McKinney Chapter 26: Gestational Diabetes NCLEX

McKinney Chapter 26: Gestational Diabetes NCLEX

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38 terms nelvehjemPreview gestational diabetes nclex question...16 terms slsxo821Preview Chapte 32 terms suc Which of the following is associated with preexisting diabetes in a pregnant woman, but not in a woman with gestational diabetes?

• Neonatal hypocalcemia
• Neonatal hypoglycemia
• Congenital malformations
• Macrosomia
• Congenital malformations

(Because gestational diabetes develops after the first trimester, the critical period of major fetal organ development, it usually is not associated with an increase in major congenital malformations. Hypocalcemia, hypoglycemia, and macrosomia can occur with preexisting and gestational diabetes.) A pregnant woman at 28 weeks of gestation has been diagnosed with gestational diabetes. The nurse caring for this client should know that:

• Oral hypoglycemic agents are the preferred choice to control an elevated blood sugar level.
• Dietary modifications and insulin are both required for adequate treatment.
• Glucose levels are monitored by testing urine four times a day and at bedtime.
• Dietary management involves distributing nutrient requirements over three meals and two or three snacks.
• Oral hypoglycemic agents are the preferred choice to control an elevated blood sugar level.

(Small frequent meals over a 24-hour period help decrease the risk for hypoglycemia and ketoacidosis. Insulin is the preferred medication to use, if needed, because it does not cross the placenta. Oral hypoglycemic agents can be harmful to the fetus and are less effective than insulin in achieving tight glucose control. In some women, gestational diabetes can be controlled with dietary modifications alone. Blood, not the urine glucose level, is monitored several times a day. Urine is tested for ketone content; results should be negative.)

A woman with gestational diabetes is at 36 weeks' gestation. On the regular antepartal visit, the woman tells the nurse, "I am so excited. My blood sugars have gone down and I have been able to decrease the amount of insulin I need by about half." The nurse should be aware that this

is an indication of a:

• Diabetic in good glycemic control.
• Fetal problem that needs further investigation.
• Placental problem that needs further investigation.
• Maternal pancreas that is increasing its insulin production.
• Placental problem that needs further investigation.

(Insulin needs should increase markedly during the second and third trimesters when placental hormones reach their peak. The placental hormones initiate maternal resistance to the effects of insulin. If the insulin needs decrease, it is a sign that the placental production of the hormones has decreased and the placenta may be failing.) A newly diagnosed pregnant woman has diabetes mellitus, type 2. When planning the prenatal care for this woman, the nurse identifies actions

based on the knowledge that:

• Insulin needs increase during the first trimester and decrease thereafter.
• The danger of diabetic ketoacidosis is highest during the second and third trimesters.
• Oligohydramnios can occur, leading to fetal distress during labor.
• Maternal blood glucose levels need to be maintained between 125 and 135 mg/dL.
• The danger of diabetic ketoacidosis is highest during the second and third trimesters.

(Maternal insulin requirements are reduced during the first trimester. Higher insulin requirements during the second and third trimesters increase the risk for ketoacidosis. Polyhydramnios is associated with diabetes during pregnancy, increasing the risk for preterm labor and postpartum hemorrhage from an overstretched uterus. Blood glucose levels should be maintained between 70 and 120 mg/dL.) Increased fetal surveillance should occur in the first trimester of a pregnant woman with preexisting diabetes mellitus to monitor for:

• Congenital anomalies.
• Signs of hypoxia.
• Evidence of placental failure.
• Signs of macrosomia.
• Congenital anomalies.

(There is an increased risk for congenital anomalies, so surveillance should begin early for women with preexisting diabetes. Testing should be done to identify possible neural tube defects, chromosomal abnormalities, and cardiac anomalies. The goal of increased surveillance in the last trimester is to monitor for signs of worsening intrauterine environment, such as signs of fetal hypoxia and evidence of placental failure.)

Which pregnancy hormones are responsible for creating insulin resistance in maternal cells?Select all that apply.

• FSH (follicle- stimulating hormone)
• Estrogen
• Progesterone
• HPL (human placental lactogen)
• LH (luteinizing hormone)
• Testosterone
• Estrogen

When teaching a diabetic pregnant woman to give herself insulin injections, the nurse should emphasize that:

• A meal should be eaten before insulin injections.
• The angle of the subcutaneous injection should be 45 degrees.
• Once the needle is injected, the woman should aspirate before injecting the medication.
• The medication should be injected slowly.
• The medication should be injected slowly.

(Insulin should be injected slowly (over 2 to 4 seconds) to allow tissue expansion and minimize pressure, which can cause insulin leakage. A meal should be eaten within 30 minutes after insulin is injected. The angle of the injection should be 90 degrees unless the woman is very thin. It is not necessary to aspirate when injecting into subcutaneous tissues.) An 8-month-pregnant woman with gestational diabetes has been admitted to the antepartal unit of the hospital for fetal surveillance. The

woman's blood sugar at 2 PM was 70 mg/dL. The nurse should:

• Record this reassuring blood sugar reading.
• Offer the woman 4 ounces of apple juice.
• Administer the appropriate amount of regular insulin needed for this blood sugar level according to the sliding scale ordered.
• Reassess the blood sugar reading in 30 minutes.
• Offer the woman 4 ounces of apple juice.

(Hypoglycemia should be treated at once to prevent damage to the brain. The woman should take 15 g of carbohydrate, which is about ½ cup of fruit juice.)

A nurse is aware that more teaching is necessary when a pregnant woman with gestational diabetes states:

• "I will eat only three meals a day."
• "I will decrease my complex carbohydrates to 40% of my diet."
• "I can increase my fat intake slightly during the pregnancy."
• "I will not eat any sugary snacks until after the baby is born."
• "I will eat only three meals a day."

(A pregnant woman with diabetes should divide her calorie intake among 3 meals & at least 2 snacks a day to keep her blood sugar levels consistent. Carbohydrate intake should be about 40% to 45%, fat intake can increase to 40%, & refined sugars should be eliminated from the diet) Which of the following new pregnant clients should the nurse monitor more closely for signs of gestational diabetes mellitus?

• Gravida 2 with a body mass index of 22
• Gravida 1 who is 24 years old
• Gravida 3 whose previous children weighed 6 lb, 4 oz and 7 lb, 5 oz at birth
• Gravida 2 who is pregnant with triplets
• Gravida 2 who is pregnant with triplets

(A woman with a multifetal pregnancy is at risk for developing gestational diabetes. Greatly increased circulating HPL (human placental lactogen) levels as a result of extra placental tissue require a greater maternal insulin production. Women with a body mass index greater than 25, older than the age of 25, or have given birth to infants weighing more than 4000 g are also at risk.) The test used to screen for gestational diabetes is

• glycosylated hemoglobin test
• glucose challenge test
• oral glucose tolerance test
• postprandial glucose test
• glucose challenge test

The best evaluation for the client's goal of accurate insulin administration is that she will:

• repeat the steps for insulin injection verbally
• accurately withdraw, mix, and inject insulin
• have normal fasting and postprandial glucose levels
• state that she understands the teaching given
• accurately withdraw, mix, and inject insulin Terms (12)

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