Western Leyte College Of Ormoc City, INC

A.​ Bonifacio St. Ormoc City Leyte Philippines

A.​ Tel No. (053 ) 255-854/ 561-5310

GESTATIONAL DIABETES MELLITUS

A Case Study Presented to

The Faculty of the College of Nursing and Allied Health Sciences

of Western Leyte College of Ormoc City, INC

In Partial Fulfillment of the

Requirements for the Subject

Nursing Care Management 109 RLE

GROUP 2 AND 3

JUNE 2025

EMJOMELOU V. ARCILLAS, RN
AGNES CHRISTINE A. CANDELARIA, RN, MAN
INSTRUCTORS
 Submitted by:

DELOS REYES, KRISHNAH MAUREEN B.

DOMAEL, RASHIENE E.

DONOR, EUNICE PAULINE N.

DUJA, FRAN RODEUEL A.

ENCINAS, ROSE ANGEL L.

ESCAÑO, JEAN VERLYN J.

FLORENTINO, KYRIL MAE A.

GARCES, JENNY ROSE E.

GENESTON, JERAH BABE D.

GONTEÑAZ, ANTONET L.

GONTEÑAS, KIANA D.

GUINOCOR, JANA G.

INTIA, MARY CRIS A.

JACA, ADORA B.

JUNTILLA, JOHN CARLO Y.

LIBRES, BHEA LOURAINE C.

MAHINAY, PRINCESS RUVY A.

MAÑAS, MICHAELA V.

MANGUBAT, LIZA MAE M.

MORENO, ALLIYAH MAE

NOVAL MICHELLE T.

NUNEZ, ANGELA

2
 TABLE OF CONTENTS

PAGE NO.

COVER PAGE ……………………………………………………………………………. Ⅰ

TABLE OF CONTENTS ………………………………………………………………….1

FRONT PAGE …………………………………………………………………………….2

INTRODUCTION ……………………………………………………………………….…3

NURSING HEALTH HISTORY …………………………………………………….…….5

1.​ GORDON’S FUNCTIONAL HEALTH PATTERN ……………………….……..6

2.​ PHYSICAL ASSESSMENT ……………………………………………………...13

3.​ LABORATORY ASSESSMENT ………………………………………….……..17

ANATOMY AND PHYSIOLOGY …………………………………………………...….23

PATHOPHYSIOLOGY …………………………………………………………………..32

SIGNS AND SYMPTOMS ………………………………………………………………34

SUMMARY OF SIGNIFICANT FINDINGS ………………………………………….…41

NURSING CARE PLAN…………………………………………………………………46

DRUGS STUDY …………………………………………………………………………61

DISCHARGE PLAN ……………………………………………………………………..66

REFERENCES …………………………………………………………………………...79

1
GENERAL OBJECTIVE

●​ To further understand and gain extensive knowledge regarding a high-risk pregnancy case, this

output is accomplished for a comprehensive analysis concerning the maternal condition with the

following objectives

SPECIFIC OBJECTIVES

●​ This case study aims to understand the pathophysiology and contributing factors of cervical
dilatation arrest and gestational diabetes mellitus (GDM).

●​ This case study aims to identify the different signs and symptoms experienced by the patient
throughout labor and hospitalization.

●​ This case study aims to interpret the patient’s laboratory, diagnostic, and health assessment findings.

●​ This case study aims to develop an appropriate nursing care plan tailored to the patient’s clinical
condition.

●​ This case study aims to explore medical and nursing interventions that can address the patient’s
discomforts and potential complications.

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 CHAPTER I.

INTRODUCTION

3
 INTRODUCTION

Gestational Diabetes Mellitus (GDM) is a form of diabetes that develops during pregnancy, typically
between the 24th and 28th week. It occurs when the body cannot produce enough insulin to meet the
increased demands of pregnancy, leading to higher-than-normal blood sugar levels. During pregnancy,
hormones from the placenta, such as human placental lactogen, can make the body less sensitive to
insulin, resulting in insulin resistance. GDM is usually diagnosed through an Oral Glucose Tolerance Test
(OGTT), which involves drinking a glucose solution and measuring blood sugar levels at various
intervals.

Gestational diabetes affects multiple organs in both the mother and baby. The pancreas struggles to
produce enough insulin, leading to elevated blood sugar levels due to insulin resistance. The placenta
releases hormones that worsen insulin resistance, increasing the risk of a larger baby, which complicates
delivery. High blood sugar can also raise blood pressure, causing hypertension or preeclampsia, and stress
the kidneys, potentially impairing their function.

Risk factors for gestational diabetes include being overweight or obese before pregnancy, having a family
history of diabetes, having had gestational diabetes in a previous pregnancy, and being older than 25.
Polycystic ovary syndrome (PCOS) and other underlying metabolic issues can further increase a woman’s
chances of developing GDM. In addition, women who have had larger babies (over 9 pounds) in previous
pregnancies are also at a higher risk.

The elevated blood sugar levels can cause the baby to grow too large, a condition known as macrosomia,
which can lead to complications during delivery, such as shoulder dystocia, where the baby’s shoulder
gets stuck during birth. This may increase the likelihood of needing a cesarean section. Larger babies may
also have difficulty breathing at birth due to immature lung development, and they are at higher risk for
low blood sugar shortly after birth.

In this case study, we will discuss a difficult instance of gestational diabetes faced in a clinical setting,
aiming to understand the patient's status before and after treatment. This study will document the
prescriptions and management.

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 CHAPTER II.

NURSING
HEALTH HISTORY

5
GORDON’S FUNCTIONAL HEALTH PATTERN

DEMOGRAPHIC PROLIE

Name: A.J.

Age: 26 years old

Gender: Female

OB Score: G1P0

Age of Gestation: 37 4/7 Weeks

Last Menstrual Period: August 14, 2024

Address: Barangay. 74, Tacloban City, Leyte, Philippines 6500

Civil Status: Married

Occupation: Employee at Department of Labor and Employment , Virtual Assistant

Date Of Birth : September 21, 1998

Religion: Catholic

Weight: 89 kg

Height: 153 cm

Name of Hospital: Eastern Visayas Medical Center

Date of Admission: May 03, 2025

Time: 03:00 PM

Chief Complaint: Uterine Contraction

Admitting Physician: Dr. January Ducducan

Admitting Diagnosis: Gravida 1, Para 0, PU, 37 4/7 weeks AOG by EUR, Cephalic, Arrest in Cervical
Dilatation, Failure of Descent, Gestational DM, Obev Class 1
Temperature: 36.8°C
Heart Rate: 86 bpm
Respiratory Rate: 18 cpm

Blood Pressure: 120/90mmHg

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A. Current Health Status

Before Hospitalization

J.A., a 26-year-old patient in her third trimester of pregnancy - 37 4/7 Weeks, is generally healthy but had
been experiencing typical pregnancy-related symptoms including fatigue, morning sickness, mild back
pain, and occasional nausea. She had completed her first and second doses of the Moderna COVID-19
vaccine and used condoms only for birth control. Mentally, she reported feeling somewhat anxious about
her pregnancy and the upcoming life changes.

During Hospitalization

On May 3, 2025, at 3:00 PM, J.A. was admitted to the hospital due to consistent uterine contractions.
Upon admission, she was found to have edema in both feet. An indwelling urinary catheter was placed in
preparation for a cesarean section. Her condition is being closely monitored.

B. Past Medical History

Before Hospitalization

The patient has been in good health prior to the current admission, with no significant history of chronic
medical conditions or past illnesses. There is no history of any surgical procedures, and the patient has not
required hospitalization at any point until now. Additionally, the patient reports no known drug,
environmental, or food allergies.

During Hospitalization

Upon admission, patient J. experienced generalized body weakness and edema in both feet.

C. Family History

Before Hospitalization:
J.A. lives with her husband, with whom she shares a healthy and supportive relationship. There is no
known family history of illness. J.A.'s family is well and alive, with no chronic illnesses aside from the
occasional common cold.

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During Hospitalization:
Upon admission, J.A is diagnosed with gestational diabetes and is currently experiencing generalized
body weakness due to her condition.

D.​ Genogram

E. Sleep Rest Pattern

Before Hospitalization

Patient J. verbalized that she sleeps from 2:00 a.m. to 6:00 a.m. everyday due to her work schedule.She

works for the Department of Labor and Employment from 8:00 a.m. to 5:00 p.m. every weekdays, then

8
returns home to prepare for her virtual assistant job, which runs from 8:00 p.m. to 2:00 a.m. everyday. Her

sleep is often poor and insufficient in duration; however, she reports no difficulty falling asleep, as she has

become accustomed to this routine.

During Hospitalization

During her hospital stay, the patient mostly sleeps 7 to 8 hours throughout the day. Her sleep is

occasionally interrupted by discomfort from the IV site and mild abdominal pain.

F.Activity and Exercise

Before Hospitalization

The patient wakes at 6 a.m. and prepares for the day until 7:30 a.m. She works for the Department of

Labor and Employment from 8 a.m. to 5 p.m., then returns home to prepare for her virtual assistant job,

which runs from 8 p.m. to 2 a.m. She incorporates walking for exercise whenever she has free time.

During Hospitalization

Limited activity due to current health status and hospitalization.

G. Cognitive and Perception Pattern

Before Hospitalization

The patient experiences no difficulty in understanding, communicating, remembering, or making

decisions.

During Hospitalization

J.A experiences no difficulty in understanding and communicating.

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H. Self perception and self concept pattern

Before Hospitalization

The patient has a positive self-perception and self-concept, describing herself well. The patient had her
first menstruation at the age of 12. Her menstrual cycle typically lasts about five days. She experiences
abdominal and lower back pain, especially when under stress. She is currently expecting her first baby,
which is planned.

During Hospitalization

J.A expresses feelings of excitement and anxiety regarding the pregnancy. She is currently expecting her
first baby, which is planned. She is excited and nervous for her upcoming journey as a mother.

I. Roles and relationship pattern

Before Hospitalization

The patient works as a Department of Labor and Employment (DOLE) employee and a virtual assistant,

with primary responsibilities in auditing. She maintains a positive work environment and resides in a

healthy neighborhood.She maintains a positive work environment and regards her husband as a

significant figure in her life.

During Hospitalization

The patient is unable to work due to physical limitations. Her husband plays a supportive and active role

in her situation contributing to her emotional well-being and assisting with household and family

responsibilities, particularly in financial matters.

J. Nutrition and metabolic pattern

Before Hospitalization

Patient J. was diagnosed with Gestational Diabetes Mellitus (GDM) on her 34 weeks of pregnancy. She is

encouraged to follow a balanced diet with moderate carbohydrates, rich in fiber, protein, and essential

nutrients for fetal growth and maternal well-being. Soft drinks, chips, and highly processed or sugary

foods are restricted.

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Listed below are the usual foods that the patient consumes before hospitalization:

Breakfast Morning Snack Lunch Dinner

1 cup brown rice 1 slice whole wheat 1 cup brown rice 1/2 cup brown rice
1 boiled egg Bread Grilled tilapia Tinolang manok
1 cup 1 tbsp peanut butter Pinakbet 1 slice of papaya
unsweetened soy (unsweetened) 1 small fresh papaya
milk 1 small banana

During Hospitalization

The patient is NPO (nothing by mouth) in preparation for cesarian operation.

K. Bladder Elimination Method

Before Hospitalization

Patient J. reported urinating approximately 3 to 5 times per day. The average urine output per void was
around 180 mL, though this varied depending on her fluid intake. The urine was yellowish in color and
had no unusual odor, indicating normal bladder function without signs of infection.

During Hospitalization

During the patient hospital stay, an indwelling urinary catheter was inserted in preparation for her
scheduled cesarean operation. The urine collected in the urobag remained cloudy and yellowish in color
and free from any foul or unusual odor. There were no issues observed with the catheter or the urobag
throughout its use, and her urine output was 250mL.

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L. Bowel Elimination

Before Hospitalization

the patient usually defecates once or twice a day, with her stool typically solid and brown.

During Hospitalization

A.J. empties her bowels twice a day. The stool consistency and color remained consistent with her prior to
admission pattern, being solid and brown.

M. Coping and stress tolerance pattern

The patient demonstrates effective coping and stress tolerance, showing mental and physical strength for

the well-being of her baby. She remains resilient and focused, motivated by her role as a mother.

N.​ Sexuality and reproductive pattern

The patient verbalized that she had her first menstruation at the age of 12. Her menstrual cycle typically
lasts approximately five days and is generally regular. She experiences abdominal cramps and lower back
pain during her period, symptoms that tend to worsen when she is under physical or emotional stress.
Prior to her current pregnancy, the patient was not on any medication and used condoms for
contraception. Since becoming pregnant, she and her husband have rarely engaged in sexual activity due
to the physical and emotional changes associated with her condition.

O.​ Value and belief pattern

The patient places great value on her family and views them as her main source of strength. She aspires to

become a loving and responsible mother and partner. Her strong faith in God plays a significant role in

shaping her beliefs and guiding her actions.

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PHYSICAL ASSESSMENT

A 26-year-old gravida 1 at 37 4/7 weeks as of ultrasound, Patient J.A, is experiencing arrested labor with

no progression in cervical dilation and fetal descent. Patient medical history includes gestational diabetes

and Class 1 obesity. The patient denies any known allergies or history of asthma. Physical assessment

reveals a normal head, neck, and face with a soft voice. Patient presents with bilateral pedal edema, which

reports is causing difficulty with ambulation and standing. The patient is also apprehensive about its

Intravenous line, inserted in the metacarpal area of the right hand expressing discomfort upon touch, and

reports mild abdominal pain.

GENERAL APPEARANCE

The patient is a 26-year-old female who appears the stated age and is visibly uncomfortable, likely due to

advanced pregnancy and reported difficulty with ambulation. A fasting blood sugar of 133.6 mg/dL is

considered elevated and may indicate gestational diabetes. An intravenous line is inserted in the

metacarpal area of the right hand, and an indwelling urinary catheter is in place, with the drainage bag

positioned at the side of the bed to prevent dislodgement or infection. The patient is lying in a supine

position, is alert and oriented, and communicates with a soft voice. The urine in the drainage bag appears

yellowish and within a normal amount. Overall hygiene and grooming appear appropriate. The patient’s

vital signs and comfort level were monitored, the IV line and catheter were checked for secure placement,

and the urine drainage bag was properly maintained below bladder level.Education was provided

regarding the elevated blood sugar level and the potential risk of gestational diabetes, with emphasis on

the importance of regular monitoring. Assistance was given with mobility to help reduce discomfort. The

patient remained alert and oriented, showed no signs of infection.

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ASSESSMENT OF SKIN, HAIR, AND NAILS

Skin is noted to be normal in color and temperature, with no obvious lesions, rashes, or bruising noted on

visible areas. Skin turgor appears within normal limits on accessible areas. Hair is normal in distribution

and texture. Nails are clean and without clubbing or cyanosis.

ASSESSMENT OF THE HEAD AND NECK

The head is normocephalic and atraumatic. The face is symmetrical with no noted abnormalities. The

trachea is midline. No jugular vein distension or thyromegaly is observed. Lymph nodes are nonpalpable.

ASSESSMENT OF THE EYE

Eyes are symmetrical with pupils that are equal, round, and reactive to light and accommodation. Sclerae

are non-icteric, and conjunctivae are pink. No discharge or lesions are noted.

ASSESSMENT OF THE EAR

External ears are symmetrical and without lesions or tenderness. The ear canals are patent and without

visible cerumen or discharge. Patient reports no hearing difficulties.

ASSESSMENT OF THE NOSE AND SINUSES

The nose is midline and symmetrical. Nasal passages are patent. No nasal discharge or bleeding is noted.

Frontal and maxillary sinuses are non-tender to palpation.

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ASSESSMENT OF THE MOUTH AND THROAT

Lips are pink and moist without lesions. Oral mucosa is pink and intact. Tongue is midline without

lesions. Pharynx is pink and without exudate. Dentition appears adequate.

ASSESSMENT OF THE LUNGS AND THORAX

Thorax is symmetrical with unlabored respirations. Respiratory rate is within normal limits. Auscultation

reveals clear breath sounds bilaterally in all lung fields. No adventitious sounds such as wheezes or

crackles are noted, fetal heart tones were best heard in the left lower quadrant .

ASSESSMENT OF THE BREAST

Breasts are enlarged and consistent with pregnancy. Nipples are everted and without discharge noted at

this time.

ASSESSMENT OF THE ABDOMEN

Abdomen is gravid and distended consistent with a 37 4/7 week pregnancy. Fundal height is appropriate

for gestational age. Leopold's maneuvers indicate a cephalic presentation. Fetal heart tones are auscultated

and within the normal range. Uterine contractions are likely present given the arrest in cervical dilatation

and failure of descent, had last internal examination noted a cervical dilatation of 3 cm, The patient said

that has a slight pain in the abdomen, they expressed, “I feel a slight discomfort in my lower abdomen,

like a dull ache. It comes and goes but it’s not really painful, just uncomfortable" the patient described the

pain as starting in the left lower quadrant, rating it as 5/10 on the pain scale

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MUSCULOSKELETAL SYSTEM

Gross motor strength is assessed in upper extremities and appears within normal limits. Patient reports

significant edema in the feet, making walking and standing difficult. Lower extremity assessment is

limited due to patient's discomfort and edema. The patient hasn't use any contraceptive. No signs of

vaginal discharge , odor and color.

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 GESTATIONAL DIABETES MELLITUS
LAB VALUES INTERPRETATION

Laboratory Result 1

SONOGRAPHIC RESULT:

PHYSYCIAN:

●​ Gestational sac is well-decidualized.

●​ CRL measures 1.18 cm.

●​ Yolk sac is visualized, measuring 0.31 cm.

●​ Cervical length is 3.4 cm, long, closed, T-shaped.

●​ Ovaries are normal, with corpus luteum in the right ovary.

●​ No subchorionic hemorrhage.

●​ No free fluid is noted in the cul-de-sac.

IMPRESSION:

●​ Findings are consistent with an ongoing intrauterine pregnancy.

●​ Corpus luteum in the right ovary supports progesterone production in early gestation.

●​ No signs of cervical insufficiency or subchorionic bleeding.

●​ Urinalysis shows positive sugar, supporting diagnosis of Gestational Diabetes Mellitus (GDM).

●​ Bloodwork shows signs of stress (↑ neutrophils, ↓ lymphocytes), and elevated hemoglobin which

may need further evaluation.

●​ These findings correlate with the patient’s GDM, which increases the risk for preeclampsia,

macrosomia, and labor complications (e.g., failure to descend, arrested labor).

●​ Patient’s health status must be monitored closely to prevent maternal and fetal complications,

especially due to her Class 1 Obesity and GDM.

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 LABORATORY VALUES INTERPRETATION

2. CHEMISTRY RESULT MAY 03, 2025

Physician

Lab No. Test Result Reference Clinical Significance

Range

FASTING BLOOD 133.6 mg/dL 70.0 – 106.2 INCREASE

SUGAR mg/dL -​ A fasting blood sugar
test measures sugar
(glucose in your
blood)

-​ High fasting blood

sugar levels point to
insulin resistance or
diabetes

TOTAL 2.0 – 200.0

CHOLESTEROL
mg/dL

HDL-CHOLESTE 55.0 – 200

ROL mg/dL

LDL-CHOLESTER 0.0 – 100

OL
mg/dL

TRIGLYCERIDES 5.0 – 150.0

mg/dL

URIC ACID 1.5-7.0 mg/dL

CREATININE 0.6 – 1.3 mg/dL

BLOOD UREA 7.8 – 18.0

NITRATE (BUN) mg/dL

AST (SGOT) 10.00 – 42.00

mg/dL

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 ALT (SGPT) 10.0 – 40.0
mg/dL

HbA1c 4.0 – 6.0%

3. HEMATOLOGY RESULT:

Physician:

Lab Result Parameters Result Reference Clinical Significance

Number Range
Lab WBC 7.95 4.0-11.0x10 NORMAL
⁹/L
RBC 4.75 3.85.0x10/L NORMAL

Hematocrit 36.60 Male: NORMAL

42-52%,

Female:

36-48%

Hemoglobin 22 Male: INCREASE

14.0-17.4g/ -​ Hemoglobin is important

dL, Female: because it carries oxygen

12.0-16.0g/ to the body’s tissues, and

dL abnormal levels can

indicate conditions like

anemia or pol

-​ High hemoglobin levels

may indicate the body is

19
 producing too many red

blood cells, which can

thicken the blood and

increase the risk of clotting

or cardiovascular

problems.

Differential Count

Parameter Result Reference Clinical Significance

Range
Neutrophils 72.10 40-60% INCREASE

-​ -Neutrophils are the first immune

cells to respond to infections,

especially bacterial ones.

-​ - An increased neutrophil count

(neutrophilia) indicates that the

body is under stress, inflammation,

or fighting an infection.

Lymphocytes 18.70 20-40% LOW

-​ Lymphocytes help fight viral

infections and regulate the immune

system.

-​ A low count (lymphocytopenia)

may mean weakened immunity due

20
 to infection, stress, or certain

diseases like HIV or cancer.

Eosinophils 0.10 1-3% LOW

-​ Eosinophils respond to allergies

and parasitic infections.

-​ A low count usually has no clinical

concern but can be seen during

stress or after steroid use.

Monocytes 8.70 2-8% INCREASE

-​ Monocytes help defend the body by

digesting foreign substances,

bacteria, and dead cells.

-​ An increased monocyte count

(monocytosis) may indicate chronic

infection, inflammation, or certain

blood disorders like leukemia.

Basophils 0.40 0-1% NORMAL

Urinalysis

MACROSCOPIC Result Clinical Significance

EXAMINATION
Color YELLOWISH NORMAL
-​ Yellowish urine typically
indicates sufficient
hydration and considered a
normal urine color.
Transparency SLIGTHLY CLOUDY ABNORMAL

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 -​ May suggest the presence

of WBCs, bacteria, or

mucus. Common in

urinary tract infections or

mild inflammation,

especially in pregnancy.

pH

Specific Gravity

Albumin

Sugar POSITVE ABNROMAL

-Indicates glycosuria.

Common in Gestational

Diabetes Mellitus (GDM)

and reflects poor blood

glucose control.

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 CHAPTER III.
ANATOMY AND
PHYSIOLOGY

23
 ANATOMY AND PHYSIOLOGY

OVERVIEW:

The female reproductive system is a group of organs responsible for producing egg cells (ova),

supporting fertilization, and nurturing a developing fetus during pregnancy. It includes external and

internal organs, and it plays a vital role in menstruation, sexual function, and hormone regulation.

FEMALE REPRODUCTIVE SYSTEM

The female reproductive system consists of internal and external organs. The internal organs are:

OVARIES -The ovaries are paired, almond-shaped endocrine glands located in the pelvic cavity,

responsible for producing eggs and female hormones. They are connected to the uterus by ligaments and

housed within the broad ligament. Their primary functions include producing eggs (ova), regulating the

menstrual cycle, and supporting pregnancy through hormone secretion.

Anatomy:

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 · Location: Ovaries are paired, almond-shaped organs found in the pelvic cavity, one on each side

of the uterus.

· Shape and Size: They are almond-shaped and about the size of an almond, approximately 3.5

cm in length, 2 cm wide, and 1 cm thick.

· Structure: The ovary has an outer layer (cortex) and an inner layer (medulla).

· Ligaments: Ovaries are connected to the uterus and pelvic wall by ligaments, including the

ovarian ligament, suspensory ligament, and mesovarium.

· Ovarian Fossa: Each ovary is located within the ovarian fossa, a space bounded by blood

vessels, an artery, and the ureter.

Physiology:

· Oogenesis: Ovaries are responsible for the development and release of eggs (ova) through a

process called oogenesis.

· Follicular Development: Within the ovary, follicles develop, which contain oocytes (immature

eggs) and supporting cells.

· Ovulation: During the menstrual cycle, one follicle matures and releases an egg (ovulation).

· Hormone Production: Ovaries produce and release hormones, primarily estrogen and

progesterone, which regulate the menstrual cycle, pregnancy, and secondary sexual

characteristics.

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FALLOPIAN TUBE - The fallopian tubes (also called uterine tubes or oviducts) are two slender,

muscular tubes that connect the ovaries to the uterus. Each tube is approximately 10–12 cm long and

serves as the site of fertilization and transport of the ovum (egg) to the uterus.

Anatomy (Structure):

The fallopian tube is divided into four main regions:

1. Infundibulum

o Funnel-shaped, closest to the ovary

o Has fimbriae—finger-like projections that sweep the ovum into the tube after ovulation

2. Ampulla

o The widest and longest section

o Primary site of fertilization between sperm and egg

3. Isthmus

o Narrow, muscular part near the uterus

26
 o Helps guide the fertilized egg (zygote) toward the uterus

4. Interstitial (Intramural) Part

o Passes through the uterine wall and opens into the uterine cavity

The tube wall has three layers:

· Mucosa (inner layer): Lined with ciliated columnar epithelium to help move the egg

· Muscularis (middle layer): Smooth muscle responsible for peristaltic contractions

· Serosa (outer layer): Protective outer covering

Physiology (Function)

· Ovum capture: The fimbriae help sweep the ovulated egg into the infundibulum.

· Fertilization site: Most commonly occurs in the ampulla.

· Transport: Ciliary action and peristaltic contractions move the egg or zygote toward the uterus.

· Environment: Provides a suitable environment for sperm survival, fertilization, and early

embryonic development.

27
Pancreas is a vital organ located in the upper abdomen that serves multiple critical functions in the body.

Let me show you it’s structure and explain it’s various roles.

Structure and Location​

● Located behind the stomach in the upper left abdomen. ​

● Shaped like a flat pear or fish approximately 6-10 inches long. ​

● Composed of three main sections:​

1. Head: Wide portion near the stomach ​

28
2. Body: Central section ​

3. Tail: Narrow portion extending to the left side

Pancreatic islets

Pancreatic Islet

The endocrine part of the pancreas consists of pancreatic islets (islets of Langerhans),

which are dispersed throughout the exocrine portion of the pancreas. The islets consist of three

cell types, each of which secretes a separate hormone. Alpha cells secrete glucagon, beta cells

secrete insulin, and delta cells secrete somatostatin. These three hormones regulate the blood

levels of nutrients, especially glucose.

Pancreatic islet cells:

Alpha cells- are cells that secrete Glucagon (increases blood glucose).

Beta cells- are cells that secrete insulin (decreases blood glucose).

Delta cells- are cells that secrete Somatostatin (inhibits insulin release).

Gamma cells- are cells inhibiting release of Somatostatin.

29
Insulin

Elevated blood glucose levels stimulate beta cells to secrete insulin. Additionally, increased

parasympathetic stimulation associated with digestion of a meal stimulates insulin secretion. Increased

blood levels of certain amino acids also stimulate insulin secretion. There are two signals that inhibit

insulin secretion: low blood glucose levels and stimulation of the sympathetic nervous system. The

decrease in insulin levels allows blood glucose to be conserved to provide the brain with adequate glucose

30
and to allow other tissues to metabolize fatty acids and glycogen stored in the cells. The major target

tissues for insulin are the liver, adipose tissue, muscles, and the area of the hypothalamus that controls

appetite, called the satiety (fulfillment of hunger) center. Insulin binds to membrane-bound receptors and,

either directly or indirectly, increases the rate of glucose and amino acid uptake in these tissues. Glucose

is converted to glycogen or lipids, and the amino acids are used to synthesize protein.

References:

Vanputte, et al., (n.d.). Seeley’s Essentials of Anatomy & Physiology. In Google Books; Eight

Edition. 285-288

31
 CHAPTER IV.

PATHOPHYSIOLOGY

32
33
 CHAPTER V.
IDEAL SIGNS AND
SYMPTOMS

34
Ideal signs and symptoms Patient manifestation Scientific basis

Increased Thirst The patient reports feeling Polydipsia is a compensatory

(Polydipsia) excessively thirsty response to osmotic diuresis

throughout the day, even caused by hyperglycemia. In

after drinking fluids gestational diabetes, elevated

regularly. blood glucose levels lead to

increased urine output, resulting

in fluid loss and dehydration,

which activates the thirst

mechanism in the hypothalamus.

Source: Mayo Clinic; American

Diabetes Association

35
Frequent Urination The patient reports urinating Polyuria results from osmotic

(Polyuria) approximately every hour diuresis, a condition where excess

during the day and 3–4 times glucose in the blood is filtered

at night (nocturia). into the urine, pulling water along

with it. This is common in

gestational diabetes, where insulin

resistance leads to hyperglycemia.

Source: Cleveland Clinic;

American Diabetes Association

Increased Hunger The patient reports a Polyphagia is caused by cells

(Polyphagia) noticeable increase in being unable to access glucose

appetite, feeling hungry due to insulin resistance. Despite

again within 1–2 hours after high blood sugar levels, the cells

meals. are starved of energy, prompting

the body to stimulate hunger in an

attempt to obtain more fuel.

36
 Source: National Institute of

Diabetes and Digestive and

Kidney Diseases (NIDDK); Johns

Hopkins Medicine

Excessive Weight Gain The patient has gained 3.5 kg Excessive weight gain in

(7.7 lbs) in two weeks, which pregnancy can be due to fluid

is above the expected rate for retention and increased fat storage

her current gestational age. related to hormonal and metabolic

She denies any significant changes, including insulin

changes in diet or activity. resistance in gestational diabetes.

Mild swelling in the lower Hyperglycemia contributes to

extremities and tight-fitting both maternal and fetal growth,

clothes were also noted. increasing total body weight.

Source: Centers for Disease

Control and Prevention (CDC);

American College of

Obstetricians and Gynecologists

(ACOG)

37
Fatigue Patient reports feeling tired

and weak during In GDM, insulin resistance

hospitalization; difficulty prevents glucose from entering

staying awake during the cells effectively.

day. This leads to cellular energy

deficiency, even though blood

sugar is high.

The body cannot use glucose for

energy, resulting in tiredness and

weakness.

Source: American Diabetes

Association (ADA)

Rapid, deep respirations; Not manifested In poorly controlled GDM,

fruity odor especially if insulin is severely

lacking, the body breaks down fat

for energy, producing ketones.

Ketones cause metabolic acidosis.

The body compensates with

Kussmaul breathing (deep, rapid

breaths) to blow off CO₂.

One ketone (acetone) causes the

fruity odor.

38
 Sources:

ADA: Diabetic Ketoacidosis in

Pregnancy.

Guyton & Hall, Respiratory

System in Acid-Base Balance

Flushed, hot skin Not manifested Vasodilation can occur due to

increased blood sugar, leading to a
flushed appearance.
Dehydration from osmotic
diuresis can reduce sweating and
heat regulation, making skin feel
hot.

Source:
Harrison’s Principles of Internal
Medicine. Endocrine Disorders:
Diabetes Mellitus.

39
CHAPTER VI.
SUMMARY OF
SIGNIFICANT
FINDINGS
40
 SUMMARY OF SIGNIFICANT FINDINGS

SIGNIFICANT FINDINGS NURSING DIAGNOSIS

Gordon's 1.​ Acute Pain related to uterine

contractions and abdominal pressure

Gordon's #1 (Health Perception and Health secondary to arrested labor and

Management) failure of fetal descent (G1, G14, P1,

P10)

-the patient experiences consistent contractions. She

also has generalized body weakness and edema in both 2.​ Impaired Physical Mobility related to

feet edema and generalized body

weakness secondary to advanced

Gordon's #5 (Sleep-Rest Pattern) pregnancy and hospitalization (G1,

G4, PT, P11)

The patient's sleep is occasionally interrupted by

discomfort from the IV site and mild abdominal pain. 3.​ Diaturbed Sleep Pattern related to

Additionally, she had poor and inadequate sleep before physical discomfort from IV site and

41
admission. mild abdominal pain (G5, PT) up

Gordon's #4 (Activity-Exercise Pattern) 4.​ Imbalanced Nutrition: More Than

Body Requirements related to

-the patient has limited activity due to her current gestational diabetes mellitus and

health status and hospitalization Class 1 obesity (G10. Lab 2.3)

Gordon's #10 (Nutrition-Metabolic Pattern) 5.​ Anxiety related to pregnancy

complications and upcoming

The patient was diagnosed with Gestational Diabetes procedure (G14)

Mellitus at 34 weeks of pregnancy. She is currently

NPO in preparation for a procedure. 6.​ Risk for Infection related to presence

of indwelling urinary catheter and IV

Gordon's #11 (Elimination Pattern-Bladder) line (P1, G11)

-the patient is catheterized at her hospital. stay to

monitor intake and output.

Gordon's #14 (Sexuality-Reproductive Pattem).

Patient reports abdominal and lower back pain,

especially when stressed, and experiences arxiety

related to her pregnancy.

42
PHYSICAL ASSESSMENT

P1-GENERAL APPEARANCE

The patient appears visibly uncomfortable, likely due

to her advanced pregnancy and swelling in her feet,

which makes walking and standing difficult. She has

an intravenous (IV) line and an indwelling urinary

catheter in place, causing discomfort when touched.

P10-ASSESSMENT OF THE ABDOMEN

The abdomen is gravid and distended, appropriate for

37 4/7 weeks of gestation, with the patient reporting

mild abdominal pain. There is arrest in cervical

dilatation and failure of fetal descent indicating labor

is not progressing.

P11-ASSESSMENT MUSCULOSKELETAL

SYSTEM

There is significant edema noted in both feet, limiting

her ability to walk and stand Assessment of her lower

extremities is limited due to discomfort and swelling.

43
LABORATORY RESULTS

HEMATOLOGY RESULT

Lab 1.1 Increased Hemoglobin 22 g/dL

Lab 1.2 Increased Neutrophils 72.10%

Lab 1.3 Decreased Lymphocytes 10.70%

Lab 1.4 increased Monocytes 8.70%

Lab 1.5 = Decreased Eosinophils = 0.10%

URINALYSIS RESULT

Lab 2.1 Color Yellowish

Lab 2.2 Transparency Slightly Cloudy

Lab 2.3 Positive Sugar

CHEMISTRY RESULT

Lab 3.1 Increased Fasting Blood Sugar 133.6 mg/dL

44
 CHAPTER VII.
NURSING CARE
PLAN

45
 ​

CUES NURSING SCIENTIFIC PLANNING INTERVENTIONS RATIONALE EVALUATION

DIAGNOSIS RATIONALE (DESIRED (INTERVENTIONS)

(NURSING OUTCOME)

DIAGNOSIS)

Subjective: Acute pain Uterine contractions Short-Term Goal: ●Assess pain intensity ●Helps determine the The goal was met.
related to uterine during labor cause cervical using a standardized pain severity of pain and evaluate The patient reported
• Patient reports contractions dilation, which stimulates Within 1 hour of scale every 30 minutes and the effectiveness of pain pain was reduced
"Lisod kaayo, pain receptors and leads nursing interventions, during contractions. management strategies. from 8/10 to 3/10
sakit akong puson to acute pain. This the patient will: after nursing
kada hugot sa discomfort can interfere ●Encourage deep ●Promotes muscle interventions. She
tiyan, dili gyud ko Sub-problem: ● Demonstrate signs of breathing and relaxation relaxation, reduces tension, was able to nap for 1
with the patient’s ability
katulog og tarung Disturbed sleep to rest, contributing to comfort such as techniques during and enhances the body's hour without
ani." pattern reduced grimacing, contractions. ability to manage pain.
sleep disturbance. Poor interruption. Her
more relaxed posture,
sleep increases fatigue, mucous membranes
and decreased verbal ●Provide continuous ●Reduces anxiety, which can
lowers pain tolerance, and appeared moist, and
complaints of pain. emotional support and worsen the perception of
Objective: affects coping. Managing she looked more
reassurance. pain and interfere with rest.
both pain and sleep relaxed and
• Facial grimacing disturbances is essential ●Assist the patient to ●Position changes can relieve responsive after
and restlessness to promote comfort, Long-Term Goal: change positions pressure, enhance receiving care.
during conserve energy, and frequently to improve circulation, and reduce
contractions Within 7 hours of
support a smoother labor comfort. uterine discomfort.
nursing interventions,
process.
•Pain scale 8/10 the patient will: ●Apply warm compresses ●Heat application soothes
to the lower back or tense muscles and helps
• Guarding ● Verbalize improved
abdomen if appropriate. reduce pain intensity.
behavior and References: sleep and show signs
of adequate hydration,

46
clenched fists • NANDA International. such as moist mucous ●Administer prescribed ●Medication directly relieves
observed (2021). Nursing membranes and analgesics or epidural uterine contraction pain,
Diagnoses: Definitions and improved skin turgor. anesthesia as ordered. improving maternal comfort.
• BP: 120/90 Classification 2021–2023.
mmHg (elevated ● Monitor vital signs ●Ensures medication safety
diastolic) • Silbert-Flagg, J., & before and after analgesic and assesses physiological
Pillitteri, A. (2017). administration. responses to pain relief.
• HR: 86 bpm Maternal & Child Health
Nursing (8th ed.). Wolters ●Collaborate with the ●Ensures effective and
• Patient appears physician to adjust pain individualized pain control
Kluwer.
drowsy and management based on without overmedication.
irritable patient response.
●Enhances comfort by
● Work with the labor and integrating safe,
delivery team to provide complementary
non-pharmacologic pain interventions.
relief options.
●Ensures access to advanced
● Coordinate with pain management in a timely
anesthesiology for timely and safe manner
administration of epidural.

47
 CUES NURSING SCIENTIFIC PLANNING INTERVENTIONS RATIONALE EVALUATION

DIAGNOSIS RATIONALE (DESIRED (INTERVENTIONS)

(NURSING OUTCOME)

DIAGNOSIS)

Subjective: Fatigue Sleep deprivation Within 1 hour of ●Assess patient’s

● Patient related to impairs the body's nursing sleep patterns and ●Regular assessment The goal was met
reports, “Kapoy
sleep ability to restore interventions, the factors interfering helps identify patterns as evidenced by
kaayo akong
deprivation energy, leading to patient wil:l with sleep every shift. and causes of sleep the patient
lawas kay di ko
fatigue. Pregnant ●Demonstrate signs deprivation. showing
katulog og
women in the third of comfort and ●Provide a quiet and decreased
tarong tungod sa
trimester often reduced irritability dim environment ●A calm environment irritability and
kasakit ug
experience (e.g., relaxed facial during rest periods to reduces stimuli that can reporting
kasaba sa

palibot.” disrupted sleep expression, stable promote sleep. prevent restful sleep. improved energy

due to physical vital signs). levels after rest

Objective: discomfort and ●Encourage ●Relaxation techniques and nursing

anxiety, which Within 6 hours of relaxation techniques reduce anxiety and interventions.

●Patient’s worsens fatigue nursing such as deep promote natural sleep.

sleep duration

48
is less than 4 and affects daily interventions, the breathing or guided ●Position changes

hours in 24 functioning patient will: imagery before sleep. relieve discomfort that

hours. ●Report improved can interrupt sleep.

●Patient sleep quality and ●Assist the patient

appears increased energy with repositioning to ●Patient education

drowsy and levels, evidenced by improve comfort and empowers

less responsive more alertness and reduce pain self-management of

during participation in fatigue.

assessments. self-care activities. ●Educate the patient

●Vital Signs: Reference: about the importance

BP = 120/90 (NANDA-I, of sleep and suggest

mmHg 2021; Pillitteri, strategies for better ●Medications may be

(elevated rest. necessary to control pain

2017).
diastolic and enable rest.

pressure)

●Administer ●Monitoring ensures

prescribed analgesics patient safety after

or sedatives as medication use.

49
ordered to relieve pain

and facilitate sleep.

●Adjusting medications

● Monitor vital signs can reduce side effects

and level of that impair sleep.

consciousness after

medication ●Gentle exercise

administration. improves circulation and

reduces fatigue.

● Collaborate with the

physician to adjust ●Proper nutrition

medications if side supports energy levels

effects interfere with and prevents sleep

sleep disturbances caused by

hunger or discomfort.

● Coordinate with

physical therapy or

occupational therapy

50
for gentle exercises to

reduce fatigue.

● Work with dietary

services to schedule

meals that do not

disrupt sleep and

promote energy.

51
 SCIENTIFIC

NURSING RATIONALE PLANNING INTERVENTIONS RATIONALE

CUES DIAGNOSIS (NURSING (DESIRED (INTERVENTIONS) EVALUATION

DIAGNOSIS) OUTCOME)

● Fasting Risk for Pregnant women The patient will Educate the patient on To reduce postprandial Goal met if blood

blood sugar: unstable blood with GDM are at maintain fasting the importance of low glucose spikes and glucose levels

123.6 mg/dL glucose levels increased risk of blood glucose within glycemic index foods. improve glycemic remain within

(↑) related to glucose the target range of control. target ranges during

insulin intolerance due to 70–95 mg/dL Teach self-monitoring follow-up visits.

● Positive resistance hormonal changes throughout of blood glucose Enables early detection

sugar in secondary to affecting insulin pregnancy, as using a glucometer. of hyper/hypoglycemia

urinalysis gestational sensitivity. monitored during for timely correction.

diabetes each prenatal visit, Encourage consistent

● Diagnosis: mellitus. for the next 3 weeks. physical activity such Enhances insulin

GDM as walking after sensitivity and helps

meals. lower blood glucose

levels.

52
Administer insulin or To control elevated

oral hypoglycemics as glucose when lifestyle

ordered. alone is insufficient.

Monitor blood Identifies trends and

glucose levels before evaluates effectiveness

meals and at bedtime. of therapy.

Provides

Refer to a registered individualized,

dietitian for meal balanced diet essential

planning. for glucose regulation.

Collaborate with the Ensures appropriate

endocrinologist for titration of

medication insulin/medications.

adjustments.

53
 Reinforces lifestyle

Work with dietitian changes and glucose

and diabetes educator management skills.

for ongoing

counseling. Ensures maternal-fetal

well-being in response

Coordinate with to glucose control.

OB-GYN for

pregnancy

progression

monitoring.

54
 SCIENTIFIC

NURSING RATIONALE PLANNING RATIONALE

CUES DIAGNOSIS (NURSING (DESIRED INTERVENTIONS (INTERVENTIONS) EVALUATION

DIAGNOSIS) OUTCOME)

Subjective: Impaired Edema in the Within 2hours ● Assess pain level ● Helps tailor Goal was

Patient physical lower extremities patient will before and after intervention based on partially met as

verbalizes mobility causes tissue improve physical activity discomfort evidenced by

“Lisod kaayo related to swelling, mobility by swelling is

molakaw ug edema and discomfort, and walking with ● Encourage range of ● Maintains joint reduced,

motindog kay discomfort decreased assistance or motion exercise two flexibility and patient able to

hubag akong flexibility in the using assistive (2) times daily muscle tone ambulate with

tiil.” Sub-problem: joints, which devices and minimal

Risk for limits the patient's guided exercises. ● Encourage patient ● Early detection of assistance.

Objective: impaired skin ability to move to report changes in complications aids

integrity independently. As Reduce swelling or pain timely intervention

related to mobility becomes complications of

55
●​ Signifi decreased restricted, the risk immobility within ● Reposition every ● Prevents skin

cant mobility and for complications 24 hours of two (2) hours breakdown and

edema edema such as pressure implementation ● Administer enhances circulation

in both injuries and prescribed analgesics

feet impaired skin ● Manages pain that

●​ Visibl integrity ● Apply cold limits mobility

y increases. Prompt compress if ordered

uncom intervention is ● Decreases

fortabl necessary to ● Assist with inflammation and

e and restore function, ambulation using discomfort

limite manage swelling, assistive devices

d and prevent ● Ensures safe

mobili further physical ● Monitor intake and mobility with

ty decline. output and daily reduced risks of falls

weight

Reference:

56
Perry, S.E., ● Coordinate with ● Help access fluid

Hockenberry, dietitian for balance and

M.J., Lowdermilk, low-sodium diet effectiveness of

D.L., & Wilson, diuretics

D. (2022). ● Consult physician

Maternal Child for on going ● Manages fluid

Nursing Care (6th evaluation retention by reducing

ed.). Elsevier. sodium intake

● Guides adjustment

of treatment as

needed.

57
58
CHAPTER VIII.

DRUG STUDY

59
 GENERIC NAME MECHANISM INDICATION CONTRAINDICATION ADVERSE NURSING
OF ACTION EFFECTS CONSIDERATIONS

NAME: Metoclopramide is ● To prevent or ● Hypersensitivity to Extrapyramidal BEFORE:

metoclopramide a medication that treat nausea metoclopramide Symptoms
has been used to and (EPS) • consider different rights
vomiting perio ● Gastrointestinal to drug administration
treat
- Right assessment
gastrointestinal peratively. hemorrhage, obstruction, or ●​ Acute
- Right patient
(stomach / bowel) perforation dystonia - Right dose
● Used ●​ Akathisia - Right dose
motility issues, for
preoperatively ● Seizure disorders
nausea and to reduce gastric
DRUG vomiting caused ●​ Parkinso • monitor patient for
volume and ● Pheochromocytoma (risk of
CLASSIFICATION: by surgical nism involuntary movement of
acidity, hypertensive crisis)
Dopamine antagonists
helping prevent
●​ Tardive face, tongue and
operations,pregna
(D2 receptor blocker) dyskinesi extremities, which may
ncy, and to help aspiration
a indicate tardive dyskinesia
with lactation. pneumonia durin
or other extrapyramidal
g anesthesia
Metoclopramide is adversity effects
induction. GI:• Sedation or
used in pregnant drowsiness
DOSAGE: women to treat • monitor patient’s vital
10 mg IVTT •Diarrhea or signs and notify the
nausea, vomiting abdominal cramp physician of abnormalities
(especially
hyperemesis Endocrine: • obtain patients drug
gravidarum), and galactorrhea, history
acid reflux by gynecomastia,
improving menstrual
stomach irregularities
emptying. It is

60
generally DURING:
considered safe
for short-term use • Consider the different
rights to drug
during pregnancy. administration

- Right approach
- Right patient
- Right dose
- Right route

AFTER:

- Informed the patient to

avoid activities that require
alertness for 2 hours after
doses

- Urge patient to report

persistent or serious
adverse reactions promptly

- Teach patient signs and

symptoms of tardive
dyskinesia, other
extrapyramidal signs and
symptoms, and NMS.
Advise patient to
discontinue drug and to
seek immediate medical
attention if such signs and
symptoms occur

61
 - Advise patient not to
drink alcohol during
therapy
​
​

GENERIC NAME MECHANISM OF INDICATION CONTRAINDICATION ADVERSE NURSING

ACTION EFFECTS CONSIDERATIONS

NAME: Blocks H2 receptors on • Relief of Hypersensitivity to •headache BEFORE:

Ranitidine the gastric parietal heartburn, acid ranitidine or other
cells. Reduces indigestion, and H2-receptor antagonists • dizziness or - Assess patient for
secretion of gastric gastric lightheadedn abdominal pain
acid and lowers gastric reflux (common Use caution in patients with ess
DRUG impaired renal functions - Informed the purpose of
CLASSIFICATION:
volume and acidity. in pregnancy) • fatigue the drug
Histamine H2 This used to reduce
Antagonists stomach acid and treat • Treatment •diarrhea or - Check the doctors order
heartburn or GERD in and prevention constipation
pregnancy, of: - Assess for
•nausea hypersensitivities
●​ Gastroes ​
ophagea - Check IV site before
l reflux administration
disease
DOSAGE: • monitor patient for
(GERD)
50 mn IVTT involuntary movement of
●​ Gastric
face, tongue and
and extremities, which may
duodena indicate tardive dyskinesia
l ulcers or other extrapyramidal
●​ Hyperac adversity effects
idity and

62
dyspepsi • monitor patient’s vital
a signs and notify the
physician of abnormalities

• obtain patients drug

history

DURING:

- Explain to the patient the

function of the drug

- Monitor site frequently for

thrombophlebitis ( pain,
redness, swelling)

AFTER:

- Advice patient to report

abdominal pain, blood in
stool
- Or emesis, black , tarry
stool or coffee ground
emesis

63
CHAPTER IX.

DISCHARGE
PLAN

64
HEALTH TEACHING ●​ Restrict food and beverages high in sugar.
●​ Educate the patient on proper incision care, keeping the area
dry and clean by using warm, soapy water to wash the
incision daily.
●​ Educate the patient/SO on signs of infections such as fever,
foul-smelling discharge, and increasing pain at the incision
site.
●​ Teach the proper position and importance of breastfeeding.

ACTIVITY ●​ Encourage early ambulation.

●​ Encourage the significant other to assist the patient with gradually
increasing activity, starting with walking,ankle circles and pumps.
●​ Advise the patient to find ways to manage stress, whether through
relaxation techniques like deep breathing and meditation.
SIGNS AND ●​ Instruct the patient on signs of infection, such as fever, increased
SYMPTOMS
pain, redness, swelling, or pus drainage at the incision site.
●​ Provide information to the patient about the symptoms of
postpartum depression, such as mood changes, lack of interest,
persistent sadness, and encourage to seek help if needed.
MEDICATIONS
●​ Encourage the significant other/patient in adhering to the
doctor's prescription medication.
●​ Take the prescription drug as required.
INCISION
●​ Educate the patient/SO the proper care of the incision site by
gently wash the incision with mild soap and water, avoiding
harsh scrubbing, pat the area dry thoroughly and do not rub,
and avoid soaking the incision in baths or hot tubs until it's
fully healed.
●​ Instruct the patient/SO to inspect any signs of redness,edema
,ecchymosis, discharge, approximation of wound edges in the
incision site.

65
 ●​ Encourage the SO to assess the incision's integrity, noting any
separation of the wound edges or signs of excessive bleeding.
NUTRITION ●​ Instruct the patient to take a balanced, diabetic-friendly diet
such as
​ Eat plenty of fruits and vegetables such as apples,
avocados, and leafy greens.
​ Moderate amounts of lean proteins and healthy fats,
such as chicken breast, fish, and almond nuts.
​ Limit caffeine and avoid alcohol
​ Stay well-hydrated
​ Foods that are high in fiber such as Quinoa, and brown
rice.

ENVIRONMENT ●​ Advise the significant other to maintain cleanliness by

frequently cleaning surfaces and floors to minimize exposure to
dust and bacteria, Change and wash bed linens, towels, and
clothing regularly to prevent bacterial buildup.

●​ Ensure the surroundings are safe for ambulation and away from
any hazardous incident.

HEALTH TEACHING ●​ Restrict food and beverages high in sugar.

●​ Educate the patient on proper incision care, keeping the area dry
and clean by using warm, soapy water to wash the incision daily.
●​ Educate the patient/SO on signs of infections such as fever,
foul-smelling discharge, and increasing pain at the incision site.
●​ Teach the proper position and importance of breastfeeding.

66
CHAPTER X.

REFERENCES

67
 REFERENCES

Vanputte, et al., (n.d.). Seeley’s Essentials of Anatomy & Physiology. In Google Books; Eight Edition.
285-288

Johns Hopkins Medicine. (n.d.). Gestational Diabetes Mellitus (GDM). Retrieved from
https://www.hopkinsmedicine.org/health/conditions-and-diseases/diabetes/gestational-diabetes

Mayo Clinic. (n.d.). Gestational diabetes - Symptoms & causes. Retrieved from
https://www.mayoclinic.org/diseases-conditions/gestational-diabetes/symptoms-causes/syc-203
55339

Moon, J. H., & Jang, H. C. (2022). Gestational Diabetes Mellitus: Diagnostic Approaches and
Maternal-Offspring Complications. Diabetes & Metabolism Journal, 46(1), 3–14.
https://doi.org/10.4093/dmj.2021.0335

Rees, A., & Green, A. (2023). Cellular and Molecular Pathophysiology of Gestational Diabetes.
International Journal of Molecular Sciences, 25(21), 11641.
https://www.mdpi.com/1422-0067/25/21/11641

Wolters Kluwer, Nursing 2024 Drug Handbook

68
NAME CONTRIBUTION

DELOS REYES, KRISHNAH MAUREEN B. Physical Assessment

DOMAEL, RASHIENE E. drug study

DONOR, EUNICE PAULINE N. Discharge plan

DUJA, FRAN RODEUEL A. ncp

ENCINAS, ROSE ANGEL L. Pathophysiology

ESCAÑO, JEAN VERLYN J. Summary of Significant Findings

FLORENTINO, KYRIL MAE A. Introduction

GARCES, JENNY ROSE E. Lab Valies

GENESTON, JERAH BABE D. Gordons

GONTEÑAZ, ANTONET L. Anatomy and Physiology

GONTEÑAS, KIANA D. Pathophysiology

GUINOCOR, JANA G. Signs and Symptoms

INTIA, MARY CRIS A. Gordons

JACA, ADORA B. Ncp

JUNTILLA, JOHN CARLO Y. Pathophysiology

LIBRES, BHEA LOURAINE C. Signs & Symptoms-

MAHINAY, PRINCESS RUVY A. Summary of Significant findings

MAÑAS, MICHAELA V. Pathophysiology

MANGUBAT, LIZA MAE M. Anatomy and Physiology

MORENO, ALLIYAH MAE Summary of significant findings

NOVAL MICHELLE T. Signs and symptoms, NCP

69
NUNEZ, ANGELA Drug Study, Complete document revision and
organization

70