Table of Contents
As per the case study, it has been observed that Ms. Cho Chang was suffering from Gestational Diabetes Mellitus- Hyperglycaemia and the problems that had been associated in this context are the increased thirst, the amount of urination had also increased rapidly. Among the other problems, these two are the main problems (Barquiel,2014,p.206). As per the ABCDE framework, t have to be looked after that whether the patient suffering from the particular disease is getting any airway obstruction or not. In this aspect, the use of accessory muscle respiration turned out to be necessary.
Next comes breathing where the intervention of the clinical person should be there to see that whether the patient is suffering from central cyanosis or having some respiratory problems or not. Then comes circulation where the color of the hands needs to be noticed where the limb temperature needs to be noticed along with the measurement of capillary refill time (Bempah, 2016,p.17). Then in the case of D that is Disability, the common causes of unconsciousness if present among the patient needs to be determined well through the initial assessment of the patient’s conscious levels and also through their thorough examination of the pupils (size, reaction to the light and equality).
Gestational diabetes is a condition where the level of blood sugar rises at the time of pregnancy. There are two types of gestational diabetes. Women having A1 class can be able to manage gestational diabetes through certain diets and exercises. However, women with class A2 have to take either insulin or certain medications (Cosson, 2019,p.126). In this particular disease, some of the common symptoms which have usually been found in the patient and also been observed in the patient of the case study were feeling thirstier than the usual time, feeling more hungrier, and at the same time peeing more than the usual time.
The causes behind this particular type of diabetes during pregnancy state that at the time of pregnancy, the individual’s placenta develops hormones that cause the glucose to be get generated easily in the blood. In the usual cases, the pancreas sends out enough insulin to handle the situation properly. The main reason behind this occurrence of the disease is that when the body rejects in the development of enough insulin and hence the blood sugar within the body of the individual rises and this might lead to gestational diabetes (Jeong, 2018,p.71).
In other explanations, it can be stated that pregnant women suddenly gained weight, and hence the extra weight of the body makes things harder in the body in using enough amount of insulin. The other causes of this type of diabetes might be hereditary. Again it might happen that the particular pregnant woman is having the polycystic ovary syndrome and the lady might be more than 25 years of age. From the knowledge of pathophysiology, it can be highlighted that the patent suffering from this particular kind of diabetes might suffer from the complicated delivery of the baby.
In addition to this, the baby just after birth might be affected by a low rate of blood sugar (Ravi, 2016,p.110). Now the women who are pregnant like the one in the case study have been continuously elevated the levels of the blood glucose at the time of pregnancy then the fetus will be affected that time and it might cause the fetus to be larger than the expected where the delivery of the baby might get complicated. The other risks which the newborn baby can adapt are the increased rate of jaundice, increased amount of respiratory disease (Ute, 2020,p.56).
Self-monitored blood glucose: The women like one in the case study should keep a record of the SBMG along with the maintenance of the food diary which should be comprised of the time of SBMG test, composition and the adequate amount of food and the beverages that have been consumed (Ute, 2020,p.56). The women, as well as the nurse in this way, should examine the records so that postprandial hyperglycemia could not occur in the future. The increased amount of thirst among the pregnant women can be regulated well through the monitoring of the blood glucose by inducing the patients like the one in the case study to develop some of the essential healthy habits like to drink eight to ten glasses of water or other fluids in each day so that the patient can be able to get easily coped up nausea and the morning sickness (Yashdeep, 2020,p.265).
This way the thirst among the patient can be easily eradicated. In addition to this, the love for fruits also needs to be developed among the patient like the one in the case study that sips on the lemon water so that excess weight and nausea, as well as vomiting condition, can be reduced effectively In addition to this, the women should also suck on the ice-chips, popsicles to quench the thirst which will help the body in rehydrating and also quenching of the thirst without getting the stomach upset (Cosson, 2019,p.128). The reduction of the salt in the diet should be mandatory for the women in gestations like the one in the case study to avoid thirsty so often.
Besides this, the patient should also be aware of the consumption of enough amount of fruits and vegetables with the higher content of the water so that the excessive amount of thirst can be readily solved. This entire process is known as the self-monitored blood glucose through which the thirst level among the patients can be reduced effectively. The type of fruits which should be referred by the nurses at the time of gestation diabetes are the cucumbers, watermelon, muskmelons, etc where there exists higher content of the water. It is not that sweet but at the same time helps in rehydration of the body. The consumption of the curd is also useful for pregnant women suffering from gestation diabetes through which protein, as well as calcium in the body, can be boosted and the body will get more hydrated (Bempah, 2016,p.18).
Medical nutritional therapy: First of all, it will be highly important for the nurse to check that how the carbohydrates (carbs) are working among the patient that is among the women suffering from gestation diabetes. Some of the carbs release sugar in the bloodstream, which is known as the simple carbs, and some of them release sugar in the body very slowly which is known as starchy or the complex carbs. Starchy carbohydrates like pasta, rice, couscous potatoes when broken down in the blood and before the release of the sugar in the bloodstream he process affects the patient very slowly (Ravi, 2016,p.111). The versions of the wholegrain are usually better than the processed versions since they get digested slower due to the presence of extra fiber. The name of some of the healthiest carbs is wholegrain, pulses, and vegetables. At the time of consumption of these healthy diets, it is important for the nurse to look at the portion sizes and should also ensure that the patient is also having the regular meal in a proper manner which is helpful both for the child as well as for the mother (Barquiel, 2014,p.209).
There should be the proper measurement of every meal taken by the pregnant women starting from cooked rice breakfast cereals, boiled pasta, hard cheese, lean meat, nuts or peanut butter, etc. This will help in the measurement of the carbs within the individual’s body. Side by side, the intervention also involves checking the calorie count by the patient wherein most of the cases like in the first trimester, most of the mothers do not need extra calories. However, during the second trimester, some of the individuals might require 350 more calories amount than normal diets (Yashdeep, 2020,p.265). Again also to avoid dehydration, the patient should be taking around 12-13 cups of water daily so that lot of sweating can occur. At the same time, the meals need to be spread into mini-meals over three hours instead of consuming higher amounts in every sitting. It causes more bloating, gas as well as heat burns (Cosson, 2019,p.125).
Following the social justice framework, the discharge planning for the patient suffering from gestation diabetes involves that the patient should abide by all the rules highlighted by the doctors and the nurses in the hospitals. It has to be observed that whether the heartbeat of the patient is weak or slow and ay the same time, it also needs to be noticed that whether the patient is suffering from headache or not. Again, in addition to this, insulin consumption is proper or not, and also the patient is undergoing the medications properly or not.
Again the blood sugar levels should be regularly tested so that changes can be made in the health habits of the patients, exercises, and foods. At the same time, the meal plan should also be followed well along with the maintenance of the healthy weight both for the mother and the baby (Jeong, 2018,p.71). Again, during pregnancy, smoking is not at all allowed by the mother which might affect the health of the baby. Before discharge, the patient should ensure that she should make a regular visit to the clinics often and should undergo certain screening tests every 1 to 3 years for life to control the blood sugar levels (Bempah, 2016,p.16).
Barquiel, 2014. Body weight, weight gain and hyperglycaemia are associated with hypertensive disorders of pregnancy in women with gestational diabetes. Diabetes & Metabolism, 40(3), pp. 204-210.
Bempah, O. A., 2016. The Cure and Prevention of Early-Stage Symptoms of Long-term Diabetes Complications are Independent of the Methods used to Control Blood Plasma Glucose. Journal of Diabetes, Metabolic Disorders & Control, 3(2).
Cosson, 2019. Initially untreated fasting hyperglycaemia in early pregnancy: prognosis according to occurrence of gestational diabetes mellitus after 22 weeks’ gestation: a case–control study. Diabetic Medicine, 37(1), pp. 123-130.
Jeong, H. P., 2018. Paradigm Changes in Diabetes Management Guidelines: American Diabetes Association 2018. The Journal of Korean Diabetes, 19(2), p. 71.
Ravi, R., 2016. Impact of Twin Gestation and Fetal Sex on Maternal Risk of Diabetes During and After Pregnancy. Diabetes Care, 39(8), pp. 110-111.
Rowan, H., 2018. Dizziness in diabetes. Practical Diabetes, 35(2), pp. 41-42.
Ute, S., 2020. Diabetes geschlechtersensibel betrachtet. Diabetes aktuell, 18(02), pp. 56-56.
Yashdeep, G., 2020. Variation in the classification of hyperglycaemia in pregnancy and its implication. The Lancet Diabetes & Endocrinology, 8(4), pp. 264-266.
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