ATI Gestational Diabetes Care Plan

2020 [Type here] CARE PLAN NANDA Nursing DX 1. Risk for fetal injury related to Elevated maternal serum glucose levels. 2. Risk for maternal injury related to changes in diabetic control, abnormal blood profile, tissue hypoxia, altered immune response. Plan/ Goal 1. Client will display normally reactive NST and negative OCT and/or CTS during second trimester. 2. Client will remain free of complications during second trimester of pregnancy. ATI GESTATIONAL DIABETES CARE PLAN Interventions Evaluation 1. Assess fetal movement and fetal heart rate. Fetal movement 1. Goal met, client may be negatively affected when placental insufficiency and displayed maternal ketosis occur (Ackley). normal NST 2. Monitor fundal height each visit. Useful in identifying and negative abnormal growth pattern OCT/CTS (macrosomia or IUGR, small or large for gestational during second age [SGA/LGA]) (Ackley). trimester. 3. Monitor urine for ketones. Note fruity breath. Irreparable CNS damage or fetal death can occur as result of maternal ketonemia, especially in the third trimester (Ackley). 4. Provide information and reinforce procedure for home blood glucose monitoring and diabetic management. Decreased fetal/newborn mortality and morbidity complications and congenital anomalies are associated with optimal FBS levels between 70 and 96mg/dl (Ackley). 5. Monitor for signs of pregnancy induced hypertension (PIH). About 12 to 13% of diabetic individuals develop hypertensive disorders due to cardiovascular changes associated with diabetes (Ackley). 1. Assess client for vaginal bleeding and abdominal tenderness. Vascular changes associated with diabetes place client at risk for abruptio placentae (Ackley). 2. Monitor for s/s of preterm labor. Overdistention of uterus caused by macrosomia or hydramnios may predispose client to early labor (Ackley). 3. Assist client in learning home monitoring of blood glucose, to be done at least 4 times a day. Allows greater accuracy than urine testing because renal threshold for glucose is lowered during pregnancy (Ackley). 4. Request that client check urine for ketones daily. Ketonuria indicates presence of starvation state, which may negatively affect developing fetus (Ackley). 2. Goal met. Client remained free of complication s during second trimester of pregnancy. 2020 ATI GESTATIONAL DIABETES CARE PLAN [Type here] 5. Assess for presence of edema. Because of vascular changes, the diabetic client is prone to excess fluid retention and PIH (Ackely). 3. Knowledge deficit regarding diabetic condition, related to lack of exposure to information, as evidenced by clients’ questions/conc erns. 3. Client will participate in the management of diabetes during pregnancy. 1. Discuss importance of home glucose monitoring and the need for frequent readings. Frequent blood glucose measurements allow client to recognize the impact of her diet and exercise on serum glucose levels (Ackley). 2. Review reasons why oral hypoglycemic medications should be avoided. Although insulin does not cross the placenta, oral hypoglycemic agents do and are potentially harmful to the fetus (Ackley). 3. Explain normal weight gain to client. Total gain in the first trimester should be 2.5 to 4.5 lbs. then 0.8-0.9 lb./wk. thereafter (Ackley). 4. Provide information about the need for regular daily mild exercise program. Regular exercise may decrease insulin requirements (Ackley). 5. Discuss how client can recognize signs of infection. Important to seek medical help early to avoid complications (Ackley). 3. Goal met. Client participated in the management of diabetes during pregnancy.