Diabetes Management in Nursing

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Questions and Answers

What is the recommended nutrition plan for diabetes management during pregnancy?

Restrictive diet with limited meal frequency
Choose nutrient-dense foods with small, frequent meals (correct)
Liquid diet with high sugar content
High-calorie diet with increased meal portion

Why may insulin dosage need to be adjusted during pregnancy?

Insulin needs will decrease during pregnancy
Insulin needs will remain constant throughout pregnancy
Insulin needs will increase during the first trimester (correct)
Insulin does not cross the placental barrier

What is a potential maternal complication of diabetes during pregnancy?

Easier delivery and postpartum recovery
Lower risk of infection
Higher risk of postpartum hemorrhage (correct)
Lower risk of postpartum hemorrhage

What is a fetal complication of diabetes during pregnancy?

Neonatal hypoglycemia after birth (B) Signup and view all the answers

What is the goal of glucose control during labor?

Maintain a glucose reading of 80-110 mg/dL (D) Signup and view all the answers

Why is gestational diabetes sometimes treated with diet and exercise?

Because diet and exercise can effectively manage blood glucose levels (A) Signup and view all the answers

What is the effect of pregnancy on the respiratory system?

Increased oxygen demand (D) Signup and view all the answers

What is the cause of epistaxis during pregnancy?

Vascular congestion (D) Signup and view all the answers

What is the characteristic change in the breasts during pregnancy?

Nipples become more erect and areolas darken (D) Signup and view all the answers

What is the cause of varicose veins during pregnancy?

Vascular congestion (B) Signup and view all the answers

What is the characteristic skin change during pregnancy?

All of the above (D) Signup and view all the answers

What is the cause of constipation during pregnancy?

Hormonal changes (D) Signup and view all the answers

What is the characteristic gastrointestinal change during pregnancy?

Increased flatulence (A) Signup and view all the answers

What is the cause of frequent urination during pregnancy?

Pressure of the uterus on the bladder (A) Signup and view all the answers

What is the primary focus of medical treatment for hyperemesis gravidarum?

Restoring physiologic balance (C) Signup and view all the answers

Which of the following is a common complication of pregnancy?

Hemorrhoids (C) Signup and view all the answers

What is the main reason for administering pyridoxine (vitamin B6) to pregnant women?

To treat hyperemesis gravidarum (C) Signup and view all the answers

Which of the following is NOT a risk factor for hyperemesis gravidarum?

Gestational diabetes (D) Signup and view all the answers

What is the primary goal of nursing management for hyperemesis gravidarum?

To administer medications as ordered (D) Signup and view all the answers

Which of the following is a common cause of leg cramps during pregnancy?

All of the above (D) Signup and view all the answers

What is the primary cause of pyrosis (heartburn) during pregnancy?

Enlarging uterus (C) Signup and view all the answers

What is the primary risk factor for ectopic pregnancy?

Tubal scarring (A) Signup and view all the answers

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Study Notes

Nutrition

Choose nutrient-dense foods and small frequent meals for optimal nutrition during pregnancy

Nursing Management/Treatment

Recognize signs and symptoms of hypoglycemia (cold and clammy, neuro changes, shakiness) and hyperglycemia (3 P's and fatigue)
Insulin does not cross the placental barrier and reach the fetus, but dosage adjustments may be needed during pregnancy
Gestational diabetes can be treated with diet and exercise, but insulin may be required if blood glucose levels remain high
Insulin needs increase during the second and third trimester
Better glucose control during pregnancy results in a better outcome for mom and baby at delivery
During labor, continuous infusion of insulin with a separate IV solution containing 5% dextrose may be required, with titration to maintain a glucose reading of 80-110 mg/dL

Complications

Fetal complications:
- Macrosomia
- Neonatal hypoglycemia
- Neonatal hyperbilirubinemia
- Respiratory distress syndrome
Maternal complications:
- Difficult delivery and postpartum recovery due to macrosomia
- Higher risk for postpartum hemorrhage
- Increased risk for infection
- Increased risk for hypertension and preeclampsia

Hyperemesis Gravidarum

Persistent, uncontrollable vomiting that begins in the first weeks of pregnancy and continues beyond the first trimester
More common in twins, nulliparous, H.pylori, thyroid issues, family history, migraines, and motion sickness
Medical treatment focuses on preventing severe vomiting and restoring physiologic balance using IV hydration and possibly enteral nutrition
Pharmacologic treatment options include:
- Pyridoxine (vitamin B6)
- Doxylamine
- Metoclopramide
- Ondansetron
- Proton pump inhibitors (omeprazole)
- Antacids (calcium carbonate)
- H2 histamine blockers (famotidine)

Nursing Management/Treatment for Hyperemesis Gravidarum

Administer medications as ordered
Encourage small, frequent meals of bland, non-greasy foods
Teach ways to counteract nausea
Provide empathy and compassion

Ectopic Pregnancy

Fertilized ovum implants in the fallopian tube instead of the uterus
Can be life-threatening
More common in cases of tubal scarring or STIs

Complications of Pregnancy

Normal pregnancy discomfort includes:
- Pyrosis (heartburn)
- Constipation
- Hemorrhoids
- Leg cramps
Physiological changes during pregnancy:
- Increased RBCs but decreased hemoglobin due to hemodilution
- Postural hypotension
- Dependent edema
- Varicose veins
- Hemorrhoids
- Respiratory changes:
  - Increased oxygen demand
  - BMR increased
  - Uterus pressing on diaphragm
  - Nasal stuffiness
  - Epistaxis
  - Slight hyperventilation
- Breast changes:
  - Nipples more erect
  - Areolas darken
  - Enlarged breasts
  - Increased sensitivity and heaviness
  - Superficial veins more prominent
- Skin changes:
  - Linea nigra
  - Striae gravidarum
  - Chloasma
  - Increased pigmentation
  - Hair/nail growth accelerated
  - Angiomas
  - Erythema of the hands
  - Mild pruritus of the abdomen
  - Oily skin
  - Gum hypertrophy
  - Hirsutism
- Musculoskeletal changes:
  - Forward pelvic tilt
  - Lordosis
  - Venous stasis/edema
  - Nerve compression/numbness tingling in legs
  - Round ligament pain
  - Diastasis recti
  - Relaxation of the pelvic joints
- Gastrointestinal changes:
  - Nausea
  - Pyrosis
  - Increased salivation
  - Flatulence
  - Constipation
  - Hemorrhoids
- Genitourinary changes:
  - Frequent urination

Maternal Changes in Pregnancy

Chadwick Sign: vaginal/cervical bluish color change
Goodell's Sign: cervical softening
Chloasma: "mask" of pregnancy/hyperpigmentation spots on face
Striae Gravidarum: stretch marks
Linea Nigra: dark vertical line on the abdomen
Supine Hypotensive Syndrome: when the pregnant woman is in the supine position, the weight of the uterus partially occludes the vena cava and the aorta