Gestational Diabetes Essay

The clinic RN reviews Amanda’s prenatal record prior to performing a nursing assessment. Amanda has given birth twice, once at 35-weeks (twins) and once at 39-weeks (singleton). All of these children are alive and well. She has had one spontaneous abortion at 9-weeks gestation. 1. How should the nurse record Amanda’s obstetrical history using the G-T-P-A-L designation? A) 3-2-0-1-3. B) 3-1-1-1-2. C) 4-1-1-1-3. D) 4-2-1-0-2. Correct answer(s): C The nurse notes that Amanda’s fasting 1 hour glucose screening level, which was done two days previously, is 158 mg/dl. 2. The nurse recognizes that what information in the client’s history supports a diagnosis of gestational diabetes? A) Maternal great-aunt has insulin dependent (Type 1) diabetes. B) Youngest child weighed 4300 grams at 39-weeks gestation. C) Trace of protein noted in urine specimen at last prenatal visit. D) Client is 64 inches tall and weighed 134 prior to pregnancy. Correct answer(s): B Further Glucose Screening Amanda is scheduled for a 3 hour oral glucose tolerance test in 5 days, and is told to arrive at the lab at 8:30 am. Amanda asks if there are any special instructions for the test in addition to fasting for 8 hours immediately prior to the test. 3. Which instruction should the nurse give the client? A) Only coffee or tea is allowed once the fasting level has been drawn. B) Follow an unrestricted diet and exercise pattern for at least 3 days before the test. C) Write down questions and call the laboratory for instructions the day before the test. D) Smoking in moderation is allowed up until the time the test begins. Correct answer(s): B Amanda asks the nurse why she wasn’t tested for gestational diabetes until she was almost 28-weeks gestation. 4. The nurse’s response should be based on the understanding of which normal physiologic change of pregnancy? A) Maternal insulin crosses the placenta to regulate fetal glucose levels throughout pregnancy. B) In the first trimester, estrogen and progesterone cause an increase in maternal fasting glucose levels. C) Hormonal changes in the second and third trimesters result in increased maternal insulin resistance. D) Fetal insulin production increases each trimester, forcing the mother’s body to produce more glucose. Correct answer(s): C Interdisciplinary Client Care Amanda’s 3 hour Oral Glucose Tolerance Test indicates that she does have gestational diabetes. The RN phones Amanda and arranges for her to meet with the CNM and perinatologist, as well as an RN diabetes educator and a registered dietician (RD) the next day. The perinatologist and CNM discuss gestational diabetes with Amanda and after seeking input from Amanda, outline their suggested plan of care, which includes dietary control and glucose self-monitoring. After the perinatologist and CNM leave, Amanda appears confused and asks the RN, â€Å"Does this mean I will always have diabetes?† 5. Which response should the nurse give to the client? A) â€Å"You will need to be periodically evaluated for Type 2 diabetes for the rest of your life.† B) â€Å"There should be no problem as long as you do not have to use insulin during this pregnancy.† C) â€Å"There is no need to talk about this now. We’ll discuss it at your first postpartum visit.† D) â€Å"Tell me what worries you about the possibility of developing Type 2 diabetes after your pregnancy ends.† Correct answer(s): A After all her questions are answered, Amanda is scheduled for a return visit with the CNM in one week, and is escorted to the office of the registered dietician (RD). The RD discusses the need to control carbohydrates while maintaining an appropriate carbohydrate-protein-fat ratio to promote consistent weight gain (based on the woman’s body mass index), prevent ketoacidosis, and encourage normoglycemia (euglycemia). Amanda is then introduced to the RN diabetes educator. She asks the nurse to clarify what the RD told her about the content and timing of her meals. 6. Which response should the nurse give to the client? A) Eliminate the bedtime snack if heartburn develops after eating. B) Choose complex carbohydrates that are high in fiber content. C) Increase the percentage of protein in the diet if anemia develops. D) Vary timing of meals and snacks based on individual preferences. Correct answer(s): B The RN diabetes educator makes a plan of care to teach Amanda to monitor her glucose levels. The RN diabetes educator discusses the use of self-glucose monitoring and gives Amanda verbal and written guidance about optimal glucose levels at each glucose testing point throughout the day. The nurse also provides instruction about calibration of the glucose monitor, fingerstick technique, and use of the monitor for testing. After reviewing the instructions and a successful return demonstration, the diabetes educator and Amanda agree to meet after Amanda’s prenatal appointment to follow-up on today’s teaching/learning. 7. Which fingerstick blood glucose (FSBG) testing protocol should the diabetes educator recommend for Amanda? A) Only if symptoms of hypoglycemia or hyperglycemia occur. B) Prior to breakfast (fasting) and two hours after each meal. C) Before and two hours after all meals, at bedtime, and during the night. D) Once daily until glucose levels are stabilized, then weekly. Correct answer(s): B A Complication Occurs Amanda manages her gestational diabetes with diet. She experiences a few episodes of postprandial hyperglycemia, but does not have to go on insulin. At her 36-week prenatal visit, the CNM assesses Amanda and finds that there is no increase in fetal growth since the week before. When questioned further, Amanda tells the CNM that the infant has seemed to â€Å"slow down† a little the last few days. After consultation with the perinatologist, a biophysical profile (BPP) is scheduled and Amanda is admitted to the hospital’s antepartum unit. The antepartum RN performs a nonstress test (NST) as part of the BPP. 8. The nurse recognizes which fetal heart rate (FHR) changes indicate a reactive nonstress test? A) Persistent late decelerations associated with three uterine contractions, lasting 40 to 60 seconds each in a 10 minute period. B) An increase in the FHR baseline to 170 beats per minute, lasting for at least 20 minutes. C) Marked, long term FHR variability in response to contractions caused by nipple stimulation. D) Two episodes of acceleration (> 15 beats/minute, lasting > 15 seconds) related to fetal movement in a 20 minute period. Correct answer(s): D Amanda has a non-reactive Non-stress Test. She is taken to the ultrasound department for completion of the BPP and her total score is 6 (Fetal Breathing Movements = 2, Gross Body Movements = 0, Fetal Tone = 2, Reactive Non-stress Test = 0, and Qualitative Amniotic Fluid Volume = 2). Based on this score, the perinatologist recommends an amniocentesis be completed to assess for lung maturity prior to making a decision whether to induce delivery for Amanda the next day. 9. Prior to the amniocentesis, which action should the nurse take first? A) Administer Rh immune globulin (RhoGAM) if client is Rh negative. B) Assist the client to the bathroom and ask her to empty her bladder. C) Apply the external fetal monitor to evaluate uterine contractility. D) Clean the abdomen with betadine solution and sterile 4 by 4s. Correct answer(s): B Amanda and her fetus are monitored for two hours after the procedure and display no adverse effects so the external fetal monitor is discontinued. The amniocentesis reveals fetal lung maturity and an induction is scheduled for the next morning. At 2 a.m. Amanda complains of increased uterine discomfort. She is contracting every 10 minutes and while the antepartum nurse is in the room, Amanda’s membranes rupture spontaneously. 10. Which action by the nurse takes priority? A) Notify the CNM and perinatologist of the changes in Amanda’s status. B) Transfer Amanda to the labor-delivery-recovery (LDR) suites. C) Reapply the external fetal monitor to evaluate the fetal heart rate. D) Start an intravenous line using an 18 gauge or larger intravenous catheter. Correct answer(s): C