Gestational Diabetes Essay

The clinic RN reviews Amandas prenatal file anterior to performing a nursing assessment. Amanda has exposen birth twice, at once at 35-weeks (twins) and once at 39-weeks (singleton). All of these boorren are alive and well. She has had unitary spontaneous abortion at 9-weeks gestation. 1.How should the encourage record Amandas obstetrical fib 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. counteract answer(s) CThe nurse notes that Amandas fasting 1 hr glucose screening level, which was done two geezerhood previously, is 158 mg/dl. 2. The nurse recognizes that what information in the clients history supports a diagnosis of gestational diabetes? A) maternal(p) 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 t exclusively and weighed 134 prior to pregnancy. proper answer(s) BFurther Gluc ose ScreeningAmanda is plan for a 3 hour oral glucose tolerance turn up in 5 days, and is told to arrive at the lab at 830 am. Amanda asks if thither are every special instruction manual 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) scarce coffee or tea is allowed once the fasting level has been drawn. B) survey 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 beat the test begins.Correct answer(s) BAmanda asks the nurse why she wasnt tested for gestational diabetes until she was almost 28-weeks gestation. 4.The nurses response should be found 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) foetal insulin production increases each trimester, forcing the mothers body to produce much glucose.Correct answer(s) CInterdisciplinary Client CareAmandas 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 pedagog and a registered dietitian (RD) the next day.The perinatologist and CNM discuss gestational diabetes with Amanda and by and by seeking arousal from Amanda, outline their suggested plan of care, which includes dietary control and glucose self- manageing. after(prenominal) the perinatologist and CNM leave, Amanda appears confused and asks the RN, Does this cockeyed I will always have diabetes? 5.Which response should the nurse giv e to the client?A) You will need to be periodically evaluated for Type 2 diabetes for the rest of your life. B) There should be no problem as yen as you do not have to use insulin during this pregnancy. C) There is no need to talk just about this now. Well discuss it at your first postpartum visit. D) Tell me what worries you about the possibility of developing Type 2 diabetes after your pregnancy ends. Correct answer(s) AAfter 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 time maintaining an appropriate carbohydrate-protein-fat ratio to promote consonant weight gain (based on the womans body plurality 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 me als. 6.Which response should the nurse give to the client?A) go past the bedtime snack if heartburn develops after eating. B) Choose complex carbohydrates that are broad(prenominal) in fiber content. C) Increase the percentage of protein in the diet if genus Anemia develops. D) Vary timing of meals and snacks based on individual preferences.Correct answer(s) BThe RN diabetes educator makes a plan of care to teach Amanda to observe her glucose levels. The RN diabetes educator discusses the use of self-glucose monitoring and gives Amanda verbal and written counselor-at-law 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 maintain to meet after Amandas prenatal appointment to follow-up on todays 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) foregoing 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) BA Complication OccursAmanda manages her gestational diabetes with diet. She experiences a few episodes of postprandial hyperglycemia, exclusively 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 child has seemed to 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 hospitals antepartum unit. The antepartum RN performs a nonstr ess 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 pablum stimulation. D) Two episodes of acceleration ( 15 beats/minute, lasting 15 seconds) connect to fetal movement in a 20 minute period.Correct answer(s) DAmanda has a non-reactive Non-stress Test. She is taken to the ultrasound department for completion of the BPP and her match score is 6 (Fetal Breathing Movements = 2, Gross Body Movements = 0, Fetal life = 2, Reactive Non-stress Test = 0, and Qualitative Amniotic Fluid Volume = 2). establish 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 tolerant globulin (RhoGAM) if client is Rh negative. B) Assist the client to the bathroom and ask her to fire her bladder. C) Apply the outside(a) fetal monitor to evaluate uterine contractility. D) refined the abdomen with betadine solution and sterile 4 by 4s. Correct answer(s) BAmanda 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, Amandas membranes rupture spontaneously. 10.Which action by the nurse takes priority?A) Notify the CNM and perinatologist of the changes in Amandas status. B) Trans fer 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