Diabetes Care in Pregnancy Chapter 29

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Questions and Answers

Which of these options are correct regarding treatment for a client with hypotension? (Select all that apply)

Restriction of intravenous fluids to prevent fluid overload

Administration of oxygen (correct)

Antipyretics (correct)

PTU (correct)

Synthroid

What should the nurse be aware of regarding a pregnant woman diagnosed with gestational diabetes? (Select all that apply)

Glucose levels are monitored by testing urine four times a day and at bedtime

Dietary modifications and insulin are both required for adequate treatment (correct)

Oral hypoglycemic agents can be used if the woman is reluctant to give herself insulin

Dietary management involves distributing nutrient requirements over three meals and two or three snacks (correct)

What does the nurse categorize a pregnant client with type 2 diabetes and an A1c of 7 as having? (Select one)

Pregestational diabetes mellitus (correct)

Gestational diabetes

Non-insulin-dependent diabetes with complications

Insulin-dependent diabetes complicated by pregnancy

Which are rapid and short-acting insulins? (Select all that apply)

Regular (Humalin) Signup and view all the answers

What information does the nurse provide about lispro (Humalog) insulin? (Select all that apply)

It is rapid-acting insulin preferred for use during pregnancy Signup and view all the answers

What should the nurse teach the client about diet during pregnancy for gestational diabetes? (Select one)

Eat three meals a day with two or three snacks Signup and view all the answers

What should the client taking levothyroxine and an iron supplement do? (Select one)

Take the two medications at different times of the day Signup and view all the answers

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)

Preeclampsia Signup and view all the answers

Which of the following findings is not likely to be seen in a pregnant client who has hypothyroidism? (Select one)

Macrosomia Signup and view all the answers

What risks are associated with untreated hypothyroidism during pregnancy? (Select all that apply)

Gestational hypertension Signup and view all the answers

What is gestational diabetes? (Select one)

Diabetes that is diagnosed during pregnancy Signup and view all the answers

What is done to confirm the condition for a client suspected of class R pregestational diabetes? (Select one)

The client is referred for a dilated eye examination Signup and view all the answers

For what condition is a client at risk in early pregnancy due to poorly controlled hyperglycemia? (Select one)

Miscarriage Signup and view all the answers

What intervention by the nurse is appropriate while caring for a client undergoing the OGTT for gestational diabetes? (Select one)

Draw blood for a fasting blood glucose level just before the test Signup and view all the answers

What are the side effects of propylthiouracil (PTU) prescribed for hyperthyroidism? (Select one)

Hepatic toxicity Signup and view all the answers

What should the nurse do next if a hypoglycemic client remains low after administering glucose tablets? (Select one)

Notify the primary health care provider Signup and view all the answers

What is the pathologic change associated with diabetic ketoacidosis? (Select one)

Cellular dehydration Signup and view all the answers

What does the nurse teach about glucose metabolism in the first trimester for a client with type 2 diabetes? (Select one)

Maternal glucose levels are affected by nausea and cravings Signup and view all the answers

When a pregnant woman with diabetes experiences hypoglycemia while hospitalized, what should the nurse have the woman do?

Eat 5 or 6 hard candies or drink 8 oz of milk. Signup and view all the answers

Which statement made by the nurse indicates accurate information for a pregnant woman with maternal phenylketonuria (PKU) about breastfeeding?

The client should be advised to not breastfeed the infant, because her breast milk will contain large amounts of phenylalanine. Signup and view all the answers

Which foods should a client diagnosed with phenylketonuria (PKU) avoid in their daily diet? (Select all that apply)

Milk Signup and view all the answers

What should the nurse instruct a pregnant diabetic client about self-care during illness? (Select all that apply)

Check your blood glucose levels at regular intervals. Signup and view all the answers

What complications are associated with polyhydramnios? (Select all that apply)

Postpartum hemorrhage Signup and view all the answers

Which manifestation is related to hypoglycemia in a diabetic client?

Clammy skin Signup and view all the answers

What are the features of White's classification of diabetes in pregnancy? (Select all that apply)

It is based on the involvement of the eye and the kidneys. Signup and view all the answers

Which nonpharmacologic measure is appropriate for a client with hyperemesis gravidarum?

Providing an environment that is free from odors Signup and view all the answers

Which client may need a cesarean delivery due to complications related to gestational diabetes?

A client with a big fetus Signup and view all the answers

What risks to the fetus may arise from poorly controlled gestational diabetes? (Select all that apply)

Shoulder dystocia Signup and view all the answers

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?

Ketones in urine Signup and view all the answers

What is the priority assessment in evaluating a pregnant woman with severe nausea and vomiting?

Ketonuria Signup and view all the answers

Which patients with diabetes may develop complications if they perform exercises? (Select all that apply)

A client with uncontrolled hypertension Signup and view all the answers

What should nurses be aware of regarding diabetes in pregnancy and risks to the fetus?

The most important cause of perinatal loss in diabetic pregnancy is congenital malformations. Signup and view all the answers

What factor is known to increase the risk of gestational diabetes mellitus?

Previous birth of large infant Signup and view all the answers

What should the nurse teach the client about using insulin during gestational diabetes?

Inject insulin in the abdomen. Signup and view all the answers

What is the primary goal of treatment for a pregnant woman with hyperemesis gravidarum at 14 weeks of gestation?

Reverse fluid, electrolyte, and acid-base imbalances. Signup and view all the answers

Which finding indicates the need for early screening for gestational diabetes mellitus (GDM)?

The client had a previous stillbirth. Signup and view all the answers

When can a pregnant client expect her insulin dose to return to the prepregnant level?

When the client weans the baby from breastfeeding. Signup and view all the answers

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

Types of Insulin:
- Rapid-Acting: Lispro (Humalog), Aspart (NovoLog)
- Short-Acting: Regular (Humulin)
- Intermediate-Acting: NPH (Novolin N)
- Long-Acting: Glargine (Lantus)
Lispro (Humalog): Preferred rapid-acting insulin during pregnancy; injected before meals, causing less hyperglycemia compared to regular insulin.

Dietary Recommendations

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

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.