DATE/ ASSESSMENT NEED NURSING PLAN OF NURSING INTERVENTION/RATIONALE EVALUATION

SHIFT DIAGNOSIS CARE

03-04- SUBJECTIVE: NUTRITIONAL- Altered short term: 1.Teaching the importance of regularity of Short term:
20 “hilig ko mo METABOLIC nutrition: less -After 30mins meals and snacks when taking insulin. After 30minsof
kaon og sweet PATTERN than body of health health teaching
@ ma’am of fast requirements teaching, Rationale: Eating very frequentsmall meals improveinsulin function the patient is able
8:00 foods. related to patient will be to verbalized
am gestational able to 2.Refer to Reistered dietician to individualized diet and counsel regarding dietaryquestions. Her understanding
diabetes verbalized her About
OBJECTIVE: understanding Rationale: Diet specific is necessary to Gestational
-Decreased about maintain normoglycemia and to obtain desired weight gain. Diabetes,
respiratory rate gestational
- dry mouth diabetes 3.Assess understanding of the effect of stress on diabetes. Teach patient about stress Long term:
-weak and pale management and relaxation measures. After a week
Long term: of nursing
Vital signs taken -After a week Rationale: It is proven that stress can increase serum blood glucose levels, creating Interventions the
as follow of nursing variations in insulin requirements. patient is able to
T: 36.0 intervention Demonstrate her
PR: 86 the patient will 4. Observe for the presence of nausea and vomiting, especially during the first trimester. improved
RR: 16 be Behavior and
BP: 100/80 able to Rationale: Nausea and vomiting may be brought about by a deficiency in carbohydrates, lifestyles
demonstrate which may result in the metabolism of fats and development of ketosis.
There is a an
present of improved 5. Assess understanding of the effect of stress on diabetes teach patient about stress
protein in the behavior and management and relaxation measures.
urine. lifestyle
Rationale: It is proven that stress can increase serum blood glucose levels, creating
variations in insulin requirements.

6. Teach the importance of regularity of meals and snacks (e.g., three meals or 4 snacks)
when taking insulin.

Rationale: Eating very frequent small meals improves insulin function.

7. Recommend monitoring urine ketones on awakening and when a planned meal or snack
is delayed.
Rationale: Insufficient caloric intake is reflected by ketonuria, indicating a need for an
increased intake of carbohydrates or additional snack in the dietary plan. The presence of
ketones during the second trimester may reflect “accelerated starvation” as the diminished
effectiveness of insulin results in a catabolic state during fasting periods

8. Adjust diet or insulin regimen to meet individual needs.

Rationale: Prenatal metabolic needs change throughout the trimesters, and adjustment is
determined by weight gain and laboratory test results. Insulin needs in the first trimester are
0.7 unit/kg of body weight.

9. Ascertain results of HbA1c every 2-4weeks.

Rationale: Provide an accurate picture of average serum glucose control during the
preceding 60 days. Serum glucose control takes six weeks to normalize.

10. Coordinate multispecialty care conference as appropriate.

Rationale: Provides an opportunity to review the management of both pregnancy and

diabetic condition, and to plan for special needs during intrapartum and postpartum
periods.