1.Make the pathophysiology of gestational diabetes mellitus.
1.Make the pathophysiology of gestational diabetes mellitus…. 1.Make the pathophysiology of gestational diabetes mellitus. Conduct a comprehensive hypothetical case analysis on the given case scenario Mrs. Diaz , a 35-year-old obese female patient, G2P1 (1001), came in to the Emergency Roomwith a chief complaint of body weakness and dizziness. She verbalized, “agkapsutak nga kaslaagpulpuligos iti lawlaw ko”. He is restless and noted to have cold clammy skin.Initial vital signs revealed:Blood Pressure: 130/80 mmHgPulse Rate: 110 beats per minuteRespiratory Rate: 24 breaths per minuteTemperature: 36. 9oC per axillaUpon history taking, she presented with a three-month history of intermittent feeling of thirst and hunger for no reason. She further claimed, “alisto nak mawawaw ken mabisbisinan uray kuma kapangpagan ko.”Her diet history reveals excessive carbohydrate intake in the form of bread, pasta and rice. Her normal dinners consist of 2 cups of rice and three to four slices of wheat bread. She also eats eight to ten pieces of fresh fruit per day at meals and as snacks. She prefers chicken and fish. Her husband has offered to make her plain grilled meats, but she finds them “tasteless.” She drinks 12 oz. of soda every meal. She stopped smoking more than 10 years ago.Further, she claimed that both his parents died due to complications of diabetes. The resident on-duty ordered stat CBG and yielded 184 mg/dL with a normal reference range of 65-109 mg/dL.Based from the information gathered through interview, physical assessment and records review, shewas admitted with the diagnosis of: G2P1 (1001) PU 27 5/7 weeks AOG, T/C Gestational Diabetes MellitusAdmission Orders 3/23/20022 @8:00am? Please admit to High-Risk Pregnancy Unit ? Secure consent for admission and management ? TPR q shift and record ? DM diet ? Hook IV Fluid: PNSS 1 L – fast drip 200 cc STAT then regulate to 8 hours ? IVF TF: PNSS 1L x 8 for 2 cycles ? Diagnostics: – CBC with APC – Urinalysis (UA) – Fasting Blood Sugar with Lipid Profile – Serial CBG monitoring TID pre-meals – HbA1C – OGTT on the 3rd day of admission ? Therapeutics: Humulin R 5 units SQ now Metformin 500 mg/tab – 1 tablet TID ? Continue monitoring ? Refer accordingly C. J. CRUZ, MD, FPOGS OB-Gynecologist License No. 12345Remarkable results of several diagnostic procedures were in and referred to the attending physician.Diagnostic Tests Reference Ranges ResultsFasting Blood Glucose 65 – 109 mg/dL 178 mg/dLHbA1C 4 – 6 % 8.1 %Urinalysis (Urine Microalbumin) <30 mg 32 mgOGTT (on the 3rd day of admission) Below 140 mg/dL 200 mg/dLThe capillary blood glucose monitoring of the patient for his 2-day hospital confinement is reflected below:hospital daytime of the dayResults(Reference Range: 65-109 mg/dL)1Initial RBS (ER)184 mg/dLPre-Lunch150 mg/dLPre-Dinner152 mg/dL2Pre-breakfast111 mg/dLPre-Lunch104 mg/dLPre-Dinner100 mg/dLWith the trend of the patient's blood sugar monitoring results, the attending physician discontinued the serial CBG monitoring on the third hospital day. Progress notes indicated patient's positive response to treatment.Below is the 3-day monitoring of the patient's vital signs.daytime/shiftbprrprt107-03 (2:00pm)100/70209836.703-11 (10:00pm)120/80188836.811-07 (6:00am)110/701610036.6207-03 (2:00pm)100/70207836.503-11 (10:00pm)100/80209636.811-07 (6:00am)100/80209736.6307-03 (2:00pm)110/80188836.503-11 (10:00pm)120/70179237.011-07 (6:00am)110/80209537.2Daily rounds were conducted to monitor the progress of the patient. It was noted that the patient shows signs of significant improvement from day 1 up to day 3 of confinement. Latest diagnostic workups of the patient were within the normal limits except for the OGTT on the 3rd day of hospitalization. No further complaints were noted from the patient and verbalized "maymayat iti riknak itan, saan nga kasla datin."The patient was discharged on the fourth day with improved and stable condition. Discharge instructions were given.Health Science Science Nursing
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