Module A Case Study on Care Clients With Gestational DM

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1. Davao Doctors College General Malvar St., Davao City Nursing Program A Case Study on Care of Clients with Gestational Diabetes Mellitus   A Case Study Presented to the Nursing Clinical Instructors of Davao Doctor’s College In Partial Fulfillment of the Requirements in NRG 204: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (ACUTE AND CHRONIC)

2. Members: Nicolas, Marie Cristy Pagas , Tracy Fleur Pajulas , Zyla Faith Papica , Isaac Sabelo, Nathaniel Sarausa , Charmine Siarez , Patricia Mae Tan, Gwyneth Christine Varquez , Raphael Enrico Virgo, Ma. Sheenna (February 14, 2022)

3. TABLE OF CONTENTS I . Objectives i . General Objectives ii.Specific Objectives II. Introduction III. Patient’s Profile i . Biographic Data ii. Clinical Data iii. Past Health History iv. Present Health History v. Family History (with Genogram) IV. Health Assessment V. Review of Anatomy and Physiology VI. Course in the Ward/Treatment/Interventions i . Doctor’s Progress Notes ii. Laboratory/Diagnostic Examinations iii. Pharmacologic Management (Drug Study) iv. Surgical Management VII. Nursing Management i . Nursing Care Plan ii. Nurse’s Notes – CHECKLIST + FDAR iii. Clinical Reasoning Questions- Colaboration iv. Clinical Reasoning Questions- Ethico -Moral-Legal v. Discharge Plan VIII.Reference

4. I. GOALS AND OBJECTIVES General Objective The Bachelor of Science in Nursing 12G – Group 8 aims that within a week of modular activity and case study analysis, this group will be able to formulate a comprehensive case study on the topic Gestational Diabetes Mellitus. In participation of a learning the relevance and importance of overall health plan through case study analysis and organizing a drug study and nursing care plans with appropriate teaching and interventions. Thus, it would improve our knowledge and broaden or analytical skills in carrying out appropriate and effective Nursing Process Approach.

5. Specific Objective Within a week span of nursing care analysis, the following specific objectives will guide us to accomplish our general objectives. Specifically, the group aims to attain the following objectives: the student will be able to analyze the client’s case as a group; develop an appropriate and effective nursing care plan for our client; present the client’s past health history up to her present health condition status; define appropriate diagnosis for the client;

6. II. INTRODUCTION Diabetes mellitus, commonly known as diabetes, is a group of metabolic disorders characterized by a high blood sugar level over a prolonged period of time. Gestational diabetes is a type of diabetes that is first seen in a pregnant woman who did not have diabetes before she was pregnant. Some women have more than one pregnancy affected by gestational diabetes. Gestational diabetes usually shows up in the middle of pregnancy. Doctors most often test for it between 24 and 28 weeks of pregnancy. All women should be given information regarding what is gestational diabetes is all about, pregnant should be educated and understand about it appropriately because blood sugar that is not well controlled in a woman with gestational diabetes can lead to problems for the pregnant woman and the baby. Untreated gestational diabetes leads to increased maternal and perinatal morbidity. Treatment reduces these adverse pregnancy outcomes.

7. According to World Health Organization, in 2014, 8.5% of adults aged 18 years and older had diabetes. In 2019, diabetes was the direct cause of 1.5 million deaths and 48% of all deaths due to diabetes occurred before the age of 70 years. Between 2000 and 2016, there was a 5% increase in premature mortality rates (i.e. before the age of 70) from diabetes. In high-income countries the premature mortality rate due to diabetes decreased from 2000 to 2010 but then increased in 2010-2016. In lower-middle-income countries, the premature mortality rate due to diabetes increased across both periods. Gestational diabetes (GDM) is prevalent in the Philippines. Published data from the Asian Federation of Endocrine Societies Study Group on Diabetes in Pregnancy (ASGODIP) showed that the Philippines has a GDM prevalence of 14% in 1203 pregnancies surveyed.8 Because of this high prevalence rate, the Unite for Diabetes Clinical Practice Guideline (CPG) recommends universal GDM screening for the Filipino population.6 The ASGODIP data found that about 40.4% of high-risk women were positive for GDM when screening was performed beyond the 26th week of pregnancy.

8. The key to a healthy pregnancy for a woman with diabetes is keeping blood glucose levels in the target range—both before she is pregnant and during her pregnancy that’s why all women should be educated on the necessity of planning for pregnancy. Women with type 1 or type 2 diabetes should discuss pregnancy plans with their diabetes health-care team to assess general health and status of any diabetes-related complications. The aim of this study is to review the prevalence of diabetes and to describe extensively the characteristics of diabetes care from availability of diagnostics tests to the procurement of medications. Fundamental and transformative changes that increase diabetes awareness, emphasize lifestyle change while respecting cultural preferences and to improve overall diabetes care and outcomes. Fundamental and revolutionary reforms that boost diabetes awareness and encourage lifestyle modification.  

9. III. PATIENT’S PROFILE Patient profile contains a brief and important description of the patient or client such as biographical data which contains name, gender, marital status, date of birth, place of birth, school attainment, occupation and nationality; clinical data on the other hand contains chief complaint, time of admission, date of admission, room no., allergies, attending physician, and vital signs; past health history is a holistic assessment of all factors affecting a patient's health status; present health history is a current collection of organized information unique to an individual and family history is a record of the relationships among family members along with their medical histories. Thus, family history may show a pattern of certain diseases in a family.

10. Biographical data i i . Clinical data Name: Samut, Jedah Age: 42 years old Marital Status: Married Gender: Female Birthdate: January 05, 1980 Nationality: Filipino School attainment: Business Administration graduate Occupation: business woman Birthplace: Davao City Chief Complaint: irregular contraction coupled with lower back pain Date of Admission: January 15, 2022 Time of Admission: 8:00 AM Hospital: Davao Doctors Hospital Room No: 401a Allergies: food-shrimps Attending Physician: Dr. Ran Vital Signs taken upon assessment: Pulse rate: 99 bpm Respiratory rate: 23 cpm Temperature: 35.8 ˚C

11. iii. Past Health History No other reported diseases except for allergy to shrimp which she was only taking Cetirizine 10mg once a day at bedtime whenever needed as per her doctor’s order. She reported that she was able to received two doses of Tetanus toxoid and Tdap immunization. She was also given with Pneumococcal Polysaccharide Vaccine Polyvalent (Pneumovax) IM at 25 weeks AOG. The patient had a history of hospitalization (surgery) way back in 2013. Patient claimed that her gallbladder was removed because of gallstones.

12. iv. Present Health History Jedah is at 37 weeks and 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.

13. Family History Jedah is married to Paterno 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.  

14. IV. Health Assessment Health assessment is a plan of care that identifies the specific needs of a person and how those needs will be addressed by the healthcare system or skilled Name of Patient: Samut, Jedah Age: 42 years old Sex: Female Civil Status: Married Impression/Diagnosis: Gestational Diabetes Mellitus Date of Admission: January 15, 2022 Attending Physician: Dr. Ran Room No: 401a Date of Assessment: January 15, 2022  

15. Health History Chief Complaint: Dizziness Present health status: Patient has Gestational Diabetes Mellitus. Generally, patient looks pale, tired, and sleepy. Patient is hypothermic and tachycardic. Vital signs are the ff; BP: 130/80 mmHg, T: 35.8, PR: 99 bpm, RR: 23 cpm . Blood glucose level were checked result of 100mg/dL. Past health history: The patient had a history of hospitalization (surgery) way back in 2013. Patient claimed that her gallbladder was removed because of gallstones. No other reported diseases except for allergy to shrimp which she was only taking Cetirizine 10mg whenever needed as per her doctor’s order. Complete immunization and received tetanus toxoid from her in this pregnancy. Current Lifestyle: Patient manages their own business at their house. Patient does not eat much (e.g., half rice and drink more water).

16. Psychosocial status: Patient is anxious about her baby’s condition due to the sudden feeling of dizziness. Patient is also married to Paterno for almost 15 years and live in a 6-room-house in an exclusive subdivision. Family history: The patient’s family history reveals that her father and her father's sister has type 2 diabetes mellitus and 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. Gynecologic history (if applicable): Menstrual History (Usual Cycle) Interval: 28-30 days Duration: 3-5 days Amount of Menstrual Flow: Moderate to heavy flow Last Menstrual Period and LMP: April 25, 2021 Expected Date of Delivery EDD: January 30, 2022 History of Dysmenorrhea? [/] Yes [ ] No Gynecologic surgeries? [/ ] No [ ] Yes; pls. specify:

17. Physical Examination VITAL SIGNS AND ANTHROPOMETRIC MEASUREMENTS Blood pressure: 130/80 mmHg Height: 5 feet and 5 inches Heart rate: 99 bpm Weight: 170 lbs Pulse Rate: 99 bpm BMI: 28.3 Temperature: 35.8°c [X ] within ideal body weight (IBW) Respiratory Rate: 23 cpm [X ] less than IBW Others: Fundic Height: 38 cms Blood type: A+ Fetal Heart tone: 138-152 bpm [ ✓ ] more than IBW; specify: Overweight

18. General Survey Patient arrive name “ Jedah ” and was in sitting position there is no sign of difficulty in her position. Patient has fair-colored complexion skin but the patient looks pale, tired, and sleepy. Patient is conscious no sign of disoriented. Patient is awake and aware of the environment and was able to answer the question coherently. In addition, there is no attached IVF on the patient.

19. INTEGUMENT Skin The patient has fair-colored complexion. Pallor noted. Turgor snaps rapidly back to its normal position noted. Patient has soft and smooth texture and there is no sign of dryness. There is no sign of Lesions and scars. Head and Neck The patient’s head is rounded, normocephalic and symmetrical. Neck veins are visible, and no enlargement is noted. The neck muscles are equal in size, no palpable nodules. Mask of pregnancy is visible on the face and neck. No lesions noted. Eyes and Ears The pupils of the eyes are black and equal in size.

20. CARDIOPULMONARY Heart and Vascular Patient has Clear to auscultation in all lobes. Cardiac rate of 99 beats per minute bounding pulse has strong and regular. Blood type A+ Thorax and Lungs Respiratory Rate of the patient is 23 cpm . Lungs have normal breath sounds without dyspnea. The chest is symmetrical. There is no sign of difficulty in breathing when in sitting position but she reported that once in a while, difficulty of breathing is experienced especially when she is in supine position or flat on bed and doing household activity. No signs of crackles, wheezing, stridor.

21. GASTROINTESTINAL Abdomen Patient is pregnant. The abdomen is globular and a faint Linea nigra and stretch marks are still visibly noted. Fundic height: 39 cms . Vowel sounds is present. Able to digest food but like to consume fruits and vegetable. The patient is constipated, hemorrhoids are present. GENITOURINARY (GYNECOLOGICAL & BREASTS) Breasts Breasts are symmetric, no dimpling and discoloration noted, nipples and areolas are dark in color, according to the patient her breast seems to appear larger and firmer MUSCULOSKELETAL No pelvic girdle pain or back pain was noted. Extremities have a good range of motion, sometimes felt leg pain due to prolong standing at work and some varicosities were noted. No present edema. Low and upper extremities no edema noted.

22. SUMMARY OF SIGNIFICANT FINDINGS (Narrative): For the physical examination, for the preliminaries, the vital signs collected are BP 130/80 mmHg, PR 99 bpm, RR 23 cpm (Tachycardic), and Temp 35.8 degrees (Hypothermic). For the integumentary, the color of the skin is pale, and the texture is rough due to stretch marks. For the head, the head of the patient is symmetric is able to easily move around his head and neck. Shows that the neck veins are visible, and no enlargement noted, no edema noted, and some varicosities were noted. For the eyes, the pupils of the eyes are black and equal in size. For the cardiopulmonary, the Heart & Vascular assessment Cardiac rate of 99 bpm. For the Thorax & Lungs Chest is symmetrical, Difficulty of breathing experienced especially when she is lying flat on bed and doing household activity, no flaring noted, Lungs have normal breath sounds without dyspnea no signs of crackles, wheezing, stridor. and For the Gastrointestinal, Patient is pregnant and able to digest food but like to eats fruits and vegetable. Abdomen is globular, and shows a faint Linea nigra that are still visible. The Breasts are symmetric, no dimpling and discoloration noted. Nipples and areolas are dark in color. For the Genito-urinary & gynecologic, no edema was noted. For the Musculoskeletal, sometimes felt leg pain due to prolong standing at work, and bilateral symmetry and alignment.

23. For the Mental & Emotional status, the patient is aware of the environment and was able to answer the question coherently. And in the interview conducted with the patient she stated a lot of things and was able to effectively explain her condition.

24. V. Review of Anatomy and Physiology Anatomy and physiology are two of the most basic terms and areas of study in the life sciences. Anatomy refers to the internal and external structures of the body and their physical relationships, whereas physiology refers to the study of the functions of those structures. When a person has diabetes, they have high levels of blood sugar. Managing these levels can reduce the risk of excess blood sugar causing damage across the body. If glucose levels remain high, many health issues can arise

25.   CARDIOVASCULAR SYSTEM The heart is composed of two hearts: the right and   left heart . The right heart consists of the right atrium, which receives deoxygenated blood from the body, and the right ventricle which pumps it to the lungs under low pressure; and the left heart, consisting of the left atrium, which receives oxygenated blood from the lung, and the left ventricle, which pumps it out to the body under high pressure . High blood pressure is a risk factor for  heart disease . According to the Centers for Disease Control and Prevention (CDC),  74 percent  of adults with diabetes have  hypertension . Complications from macrovascular disease include: heart attack , stroke , peripheral arterial disease  

26. The nervous system is a complex network of nerves and cells that carry messages to and from the brain and spinal cord to various parts of the body, the nervous system includes both the Central nervous system and Peripheral nervous system. The central nervous system is made up of the brain and spinal cord, and the peripheral nervous system is made up of the Somatic and the Autonomic nervous systems. Neuropathy , or nerve damage, is a common complication of diabetes. According to the CDC, symptoms are most likely in people who have had diabetes for 25 years or more, but it can happen much sooner as well. Neuropathy can affect any part of the nervous system, including the nerves that control autonomic or involuntary functions, such as digestion. However, the most common form is peripheral neuropathy. This causes pain and numbness in the extremities, specifically: the legs, feet, and toes the arms, hands, and fingers Neuropathy can also affect the hips and upper legs. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) say that up to 50 percent of people with diabetes have peripheral neuropathy and more than 30 percent have autonomic neuropathy.

27. SKIN The skin is the largest organ of the body. The skin and its derivatives (hair, nails, sweat and oil glands) make up the integumentary system. One of the main functions of the skin is protection. It protects the body from external factors such as bacteria, chemicals, and temperature. Studies have  also found  links between the incidence of type 2 diabetes and  psoriasis . Ulcers can develop if a skin infection becomes severe. Ulcers are open wounds that are slow to heal. A person with high blood sugar levels may also have  high levels  of triglyceride, or fat, in the blood. This can lead to eruptive xanthomatosis , a rash of reddish-yellow lesions called xanthomas that can also be a warning sign for  pancreatitis . Calluses , foot sores, and dry skin can also pose problems. If wounds develop from these, ulcers can appear. Without attention, a foot ulcer can become dangerous, possibly resulting in the need for an amputation.

28. The kidneys are very important organs in the body. About one-third of all blood leaving the heart passes into the kidneys for filtration before being pumped to the cells and tissues of the body. When the kidneys malfunction, or if they stop working (kidney failure), it may lead to various complications such as fluid retention that can lead to edema or swelling of the extremities, pulmonary edema or fluid in the lungs   Over time, high blood sugar levels can damage blood vessels in the kidneys. This damage prevents the kidneys from filtering waste out of the blood. In time, kidney failure can result. The NIDDK describe diabetes as one of the main causes of kidney disease. It affects 1 in 4 people with diabetes. Diabetic nephropathy is kidney disease that affects people with diabetes  

29.   VI. Pathophysiology Pathophysiology is the study that addresses abnormal or detrimental changes in the physical and biological processes within the body caused by a disease process. Gestational diabetes mellitus (GDM) is a serious pregnancy complication, in which women without previously diagnosed diabetes develop chronic hyperglycemia during gestation. In most cases, this hyperglycemia is the result of impaired glucose tolerance due to pancreatic β-cell dysfunction on a background of chronic insulin resistance. Risk factors for GDM include overweight and obesity, advanced maternal age, and a family history or any form of diabetes which is the case of the patient her father also her father’s sister has type 2 diabetes mellitus.

30. Consequences of GDM include increased risk of maternal cardiovascular disease and type 2 diabetes and macrosomia and birth complications in the infant. There is also a longer-term risk of obesity, type 2 diabetes, and cardiovascular disease in the child. GDM affects approximately 16.5% of pregnancies worldwide, and this number is set to increase with the escalating obesity epidemic. While several management strategies exist including insulin and lifestyle interventions there is not yet a cure or an efficacious prevention strategy. One reason for this is that the molecular mechanisms underlying GDM are poorly defined. This review discusses what is known about the pathophysiology of GDM, and where there are gaps in the literature that warrant further exploration.

31. Definition of diagnosis GDM (gestational diabetes mellitus) is defined as any degree of glucose intolerance that develops or manifests during pregnancy. Women with GDM and their children are at a higher risk of getting type 2 diabetes later in life. Due to a lack of uniform diagnostic criteria, estimating the global incidence of GDM is difficult. There have been a number of diagnostic criteria offered. The high prevalence of diabetes mellitus (DM) and genetic predisposition to metabolic syndrome in Asians, particularly in Indian women, puts them at risk for GDM and associated consequences. As a result, a cost-effective universal screening and diagnosis procedure is required. (Rani P.R., & Begum J.2016)  

32. ii. Etiology

33. iii. Symptomatology

34. iii. Schematic diagram

35. iv. Narrative   The pathophysiology contains the study of cause and effects of the following content. This study of how illnesses influence the body's systems, resulting in functional changes that might lead to health problems. This chapter discusses etiology, which is the source or genesis of illness, and symptomatology, which is a group of symptoms that are distinctive of a medical condition or that a patient exhibits. How does it work inside our bodies with day to day especially we talk about the ones who are pregnant. The illness called Gestational diabetes mellitus is a disease that can be deadly to a pregnant woman in which women without previously diagnosed diabetes develop chronic hyperglycemia during gestation. The root cause of gestational diabetes mellitus. During pregnancy, your placenta produces hormones that create a buildup of glucose in your blood. Normally, your pancreas can produce enough insulin to meet your needs. However, if your body does not produce enough insulin or does not use insulin as it should, your blood sugar levels rise and you get gestational diabetes.

36. Etiology talks about its causes, factors and its justification or its development. Examples of these according to the data around the maternal age of women GDM is highly linked to maternal age. It has been stated that the risk of GDM rises dramatically as the mother's age rises. GDM affects 2.2 percent of women under the age of 25 and 14.7 percent of women over the age of 35. In the symptomatology shows the signs and symptoms if its present to the woman and its definition example at the data that the woman is fatigue positive so therefore insulin is required for cells to absorb glucose from the blood. Glucose is required to supply energy to the cells. When the cells do not receive enough glucose, fatigue and weakness might occur.

37. VII. Course in the Ward Medical Management ➢ Orders must be presented CHRONOLOGICALLY. ➢ Aside from the doctor’s orders, take note of the assessment notes made by the physician(s) of the patient being investigated

38. Laboratory/Diagnostic Examinations ➢ Include implications and relevant nursing considerations ➢ All laboratory and diagnostic tests performed for the patient must be included.

39. In the surgical administration of patients, nurses perform a lot of tasks a responsibility. Before, during, and after a surgical procedure, nurses look after the patient. As a result, the role of nurses in surgical management is the focus of this section iii. Pharmacologic Management (Drug Study) Individual

40. Nicolas, Marie Cristy

41. Pagas , Tracy Fleur

42. Pajulas , Zyla Faith

43. Papica

44. Sabelo

45. Sarausa

46. Siarez , Patricia Mae

47. Tan, Gwyneth Christine

48. Varquez

49. Virgo, Ma. Sheenna

50. Surgical Management (tabular) In the surgical administration of patients, nurses perform a lot of task and responsibilities. Before, during, and after a surgical procedure, nurses look after the patient. As a result, the role of nurses in surgical management is the focus of this section

51. VIII. Nursing Management   Nursing management consists of the performance of the leadership functions of governance and decision-making within organizations employing nurses. In this chapter we are going to tackle the Nursing Care Plans an individualized and comprehensive plan guiding the nursing care for a client; Nurse’s Notes including the checklist and FDAR (Focus Charting) is a medical note into a medical or health record made by a nurse that can provide an accurate reflection of nursing assessments, changes in patient conditions, care provided and relevant information to support the clinical team to deliver excellent care; Clinical Reasoning Questions is collection of cues, process the information, come to an understanding of a patient problem or situation, plan and implement interventions, evaluate outcomes, and reflect on and learn from the process; and, Discharge Plan is the process of identifying and preparing for a patient's anticipated health care needs after they leave the hospital.

52. i . Nursing Care Plan

53. Papica

54. Sabelo

55. Sarausa

56. Varquez

57. ii. Nu rse’s Notes – CHECKLIST + FDAR (Individual)

58. ii. FDAR (Individual)

59. Papica

60. Sabelo

61. Sarausa

62. Clinical Reasoning Questions-Collaboration You are assigned to a gravid woman at 34 weeks gestation diagnosed with GDM. On your third night duty, feeling tired & weary you checked the blood sugar level of the pt. and it reads 155mg/dL. As you are preparing the medication, you mistakenly prepared the wrong dose of units to be given, and forgets to re-check and compare it with e-MAR and pts chart (Doctors order). Instead of administering only 3 “units” of Novolog FlexPen , you turn it at 5 ‘units dose. You are worried that the dosage of the insulin given may have an effect to pregnancy. Using C-U-S as an assertive technique, what would you tell the ROD or attending physician to address this concern? Answer narratively.

63. Clinical Reasoning Questions- Ethico -Moral-Legal You are assigned in one of the barangay health center in your area as a volunteer nurse, a 40 year old woman approached you. Patient Xena G6P4A1, known to have a heredofamilial disease of diabetes confided to you that she intends to terminate the pregnancy (18 weeks AOG) as she is unsure of her health condition because of being diagnosed with GDM. She and her partner prompted to have this conception terminated because the last pregnancy almost caused her to lost her life due to a macrosomia delivery. She believed that is it better to not continue it for the reason that it is unplanned, and due to the scarcity of budget rearing children. What would be your nursing action in this scenario? What ethical-moral-legal principle is applicable in this scenario? Justify? Answer narratively. All patients have their own opinion in terms of their decisions in life. As a student nurse, autonomy is very important for us to practice. Where in, we should accept the client as a unique person.

64. If this is the case, we should tell first the possible outcome and the consequences of the action with veracity. Completely truthful is very beneficial for the patient even when it led to patient’s distress. With a thought, the nurse can make proper moves when confronted with a moral issue by comprehension and applying the moral rules gave in the American Nurses Association's Code of Ethics. Above all, nursing action should be accompanied with accountability. Where in the nurse must be responsible for one’s actions.

65. Discharge Plan MEDICATION Continue prescribed medication as ordered. Educate the patient with the purpose of each drug, right dosage and its side effects. Take medicines as prescribed by doctors.   EXERCISE Start some light exercise, taking a short walk. Exercise also can help boost energy level and mood. Don't overdo it and use up all your energy. Avoid heavy lifts. TREATMENT Inform the patient about the importance of follow up checkups to comply. include daily blood glucose testing and insulin injections

66. Hygiene   Foot Care and Diabetes Common  foot problems  can cause many complications, including  athlete's foot , fungal infections in nails,  calluses , corns,  blisters , ingrown toenails, and  plantar warts . While anyone can have these problems, they're more critical for people with diabetes because: If you have  nerve damage , you may not feel small wounds that need treatment. Poor blood flow can slow wound healing. Prevention tips: Make time for foot care daily. Wash, dry and examine the tops and bottoms of your feet.  Eye Care and Diabetes Diabetes can damage the blood vessels in the  eyes , leading to serious preventable problems like cataracts and glaucoma With a cataract, the eye's lens becomes cloudy, blurring  vision . While anyone can get  cataracts , they may develop at an earlier age -- and progress more quickly -- if you have diabetes. Glaucoma  occurs when pressure builds inside the eye due to fluid not draining properly. The pressure damages the eye's nerves and blood vessels, harming  vision Prevention tips: Prevent these problems from becoming serious by making sure your blood sugar is under control and see an eye doctor for an annual exam.

67. Check up   You may need to return to have your A1c checked every 3 months. You will need to have your feet checked during at least 1 visit each year. You will need an eye exam 1 time each year to check for retinopathy. You will also need urine tests every year to check for kidney problems. You may need tests to monitor for heart disease, such as an EKG, stress test, blood pressure monitoring, and blood tests. Write down your questions so you remember to ask them during your visits.

68. Diet   “Diabetes Plate Method” (American Diabetes Association, 2020) is a strategy to change portion size to larger amounts of non-starchy vegetables and smaller portions of starchy foods. Draw a line down the middle of the plate. Then, on one side, cut in half again, giving you a total of three sections. Fill 1/2 the plate with non-starchy vegetables. Add carbohydrates (whole grains and starchy vegetables) to fill 1/4 the plate. Add lean protein to the last 1/4 section of the plate. Choose water or a low-calorie drink.  

69. IX. Reference: Cardiovascular system: https://www.medicinenet.com/image-collection/heart_picture/picture.htm Centers for Disease Control and Prevention. (2015, September 16). Gestational Diabetes and Pregnancy. Centers for Disease Control and Prevention. https://www.cdc.gov/pregnancy/diabetes-gestational.html Diabetes and Pregnancy. (n.d.). DiabetesCanadaWebsite . https://www.diabetes.ca/health-care-providers/clinical-practice-guidelines/chapter-36#panel-tab_FullText Jones & Barlett Learning. (2021). Nurse’s Drug handbook. Sudbury, MA: Jones and Barlett Publishers Https://t.me/mebooksfree Laguipo , A. BSN: Anatomy of the Kidney: https://www.news-medical.net/health/Anatomy-of-the-Kidney.aspx Nervous System: https://www.news-medical.net/health/What-is-the-Nervous-System.aspx Patient Education: Diabetes, Prevention: https://shcc.ufl.edu/services/primary-care/self-help-resources/health-care-info-online/patient-education-diabetes-prevention/ Plows, J. F., Stanley, J. L., Baker, P. N., Reynolds, C. M., & Vickers, M. H. (2018). The Pathophysiology of Gestational Diabetes Mellitus. International journal of molecular sciences, 19(11), 3342. https://doi.org/10.3390/ijms19113342 Prelipcean , M. M.D. (2019) Effects of diabetes on the body and organs https://www.medicalnewstoday.com/articles/317483#nervous-system Ramin Fathi , MD, FAAD, Director: https://medlineplus.gov/ency/imagepages/19679.htm Rani, P. R., & Begum, J. (2016, April). Screening and diagnosis of gestational diabetes mellitus, where do we stand. Journal of clinical and diagnostic https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866200/#:~:text=Gestational%20Diabetes%20Mellitus%20(GDM)%20is,adverse%20maternal%20and%20prenatal%20outcome . World Health Organization. (2021, November 10). Diabetes. Who.int; World Health Organization: WHO. https://www.who.int/news-room/fact-sheets/detail/diabetes

70. THANK YOU !!