
by the
physician
Collaborative Collaborative
● Refer to a ● To assess for
medical increase or
technologist decrease in
for blood glucose level and
glucose testing to check for the
and urine presence of
dipstick glucose in the
urine
4956
.
XI. Health Teaching Plan

Topic: Blood Glucose Self Monitoring
Goal: To educate the patient the importance of blood glucose monitoring as part of a regular management plan and
demonstrate proper execution of using glucose monitoring devices
Time Allotment: 20 minutes
Learning Objectives Learning Content Methodology Resources Method of

Evaluation
● The patient will ● Discuss the ● Lecture and ● Visual-aids ● Have the client
be able to significance of how Discussion (powerpoint) briefly summarize
understand the blood glucose ● Question and ● Pamphlets what they have
importance of monitoring can be answer learned, and
blood glucose useful for GDM correct and clarify
monitoring on a patients. the client about
daily basis as part ● Discuss the ideal blood what needs
of effectively glucose level for improvement and
managing pregnant mothers. further
gestational ○ fasting: 5.3 clarification.
diabetes. mmol/liter
○ 1 hour after meals:
7.8 mmol/liter
○ 2 hours after
meals: 6.4
mmol/liter.
● The patient will ● Lecture and ● Visual-aids
be able to explain ● Discuss the proper Discussion (powerpoint)
and demonstrate ways and tips for ● Question and ● Pamphlets
how to properly correctly self– answer ● Video Clips
test blood glucose monitoring blood ● Demonstration
with a fingersticks glucose level during
method and blood pregnancy.
glucose monitor. ○ Emphasize the
importance of
having one-time
use of lancets.
● Elaborate on how
● The patient will frequently the patient ● Lecture and ● Visual-aids
be able to should be monitored Discussion (powerpoint)
understand factors based on their ● Question and ● Pamphlets
that can affect the treatments, initial lab answer
accuracy of blood test results and
5057
.
glucose doctor’s order.

monitoring for the ○ Encourage patients
patient to prevent. to keep a glucose
diary for the
correct schedule of
monitoring and
logs of previous
records.
● Enumerate factors that

may affect results:
○ Expired strips
○ Exposure to high
temperature and
humidity of the
strips.
○ Inadequate
cleansing of the
skiing
○ Episodes of low
blood glucose
Topic: Insulin Administration

Goal: To educate the patient significance of insulin administration during pregnancy and the proper way how to inject
insulin

Evaluation
● The patient will be ● Discuss in simpler ● Lecture and ● Visual-aids ● Have the client
able to understand terms how Insulin Discussion (powerpoint) briefly
how insulin works inside the ● Question and ● Pamphlets summarize what
administration will body and how it is answer they have
help in managing necessary for patients learned, and
GDM. with Gestational correct and
Diabetes. clarify the client
● Discuss the common about the things
side effects of insulin that need
in pregnancy and improvement and
how to manage. further
5158
.
○ Hypoglycemia clarification.
○ Edema
○ Injection site
reaction.
○ Hunger
○ Feeling shaky
● Established proper
schedule of insulin
● The patient will be administration ● Lecture and ● Visual-aids
able to execute the appropriate for Discussion (powerpoint)
right way of patient’s treatment ● Question and ● Pamphlets
insulin and lifestyle. answer ● Video Clips
self-administration ○ Advisable to ● Demonstration
administer 10
to 30 minutes
before meal.
● Teach patients how

to properly inject
insulin with the right
angle (90 degrees) on
the right tissue space,
noting the time of
administration.
● Teach the patient
how to properly store
insulin medication
appropriately.
○ Unopened insulin
bottles should be
kept in the
refrigerator door.
○ Should not be kept
in the freezer or in
direct sunlight
because extreme
temperatures affect
insulin.
● Enumerate where the
pregnant patient can
5259
.
inject insulin to
establish a rotating
injection site which
will prevent
lipodystrophy.
Sites of injection:
○ Abdomen/belly
or two inches
away from the
belly button
○ Outer side of the
arms that contain
more fat
○ Upper and outer
side of the thighs
○ Outer side of the
buttocks
● Enumerate tips in
selecting insulin
injection sites.
○ Avoid areas that
are most likely
used for ADLs.
○ Avoid areas that
have bruises or
injection sites.
○ Note any rashes
at the injection
site.
● Advise the patient to
keep a notebook for
records of the
previous injection
site.
● Explain that the
needle that is used to
administer the
insulin should only
be used once to
prevent infection.
5360
.
Topic: Self-monitoring of Fetal well-being

Goal: To enhance the patient’s knowledge in daily self monitoring of her fetal well being through Fetal Kick Counting
Method (FKC).

Evaluation
● The patient will be ● Discuss different ● Lecture and ● Visual-aids ● Have the client
able to assess and methods of fetal Discussion (powerpoint) briefly
distinguish healthy kicks monitoring. ● Question and ● Pamphlets summarize what
fetal kicks ○ Sadovsky answer (Infographics) they have
movement. Method ● Demonstration ● Video Clips learned, and
○ Cardiff correct and
‘Count-to-Ten clarify the client
Kick Chart about what needs
● Discuss the different improvement and
movements or kicks further
can occur on a clarification.
healthy fetus
○ Twists
○ Turns
● The mother with a ● Emphasize that a ● Lecture and ● Visual-aids

daily healthy fetus usually Discussion (powerpoint)
self-monitoring moves around at ● Question and ● Pamphlets
routine will least 10 times per answer (Infographics)
increase her ability hour.
to recognize ● Discuss to the
warning signs of patient that
fetal distress. recognizing warning
signs will easily help
physicians assess
factors that affect
decreased fetal
kicks.
○ If 20 min passed,
● The mother will be explain that the ● Lecture and ● Visual-aids
able to enhance fetus might be Discussion (powerpoint)
maternal-fetal sleeping or ● Question and ● Pamphlets
bonding. experiencing low answer (Infographics)
glucose so must be
5461
.
stimulated by
carbohydrate
snack or loud
music. .
● Elaborate the
importance of
bonding between
mother and fetus
during pregnancy as
it will impose
healthy fetal
behavior and
improve the
mother’s
psychological status.
Topic: Nutrition and Weight Management during pregnancy

Goal: To enhance patient’s knowledge on proper nutrition and weight management during pregnancy

Evaluation
● The client will be ● Discuss the adequate ● Lecture and ● Visual-aids ● Have the client
able to intake essential Discussion (powerpoint) briefly
comprehend proper nutrition in ● Question and ● Pamphlets summarize what
nutrition and diets pregnancy answer (Infographics) they have
that are appropriate ○ Vitamins & learned, and
for the client. Minerals correct and
○ Different clarify the client
healthy Food about what needs
group improvement and
● Sample foods and further
viands applicable to clarification.
patient’s status:
○ Sinigang na Isda
● Useful tips in
nutrition appropriate
with the patient
5562
.
● The client will ● Lecture and ● Visual-aids

understand ● Ideal weight gain Discussion (powerpoint)
appropriate weight appropriate for a ● Question and ● Pamphlets
gain management patient's BMI and answer (Infographics)
during pregnancy. weeks of gestation. ● Demonstration ● Video Clips
● Explain to the
patient the use of
“The Eatwell Plate”
that shows
appropriate
proportions of each
food group which
will help limit
weight gain during
pregnancy.
● Basic exercises for
pregnant women.
XII. Discharge Plan
Medication ● Instruct the client on correct medicine administration.

● Instruct the client to eat soon after receiving short-acting insulin to avoid hypoglycemia
prior to mealtimes.
● Assist the client in planning the time interval to take her insulin to reach its peak.
● Instruct the client to take medications exactly as prescribed by the doctor to maintain a
constant absorption rate.
● Advise the client to call her physician when adverse reactions occur when taking
medication, such as rashes, SOB, and fast heart rate.
Exercise ● Instruct the client to exercise daily, such as walking for 40 minutes.
● Advise the client to avoid strenuous activity, which can increase in blood glucose and may
result in ketoacidosis since the liver both releases glucose and breaks down fatty acids to
provide adequate energy for the exercise.
● Encourage the client to exercise at the same time every day to keep the time and duration of
each session consistent.
Treatment ● Emphasize the significance of blood glucose monitoring.

● Provide additional information on self-administration of insulin, such as the proper
administration angle, injection site, how to load (if not preloaded), and dose.
● Advice the client to increase fiber consumption to lower total cholesterol and low-density
lipoprotein levels in the blood.
5663
.
● Instruct the patient on establishing a food plan that consists mostly of carbs, healthy fats,
and protein.
● Advise the client to maintain a regular fitness routine to help regulate blood sugar levels.
Health Education ● Educate the patient regarding proper exercising routines and duration. Increased physical
activity can help maintain a healthy weight gain that could help prevent any order
pregnancy-related problems. Exercising could improve sleep, boost mood, increase energy,
prevent back pain or constipation and lastly prepare your body for when labor comes. At
the same time, exercising, risk in doing physical activity, or participating in sports should
be limited or be extra cautious; also, remember to use proper equipment such as shoes,
clothes, helmet, and support guards.
● Educate patients regarding proper nutrition for calorie count, vitamins and mineral needs,
healthy food choices, and foods to be avoided. The Patient should prioritize foods with
carbohydrates, protein, healthy fats, and fiber to help the patient's problem with diabetes.
● Educate the patient on proper administration, preparation, and possible side effects of
insulin, especially this done by the patient itself.
● Educate that excess weight loss is alarming and should be notified immediately to the
healthcare team, maintaining a healthy weight gain is important as the fetus is developing,
● Educate the patient regarding the likelihood of developing diabetes after delivering or in
the future. These risk factors are as follows: obesity, age over 25 yrs, history of diabetes,
GDM before 24th-week of pregnancy, and blood sugar constantly high.
● Notify the patient that symptoms of gestational diabetes will fade upon completion of
pregnancy. But educating the patient regarding the likelihood of developing type 2 diabetes
later in life may be as high as 50% - 60%.
● Educate the patient on proper perineal care as good perineal care can prevent odor,
irritation and most importantly infection.
OPD Follow-up ● Prenatal check up every 4 weeks until 32 weeks of gestation

● Prenatal check up every 2 weeks until 36 weeks of gestation
● Prenatal check up weekly until delivery of baby
Diet ● Recommending an increased amount of fiber in the diet may improve blood glucose levels,
decrease the need for exogenous insulin, and lower total cholesterol and low-density
lipoprotein levels in the blood.
● Recommend to eat at least 3 small to medium-sized meals and two to four small snacks
throughout the day; at the same time, reduce or eat smaller carbohydrates for each meal.
This will help maintain blood sugar levels.
● Educate the patient on how to properly count for carbohydrates and make sure that every
meal and snack are within the normal range as determined by your healthcare provider. To
be safer, make sure that you are in line within total carbohydrate intake
Spiritual ● Continue as practiced
5764
.
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A Case Study

Manila Doctors’ College of Nursing

In Partial Fulfillment of the

MATERNAL AND CHILD

Buenviaje, Lorraine Tuesday

Dulay, Mia Nicole

Gotan, Christine Ann

Horca, Sophia Aldona

Lutap, Shyna Mitchelle

Ong, Maria Krzandra

Oreza, Erik Miguel

Sy, Maria Pauline Antoinette

Vicente Rey Roldan, RN, MAN

I. Case Abstract ……………...………………....……………………………………………………..……...………..….3

II. Nursing Health History

Patient’s Initial: M.J. Gender: F Age: 42 years old Date of Birth:

Educational Attainment: Occupation: Fish Vendor Place of Birth: Manila

c. History of Present Illness

Childhood illness(es) Chicken Pox (1990)

Childhood/adult ● BCG (March 11, 1980)

Accidents and Injuries N/A

Previous NSD (June 8, 2014 - Manila Doctors Hospital)

Medication prior to Folic Acid tablet 400 mg OD

M.M. Mother 63 F N/A High School Grad Diabetes

F.M. Father 65 M Househusband High School Grad None

M.L.J Mother-in-law 65 F Housewife High School Grad Hypertensive

F.L.J. Father-in-law 66 M Househusband High School Grad Hypertensive

A.J. Husband 43 M Carpenter High School None

F.C.J. Child 7 M Student Elementary None

S.C.J. Child 6 F Student Kindergarten None

T.C.J. Child 3 1/2 F N/A N/A None

Heredo-familial illnesses (use genogram): Please see attached for legend

Theory Age Developmental Task Client Description Interpretation

Psychosexual 42 Genital Stage According to the client, The client is showing

that she does not allow

Spiritual 42 “Conjunctive” Faith Client stated that Client shows appropriate

beliefs he may have she believes that prayer

Duration: 5 days Associated Symptom: Dysmenorrhea and lower back pain

Obstetric History G: T: P: A: L: M: Type of Delivery: (3) Normal Spontaneous

Complications: None Exposure to Teratogenic Agents: None

Fundal Height: 28 cm (Normal for AOG)

III. Gordon’s Typology of Functional Health Pattern

A. Health Perception / Health Management

B. Nutritional / Metabolic Pattern

D. Activity / Exercise Pattern

IV. Physical Assessment

Signs of Distress: Obvious Signs of Illness(es)

Orientation: Level of Affect: Mood:

Quantity & Quality of Speech: Speech is clear, Organization of thoughts:

Height: 155 cm Weight: 110 lbs (pre-pregnancy) IBW/BMI: 20.81 (Normal)

Weight: 142 lbs (pregnant)

FHR: 136 bpm

Decreased moisture of the skin

Diabetic patients are most

marks and Linea Nigra found

bruits sound during

Weber, J. Kelley, J. (2018).

Ears Ears are bilaterally equal in Client has no exhibition of Analysis:

The patient has no obstruction