A nurse is reviewing laboratory results from a client who is at 28 weeks of gestation and has gestational diabetes. The nurse notes that blood glucose levels taken 1 hr following a meal range from 145 mg/dL to 162 mg/dL over the past week. Which of the following actions should the nurse take?
A.
Schedule a 3-hr oral glucose tolerance test.
B.
Tell the client to increase carbohydrates to 65% of daily nutritional intake.
C.
Obtain an HbA1c.
D.
Reinforce instruction about insulin administration.
The Correct Answer and Explanation is:
Correct Answer: D. Reinforce instruction about insulin administration.
Explanation:
Gestational diabetes mellitus (GDM) is a condition characterized by glucose intolerance that is first identified during pregnancy. Managing blood glucose levels is crucial to preventing complications for both the mother and the fetus. The American Diabetes Association (ADA) recommends that postprandial (after meal) blood glucose levels should be less than 140 mg/dL one hour after eating and less than 120 mg/dL two hours after eating.
In the scenario provided, the client’s blood glucose levels are ranging from 145 mg/dL to 162 mg/dL one hour after meals, which exceeds the recommended threshold of 140 mg/dL. This indicates that the current management plan is insufficient, and the client may need further intervention to achieve optimal glycemic control.
Option A: Schedule a 3-hour oral glucose tolerance test (OGTT). The 3-hour OGTT is typically used to diagnose gestational diabetes, not to manage it once the diagnosis has already been established. Since the client has already been diagnosed with gestational diabetes, repeating this test is unnecessary.
Option B: Tell the client to increase carbohydrates to 65% of daily nutritional intake. Increasing carbohydrates to 65% of daily intake would likely worsen glycemic control, as excessive carbohydrate consumption can lead to elevated blood glucose levels. Typically, dietary management in gestational diabetes focuses on controlling carbohydrate intake, not increasing it.
Option C: Obtain an HbA1c. HbA1c provides information about average blood glucose levels over the past 2 to 3 months, but it is not as useful in monitoring short-term glucose control, especially in pregnancy. Furthermore, HbA1c values are not routinely used for managing gestational diabetes as strict postprandial glucose monitoring is preferred.
Option D: Reinforce instruction about insulin administration. Since the client’s blood glucose levels are above target, it is essential to review and reinforce insulin administration. Insulin is often required when diet and exercise alone are insufficient to control blood glucose levels in gestational diabetes. Proper education on insulin administration, including dosage, timing, and injection techniques, can help the client achieve better glycemic control, thereby reducing the risk of complications such as macrosomia, preterm birth, and neonatal hypoglycemia.
In summary, the most appropriate action for the nurse is to reinforce instructions about insulin administration, as this is the key to improving blood glucose control in a client with gestational diabetes who is not meeting target glucose levels.