Questions and Answers
Which of these options are correct regarding treatment for a client with hypotension? (Select all that apply)
What should the nurse be aware of regarding a pregnant woman diagnosed with gestational diabetes? (Select all that apply)
What does the nurse categorize a pregnant client with type 2 diabetes and an A1c of 7 as having? (Select one)
Which are rapid and short-acting insulins? (Select all that apply)
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What information does the nurse provide about lispro (Humalog) insulin? (Select all that apply)
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What should the nurse teach the client about diet during pregnancy for gestational diabetes? (Select one)
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What should the client taking levothyroxine and an iron supplement do? (Select one)
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Which obstetric or medical complications should the nurse be alert for when providing care to a pregnant client with diabetes mellitus? (Select all that apply)
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Which of the following findings is not likely to be seen in a pregnant client who has hypothyroidism? (Select one)
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What risks are associated with untreated hypothyroidism during pregnancy? (Select all that apply)
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What is gestational diabetes? (Select one)
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What is done to confirm the condition for a client suspected of class R pregestational diabetes? (Select one)
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For what condition is a client at risk in early pregnancy due to poorly controlled hyperglycemia? (Select one)
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What intervention by the nurse is appropriate while caring for a client undergoing the OGTT for gestational diabetes? (Select one)
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What are the side effects of propylthiouracil (PTU) prescribed for hyperthyroidism? (Select one)
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What should the nurse do next if a hypoglycemic client remains low after administering glucose tablets? (Select one)
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What is the pathologic change associated with diabetic ketoacidosis? (Select one)
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What does the nurse teach about glucose metabolism in the first trimester for a client with type 2 diabetes? (Select one)
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When a pregnant woman with diabetes experiences hypoglycemia while hospitalized, what should the nurse have the woman do?
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Which statement made by the nurse indicates accurate information for a pregnant woman with maternal phenylketonuria (PKU) about breastfeeding?
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Which foods should a client diagnosed with phenylketonuria (PKU) avoid in their daily diet? (Select all that apply)
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What should the nurse instruct a pregnant diabetic client about self-care during illness? (Select all that apply)
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What complications are associated with polyhydramnios? (Select all that apply)
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Which manifestation is related to hypoglycemia in a diabetic client?
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What are the features of White's classification of diabetes in pregnancy? (Select all that apply)
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Which nonpharmacologic measure is appropriate for a client with hyperemesis gravidarum?
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Which client may need a cesarean delivery due to complications related to gestational diabetes?
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What risks to the fetus may arise from poorly controlled gestational diabetes? (Select all that apply)
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What test should be performed on a pregnant client with a blood glucose level of 325 mg/dl to assess the risk of maternal or intrauterine fetal death?
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What is the priority assessment in evaluating a pregnant woman with severe nausea and vomiting?
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Which patients with diabetes may develop complications if they perform exercises? (Select all that apply)
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What should nurses be aware of regarding diabetes in pregnancy and risks to the fetus?
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What factor is known to increase the risk of gestational diabetes mellitus?
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What should the nurse teach the client about using insulin during gestational diabetes?
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What is the primary goal of treatment for a pregnant woman with hyperemesis gravidarum at 14 weeks of gestation?
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Which finding indicates the need for early screening for gestational diabetes mellitus (GDM)?
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When can a pregnant client expect her insulin dose to return to the prepregnant level?
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Study Notes
Hypoglycemia Management in Pregnant Women
- For a pregnant woman with diabetes experiencing hypoglycemia, consume 5 or 6 hard candies or drink 8 oz of milk.
- Quick sugars raise blood glucose but do not sustain levels; carbohydrates from polysaccharides are preferred.
Maternal Phenylketonuria (PKU) and Breastfeeding
- Mothers with PKU should avoid breastfeeding due to high phenylalanine in breast milk.
- Dietary restrictions do not lower phenylalanine in breast milk, making breastfeeding unsafe.
Foods to Avoid with PKU
- Clients with PKU must avoid milk, eggs, and nuts; these foods are high in protein and phenylalanine.
- Fruits and vegetables are safe as they contain minimal protein.
Self-Care for Pregnant Diabetic Clients
- Encourage fluid intake to prevent dehydration and regular blood glucose checks during illness.
- Insulin must be taken according to the regular schedule even if appetite diminishes; seek emergency treatment for glucose levels over 200 mg/dl.
Complications of Polyhydramnios
- Polyhydramnios can lead to complications like placental abruption, uterine dysfunction, and postpartum hemorrhage.
- It is characterized by excessive amniotic fluid (>25 cm) but may not directly cause conditions like gestational diabetes.
Indicators of Hypoglycemia
- Symptoms of hypoglycemia include clammy skin, sweating, and pallor, contrasting with hyperglycemia which causes rapid breathing and nausea.
White's Classification of Diabetes in Pregnancy
- This classification considers the duration and age of diabetes onset, as well as complications affecting the kidneys and eyes.
- Diabetic classifications include type 1, type 2, gestational, and other categories.
Management of Hyperemesis Gravidarum
- A nonpharmacologic measure to ease nausea includes providing an odor-free environment, as strong odors exacerbate symptoms.
Cesarean Delivery Considerations
- A client with a macrosomic fetus may require cesarean delivery due to complications associated with gestational diabetes.
Risks from Poorly Controlled Gestational Diabetes
- Complications for the fetus from poorly controlled gestational diabetes include macrosomia, shoulder dystocia, and facial nerve injury.
Urine Ketones and Gestational Diabetes
- Presence of ketones in urine indicates the risk of diabetic ketoacidosis, a serious concern for pregnant clients with high blood glucose levels.
Screening for Gestational Diabetes
- Early screening for GDM is indicated for clients with a history of stillbirth or giving birth to a macrosomic child, not based on age or BMI alone.
Insulin Requirements During and After Pregnancy
- Postpartum, insulin doses will normalize when the mother weans the baby; during pregnancy, insulin demands typically increase.
Management of Thyroid Storm Post-Delivery
- Interventions include providing oxygen, administering antipyretics, and using PTU, not Synthroid, to manage hyperthyroidism during a thyroid storm.
Treatment Considerations for Gestational Diabetes
- Dietary management should distribute nutrient intake over three meals and two to three snacks for proper glucose control.
- Continuous monitoring of blood glucose levels is crucial, avoiding oral hypoglycemic agents that may harm the fetus.### Diabetes and Pregnancy
- Pregestational Diabetes Mellitus: Refers to type 1 or type 2 diabetes that existed prior to pregnancy.
- Gestational Diabetes: Develops during pregnancy and is diagnosed when diabetes occurs during this time.
- Class R Diabetes: Indicates signs of diabetic retinopathy; confirmed through a dilated eye examination.
Insulin Use in Pregnancy
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Types of Insulin:
- Rapid-Acting: Lispro (Humalog), Aspart (NovoLog)
- Short-Acting: Regular (Humulin)
- Intermediate-Acting: NPH (Novolin N)
- Long-Acting: Glargine (Lantus)
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Lispro (Humalog): Preferred rapid-acting insulin during pregnancy; injected before meals, causing less hyperglycemia compared to regular insulin.
Dietary Recommendations
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Gestational Diabetes Diet:
- Eat three meals with 2-3 snacks to maintain steady blood sugar levels.
- Include a bedtime snack with complex carbohydrates and protein to prevent nighttime hypoglycemia.
- Avoid food high in refined sugars and artificial sweeteners; opt for fiber-rich foods.
Medication Management
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Levothyroxine and Iron Supplements:
- Must be taken at least 4 hours apart; iron reduces absorption of levothyroxine.
Hypoglycemia Management
- Intervention: If a client remains hypoglycemic after two doses of glucose tablets, notify the healthcare provider rather than offer more tablets.
Complications in Diabetic Pregnancies
- Risks: Pregnant clients with diabetes may face complications including preeclampsia, hypoglycemia, hydramnios, vaginitis, and potential brachial plexus palsy in the infant.
Understanding Gestational Diabetes
- Defined as diabetes diagnosed during pregnancy; not present beforehand.
Pregnancy Outcomes and Glycemic Control
- Key Factor for Pregnancy Success: The level of glycemic control during pregnancy is crucial for healthy outcomes.
Screening for Genetic Conditions
- Maternal PKU Screening: Necessary for clients with a history of microcephalic infants, due to the risk of phenylalanine toxicity affecting brain development.
Exercise Recommendations for Diabetic Pregnant Clients
- Advisable to exercise with a partner for safety, stop immediately if contractions occur, and maintain a consistent exercise schedule to stabilize blood glucose levels.
pH Levels and Diabetic Management
- A blood pH of 6.5 indicates acidosis; sodium bicarbonate is administered to normalize pH levels.
Overall Patient Care
- Regular monitoring and education on insulin administration techniques, including injection site care, is essential for managing diabetes in pregnancy effectively.### Antenatal Visits for Diabetic Clients
- Third trimester clients with poorly controlled diabetes require more frequent visits, ideally twice a week.
- If a visit occurs on a Monday, the next should be the same week on Thursday.
Insulin Requirements Post-Childbirth
- Breastfeeding mothers see insulin requirements return to prepregnancy levels after weaning.
- At birth, insulinase levels drop, but insulin needs remain lower during lactation.
Preoperative Care for Diabetic Clients
- Ensure clients have nothing by mouth the morning of a cesarean surgery.
- Insulin should be administered the night before surgery; fasting clients do not receive morning doses.
- Monitor for glucose levels and provide IV dextrose if levels drop below 70 mg/dl during labor.
Metabolic Changes in Pregnancy
- Insulin production increases in the first trimester due to hormonal changes.
- Fasting blood glucose levels typically decrease by about 10% during the first trimester.
- Increased insulin resistance occurs in the second and third trimesters to support fetal glucose needs.
Preparedness for Vacation with Diabetes
- Pregnant clients should carry insulin vials, glucose tablets, and a blood glucose meter to manage diabetes while traveling.
Risks Associated with Gestational Diabetes
- Women experience increased risk for preeclampsia and may have infants with macrosomia.
- Gestational diabetes does not correlate with premature rupture of membranes, hyperemesis, or low birth weight.
Dietary Changes for Hyperemesis
- A high-protein snack at bedtime can alleviate protein deficiency and symptoms of hyperemesis.
- Cold foods may be better tolerated than warm foods; dry, bland foods are advisable.
Symptoms of Hypoglycemia
- Common manifestations include dizziness, blurred vision, and excessive hunger due to low blood glucose levels.
- Fruity breath and acetone in urine are related to high ketone levels, typically seen in hyperglycemic individuals.
Insulin Self-Administration Techniques
- Injection sites should be clean; if using alcohol, allow it to dry before injecting.
- Apply gentle pressure post-injection and maintain a record of dose and timing for insulin administration.
Complications of Diabetes
- Major complications include neuropathy, nephropathy, and atherosclerosis due to chronic high blood sugar.
- Cardiomyopathy and restrictive lung disease are not directly associated with diabetes.
Monitoring After Terbutaline Administration
- Pregnant clients receiving terbutaline require monitoring for ketoacidosis, as the medication can induce hyperglycemia.
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Description
Test your knowledge about managing hypoglycemia in pregnant women with diabetes. This quiz focuses on the appropriate nursing interventions and dietary recommendations. Evaluate your understanding of essential care practices for diabetic patients during hospitalization.
