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EVIDENCE-BASED PATIENT-CENTERED NARRATIVE
FP6011
Evidence-Based Patient-Centered Narrative
Capella University
Evidence-Based Practice for Patient-Centered Care and Population Health
Evidence-Based Patient-Centered Narrative
Carole Lund is a forty-four-year-old woman of Native American and European descent.
Carole is a new mother who is concerned about not recovering from gestational diabetes. Carole
was diagnosed with gestational diabetes at thirty weeks gestation. Carole Lund is ten weeks
postpartum. Carole has been tracking her blood glucose with fasting results of 150-200 and
greater than 200 after meals. During her pregnancy, Carole was offered insulin however, she did
not want to take a drug or inject an animal product into her body. Carole elected to make lifestyle
and dietary changes instead.
Nursing Diagnosis One
The most important diagnosis to address is the patient’s risk for unstable blood glucose.
Women who have gestational diabetes are ten times more likely to develop type two diabetes in a
ten-year time frame compared to women who were not diagnosed with gestational diabetes,
according to a retrospective study in Sri Lanka (Herath et al., 2017). Carole has nonmodifiable
risk factors that increase the risk of developing type two diabetes postpartum. Carole has a
maternal age over thirty-five and delivered a baby over three and a half kilograms. With these
nonmodifiable risk factors, Carole must modify her lifestyle factors to decrease her likelihood of
developing type two diabetes. Modifiable factors for Carole would be weight loss, balanced

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EVIDENCE-BASED PATIENT-CENTERED NARRATIVE
nutrition, and increased exercise. According to a meta-analysis, lifestyle modification of
exercise, BMI reduction, and waist circumference reduction may reduce the likelihood of
developing type two diabetes by twenty-five percent (Rayanagoudar et al., 2016). However, it is
difficult for a new mother with limited support to make these changes. Carole will meet with our
registered dietitian to continue to make appropriate food choices and make a food plan that
allows her to enjoy meals that she is able to make and are authentic to her culture. The meal plan
will allow her to meal prep and highlight a diet low in fat and sugar and high in protein. Meal
prepping will decrease the amount of time spent cooking and ensure that Carole will have a
consistent diet to prevent peaks and drops in blood glucose. The dietitian will discuss resources
in the community, such as WIC and local food banks to help provide financial assistance with
food costs. Carole will participate in thirty minutes of exercise three to five days a week. The
exercise will decrease her weight and waist circumference which will lower her risk for type two
diabetes. Carole will lose 1 kilogram within three months.
Nursing Diagnosis Two
Carole is experiencing ineffective coping. Carole expressed that her family is no longer
offering as much support as when she was first home from the hospital recovering from her
cesarean delivery. Carole is a freelance worker and reports, "I make my own hours, but that also
means if I am not working, I do not get paid." Carole also expresses that if she cant balance all
the aspects of her life, her health would be what she gives less attention to. Carole will identify
three family members or friends to call for support. This will allow Carole to have periods of
time to herself to rest, exercise and take care of herself. Exercise will decrease Carole’s body
mass index and waist circumference, which will decrease Carole's risk for developing type two
diabetes (O'Reilly et al., 2016). Carole will attend a biweekly postpartum support group to

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1 EVIDENCE-BASED PATIENT-CENTERED NARRATIVE FP6011 Evidence-Based Patient-Centered Narrative Capella University Evidence-Based Practice for Patient-Centered Care and Population Health Evidence-Based Patient-Centered Narrative Carole Lund is a forty-four-year-old woman of Native American and European descent. Carole is a new mother who is concerned about not recovering from gestational diabetes. Carole was diagnosed with gestational diabetes at thirty weeks gestation. Carole Lund is ten weeks postpartum. Carole has been tracking her blood glucose with fasting results of 150-200 and greater than 200 after meals. During her pregnancy, Carole was offered insulin however, she did not want to take a drug or inject an animal product into her body. Carole elected to make lifestyle and dietary changes instead. Nursing Diagnosis One The most important diagnosis to address is the patient’s risk for unstable blood glucose. Women who have gestational diabetes are ten times more likely to develop type two diabetes in a ten-year time frame compared to women who were not diagnosed with gestational diabetes, according to a retrospective study in Sri Lanka (Herath et al., 2017). Carole has nonmodifiable risk factors that increase the risk of developing type two diabetes postpartum. Carole has a maternal age over thirty-five and delivered a baby over three and a half kilograms. With these nonmodifiable risk factors, Carole must modify her lifestyle factors to decrease her likelihood of deve ...
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