g diabetes mellitus
TRANSCRIPT
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TABLE OF CONTENTSI. INTRODUCTION...................................................................................................................................2
II. OBJECTIVES.........................................................................................................................................3
III. INITIAL DATABASE FOR FAMILY NURSING PRACTICE.....................................................................5
IV. HEALTH HISTORY...........................................................................................................................11
V. PHYSICAL ASSESSMENT....................................................................................................................12
VI. ETIOLOGY......................................................................................................................................15
VII. SYMPTOMATOLOGY.....................................................................................................................17
VIII. PATHOPHYSIOLOGY......................................................................................................................19
IX. DRUG STUDIES..............................................................................................................................20
X. TYPOLOGY OF NURSING PROBLEMS.................................................................................................26
XI. FAMILY COPING INDEX.................................................................................................................30
XII. RANKING AND PRIORITIZATION OF HEALTH PROBLEMS.............................................................32
XIII. FAMILY NURSING CARE PLANS.....................................................................................................33
XIV. NURSING THEORIES......................................................................................................................36
XV. SUMMARY OF HEALTH TEACHINGS..............................................................................................41
XVI. SYNTHESIS.....................................................................................................................................42
XVII. RECOMMENDATION.....................................................................................................................43
XVIII. BIBLIOGRAPHY..........................................................................................................................45
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I. INTRODUCTION
Pregnancy has long been recognized as a diabetogenic state whereby insulin sensitivity
decreases with advancing gestational age. Those who cannot meet the increased demands
usually develops diabetes. Diabetes is the most common medical complication of pregnancy.
(Philippine Journal of Internal Medicine, 2012)
Gestational Diabetes Mellitus or GDM, is a state where a woman without previously
diagnosed with diabetes displays high blood glucose levels during pregnancy. The difference of
GDM between DM is that pregnant women only acquire it. Not only is the mother at risk of
secondary complications, but also at the same time, so is the baby. Babies born to mothers with
gestational diabetes can have some complications after birth. Usually, these babies are large for
their gestational age or weigh more than normal that can cause delivery difficulties, problems
and complications.
GDM has been associated with a lot of adverse outcomes in which it puts a mother at a
much higher risk during pregnancy. Several studies have shown that hyperglycemia during
pregnancy may extend beyond the postpartum period between the mother and infant. According
to the Philippine Journal of Internal Medicine, women with gestational diabetes were found to
have a 20% to 50% risk of developing impaired glucose tolerance and Type 2 diabetes in the
next 5 to 10 years following pregnancy. Moreover, their child would be more likely to become
obese or diabetic later in life.
According to research by the Kaiser Permanent Center for Health Research, Filipinas
are at high risk for GDM. In the study covering different ethnic groups in the US, Filipinos, along
with Koreans, had the highest incidence of the condition among nearly 17,000 women aged 13
to 39 who were surveyed. (The Philippine Star, 2014)
The group decided to conduct a case study on this particular patient and condition
because of how it is a common complication of most pregnant women and of how it can lead to
many causes of secondary or adverse complications. Also, it is for the benefit of the group to
broaden their knowledge on the said disease through the data gathered.
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II. OBJECTIVES
General Objective
Within the four weeks of Community Health Nursing at the Matina Health Center,
the proponent should be able to present a comprehensive case study, particularly on a
high-risk pregnancy, which explains the condition and the appropriate medical and
nursing management regarding the state of the chosen client.
Specific Objectives
Cognitive:
List all necessary information regarding the chosen client’s family that is
associated to our case study by using the Initial Database as a tool;
Trace the family background of the client through generating a Genogram or a
Family Tree;
Ascertain the client’s past and present health history;
Distinguish the clinical significance and diagnostic tests that our client has
undergone including their implications, normal and abnormal values, findings for
comparison, and specific interventions associated with each diagnostic
procedure;
Evaluate the patient’s overall health condition through a Physical Assessment;
Identify the Etiology of the disease condition of the client;
Review the common Signs and Symptoms on of the disease condition and
compare it to the client’s circumstances;
Design the Pathophysiology of the disease condition of the client;
Identify the drugs prescribed to our client, including their actions, indications,
contraindications, side and adverse effects, and nursing responsibilities;
Organize the Nursing problems diagnosed from the client and further classify it in
the Typology of Nursing Problems;
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Measure the need of nursing care to the particular family by using the Family
Coping Index;
Rank the nursing problems as to the nature, modifiability, preventive potential,
and salience based on the client’s condition;
Formulate appropriate family nursing care plans and associate them with the
typology of nursing problems;
Identify the Nursing Theories that would most likely fit the client’s condition;
Summarize the health teachings given to the client during the nursing
intervention;
Synthesize the disease condition of the client up to the proponent’s practice
nursing interventions to the client; and
Prepare recommendations that will be supportive for the benefit of the Patient
and Friends, the Nursing Education, the Nursing Practice, and the Nursing
Research.
Psychomotor
Detect the client’s non-verbal communication cues and relate it to the sensitivity
of the conversation;
Display competence while dealing with the client;
Provide care based on the various nursing care plans formulated by the
proponents; and
Respond to the outcomes that the client has shown by distinguishing the positive
and negative results.
Affective
Actively listen with respect to the accounts of the client;
Show genuine and willingness in serving the client;
Develop a caring, non-judgmental, and therapeutic attitude towards the client and
significant others; and
Be aware of the client’s progress on the succeeding interactions.
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III. INITIAL DATABASE FOR FAMILY NURSING PRACTICE
A. Family Structure, Characteristics, And Dynamics 1. Demographic Data
Name Age SexCivil
StatusBirthdate Place of Residence
Alson Catcho Doria (Husband)
36 yrs. M MarriedFebruary 3,
1979 Shrine Hills
Emma Formentera Doria (Wife)
36 yrs. F MarriedMarch 11,
1979 Shrine Hills
Billy Doria (Nephew) 11 yrs. M Nephew - Shrine Hills
Alson Jr. Doria (Son) 3 mos. M SingleAugust 25,
2015 Shrine Hills
The couple got married on both Civil and Church on September 14, 2003. They are currently 14 years married. They have adopted the son of the Husband’s brother, or their nephew, since the baby was still three months old. The couple had attempted to have children twice but had two consecutive miscarriages both happened on the first day of the third month on both pregnancies. However, they have managed to have a baby on their third attempt, subsequent to their three month-old Son.
2. Type of Family Structure
The family is Egalitarian in nature wherein no gender dominance is evident in decision making. The household is also being comprised of a couple, their nephew, and their three month-old son. Thus, the family is considered to be an extended family wherein a nephew has been living together with the couple even before they have had their son.
3. Dominant Family members(Decision making in Health care)
In, the Doria family, the mother is the one who dominantly decides for the family. She is the one who handles the expenses and other budgeting of the family. She is also the one who decides on or about health care for the family.
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4. Educational Attainment of each member
Name Educational Attainment1. Alson Catcho Doria 1st year at Pantukan National High School2. Emma Formentera Doria 1st year at Pantukan National High School3. Billy Doria Grade 5 at Matina Central Elementary4. Alson Jr. Doria N/A
5. General Family Relationship
The family has a good relationship with each other. Their main core attitude as a family is patience and understanding. They built their family among these values to have a stable and good relationship in their family.
B. Socio-Economic, And Cultural Characteristics
1. Income And Expenses
Name Occupation Ave. Income/1month
Husband Bachelor Bus Driver15,000php (7,000 average/ 15days)
Wife Unemployed -Total: 15,000php
House Rent:800/month
Food: Viand: 100/day x 30 days = 3,000Rice: From company (1 sack for Free good for 2 mos)
Water Bill:150php/month
Electricity Bill:600/Month
Infant’s milk1,015php / 6 days = 5,075 / monthTotal Monthly Expenses: Php 9,625 php
Savings: 15,000-9,625= 5,375php
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2. Ethnic Background And Religious Affiliation
The Husband’s origin are Bul-anon, or the natives of Bohol. The origins of the wife’s origin is purely Cebuano. The wife was born as a Roman Catholic. The husband, on the other hand, was then an Adventist but converted himself into Catholism when both got married in the church.
3. Relationship Of The Family To The Larger Community
The family does not really participate on the activities of their barangay. They do not even know when the fiesta of their barangay is held on. However, they have gone to the day care center just a block away from their house.
C. Home And Environment
1. Floor Plan
800
3000
1506005075
5375
Monthly Budgeting
House rent Food Water Bill
Electric Bill Infant's milk Savings
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2. Housingi. Adequacy of Living space
Insert floor plan
ii. Sleeping arrangementThe husband, the wife and their son sleep beside each other in the living room of their house. The mother sleeps in between her husband and her son, so that it would be easier for her to take care of her son’s immediate needs. Their nephew sleeps alone in the master’s bedroom.
iii. Presence of Breeding or Resting sites of Vectors of DiseasesThere are presence of breeding sites at their backyard, a meadow is growing at the back of their house, there is also a compost pit located at the back of their dirty kitchen.
iv. Presence of accident hazards
1. The family’s house is located near an accident prone highway. It is hazardous especially for their nephew who is a preschooler.
2. Stray dogs and cats – Rabies, cat’s scratch disease and food contamination are potential diseases that can be acquired through the said vectors.
3. Mosquito breeding area – their backyard has this stagnant puddles where mosquitoes can breed.
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v. Food Storage and cooking facilities
Leftover foods are placed inside their refrigerator. They have a dirty kitchen outside their house, they use charcoal or firewood in cooking. They wash their dishes in a modified sink.*
vi. Water Supply
The family is the main source of water supply of their neighborhood and they just divide the payment of their bills. The family pays Php 150.00 for their water bill ever month.
vii. Toilet facility
The family has a water sealed toilet with a bathing area, the bathing area is located just beside their bedroom and kitchen sink. The toilet area and bathing area is separated by laminated shower curtain. Their septic tank is located outside the toilet area.
viii. Garbage Disposal
The family throws their garbage in a compost pit, but they collect it twice a week for the garbage trucks to pick it up. They practice proper waste disposal and segregation. The dry wastes are being burned, the wet ones are being collected.
ix. Drainage System
Their washing area has no proper drainage system. Thus, the used water from bathing, washing kitchen utensils is only flushed on the ground soil.
3. Kind of Neighborhood
The family is living in a shanty-surrounded compound which are mostly for rentals. These shanties are just part of the squatter. The neighborhood is located at the only hill in the heart of Davao City wherein mostly all of the Television and Radio Stations are also located on.
4. Social Health Facilities Available
The residence is just a block away from a day care center in which nurses and a physician usually goes on duty. The Health Center is also a kilometer away from their residence that is only just below the hill in which their house is located on.
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D. Health Status Of Each Family Member
1. Medical and Nursing History indicating current or past significant illnesses or beliefs and practices conducive to health and illness.
a. WifeThe wife underwent two miscarriages on the both on their 12 weeks before having their only son. The pregnancy of her only son had acquired her Gestational Diabetes Mellitus. The Obstetrical Score (GTPAL) of the patient would be G3 (1121).
b. Overall (family)
The family has no significant illness that affects them at current time. The Wife had Gestational Diabetes Mellitus when she was pregnant but does not have any serious illnesses at present. The family practices the administration of both herbal and traditional medications and become will but may affect her badly a future times.
2. Nutritional Assessement
a. Anthropometric data (SON)
Birth weight: 7.7 lbs. or 3.5 kg
Current weight: 15.4 lbs. or 7.0 kg
Current Height: 67 cm
Current Waist Circumference: 110cm
Current Hip Circumference: 114cm
Waist Hip Ratio: 0.96 (Not less than 1cm) therefore, Son is not obese
b. Dietary History
The three month old son has ended his exclusive breastfeeding on his first month and is being fed with Formula milk, particularly S-26 and Bonakid interchangeably. The 3-month old baby is usually fed ten times a day.
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E. Values, Habits, Practices On Health Promotion, Maintenance, And Disease Prevention
The family practices good food nutrition, eating vegetables, white meat and good
carbohydrates like rice. The Husband and the Wife does not drink alcohol and does not
smoke thus they prevent themselves from getting sick by having proper nutrition and
doing good hygiene and sanitation. The wife cleans the house daily to provide goof
environment for the children.
IV. HEALTH HISTORY
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Genogram
Legend:
- deceased
- GDM
A. Family Background
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The mother stated that the family has no history of illnesses.
B. Past Health History
A 36-year old pregnant woman, who was on her 3rd pregnancy and has had 2
miscarriages was seen for prenatal care at 26 weeks gestation. Her weight was 54.5kg
and her BP was 110/70. The patient’s past obstetric history includes spontaneous
miscarriage, both of it happened on the 12th week of gestation. Her family history
revealed that there were no history of past illnesses, as stated by the client.
On the 26th week of the mother’s pregnancy, she went to Friendly Care Clinic for her
regular pre-natal check-up. The doctor ordered her for laboratory tests. Upon
interpretation of the 2-hour postprandial glucose test, her results revealed 7.9mmol/L.
The mother was then diagnosed with Gestational Diabetes Mellitus. Afterwards, the
mother still continued going to her regular pre-natal check-ups.
On August 21, 2015, she went to a hospital in Pantukan because she stated that the
contractions were already strong. Upon arriving in the hospital, she was sent home by
the doctor since her dilatation was only 1cm. On August 22, 2015, she went back to the
hospital because the contractions were stronger. She gave birth on August 23, 2015, at
11:13AM to a 3.5kg Macrosomic baby boy.
C. Present Health History
The mother is a 3-month postpartum patient.
V. PHYSICAL ASSESSMENT
Patients’s Name: Emma Doria
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Age/Gender: Female, 36 years oldG3P1A2Post Partum Patient.
General Survey:
Vital signs of the patient are: body temperature of 35.7 C; pulse rate 82 beats per
minute with regular rhythm upon palpitation; respiratory rate of 27 cycles per minute
with regular rhythm; with equal expansion of the chest; blood pressure of systolic 130
and diastolic of 90 mmHg noted upon auscultation.
The patient’s age is congruent with her age. Her body is symmetrical all over. No
obvious deformities observed. She has a pear-shaped body and body fat is distributed
well, but mostly around the abdomen area due to post pregnancy (cesarian delivery).
She is able to move without difficulty; gaits and body movements are normal. The
patient has is well groomed. She is cooperative and pleasant. The patient’s clothing
choice is appropriate with her situation. She is awake and attentive; responds to
questions easily. Her voice is clear and loud enough, and speaks in a relaxed manner.
The patient’s breathing is unlabored and also maintains good eye-to-eye contact.
Skin, Hair, and Nails Assessment
Patient has brown skin complexion upon inspection. Hypertrophic scar secondary
to caesarian section approximately 9 centimetre long noted on the lower abdomen.
Skin is warm to touch, with good skin turgor, and with adequate moisture upon
palpitation. Body hair is fine and thinly distributed. Hair is medium in length, black with
brown highlights and some white hair are present and well-distributed. Scalp is white.
No lesions, swelling, and tenderness noted. Nails are short. Nail beds and nail plate are
slightly pinkish. Capillary refill of 1 second was noted. Melasma or chloasma was noted
at the armpit.
Head, Neck, and Regional Lymphatics Assessment
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The patient’s head is normocephalic. Facial features are symmetrical. No lumps and lesions noted. Frontal and zygomatic sinuses are palpable and non-tender. The skull is smooth and without masses. The scalp is shiny and intact. Her lips was red in colour due to her lipstick and well-hydrated. Trachea is in the midline. Thyroid tissue moves up with swallowing. No enlargement or masses noted. Lymph nodes are non-inflamed and non-palpable.
Eye Assessment
Eyes are symmetrical upon inspection. The patient’s eyelids are symmetrical with no drooping noted. Lid margins are smooth. Eyelashes are evenly distributed. Eyebrows are symmetrically aligned. Sclera is white with tiny vessels present. The cornea is moist and shiny. The pupils are dark brown in colour, equal and round. She is able to recognise size, shape and colours correctly. Patient doesn't use any correctional eyeglasses.
Ears, Nose, Mouth, and Throat Assessment
Both ears are in symmetric position and match the flesh colour of the patient’s skin. Also, tops of the ears are aligned with the outer canthus of the eye noted suggesting no signs of down syndrome. The patient’s tympanic membrane is pearly grey in colour. No foreign bodies, drainage, deformities, and lesions noted. She reported no history of ear pain, ringing of the ear, or ear infections. She does not use hearing aids to facilitate hearing. Nose is located in the midline of the face. Nasal septum is also located in the midline. No septum deviation, swelling, bleeding, lesions, or masses noted. The patient is able to breathe through her nose without difficulty. She is able to smell pleasant and foul odours suggesting that she has a great olfaction.The tongue was in the centre of the mouth; with papillae noted. Teeth are yellowish in colour, but natural looking. Also, the patient’s teeth are intact and complete.
Thorax and Lungs Assessment
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The patient’s thorax is symmetrical and moves easily through non-labored breathing. The chest movement is symmetric. No masses, lumps, and tenderness noted. The patient’s respiratory rate is 27 breaths per minute and regular in rhythm. No adventitious sounds heard. Depth of the respiration is normal and requires no effort.
Heart and Peripheral Vasculature Assessment
The patient’s pulse rate is 82 beats per minute. The pulse is consistent and palpable in the radial and carotid pulse sites. The pulse sites were easily palpable, and bounding. The patient’s pulsation had regular rhythm.
Abdominal Assessment
The abdomen is globular upon inspection.Skin in abdomen is intact with hypertrophic scar approximately 9 centimetre long secondary to cesarian section note on the lower abdomen. The abdomen have symmetrical movements caused by respirations. No masses and lesions noted. The patient didn’t feel any discomfort when assessment was being done. Client still put an abdominal binder on her lower stomach due to slight pain felt during cough.
Breast Assessment
There was engorgement of the breasts. Areola was darkened and wide subjectively verbalised by the patient.
Musculoskeletal System Assessment
The patient can move without difficulty. She has balance and can maintain control of her body. The client had non-purposeful movements.
Female Genitalia Assessment
The patient refused to let her genitals to be assessed.
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VI. ETIOLOGY
Predisposing Factors
Factor Presence Rationale JustificationFamily History X The risk of having gestational
diabetes mellitus increases if the woman has a close family member, such as parent or sibling who has type 2 diabetes.
The patient doesn’t have a diabetic family
member.
Personal health history
∕ A woman is more likely to develop gestational diabetes mellitus if she had it during a previous pregnancy. If she delivered a baby who weighed more than 9 pounds (4.1kg) or if the woman had an unexplained stillbirth. If the woman has a history of polycystic ovary syndrome.
The patient had two unexplained stillbirth.
Race / For reasons that are not clear, women who are black, Hispanic, American Indian or Asian are more likely to develop GDM
The patient is Hispanic-Asian, she is more likely to acquire
GDM
Age ∕ It has been observed that women age 25 and above are
more likely to develop gestational diabetes mellitus.
The patient got pregnant at the age
36.
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PRECIPITATING FACTORS
Factor Presence Rationale JustificationObesity/Excess
weightX A woman is more likely to
develop gestational diabetes mellitus if she is significantly overweight with a body mass index of 30 or higher.
The patient although had a feeling that she
gained weight, her records show that her
weight during her pregnancy is normal.
Sedentary Lifestyle
∕ Women who don’t engage themselves in increased physical activities may higher the risk of developing GDM.
The patient didn’t engage herself in
exercises.
Unhealthy diet X Poor diet may increase the risk of having GDM. The combination of a diet that was high in fibre and low glucose was associated with a halving of the risk of GDM.
The patient had a healthy diet, she
stated that she ate a lot of vegetables and
fruits during her pregnancy.
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VII. SYMPTOMATOLOGY
Source: http://www.ucsfhealth.org/conditions/diabetes_mellitus/signs_and_symptoms.html
There are three main types of diabetes:
Type 1 Diabetes: About 5 to 10 percent of those with diabetes have type 1 diabetes. It's an
autoimmune disease, meaning the body's own immune system mistakenly attacks and destroys
the insulin-producing cells in the pancreas. Patients with type 1 diabetes have very little or no
insulin, and must take insulin everyday. Although the condition can appear at any age, typically
it's diagnosed in children and young adults, which is why it was previously called juvenile
diabetes.
Type 2 Diabetes: Accounting for 90 to 95 percent of those with diabetes, type 2 is the most
common form. Usually, it's diagnosed in adults over age 40 and 80 percent of those with type 2
diabetes are overweight. Because of the increase in obesity, type 2 diabetes is being diagnosed
at younger ages, including in children. Initially in type 2 diabetes, insulin is produced, but the
insulin doesn't function properly, leading to a condition called insulin resistance. Eventually,
most people with type 2 diabetes suffer from decreased insulin production.
Gestational Diabetes: Gestational diabetes develops during pregnancy. It occurs more often in
African Americans, Native Americans, Latinos and people with a family history of diabetes.
Typically, it disappears after delivery, although the condition is associated with an increased risk
of developing diabetes later in life.
Common symptoms include the following:
Predisposing Factors:
Personal health history Race Age
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Precipitating history:
Sedentary lifestyle
Frequent urination
Excessive thirst
Unexplained weight loss
Extreme hunger
Sudden vision changes
Tingling or numbness in the hands or feet
Feeling very tired much of the time
Very dry skin
Sores that are slow to heal
More infections than usual
Some people may experience only a few symptoms that are listed above. About 50 percent of
people with type 2 diabetes don't experience any symptoms and don't know they have the
disease.
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VIII. PATHOPHYSIOLOGY
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IX. DRUG STUDIES
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Generic name Ferrous Sulfate + Zinc + Folic Acid +Cyanocobalamin
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Brand Names Sorbifer Durules; Aminofer FAClassification Iron in combination with folic acid/AntianemicDosage and Frequency Sorbifer Durules:
310 mg1-6 months of pregnancy: OD7-8 months of pregnancy: BIDAminofer FA:30mgOD
Mechanism of action Provide continuous release of active substance. Studies using the double-isotope technique have shown that iron administered I the form of ferrous sulphate durules is better utilized by the body than iron in ordinary tablets.
Indication Supplementing iron in the diet and preventing or treating low levels of iron in the blood.
Contraindication Contraindicated to patients with diverticular disease, ulcer from stomach acid, ulcerated colon, inflammation of the lining of stomach and intestines or patients with GI tract diseases/infections.
Side effects/Adverse effects
Constipation; Dark or green stools; diarrhea; loss of appetite; nausea; stomach cramps; pain or vomiting; yellowish teeth
Drug Interactions Antacids decrease iron absorption; iron decreases absorption of TETRACYCLINES,ciprofloxacin, ofloxacin; chloramphenicol may delay iron's effects; iron may decrease absorption of penicillamine. Food: Food decreases absorption of iron; ascorbic acid (vitamin C)
Nursing responsibilities Advise patient to take medicine as prescribed.• Caution patient to make position changes slowly to minimize orthostatic hypotension.• Instruct patient to avoid concurrent use of alcohol or OTC medicine without consulting the physician.• Advise patient to consult physician if irregular heartbeat, dyspnea, swelling of hands and feet and hypotension occurs.• Inform patient that angina attacks may occur 30 min. after administration due reflex tachycardia.Give on an empty stomach if possible because oral iron preparations are best absorbed then (i.e., between meals). Minimize gastric distress if needed by giving with or immediately after meals with adequate liquid.
Do not crush tablet or empty contents of capsule when administering.
Do not give tablets or capsules within 1 h of bedtime.
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Consult physician about prescribing a liquid formulation or a less corrosive form, such as ferrous gluconate, if the patient experiences difficulty in swallowing tablet or capsule.
Dilute liquid preparations well and give through a straw or placed on the back of tongue with a dropper to prevent staining of teeth and to mask taste. Instruct the patient to rinse mouth with clear water immediately after ingestion.
Mix ferosol elixir with water; not compatible with milk or fruit juice. Fer-In-Sol (drops) may be given in water or in fruit or vegetable juice, according to manufacturer.
Do not use discolored tablets.
Generic name/Brand name
Calcium + CholecalciferolCalvit Gold
Classification Mineral/VitaminsDosage and Frequency 1-2 tablets dailyMechanism of action Calcium and Phosphorous are the two major components of
bone. They are important in the metabolism of cells in the body and bone, therefore functions as a storage reservoir. Vitamin D is essential for promoting absorption & utilization of Calcium & Phosphate and for normal calcification of bone. It regulates serum Calcium concentration – a homeostatic mechanism. It stimulates Calcium & Phosphate absorption from small intestine and mobilize calcium from bone. Cholecalciferol is transferred to the liver & converted into Calcifediol (25 - Hydroxycholecalciferol) which then is transferred to kidneys & converted to Calcitriol (1, 25 – Dihydroxycholecalciferol).Calcitriol appears to act by: Increasing absorption of Calcium from the intestine; Regulates the transfer of Calcium ion from bone & re-absorption from distal
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renal tubule, Ionized Plasma Calcium level regulates the secretion of PTH. Therefore, Vit. D is included to increase Calcium absorption in Calcium Supplement for hypoparathyroidism.
Indication For prevention of osteoporosis, osteoarthritis, osteomalacia; for patients with hypocalcemia, chronic renal failure and hyperkalemia
Contraindication Patients with hypercalcemia, renal osteodystrophy with hyperphosphatemias; patients with hypersensitivity effects of Vit. D and breas feeding women – can cause hypercalcemia in infants.
Side effects/Adverse effects
S/E: ConstipationA/E: nausea/vomiting, loss of appetite, unusual weight loss, change of amount in urine, bone/muscle pain, headache, increased thirst, increased urination, weakness, and fatigue.
Drug interactions Calcium – containing preparation in high dosesDiuretics: ThiazideMineral Oils (reduce intestinal absorption)Digitalis (arrhythmia, hypercalcemia may potentiate Digitalis)
Nursing responsibilities Observe the 10 rights in drug administration Advise patient to keep all medical and laboratory
appointments Monitor progress and check for side effects Advise patient to always consult doctor Encourage patient to eat foods rich in vitamin D (e.g. dairy
products, eggs, sardines, chicken livers, and fatty fish. Tell patient about how sun can be a great source of
Vitamin D Encourage patient to eat foods that are rich in calcium Advise patient to take exercises Avoid cigarette smoking and alcohol consumption If the patient missed a dose, tell him/her to take it as soon
as he/she can remember, and do not double the dose to catch up.
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Generic name Multivitamins + Amino Acids
Brand name Moriami; MosvitClassification Multivitamins + MineralsDosage and Frequency 2 capsules/time TIDMechanism of action The action of vitamins varies widely among products and classes.
Moriamin has 8 vitamins and 11 amino acids,Indication Vitamins are used to correct and prevent vitamin deficiencies. For
patients who have protein deficiency, nutritional imbalance and hypovitaminosis.
Contraindication Hypersensitivity; HypervitaminosisSide effects/Adverse effects
A/E: Patient may experiences allergic reactions, difficulty in breathing, chest pain and extreme stomach ache.
Nursing responsibilities Ask if the patient has any sensitivity to any multivitamins. Administer or give antihistamine to patient when allergic
reactions occur. Educate patient of the possible side and adverse effects of
the multivitamins. Discuss with the patient what kind of nutrients she will get
from the multivitamins. Educate patient when and how much capsule she should
take per day. Tell patient not to take multivitamins with milk or antacids.
eneric name Dydrogesterone
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Brand name DuphastonClassification Non-androgenic steroidDosage and Frequency When treatment is started to arrest a bleeding episode
Duphaston 10 mg b.d.(twice a day) for five to seven days. For continuous treatment Duphaston 10 mg b.d. from day 11 to day 25 of the cycle. Withdrawal bleeding occurs if the endometrium has been adequately primed with either endogenous or exogenous estrogen.
Mechanism of action
IndicationIn the management of conditions associated with progesterone insufficiency: dysmenorrhoea, endometriosis, infertility, irregular menstrual cycles and pre-menstrual syndrome.
The drug may be used with an estrogen in the management of dysfunctional bleeding or secondary amenorrhoea, or in association with estrogen in hormone replacement therapy.
Contraindication Known hypersensitivity to the active substances or to any of the excipients; Known or suspected progestogen dependant neoplasms; Use in patients with undiagnosed irregular vaginal bleeding; Contraindications for the use of estrogens when used in combination with dydrogesterone
Side effects/Adverse effects
nausea, bloating, breast pain, irregular bleeding,dizziness, weight gain, skin rash and itch.
Drug interactions The metabolism of progestogens may be increased by concomitant use of substances known to induce drug- metabolising enzymes, specifically cytochrome P450 enzymes, such as anticonvulsants (eg. Phenobarbital, phenytoin, carbamezapine) and anti-infectives (e.g. rifampicin, rifabutin, nevirapine, efavirenz) and herbal preparations containing e.g., St John's Wort (Hypericum perforatum), valerian root, sage, or gingko biloba; Ritonavir and nelfinavir, although known as strong inhibitors, by contrast exhibit inducing properties when used
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concomitantly with steroid hormones; Clinically an increased metabolism of progestogens may lead to decreased effect and changes in the uterine bleeding profile.
Nursing responsibilities The medicinal product does not require any special storage condition
Any unused product or waste should be disposed of in accordance with local requirements.
X. TYPOLOGY OF NURSING PROBLEMS
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FIRST LEVEL OF ASSESSMENT
1. Readiness for Enhanced Capability for Parenting
The Wife has an adequate knowledge about parenting because of her adopted son, Nephew. She took care of him when he was still a baby, but like many parents, she still has to improve her way of parenting, as she is still 36-years old and technically a first-time mom.
2. Presence of Health Threats
1. Accidental Hazards
Their house is located at the side of the street and where many cars are travelling during nighttime, and when sometimes or even mostly, drivers are drunk. Also, they have a falling hazard because of the hammock where the baby sleeps wherein it may have a tendency to loosen up.
2. Faulty Nutritional Habits or Feeding Practicesi. Ineffective Breastfeeding
The Wife only breastfed the Baby for a month and then switched to artificial formula or bottle-feeding. This is because, as the Wife stated that the Baby easily gets fed up or “umay” and has insufficient milk production.
3. Poor Home Conditioni. Inadequate Living Space
For the four of them in the family, their house is quite small because they can’t fit in the master’s bedroom. In the master’s bedroom, sometimes the Nephew sleeps alone and the rest of them sleep on the living room’s floor. Their living room is located just right beside their dining room and with a lot of furniture.
ii. Presence of Breeding Sites of Vectors of Disease
At the back of the house, they have an accumulation of garbage and have an open bathing area wherein it can be a breeding site for mosquitoes and rodents. They can acquire diseases such as leptospirosis, aschariasis, dengue, and etc.
iii. Poor Ventilation
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With their living room just right beside their dining room, and also with a lot of furniture, their house is congested. Not just because of the inadequate living space, but also, because of the temperature of the house when the group went there during the afternoon.
iv. Air Pollution
With the house located at the side of the street and a lot of cars passing by, the smoke that the cars let out contains chlorofluorocarbon. CFC is considered as a pollutant because of its harmful effects to the ozone layer and also, humans. Their way of cooking is by using wood, and by some research, they say that burnt wood can be carcinogenic when inhaled.
4. Foreseeable Crisis
i. Additional Member
The Wife doesn’t use any family planning methods, which in turn could be a factor for a possible or unplanned pregnancy. This can be a foreseeable crisis, because even though the Husband’s salary is sometimes more than enough, as their children grow old, their needs would also become increasingly in-demand and fast-paced.
ii. Divorce/Separation
With the Husband always at work and goes to a lot of places, the Wife stated that she sometimes have doubts of the Husband might have or possibly have an affair with another woman.
SECOND LEVEL OF ASSESSMENT
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1. Inability to make decisions with respect to taking appropriate health action due to:
i. Failure to comprehend the nature/magnitude of the problem/condition
The Wife has a knowledge about diabetes and GDM as her doctor explained it to her when she was first diagnosed but she doesn’t have enough understanding of how serious it is and how it can affect her life and her baby’s. As she stated that she treats the Baby as a normally delivered boy.
2. Inability to provide adequate nursing care to the sick, disabled, dependent, or vulnerable/at-risk member of the family due to:
i. Lack of/inadequate knowledge about disease/health condition
The Wife doesn’t have enough knowledge and understanding about her condition of having GDM and that the Baby is macrosomic. According to the Philippine Journal of Internal Medicine, women with gestational diabetes were found to have a 20% to 50% risk of developing impaired glucose tolerance and Type 2 diabetes in the next 5 to 10 years following pregnancy. The child would also be more likely to become obese or diabetic later in life.
ii. Lack of/inadequate knowledge and skill in carrying out the necessary interventions/treatment/procedure
The Wife treats the Baby as normal and doesn’t have any problems, which in turn, makes her not aware of some interventions that can make the Baby be prevented of becoming obese or diabetic later in life. A factor that can contribute is the way she bottle-fed the Baby after just a month of breastfeeding. Bottle-feeding is considered as an artificial formula and has lower nutritional value/benefits. Some artificial formulas have high sugar content and can contribute or be a factor for the baby to acquire diabetes later in life or become obese.
3. Inability to provide a home environment conducive to health maintenance and personal development due to:
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i. Lack of/inadequate knowledge of importance of hygiene and sanitation
The family’s backyard has an accumulation of garbage, which can be a potential vector for diseases and also, they don’t practice proper segregation. They have a “bodega” beside their front door and looked as though it hasn’t been cleaned for weeks because of how dusty it is.
ii. Lack of/inadequate knowledge of preventive measures
The Wife doesn’t see the presence of the problem, and doesn’t have any idea of how to currently handle or fix it. The main problem is where their house is at the side of the street and has a high-risk for experiencing car accidents.
iii. Lack of skill in carrying out measures to improve home environment
The Wife doesn’t want to move to a new place because as she stated, she is much more comfortable living in that community because it is where they lived for a long time. The Husband also agrees.
XI. FAMILY COPING INDEX
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Area Scale Jusitification
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Physical independence: This category is concerned with the ability to move about to get out of bed, to take care of daily grooming, walking and other things which involves the daily activities.
5
The family receives necessary care to maintain
cleanliness, including skin care. Although there is
present infant in the family, the parents are able to
support him in terms of daily grooming and eating.
Therapeutic Competence: This category includes all the procedures or treatment prescribed for the care of ill, such as giving medication, dressings, exercise and relaxation, special diets.
5
Due to the learnings from recent check-ups and health teachings from their private clinic, health center, and day care center; the family is able to demonstrate that they can carry out the prescribed procedure safely and efficiently, with the understanding of the principles involved and with confident and willing attitude.
Knowledge of Health Condition: This system is concerned with the particular health condition that is the occasion of care
3 The Wife knows the salient facts about her gestational disease as informed by her Obstetrician. However, the family barely knows the effects of the wife’s illness on the baby she had conceived.
Application of the Principles of General Hygiene: This is concerned with the family action in relation to maintaining family nutrition, securing adequate rest and relaxation for family members, carrying out accepted preventive measures, such as immunization.
3 The surroundings of the house, especially at the back portions, is filled with unsegregated garbage. Nevertheless, the family eats a proper meal three times a day thus makes sure that they leave no left overs. The husband however, cannot get enough rest due to his hectic work schedule on bus driving. The baby also received his measles immunization at the health center recently.
Health Attitudes: This category is concerned with the way the family feels about health care in general, including preventive services, care of illness and public health measures.
5 The family understands underlying factors of the wife’s gestational illness and recognizes the need for medical care thus having frequent pre-natal examinations in her private clinic as much as possible. The wife also accepts her limits on having Gestational Diabetes Mellitus by regulating the intake of high glucose content foods.
Emotional Competence: This category has to do with the maturity and integrity with
5 The family, along with their adopted child, are able to do things together with integrity and maturity. The core attitude of the family, which is patience and
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which the members of the family are able to meet the usual stresses and problems of life, and to plan for happy and fruitful living.
understanding, helps them to meet the usual stresses and problems of life, along with planning for happy and fruitful living.
Family Living: This category is concerned largely with the interpersonal with the interpersonal or group aspects of family life – how well the members of the family get along with one another, the ways in which they take decisions affecting the family as a whole.
5 Although, arguments would be natural in a family, both the mother and the father tries to settle their misunderstanding without any physical treatments or abuses, and they would not have any unfinished arguments that would last for a day..
Physical Environment: This is concerned with the home, the community and the work environment as it affects family health.
1 The household is located on top of a hill and just beside a high-speed road. They are highly vulnerable to landslides and automobile-related accidents.
Use of Community Facilities: generally keeps appointments. Follows through referrals. Tells others about Health Departments services
1 The mother did not visit her Obstetrician for her follow-up check-up scheduled one week after her last C-section delivery even though it is mandatory for her to do so as for also undergone on Bilateral Tubal Ligation after her Cesarean-section delivery.
Total Scale:
Scaling Indicators34 – 45 Mildly need of Nursing care
21–33 Moderately need of Nursing care9 – 20 Fully Need of Nursing care
33 Analysis: the family is moderate need of Nursing Care. The nursing care specified for the family is further analyzed in the computation of the Prioritization of the Problems.
XII. RANKING AND PRIORITIZATION OF HEALTH PROBLEMS
Faulty Nutritional Habits or Feeding Practices – Ineffective Breastfeeding
Score Highest Score Possible
Weight Total
Nature of the Condition or Problem Presented
2 3 1 0.67
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Modifiability of the Condition or Problem 1 2 2 2
Preventive Potential 2 3 1 1
Salience 2 2 1 1
Total = 4.67
The faulty nutritional habits was given a score of 4.64 because its nature of the
problem is considered as a health threat. The Wife only breastfed the Baby for a month,
and then switched to bottle-feeding which in turn would show that the nutritional value
that the Baby gets was lowered because of how it is only an artificial formula and that
breastfeeding is considered to be the best option for a mother to give to her baby and
not bottle-feeding.
Presence of Breeding Sites of Vectors of Disease
Score Highest Score Weight Total
Nature of the Condition or Problem Presented 2 3 1 0.67
Modifiability of the Condition or Problem 2 2 2 2
Preventive Potential 3 3 1 1
Salience 1 2 1 0.5
Total = 4.17
The presence of breeding sites of vectors of disease as a health threat has a
score of 4.17. Their garbage disposal is not segregated and it is just piled up. It can be
an area for rodents to stay in. There is also stagnant water under their lavatory, which
may be a breeding site for mosquitoes. Its salience is 1 since the family doesn’t
perceive it as a problem.
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Poor Ventilation – Congested
Total = 3.84
The poor ventilation, because of being congested, as a health threat has a score of 3.84. It has
a modifiability of 2 since it is easily modifiable. The family can lessen their furniture to avoid
being congested and they can open their doors and windows to promote proper ventilation. It is
also moderately preventable. Its salience is 1 since the family doesn’t perceive it as a problem.
Readiness for Enhanced Capability for Parenting
Total = 3.67
The readiness for enhanced capability for parenting has a score of 3.67 because of how
its modifiability has a scale of 1, as the Wife already has an experience of parenting through the
Nephew but still has a lot to learn when it comes to her own baby because of technically being a
first-time mom. She already had 2 miscarriages which entails that she didn't take care of herself
well and also, the fetus that she was carrying. A parent should be able to provide the highest
attainable level of care to her child, whether he/she is still in her womb or is already born.
Score Highest Score Weight
Total
Nature of the Condition or Problem Presented
2 3 1 0.67
Modifiability of the Condition or Problem 2 2 2 2
Preventive Potential 2 3 1 0.67
Salience 1 2 1 0.5
Score Highest Score Weight
Total
Nature of the Condition or Problem Presented
3 3 1 1
Modifiability of the Condition or Problem 1 2 2 1
Preventive Potential 2 3 1 0.67
Salience 2 2 1 1
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Accidental Hazard
Total = 3.34
The accidental hazard as a health threat has a score of 3.34 because of how its
modifiability is 1 or poor. The scale of 1 was given because of how the Husband and Wife
doesn't want to move out of the place and as stated, is comfortable with the environment and
surrounding. Another reason is that they have already lived in that place far too long and cannot
afford to have a resettlement because of the act of adjusting or adapting to a new home.
Score Highest Score Weight
Total
Nature of the Condition or Problem Presented
2 3 1 0.67
Modifiability of the Condition or Problem 1 2 2 1
Preventive Potential 2 3 1 0.67
Salience 2 2 1 1
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XIII. FAMILY NURSING CARE PLANS
Problem # 1: presence of breeding places for mosquitoes, flies and rodents
Health Problem
Family nursing problem
Goal of care
Objective of care Nursing intervention Method of family contact
Resources required
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PRESENCE OF BREEDING PLACES FOR MOSQUITOES, FLIES AND RODENTS
Inability to provide a home environment conducive to health maintenance and personal development dueto:
1. Ignorance ofthe importance of hygiene and sanitation.
2. Lack of knowledge of regarding preventive measures
Goal:
After nursing intervention thefamily will be able to eradicatethe presence of these unwanted sites of vectors causing diseasesand therefore will maintain a home environment conducive to health.
After nursing intervention thefamily will:
a. acquire adequate information about the disease, including signs and symptoms of the disease, immediate health care assistance and preventive measures
b. Be aware and be more knowledgeable about the importance of proper sanitation especially at home.
c. Be able to eliminate the
presence of these breeding sites for mosquitoes, flies and rodents.
d. recognise the causes of breeding sites such as to prevent the occurrence of diseases
- Discuss the importance and purposes of proper sanitation
- Cite the causes and
effects of the
prevalence of these unwanted pests around the home.
- Suggest
alternatives/methods
that would eliminate
the breeding sites of
vectors.
- Explore with the
family the ways of
improving home
sanitation considering
its limited resources:
a.emphasise to the familythe proper storage of foodthat may attract vectors b. instruct all familymembers to preventaccumulation of stagnantwater around their homesince this is a good breeding place for insects- Implement the health
teaching for the
environment of the
community such as
operation linis in
order for them realise
the importance of
sanitation.
- Encourage maintainingcleanliness by regular cleaning of the surrounding area of their house.
- HOME
VISITS
Material resources: such as coloured plastic bags for segregation, brooms , boxes for dried garbage and grass cutter for eliminating breeding sitesof vectors.
Human resources: Time, cooperation and effort of the family and the student nurses
Financial resources: Expenses for teaching aids and transportation of student nurses
Health Problem
Family nursing problem
Goal of care Objective of care Nursing intervention Method of family contact
Resources required
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Inadequate living space
Inability to provide a home environment conducive to health maintenance and personal development due to lack of skill in carrying out measures to improve home environment
After the nursingintervention the familywilldevelop ways onhow to minimize theproblem as evidencedby rearrangement offurniture to maximizetheir living space
After nursingintervention the familyshould be able:a.) Identify risk factorsthat contribute to thecongestion in the areasuch as unused things.b.) Demonstratetechniques to promotegood environmentcondition such asproper arrangement ofappliances, etc.c.) Verbalizeunderstanding about theimportance of havingadequate living space
1. Suggest ways on how tomaximize the available living spaceby re-arrangement.2. Advise the family to separatethings they don’t use anymore.3. Inform the family regarding theeasy transmission of disease due toinadequate space.4. Explain to the family possibleeffects of having inadequate livingspace.5. Explain to the family advantagesof having adequate living space.6. Aid the family in maximizing theliving space
HOME
VISITS MaterialResources:-Visual Aids andlow-costmaterials neededfor the actualdemonstration
HumanResources:-time and efforton the part of thenurse and family
Problem # 2: Inadequate Living Space 1st level of assessment: poor home condition due to inadequate living space 2nd level of assessment: inability to provide a home environment conducive to health maintenance and
personal development due to lack of skill in carrying out measures to improve home environment
Problem #3: Accident Hazard as a Health Threat
Health Problem
Family nursing problem
Goal of care Objective of care
Nursing intervention
Method of
family contact
Resources required
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Accident Hazard as a Health Threat
Presence of Accidenthazards
I. Inability to makedecisions with respectto taking appropriatehealth action due to:
A. Failure tocomprehend thenature/magnitude of theproblem/condition
B. Low salience of theproblem and condition
II. Inability to providehome environmentconducive to healthmaintenance andpersonal developmentdue to:
A. Lack of familyresources
B. Inadequateknowledge of preventives measures
After the nursing intervention the family willbe able torecognise theproblem andknow somemeasures tolessen therisk for accidents.
After nursing intervention thefamily will able:
1. recognisethe presenceof environmentalhazardsas a threat
2. identify ways to modify their environment and make itless vulnerableto causeaccidents.
3. enumeratesomesafetymeasures to lessen the occurrence of accidents.
1. Assist the familymembers in identifyingthose accidentalhazards present intheir environmentto let them aware thatthese aretreats in their health.
2. Discusswith the familythe changesthat they maydo in theenvironmentto decreasethe cause of accidentssuch as toput a fence in front of their house.
3. Encouragethe familymembers totakeprecautionarymeasuressuch asprohibiting thechildren toplay near theroad.
HOME
VISITS
MaterialResources:-Visual Aids andlow-costmaterials neededfor the actualdemonstration
HumanResources:-time and efforton the part of thenurse and family
XIV. NURSING THEORIES
Orem’s Theory of Self Care Deficit Source: http://nursingtheories.weebly.com/dorothea-e-orem.html
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Orem developed the Self-Care Deficit Theory of Nursing, which is composed of
three interrelated theories: (1) the theory of self-care, (2) the self-care deficit theory, and
(3) the theory of nursing gsystems.
The focus of Orem’s model is to enhance the person’s ability for self-care and
this also extends to the care of dependents. A person’s self-care deficits are the result
of environmental situations. The basic premise of the model is that individuals can take
responsilbiity for their health and the health of others. Generally, individuals have the
capacity to care for themselves of their dependents. It is based upon the philosophy that
“all patients wish to care for themselves.” (Bautista, 2008)
On her two miscarriages, the patient had experienced self-care deficit by not
supplying her regular prenatal and by simply not knowing she had already a case of
GDM on her first two pregnancies. However, on her third pregnancy, as soon as the
patient was able to identify GDM on herself through a physician’s diagnosis, she
managed to become aware and to supply self-care not just for herself but also for the
wellness of the baby, she have had maintained her regular check-ups to her doctor,
taking her medicines and keeping up its maintenance such as insulin therapy, cutting
oily and high sugar diet, and maintaining good lifestyle through regular exercise.
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Figure 1: Dorthea Orem’s Self-Care Deficit Theory, retrieved from
www.nursingtheories.weebly.com
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Roy’s Adaptation Model
Sister Callista Roy’s Adaptation Model centers on the person as a biophysical
adaptive system that employs a feedback cycle of input (stimuli), throughput (control
processes), and output (behaviors or adaptive responses). The model assumes that the
systems of matter and energy progress to higher levels of complex self-organization.
(Bautista, 2008)
In using this model, the participant is looked at as a constantly changing
individual that if affected by its environment. Some of the stimuli that will be taken into
effect will be the group environment (in clinic), the home environment, the family unit,
the culture, individual differences in perceptions, socio-economic status and previous
health status.
Figure 2: Roy’s Adaptation Model, retrieved from www.schoolworkhelper.net
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Leininger’s Transcultural Nursing Theory
According to Leininger’s Theory, culture refers to the values, beliefs, norms,
patterns and practices of an individual or a group of similar individuals (Oulu University
Library, 2000). The culture is described as said to be learned behaviors by group
members of any specific culture and transmitted to other group members inter-
generationally. Using this theory, we are able to incorporate the specific needs of the
Latin culture, behaviors, food preferences, beliefs, and preconceived ideas about
nutrition and pregnancy as well as the importance of family involvement and other
cultural ideas. It is important to be able to bring the education to the women and their
culture in order for them to accept it and fully embrace the concepts being taught.
Figure 3: Leininger’s Transcultural Nursing Model retrieved from www.
nursingtheories.weebly.com
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XV. SUMMARY OF HEALTH TEACHINGS
The health teachings were given after the house visit in order to achieve the goals of the Family Nursing Care Plan.
1. Concerns on Maternal Health
2. Pregnancy and Postpartum care
3. Proper Hygiene
4. Proper Hand washing
5. Diet and Nutrition
6. Prenatal check up
7. Children’s health and Immunization
8. Environmental Awareness and Sanitization
9. Importance of Natural Family Planning
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XVI. SYNTHESIS
In line with the information gathered, our patient was diagnosed of Gestational
Diabetes Mellitus (GDM). Thus, GDM was given emphasis during the course of the
case study. With these, there is a need to monitor the client’s condition in terms of signs
and symptoms, as well as the degree and severity of its occurrence only during
pregnancy, so as to collaboratively intervene to stabilize the patient. However the
progress and fast recuperation of the client depends on the onset of the condition during
pregnancy, therefore modifications in activities, exercise and diet particularly in taking
food that are rich in sodium, should be avoided. There is also a need for the patient, as
well as the family members, to watch more closely in monitoring and assessing her and
her baby’s condition well to avoid further complications.
We have performed physical assessment and have documented the family
history by constructing a family genogram to trace the possibilities of the occurrence of
the disease, identified actual and potential health problems of the family, prioritized
health problems according to its respective nature, magnitude, modifiability,
preventative potential, and salience, enumerated and classified the drugs that was
given to the patient and associated its action or effects to the patient, reviewed the
anatomy and physiology of the affected organs and system, comprehended and traced
the pathophysiology, evaluated the effectiveness of the interventions performed and the
care rendered, recognized the course in the community and appropriate nursing
interventions to be done, provided nursing theories and recommendations regarding
with patient’s case, and evaluated the objectives of the study in the end.
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XVII. RECOMMENDATION
To Patients and Friends
Having a first baby is a very fulfilling event for a mother, particularly for our
patient who had experienced miscarriage twice before having her current baby. We
would recommend the wife in the family to focus on rearing on her son first. Let her be
also considerate of the potential health risks she can acquire on getting pregnant. Thus,
we commend the couple to be consulted in a family planning clinic in order to prevent
any unwanted pregnancies that might be detrimental to her health.
May the family support and nurture their three-month old son in order to let him
fully grow and develop as a normal child without attaining any mental or physical
illnesses on the duration of his childhood. May the family give his basic needs
complementing the encouragement of rights of every child living our world.
To Nursing Education
The group would like to recommend the Ateneo de Davao University – School of
Nursing to maintain its excellence. May the high spirit, knowledge and skills of the
clinical instructor be an inspiration to the student nurses, and continue to help them
surpass challenges, guide them to success, and teach them how an exemplary nurse
should be.
The Ateneo de Davao University – School of Nursing should continue to mold
students to be effective in the knowledge and skills and may they continue to nourish
the student nurses’ minds and help them become competent nurses in the future, may
they continue to mentor student nurses how to be effective in their attitudes toward the
clients.
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To Nursing Practice
Exposures in the community strengthened the meaning of being a Student
Nurse. It unlocks certain opportunities for the Student Nurses to handle real situations in
the community and allow them to deal and interact with different types of families, and
also apply Nursing knowledge and skill. In order to properly provide health actions, the
student nurse should be patient and willingly able to assist in certain situations when
required.
To Nursing Research
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XVIII. BIBLIOGRAPHY
Websites: http://www.ucsfhealth.org/conditions/diabetes_mellitus/
signs_and_symptoms.html http://nursingtheories.weebly.com/dorothea-e-orem.html
http://www.philstar.com/health-and-family/2012/10/09/857444/improving-medical-care- diabetic-moms
http://pcp.org.ph/documents/PJIM/Volume%2048%20(2010)/Number%201%20(JanuaryJune)/Prevalence%20and%20Risk%20Factors%20of%20Gestational%20Diabetes%2Mellitus.pdf
http://nursingcrib.com/nursing-notes-reviewer/maternal-child-health/gestational-diabetes/
http://pcp.org.ph/documents/PJIM/Volume%2048%20(2010)/Number%201%20(Januar yJune)/Prevalence%20and%20Risk%20Factors%20of%20Gestational%20Diabe es%20Mellitus.pdf
Theoretical Foundations of Nursing. Dorothea E. Orem: Self-Care Theory. URL: http://nursingtheories.weebly.com/dorothea-e-orem.html
Theoretical Foundations of Nursing. Sister Callista Roy: Adapation Model. URL: http://nursingtheories.weebly.com/sister-callista-roy.html
Theoretical Foundations of Nursing. Madeleine Leininger: Culture Care Diversity and Universality URL: http://nursingtheories.weebly.com/madeleine-m-leininger.html
Diabetes Mellitus. Signs and Symptoms. URL: http://www.ucsfhealth.org/conditions/diabetes_mellitus/signs_and_symptoms.htm
Books:
Maglaya, A. S. (Year of publication). Title of work: NURSING PRACTICE IN THE COMMUNTY FOURTH EDITION. Marikina City: Argonauta Corporation.
Bautista. 2008. Theoritical Foundation of Nursing. A Beginner’s Journey Into Professional Nursing.
Gestational Diabetes - Nursing Crib. URL: http://nursingcrib.com/nursing-notes-reviewer/maternal-child-health/gestational-diabetes/
Improving medical care for diabetic moms. URL: http://www.philstar.com/health-and-family/2012/10/09/857444/improving-medical-care-diabetic-moms
Uy, Cunanan & Silva. 2010. Philippine Journal of Internal Medicine. Prevalence and Risk Factors of Gestational Diabetes Mellitus at the University of Santo Tomas Hospital.
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