การพัฒนาแนวทางปฎิบัติการประเมินสตรีตั้งครรภ์ที่มีภาวะความดันโลหิตสูง โรงพยาบาลเกษตรวิสัย กรณีศึกษา 2 ราย

Sunirat  Promnopas

Authors

Sunirat Promnopas Kaset Wisai Hospital

Keywords:

Gestational hypertension, Gestational diabetes mellitus, Postpartum nursing care, Community hospital

Abstract

Purposes: To study and compare nursing care for postpartum mothers with gestational diabetes mellitus complicated by severe preeclampsia, through a two-case study.

Study design: A comparative case study.

Materials and Methods: Data were collected from the postpartum mothers, their families, health care teams, patient medical records, and the electronic database of Kaset Wisai Hospital. The nursing process was applied utilizing Gordon’s 11 functional health patterns framework, encompassing health assessment, nursing diagnosis, care planning, nursing implementation, and evaluation of outcomes in two postpartum mothers diagnosed with severe gestational hypertension complicated by gestational diabetes mellitus.

Main findings: Case 1: A 24-year-old primigravida (G1P0A0L0) at a gestational age of 36 weeks and 1 day, diagnosed with gestational diabetes mellitus managed with insulin (GDMA2) and severe gestational hypertension (PIH), received subcutaneous insulin injections and underwent a cesarean section with a 3-day hospital stay. Case 2: A 36-year-old multigravida (G3P2A0L2) at a gestational age of 37 weeks and 3 days, with a history of two previous cesarean sections, diagnosed with gestational hypertension and diet-controlled gestational diabetes mellitus (PIH c GDM diet control), received oral antihypertensive medication and underwent a cesarean section with a 4-day hospital stay. Nursing Outcomes: Both cases received standard care, including a full 24-hour course of magnesium sulfate for seizure prophylaxis, with no severe complications such as eclampsia or postpartum hemorrhage. Both mothers and infants were safe and discharged in good condition, and nursing interventions effectively addressed all 10 nursing diagnoses.

Conclusion and Recommendations: Postpartum mothers with gestational diabetes complicated by severe hypertension represent a high-risk obstetric group requiring rapid and accurate risk assessment. The application of the nursing process and Gordon’s functional health patterns enables nurses to effectively plan care, prevent life-threatening complications, and ensure the safety of both mother and neonate. Continuous postpartum follow-up is recommended to prevent future chronic diseases.

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