Reference no: EM133396241
Case Scenario: Patient with Gestational Diabetes Mellitus
Course in the Ward:
You are taking care of Zara, a 42-year-old primigravida woman, at 37 weeks 6 days gestation currently being seen at the nearest tertiary hospital. She was rush by her hubby because of irregular contraction coupled with lower back pain. Her weight is 170 pounds, and her blood pressure is 130/80 mmHg. Uterine size seems to be appropriate for gestational age as estimated.
Family Profile
Zara is married to Rendon for almost 15 years now. She is a Business Administration graduate. The couple manages four businesses in the city which include a flower shop, a coffee shop, restaurant and a farm. They live in a 6-room- house in an exclusive subdivision. Her family history reveals that her father and her father's sister has Type 2 diabetes mellitus. Her father's mother died of a cardiovascular disease. Her sister has asthma and she had a baby brother died at birth due to prematurity.
Obstetric/ Gynecologic History
This is Zara's first pregnancy. They've been trying to conceive for 12 years but failed. She was diagnosed as having primary infertility. Diagnostic work-up done to the couple- sperm cell analysis for Rendon and fertility work-up for Zara. All results came in unremarkable. Hence, she was advised to have at least 8 hours of sleep and to have a high protein diet. In vitro fertilization (IVF) was suggested which the couple agreed enthusiastically. It was successful after the first attempt. At 15 weeks AOG, while having a meeting with business associates, she experienced painful uterine contractions with no signs of bleeding. She was rushed to the hospital and admitted with a diagnosis of Threatened abortion. She was given Endometrin vaginal suppository BID, Isoxsuprine po TID, Vit C 500 mg OD, Calcium 500mg BID and Magnesium Sulfate IV incorporated to IVF for 2 cycles. She was discharged after 3 days.
Past Medical 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.
Menstrual History
Patient had her menarche @ 13 years of age. She had a regular menstruation which falls from 28-30 days cycle lasting 3-5 days, in moderate to heavy flow. She usually changes her pads 6-8 times a day and is soaked in the first 3 days and moderate to light flow in the succeeding days.
She experiences menstrual cramps (dysmenorrhea) in the 1st 2 days of menstruation but not all the time. Whenever she experiences the discomfort, she just took any over-the-counter pain reliever (Analgesics) for it. Her LMP was on May 1, 2022.
Physical Examination:
Generally, the patient looks pale, tired, and sleepy. Patient is hypothermic, and tachycardic.
Vital Signs:
BP: 130/80 mmHg
Temp: 35.8 degrees Celsius
PR: 99 bpm
RR: 23 cpm
Weight: 170 lbs
Height: 5 feet and 5 inches
Blood type: A+
Fundic height: 38 cms
FHT: ranges from 138-152 bpm via Doppler in Left upper quadrant. There were no variability noted when patient had her non-stress test a week ago at a nearby clinic.
Oral Glucose Tolerance Test
Last October 30, 2022 at 10am, she was ordered by the physician for OGTT. Prior to the test, the nurse initially check her blood glucose level and it reveals 100 mg/dL. She claimed that at 4Am she had her light snacks with a sandwich and a ½ cup of milk. Around 11am, she was loaded to drink 100grams of sweetened juice, and a fasting was enforce by the staff after that. An hour after drinking the fluid, a medical technologist took a specimen sample to check for her glucose level in the blood, it revealed 145 mg/dL. To verify the result of her blood sugar, another hour after the first test, on other site of vein, a sample was extracted and at this time, the result turns out to be elevated as well from the previous taken, it is 180mg/dL. The physician advised Zara on the treatment for her maintenance of blood sugar while on conception, she should follow the nutrition requirement, weight reduction and is encourage to do physical activity. On HGT monitoring pre and post meal. Follow the prescribed frequency and tapering of insulin injections.
At the beginning of the new year, Zara felt nervous, anytime soon she will have to deliver her baby. A month ago, Braxton hicks are most evident and sometimes it can be relieved by ambulation and activity. But 1 day prior to admission, her uterine cramping and contraction is active and she has the urge like defecating. She was then accompanied by her husband to the nearest hospital because she's worried and has apprehension of what to do, in childbirthing for the first time.