Assignment: Practicum – Journal Entry Reflect on a patient who is beyond 20 weeks gestation and presented with a health problem that commonly arises during pregnancy. Describe the patient’s personal and medical history, drug therapy and treatments, and follow-up care. Then, explain the implications of the patient’s health problem. If you did not have an opportunity to evaluate a patient with this background during the last eight weeks, you may select a related case study from a reputable source or reflect on previous clinical experiences.

Journal Entry – Patient with Gestational Diabetes Mellitus

Introduction
Gestational diabetes mellitus (GDM) is a health problem that commonly arises during pregnancy, affecting approximately 2-10% of pregnancies (American Diabetes Association, 2021). It is characterized by impaired glucose tolerance and is typically diagnosed between the 24th and 28th week of gestation (American Diabetes Association, 2021). This journal entry will reflect on a patient who presented with GDM beyond 20 weeks gestation, including her personal and medical history, drug therapy and treatments, and follow-up care. Furthermore, the implications of GDM for both the patient and the fetus will be discussed.

Patient Description
The patient, Mrs. Johnson, is a 32-year-old woman who is currently 26 weeks pregnant with her first child. She has a family history of type 2 diabetes mellitus and a body mass index (BMI) of 32, which is considered overweight. During her initial prenatal visit, Mrs. Johnson had no pre-existing medical conditions and reported a generally healthy lifestyle. However, her routine urine analysis and blood glucose screening at 24 weeks gestation revealed elevated glucose levels, leading to the diagnosis of GDM.

Medical History
Mrs. Johnson has no prior history of diabetes or abnormal glucose metabolism before pregnancy. However, her family history of type 2 diabetes suggests a genetic predisposition to the disease. She has no history of hypertension or other chronic illnesses. In addition, Mrs. Johnson has been taking prenatal vitamins and following a balanced diet as recommended by her healthcare provider.

Drug Therapy and Treatments
Upon the diagnosis of GDM, Mrs. Johnson was referred to a registered dietitian specializing in gestational diabetes management. The dietitian developed a personalized meal plan for Mrs. Johnson, focusing on portion control, balanced macronutrients, and consistent carbohydrate intake. This approach aims to control blood glucose levels and ensure appropriate weight gain for both the mother and the fetus (American Diabetes Association, 2021).

Mrs. Johnson was instructed to monitor her blood glucose levels using a glucometer four times a day – before breakfast and two hours after each meal. Target blood glucose levels were set at ≤95 mg/dL before breakfast and ≤120 mg/dL two hours after meals (American Diabetes Association, 2021).

In addition to dietary intervention, Mrs. Johnson was recommended regular physical activity. She was advised to engage in moderate-intensity aerobic exercises for at least 30 minutes most days of the week, with caution to avoid activities that could potentially lead to fetal injury or contraindications (American College of Obstetricians and Gynecologists, 2018).

Follow-Up Care
To ensure optimal management of GDM, Mrs. Johnson was scheduled for regular follow-up appointments with her obstetrician and registered dietitian. These appointments provided opportunities to assess glycemic control, address any concerns, review dietary adherence, and adjust therapy as necessary.

Mrs. Johnson’s progress was closely monitored using her self-monitored blood glucose records and HbA1c levels. HbA1c levels were checked at the initial diagnosis and repeated every four weeks thereafter (American Diabetes Association, 2021).

Implications of GDM
GDM poses several implications for both the mother and the fetus. Maternal implications include an increased risk of developing type 2 diabetes later in life and an elevated risk of developing GDM in future pregnancies (American Diabetes Association, 2021). Additionally, GDM increases the risk of preeclampsia, cesarean delivery, and obesity for the mother (American Diabetes Association, 2021). For the fetus, GDM increases the risk of macrosomia (excessive fetal growth), neonatal hypoglycemia, and respiratory distress syndrome (American Diabetes Association, 2021).

Conclusion
The case of Mrs. Johnson highlights the management of GDM beyond 20 weeks gestation. Through dietary intervention, blood glucose monitoring, and regular follow-up care, optimal glycemic control can be achieved, minimizing the risks for both the mother and the fetus. However, it is essential to recognize the potential long-term implications of GDM and provide appropriate counseling and education for the prevention and management of future health problems.

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