Evolve Gestational Diabetes Case Study – Flashcards

Gravidity [G] is defined as the number of times pregnant, including the current pregnancy. Term [T] is defined as any birth after the end of the 37th week, and preterm [P] refers to any births between 20 and 37 weeks. Both term and preterm describe live born and stillborn infants. Abortion [A] is any fetal loss, whether spontaneous or elective, up to 20 weeks gestation. Living [L] refers to all children who are living at the time of the interview. Multiple fetuses such as twins, triplets, and beyond are treated as one pregnancy and one birth when recording the GTPAL.

Birth of an infant over 9 pounds (~ 4.1 kg or 4100 grams) is a risk factor for gestational diabetes. Other risk factors include maternal age older than 25, obesity, history of unexplained stillborn, family history of Type 1 diabetes in a first-degree relative, strong family history of Type 2 diabetes, and history of gestational diabetes in a previous pregnancy. Ethnic groups at increased risk include Hispanic, Native-American, Asian, and African-American.

- By following an unrestricted diet (including at least 150 g of carbohydrates) and regular exercise patterns, the test is a true determination of the body's ability to handle the glucose load given after the fasting blood glucose is drawn -The client should refrain from eating or drinking anything during the test, although small sips of water are acceptable if the client is very thirsty. In addition, caffeine in any form should be avoided because it tends to increase glucose levels. -Smoking should be avoided at least 12 hours before, and then during the test due to the risk of false elevations in blood sugar level. In addition, smoking during pregnancy puts the fetus at risk for intrauterine growth restriction and other problems.

Increased levels of hormones increase insulin resistance because they act as insulin antagonists. This serves as a glucose-sparing mechanism to ensure an adequate glucose supply to the fetus. While most pregnant women's bodies are able to handle this insulin resistance, women with gestational diabetes cannot and, therefore, demonstrate an impaired tolerance to glucose during pregnancy and develop hyperglycemia.

The woman with gestational diabetes is at increased risk for developing Type 2 diabetes later in life. Carbohydrate intolerance should be evaluated 6 to 12 months after pregnancy, if bottle-feeding, or after breastfeeding has been stopped, and repeated at regular intervals as part of well-woman care. Women with gestational diabetes should be encouraged to lose weight (if overweight) and to exercise to reduce this risk.

Choose complex carbohydrates that are high in fiber content. The starch and proteins in high-fiber complex carbohydrates, such as whole grains, beans, fresh fruits, and vegetables help regulate the blood glucose as a result of a more sustained glucose release over time. In addition, meals and snacks should be eaten on time and never skipped in order to promote sustained glucose release and decrease the risk of hyper and hypoglycemic episodes.

Prior to breakfast (fasting) and 2 hours after each meal. This protocol will identify if the prescribed diet is promoting euglycemia, and the record obtained from it will allow the healthcare provider and RD to make changes in the plan of care as needed.

Two episodes of acceleration (>15 beats/min, lasting >15 seconds) related to fetal movement in a 20 minute period

Reposition the client using McRobert's maneuver. The nurse should assist the woman in flexing and abducting the maternal hips, positioning the maternal thighs up onto the maternal abdomen. This position decreases the angle of the pelvic inclination, rotates the symphysis pubis toward the maternal head, and causes the sacrum to straighten, freeing the shoulder. This maneuver is often combined with suprapubic pressure, which also helps free the shoulder from under the symphysis pubis.

A unilateral absence of moro reflex. This behavior is indicative of a fractured clavicle, which is a common complication of shoulder dystocia. Newborn fractures heal rapidly and immobilization is accomplished with slings, splints, or sometimes simple swaddling.