Nursing Care of Elderly Pregnancy with Gestational Diabetes Mellitus : Two Case Studies

Abstract

                                                                                                                        Abstract 

            Background : Elderly pregnancy and gestational diabetes affect pregnant women and their unborn babies, causing certain complications such as: Premature birth Caesarean section Infant abnormalities including chromosomal abnormalities of the baby and low birth weight baby, which increase perinatal mortality rate among infants. Moreover, women with gestational diabetes are at risk of developing diabetes in the future.

            Objective : To compare and study two cases of elderly pregnancy with gestational diabetes

             Method : Women of advance maternal age with gestational diabetes who attended the Obstetrics and Gynecology Building in Chum Phae Hospital were specifically selected. Data were collected from medical records, patient and family interview, as well as observation. Nursing diagnoses, nursing practice plans and nursing outcomes assessment were formulated by using the Gordon Health Model concept as a framework of the study. Data were analyzed by content analysis.

            Results : It was found that both cases were pregnant women aged over 35 years old diagnosed with gestational diabetes. In Case Study 1, the patient was diagnosed with gestational diabetes at 28 weeks of gestational age, while in case study 2, the patient was diagnosed with the symptom at 8 weeks of gestational age. Both cases were treated with different doses of insulin injection. In Case Study 2, the patient has poorer glycemic control than in Case Study 1, being injected with high doses of insulin and in diet control. Additionally, in Case Study 2, the patient was diagnosed with hypoglycemia which results in a long hospitalization period. For both cases, with the Gordon Health Model being equipped on nursing outcome assessments, the nursing diagnoses were found similar. Both patients were monitored and fully nursed until safe delivery. No post-delivery complications were detected either on the mothers or infants. Likewise, no postpartum diabetes mellitus was found.

            Recommendations : Nursing care in protecting and preventing hypoglycemia during insulin injection should be promoted. Knowledge management for patients and their families should also be developed in order to encourage families’ participation in health care for pregnant women. This will aid in glycemic control and help prevent complications of pregnancy.

Keywords : Elderly pregnancy, gestational diabetes, case study, nursing