Diabetes Management in Nursing

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