Nursing Diagnosis: Risk for Impaired Fetal Growth

Nursing Diagnosis: Risk for Impaired Fetal Growth related to gestational diabetes mellitus : Can you make a 1 Goal and 5 Objectives, and Nursing Interventions with Rationale about the Nursing Diagnosis related to the Case Scenario? Care of Mother with Gestational Diabetes Mellitus Case Scenario: Patient with Gestational Diabetes Mellitus Course in the Ward: You are taking care of Zara, a 42-year-old primigravida woman, at 37 weeks 6 days gestation currently being seen at the nearest tertiary hospital. She was rush by her hubby because of irregular contraction coupled with lower back pain. Her weight is 170 pounds, and her blood pressure is 130/80 mmHg. Uterine size seems to be appropriate for gestational age as estimated. Zara is married to Rendon for almost 15 years now. She is a Business Administration graduate. The couple manages four businesses in the city which include a flower shop, a coffee shop, restaurant and a farm. They live in a 6-room- house in an exclusive subdivision. Her family history reveals that her father and her father’s sister has Type 2 diabetes mellitus. Her father’s mother died of a cardiovascular disease. Her sister has asthma and she had a baby brother died at birth due to prematurity. Obstetric/ Gynecologic History This is Zara’s first pregnancy. They’ve been trying to conceive for 12 years but failed. She was diagnosed as having primary infertility. Diagnostic work-up done to the couple- sperm cell analysis for Rendon and fertility work-up for Zara. All results came in unremarkable. Hence, she was advised to have at least 8 hours of sleep and to have a high protein diet. In vitro fertilization (IVF) was suggested which the couple agreed enthusiastically. It was successful after the first attempt. At 15 weeks AOG, while having a meeting with business associates, she experienced painful uterine contractions with no signs of bleeding. She was rushed to the hospital and admitted with a diagnosis of Threatened abortion. She was given Endometrin vaginal suppository BID, Isoxsuprine po TID, Vit C 500 mg OD, Calcium 500mg BID and Magnesium Sulfate IV incorporated to IVF for 2 cycles. She was discharged after 3 days. Able to digest food and likes to eat fruits and vegetables as much as possible. Typical breakfast includes: cereals with berries and Anmum® chocolate milk or fruit juices. Roasted chicken or turkey with carrots, cabbage and potatoes for lunch. A cup of tea or coffee and some sweet buns for merienda. Beef or pork stew, chicken or pork adobo or chopsuey for supper. She doesn’t drink water much. The patient is constipated, hemorrhoids are present. Urine dipstick result shows 3+ glycosuria and negative ketones. Oral Glucose Tolerance Test Last October 30, 2022 at 10am, she was ordered by the physician for OGTT. Prior to the test, the nurse initially check her blood glucose level and it reveals 100 mg/dL. She claimed that at 4Am she had her light snacks with a sandwich and a ½ cup of milk. Around 11am, she was loaded to drink 100grams of sweetened juice, and a fasting was enforce by the staff after that. An hour after drinking the fluid, a medical technologist took a specimen sample to check for her glucose level in the blood, it revealed 145 mg/dL. To verify the result of her blood sugar, another hour after the first test, on other site of vein, a sample was extracted and at this time, the result turns out to be elevated as well from the previous taken, it is 180mg/dL. The physician advised Zara on the treatment for her maintenance of blood sugar while on conception, she should follow the nutrition requirement, weight reduction and is encourage to do physical activity. On HGT monitoring pre and post meal. Follow the prescribed frequency and tapering of insulin injections. At the beginning of the new year, Zara felt nervous, anytime soon she will have to deliver her baby. A month ago, Braxton hicks are most evident and sometimes it can be relieved by ambulation and activity. But 1 day prior to admission, her uterine cramping and contraction is active and she has the urge like defecating. She was then accompanied by her husband to the nearest hospital because she’s worried and has apprehension of what to do, in childbirthing for the

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