nursing diagnosis help for OB case study

[LiveYourDream]

Hi all. I am doing a case study for OB and am having trouble coming up with a priority nursing diagnosis. I just dont know where to start.

The summary of the patient is that a patient has come in with spotting for the past week, saying she missed her last period. She has reflux, nausea & vomiting for past 2 weeks. She is diabetic & is obese. Gestational age is undetermined (but assuming new since missed only one period). Medical history currently undetermined, age, gravida & parity are unknown. The pregnancy is confirmed via ultrasound. She has pre-gestational diabetes.

My approach is that the spotting is a result of implantation, so I am not going the route of 'risk for fetal demise' etc. I am not too worried about n&v & reflux as they are normal / can be treated.

I can recognize that this is a high risk pregnancy d/t the diabetes and also a complicating factor is the obesity.

What is the first thing I need to address with this patient? My ideas so far are:

Risk for decreased perfusion r/t pregestational diabetes OR

risk for maternal/placental insufficiency r/t pregestational diabetes

knowledge deficit r/t ....something?

I just need a nudge in the right direction. and an explanation as to why, lol.

[choc0late]

Personally my primary Dx is always for the reason she came in. So if it were me it would be something r/t the spotting. My next would be co-morbidities unless she came in for a few reasons, as again, it would be those reasons. I hope that helps some