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- How would you document her obstetric history (GTPAL)?
G6 T3 P0 A2 L3
- What is the diagnosis and on what criteria can this be made?
Gestational diabetes is the diagnosis as evidenced by an elevated blood glucose 2 hours after initiating the oral glucose tolerance test (OGTT). The patient’s urinalysis also reveals the presence of glucose. The International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommends screening all pregnant women, and earlier screenings for high-risk patients. Providers should administer an OGTT during weeks 24–28 of pregnancy, correlate the results with the diagnostic values for fasting glucose at 1 hour and 2 hours during the OGTT, and establish a diagnosis of gestational diabetes in pregnant women based on the value of the OGTT (Stan et al., 2023).
- What are the differential medical diagnoses?
Impaired Glucose Tolerance
Diabetes Type 2
Insulin Resistance
- Discuss the major risk factors for your diagnosis?
The major risk factors identified in the case study are high blood pressure, a high BMI, ethnicity, and age. Women are at greater risk of developing gestational diabetes if they have a history of gestational diabetes, macrosomic infant, obesity, and age 35 and older. Asians, American Indians, Pacific Islanders, African Americans, and Hispanics are all at a high risk of developing gestational diabetes as well.
- What is your treatment plan for this patient?
When a patient is diagnosed with gestational diabetes, she must maintain tight glycemic control through diet and exercise, or potentially by medical management (Johnson and Berry, 2018). The first line of treatment for this patient is lifestyle changes to promote appropriate weight gain and glycemic control. The patient should follow a meal plan and scheduled physical activity. According to Craven et al. (2018), the patient should see a registered dietician nutritionist for individualized diet recommendations. An ideal meal plan will consist of three meals a day with 2-3 snacks. The patient should be sure to limit carbohydrates. A dietician might suggest a goal of 15 to 30 grams of carbohydrates per snack and 45 to 60 g per meal (Craven et al., 2018). She can also participate in routine exercise at least 5 days a week, 30 minutes per day. Exercise can consist of walking, swimming, riding a stationary bike, or using the elliptical. The patient should also monitor blood glucose levels at home. If lifestyle changes fail to improve glucose control, the patient should start human insulin. The patient can expect to have more clinic visits for closer monitoring.
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