STUDY LOG 1: OBJECTIVE CHECK
1. A 35-year-old G1P0 is 20 weeks’ gestation with a past medical history of hypertension.
Her pregnancy has been uneventful; however, at today’s appointment, her blood pressure
was 150/100 mmHg at first check and 15 minutes later was still 136/90 mmHg. She is
also complaining of light-headedness and palpitations.
A. What actions should the nurse take?
As per priority, the nurse should administer antihypertensive medications
such as nifedipine, labetalol, methyldopa, according to the physician’s order.
Next, the nurse has to monitor the vital signs of the patient and fetal heart rate in
regular intervals. Lastly, the nurse should assess for any presence of swelling on
the face and hands of the patient.
B. What change should this patient be encouraged to do?
The patient should be encourage to make lifestyle changes such as
modifying eating habits, and observing an active lifestyle. She has to observe a
low sodium and fat diet, avoid supplements and medications that are not
prescribed by her physician, and exercise regularly according to the doctor’s
order. To replenish her body, she is to be encourage to drink plenty of fluids, and
avoid caffeine intake. Additional changes include an 1800- to 2400-calorie diet,
divided into three meals and three snacks, which is a usual regimen for a woman
with diabetes during pregnancy. In order to maintain serum glucose levels she
needs to observe the above-stated calorie diet.
C. What are the expected outcomes?
Expected Outcomes:
The patient will maintain an acceptable blood pressure level
The patient will be able to verbalize the importance considering nutrition,
exercise, and home monitoring of glucose levels during pregnancy.
The patient will state the significance of healthy eating and regular
exercise to her condition.
2. The patient is 23 years old with a 15-year history of type 1 diabetes mellitus. She has
come into the clinic because she had a positive home pregnancy test result. She is
currently using an insulin pump and her glucose levels have been under adequate control.
She is excited but also nervous about being pregnant. She shares that one of her great-
aunts died when she was pregnant because of her diabetes.
A. What nursing care plan will be appropriate for this patient?
The nursing care plan appropriate for this patient is one that focuses on
Type 1 diabetes mellitus as the problem. As one of the interventions, the nurse
should center her attention on helping the patient establish an HbA1c of less than
48 mmol/L. Also, the nurse should assist the patient in controlling the blood sugar
in the first 8 weeks of pregnancy. Preventing the occurrence of hypoglycemia and
hyperglycemia is also a must for the patient’s and fetus’ safety.
B. What nursing diagnoses will be appropriate in this case?
Specific nursing diagnoses applicable for this case includes:
Deficient knowledge related to unfamiliarity with the condition and
dietary modification as evidenced by statements of concern.
Risk for maternal injury related to changes in diabetic control.
Risk for fetal injury related to changes in diabetic control.
Risk for unstable blood glucose related to the presence of Type 1
Diabetes/ deficiency of hormone insulin.
C. What information can the nurse share with this patient to reassure her about a
successful pregnancy and birth?
The patient may feel reassured when the nurse explains to her that with
proper maintenance of blood sugar, a pregnant woman can give birth safely and
successfully. With this, the patient has to be educated to eat healthy and nutritious
foods, maintain an adequate body weight, instructed on how to use the insulin
pump as per physician’s order, and be advised to do regular follow-up on her
condition with her physician.
3. The patient is a 19-year-old African American female, G1P0, who has come to the clinic
for her second visit. When reviewing her lab, the patient has been told she is positive for
sickle-cell disease. Her hemoglobin is 8 mg/100 ml. The patient is understandably upset.
A. What are some immediate concerns for this patient?
The normal hemoglobin level of an adult woman should be around 12-16
mg/mL, therefore the patient has a very low hemoglobin level with 8 mg/mL.
This is an immediate concern and one that calls for a blood transfusion to replace
the sickle celled RBC to new and healthy RBCs. Since the patient is diagnosed
with sickle-cell disease, she is at risk for developing high blood pressure
(eclampsia). To reduce this risk, a low dose of Aspirin must be administered
starting 12 weeks of gestation. And, since she has to be blood transfused, the
blood needs to be screened for RH antibodies for the safety of the patient and her
baby.
B. What patient teaching should the nurse prepare to conduct?
The nurse should include in the patient teaching the important self-care
activities that address her condition. She should be advised to include variety of
fruits and vegetables, eggs, beans, and whole grains in her diet. She also needs to
take adequate amounts of folic acid to build healthy red blood cells. Lastly, the
patient teaching should also emphasize the importance of a regular follow up
schedule with the patient’s physician and the significance of a hospital delivery.
C. What nursing care will be appropriate in this case?
The nursing care appropriate for this patient include the prevention of
complications, monitoring of the patient’s diet and adequate fluid intake, and
examining the patient’s lower extremities for blood pooling in leg veins. Care
should be given to address the prevention of complications that may lead to
maternal morbidity such as severe anemia, heart failure, maternal infections and
those that might lead to fetal morbidity and mortality like poor fetal growth and
pre-term birth, and fetal death.
