Care Plan and Leaflet: Gestational Diabetes Management (NUR5064)

This assignment presents a comprehensive care plan and a health promotion leaflet focused on gestational diabetes. The care plan addresses constipation, a common issue during pregnancy, providing a rationale for interventions such as dietary modifications, fluid intake, and the use of faecal softeners. The leaflet aims to educate pregnant women about gestational diabetes, its risks, and preventive measures. It covers essential information about diagnosis, treatment, and lifestyle changes. The assignment highlights the importance of early intervention, patient education, and the role of nurses in managing gestational diabetes. It emphasizes the use of evidence-based practice to improve maternal and foetal health outcomes. The rationale supports the interventions with research and guidelines.

Running Head: RATIONALE
CARE PLAN AND LEAFLET RATIONALE
Name of the Student
Name of the University
Author’s Note

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Care Plan:
A care plan for Carole Howard is planned as she is suffering from constipation and according to
the Bristol tool chart she has a type 7 (overflow). She has complained of dissatisfactory bowel
movements for the last 8 week during her consultation. The care plan will begin with an enquiry
session that will get all the information regarding her symptoms and if it will be assessed, if she
has blood discharges in her stool. She will get advice and prescriptions so that her constipation
will decrease. Carole should be given the correct diet to follow that includes optimum amount of
fluid, fibre rich food, an optimum quantity of fruits and vegetables, restricting alcohol and
refined food content in the diet. She should be given a chart to explain the dos and don’ts when
suffering from constipation. She will be prescribed laxatives so that she is able to pass stools
after it has increased in its fluid content.
Care Plan Rationale
Assessment and diagnosis of constipation depends on the symptom that requires
gathering the collection of data regarding medical, surgical, dietary and drug history. Several
challenges are faced by healthcare professionals during the assessment of patients suffering from
constipation, it is not only due to the awkwardness during rectal examination but constipation
has no definite cause. It differs from person to person. It is necessary for nurses to have certain
skills so that they can efficiently assess patients because effective assessment gives relevant
information that can help in planning interventions for disease management (Shah et al. 2104).
Lack of awareness and practice can obstruct correct assessment, which will lead to incorrect
diagnosis and treatment affecting the health of the patient as well as increasing the healthcare
cost.

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The guidelines by National Institute for Health and Care Excellence (NICE) states that when a
person is suspected of constipation then they should be enquired about the regular pattern of
elimination, which includes the consistency and frequency of stool. This is done because the
bowel habits influence the diagnosis of constipation. A person’s health is determined by their
bowel movement and it impacts the functioning of the body. A person how has less than 3 bowel
movements a week is considered to be constipated, according to the clinical setting (Yue et al.
2014). This suggests that enquiring about the frequency of bowel movement is necessary.
Although, everyone has a different bowel movement according to few researchers and what is
considered normal for some may not be normal for others. Few people can have less than the 3
bowel movements but they can be termed normal because it is their system. A bowel movement
is altered due to many reasons such as age, physical activity, fluid intake, diet, social factors and
medical history. However, change in the frequency or new discharges in the stool can indicate a
problem and more when other complications are followed such as constipation, diarrhoea, or
abdominal pain. Talking about our bowel can be embarrassing but it is necessary to know so that
we can know about our health conditions (Citronberg et al. 2014). Therefore, it is the
responsibility of the nurse to have a conversation with the patient about their bowel movement.
An irregular bowel movement or constipation is a known disorder that can have a negative
influence on a person’s mental and physical wellbeing, which suggests that this condition should
be treated to restore normal process of life. Treating constipation guarantees a smooth and
comfortable bowel movement. This is only possible with the help of increased fluid intake,
healthy diet, physical activity and lifestyle changes that includes sitting in the correct posture
during bowel movement (Nurko et al. 2014). It is said that dietary and lifestyle modifications is a
treatment for constipation but some patient need laxatives to improve their stool when the other

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methods are ineffective. This is approved by the NICE (2017) guidelines and if the first
treatment is ineffective then oral laxatives should be given in the next step.
The most commonly used medications in constipations are known as laxatives that helps in
promoting bowel movement and it is used for treatment of chronic constipation and management
of mild constipation. However, there is a conflict in literature about laxatives because few
believe that there is no evidence about the benefits of laxative for chronic constipation but
several studies indicate that laxatives are effective for constipation (Candy et al. 2015).
The major groups of laxative are known as osmotic laxatives (movicol, lactulose), faecal
softeners (Docusate sodium), stimulant laxatives (Senna) and bulk-forming laxatives (fybogel).
The function of all these laxatives are to increase the peristalsis that will help in moving the
faeces but all their effects vary. A general practitioner subscribes a laxative according to a
patient’s complaint, compliance, tolerance, acceptability and the time in which the metabolic
reaction will take place (Gordon et al. 2016).
NICE guidelines recommend that a stepped approach is needed for the use of laxatives, which is
the implementation bulk forming laxatives in the initial stage of the treatment because they act as
a dietary fibre that is the reason for the water to be absorbed form the intestinal lumen, which
helps in softening stool consistency and increasing the amount of stool bulk. However, studies
suggest that bulk forming laxatives might not be acceptable by every patient especially in the old
age group because this laxative requires maintenance of high fluid intake in the body as
inadequate fluid can cause impaction. Stimulant laxatives helps in stimulating the nerves that is
required in controlling the digestive tract lining, which increases the bowel movement,
smoothens the tool consistency and escalates the stool frequency. While, osmotic laxatives helps
in increasing the fluid content of the bowel and softens the stool consistency, which makes it

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easy to pass, but it can also increase flatulence and bloating with the increased requirement of
fluid intake. Faecal softeners are used as a laxative that helps in elevating the fluid content of dry
and hard stools, softening and lubricating the stool that helps in smooth movement in the passage
(Kim et al. 2016). All the laxatives have different purposes so it is important to understand that
they are designed in different variations so that it can be prescribed to different patient according
to their complains and requirements. The symptoms should be noted so that people take the
effective laxative according to their presenting symptoms.
In Carole’s case bulk forming laxatives cannot be used as the first line of treatment because it is
unsuitable for her as it will increase impaction. A faecal softener (Docusate sodium) will be more
useful for her as it will help in lubricating and softening her stool, which will make it easier for
her to pass (Izzy et al. 2016).
Patient education is necessary for the treatment of constipation because a study suggests that
people being aware about constipation can help them in reducing the chances of suffering from
constipation and increases their quality of life. Patients with constipation should be encouraged
to work for decreasing their symptoms by increasing their fibre intake, including high amounts
of fluid intake, eating a balanced and healthy meal and having regular meals (Wald and Talley,
2017).
A poorly digested carbohydrate also known as fibre helps in allowing a smooth passing of stools
and bulking them, includes increasing transit time in the colon. According to NICE (2017), daily
recommendation of fibre for adults is 18g to 30g with increased fluid intake, incorporating a
balanced diet that contains an optimum amount of fruits, vegetables and whole grains that helps
in relieving constipation. Intake of less fibre in the diet is the reason for constipation that makes
it important to have fruits and vegetables in the diet, which is also an effective management for

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constipation. Several studies suggest that high fibre diet is given to people with constipation
because it elevates the quantity of stool bulk and increasing the speed of bowel movement
through the gut with a smooth consistency (Rao, Yu and Fedewa 2015). Additional benefits of
fibre is that it helps in providing probiotic to the gut bacteria, increases transit time, frequency of
stool and smoothening the texture of the faeces. Consuming an optimum amount of fibre through
the routes of dietary fibre supplements, foods fortified with fibre and food rich in fibre is a basic
step towards improving laxation and the effect of these laxatives differ upon the type of fibre
being taken such as soluble fibres (barley, oats, bananas, apple, root vegetables) and insoluble
fibres (nuts and seeds, bran, wholemeal bread). The soluble fibre absorbs water and enhances
stool frequency and consistency, global symptoms and straining (McCallum, Ong, and Mercer-
Jones 2009). The insoluble fibre increases bulk in the stool, which allows smooth transport of
faeces in the colon. Fibres as a treatment has its downside when consumed more than the limit
because insoluble fibre when taken in excess can cause dehydration due to loose stools and
soluble fibre can increase constipation. This suggests that having a healthy lifestyle with a
functioning bowel includes making a balance between soluble and insoluble fibre. Patients
should know about the transit time in a bowel movement and the purpose of soluble fibre and
insoluble fibre in their diet that improves their gut health because this will help them in
managing their bowel health and the consequences of constipation. This shows that increasing
fibre in our diet helps in curing constipation as the effects are seen after a few days, but it can
also take 3-4 weeks. It is also seen that taking high amounts of fibre can increase bloating and
abdominal discomfort during constipation. Experts recommend that incorporating minimum
amounts of fibre in the diet helps in reducing flatulence and bloating (Costilla and Foxx-
Orenstein 2014).

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Leaflet Rationale
A condition occurs in pregnant women known as Gestational Diabetes, which is the production
of inadequate amount of insulin that leads to increase in blood sugar levels higher than the usual.
During the first weeks of pregnancy the body is intolerant to glucose in gestational diabetes
according to few experts. It is said that diabetes mellitus is found in 700,000 pregnant women
every year, approximately 87.5% of the population is considered to be affected by gestational
diabetes, which makes it a common lifestyle disorder in pregnant women (Catalano 2014). The
popular risk factors of gestational diabetes is genetics and family history, over-age, obesity,
previous medical history of gestational diabetes, belonging from a certain race such as African,
American Indian, Asian or pacific islander descent.
Gestational diabetes is also a significant risk to the foetus in a mother’s womb and the mother as
well. The child is a target to several disorders such as macrosomia, dystocia, obesity and
neonatal hypoglycaemia, and the mother is prone to complications such as undergoing caesarean
section, pre-term birth and pre-eclampsia. Gestational diabetes is curable after delivery but the
child and the mother is still vulnerable to type 2 diabetes in the later stages of life (Kamana,
Shakya and Zhang 2015). This makes it necessary for the pregnant women to know about the
consequences of gestational diabetes, which will make them less of a target to diabetes during
pregnancy including the treatment and preventive measures that includes positive maternal
health (Zhu and Zhang 2016).
Diagnosis of diabetes during pregnancy is a critical need because the early treatment can reduce
the severity of the disease because of early interventions. The suitable treatment can reduce
chronic as well as mild complication in the early stages. However, no universal protocol or
consistency is set for the diagnostic test, sugar level cut-off or screening time for gestational

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diabetes. Several studies suggests that no global consensus about the reference ranges for blood
glucose in diabetes mellitus. NICE (2015) guidelines shows that the diagnosis of gestational
diabetes should be done if the oral glucose tolerant test after 2 hours is 7.8 mmol/litre or 5.8
mmol/litre is the result after fasting. The International Association of Diabetes and Pregnancy
Study Groups (IADPSG) after collaborating with World Health Organization (WHO)
recommended that 1-hour post glucose tolerance test that indicates 10 mmol/litre and blood
glucose after fasting is 5.1 mmol/litre should be the reason for diabetes screening. A study came
to a result that the recommendation by IADPSG and WHO is not efficient because it will be the
reason for elevation in the number of gestational diabetes cases and healthcare costs that adds to
the burden of time as faced by many healthcare systems. However, the long term cost of low risk
women not being treated should be considered because the long term implications of high risk of
diabetes and obesity is seen in child and mother suffering from gestational diabetes (Kampmann
et al. 2015).
Substantial doubts exists about the best screening approach other than the reference range of
glucose in gestational diabetes. Several debates have taken place on this topic such as the
diagnostic screening should be conducted on high risked women or every pregnant women.
NICE (2015) recommends that the selective screening approach has few loopholes because it is
not valid as to what criteria or risk factor (past medical history, baby being macrosomic in which
the baby is more or equal to 4.5 kg and BMI being more than 30 kg/m2 or the ethnicity of the
family) should be considered in women during the assessment of diabetic screening and defining
the risk factors. It is said that risk factors do not have a major correlation with gestational
diabetes because only few women have those risk factors identified. Conflict is found in the
method of screening because a ratio of women is missed who can go untreated and might be at

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the risk of pregnancy complications. Advantages are seen in the universal screening such as the
pregnant women are screened as a part of an antenatal care but this procedure will add a burden
on the financial and personal aspect of the health care systems (Dall et al. 2014).
There are controversies seen in the diagnostic criteria of gestational diabetes as the proof of
screening strategies for the same is still under conflict but it is advised that pregnant women
should go through screening according to the IADPSG criteria and universal screening approach
because some women might miss out on the NICE (2015) guidelines that allows diagnosis and
treatment that will lead to the enhancement of maternal and child health.
There is an eruption in the prevalence and incidence of gestational diabetes, which makes it
important for the implementation of physical activities in the care plan of pregnant women. This
helps in reducing glycaemic index and increasing the quality and care of mother and child.
Exercise is essential is every stage of life but it is more important during pregnancy because it
improves the health of the mother and decreases chances of complication during delivery.
However, it is seen that physical activity decreases during pregnancy due to certain factors that is
lethargy, signs of miscarriage, lung or heart problems, work-related barriers or multiple
pregnancy.
Women diagnosed with gestational diabetes are advised to increase their physical activities by
their medical experts in their first consultation. As this helps in reducing the glucose levels but
there is still a literature gap in the perfect exercise that will help during pregnancy. Some experts
suggest that few types of exercises that are low intensity walking, resistance training and
aerobics, which helps in reducing blood glucose levels. A study conducted in which randomized
control trial indicated that physical activities are an additional care for pregnant women that
lowers blood glucose level. More studies suggest that women with gestational diabetes who are

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habituated to exercises have less chances of complications or discomfort during pregnancy, less
stress and pressure, positive mood, low weight gain and pain tolerance. They also tend to have a
lower need of insulin or avoid insulin in entirety (Cordero et al. 2015).
In few cases, women face severe complications such as chronic anaemia, bleeding during the
first 3 trimesters and RCOG suggests that physical activity and exercises during the course of
pregnancy should be done within the recommended range and precautionary measures.
This shows that pregnant women should be taught about the positive effects of physical activity
during pregnancy including the recommended levels that can help in enhancing health as well as
preventing gestational diabetes during pregnancy.

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