Nursing Care Plan Gestational Diabetes Mellitus | Risk for Maternal Injury

This nursing care plan for gestational diabetes mellitus is designed for the nursing diagnosis of risk for maternal injury may be related to changes in diabetic control, abnormal blood profile/anemia, tissue hypoxia, altered immune response.

Desired Outcomes: Remain normotensive. Maintain normoglycemia, free of signs/symptoms of ketoacidosis. Be free of complications (e.g., infection, placental separation).

Nursing intervention with rationale:
1. Note White’s classification for diabetes. Assess degree of diabetic control (Pederson’s criteria).
Rationale: Client classified as D, E, or F is at higher risk for complications, as is client with PBSP.

2. Assess client for vaginal bleeding and abdominal tenderness.
Rationale: Vascular changes associated with diabetes place client at risk for abruptio placentae.


3. Monitor for signs and symptoms of preterm labor.
Rationale: Overdistension of uterus caused by macrosomia or hydramnios may predispose client to early labor.

4. Assist client in learning home monitoring of blood glucose, to be done a minimum of 4 times/day.
Rationale: Allows greater accuracy than urine testing because renal threshold for glucose is lowered during pregnancy. Facilitates tighter control of serum glucose levels.

5. Request that client check urine for ketones daily.
Rationale: Ketonuria indicates presence of starvation state, which may negatively affect the developing fetus.

6. Identify for episodes of hyperglycemia.
Rationale: Diet/insulin regulation is necessary for normoglycemia, especially in second and third trimesters, when insulin requirements often double (may quadruple in third trimester).

7. Assess for and/or monitor presence of edema.
Rationale: Because of vascular changes, the diabetic client is prone to excess fluid retention and PIH. The severity of the vascular changes before pregnancy influences the extent and time of onset of PIH.

8. Determine fundal height; check for edema of extremities and dyspnea.
Rationale: Hydramnios occurs in 6%–25% of pregnant diabetic clients; may possibly be associated with increased fetal contribution to amniotic fluid, because hyperglycemia increases fetal urine output.

9. Instruct in insulin administration, as required. Ensure that client is adept at self-administration, either subcutaneously (SC) or with pump, depending on client’s needs or care setting.
Rationale: Insulin requirements are decreased in first trimester, then double and may even quadruple as the pregnancy progresses. Highly motivated and capable clients may do well with a continuous subcutaneous insulin infusion pump to more naturally meet insulin needs.

10. Start IV therapy with 5% dextrose; administer glucagon SC if client is hospitalized with insulin shock and is unconscious. Follow with protein-containing fluids/foods, e.g., 8 oz skim milk when client is able to swallow.
Rationale: Glucagon is a naturally occurring substance that acts on liver glycogen and converts it to glucose, which corrects hypoglycemic state. (Note: Hypertonic glucose [D50] administered IV may have negative effects on fetal brain tissue because of its hypertonic action.) Protein helps sustain normoglycemia over a longer period of time.