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2. Objectives
Distinguish between normal and abnormal blood glucose levels based
on patient population
Classify the different diagnosis associated with
hypoglycemia/hyperglycemia based on patient age
Compare the common causes of hypoglycemia/hyperglycemia based on
patient population
3. Objectives
Formulate theappropriate interventions for
hypoglycemia/hyperglycemia management based on patient
population
Differentiate between the different medications used to manage the
hypoglycemic/hyperglycemic patient.
Predict immediatecomplications of hypoglycemia/hyperglycemia
4. Objectives
State potential long term complications of uncontrolled blood sugar
levels
Determine the appropriate educational strategies to prevent
hypoglycemia/hyperglycemia
5. NORMAL BLOOD GLUCOSE for PREGNANT WOMEN
65mg/dl (fasting)
200 mg/dl
Causes: Insufficient insulin, excess or wrong kinds of food,
infection, illness, injuries, emotional stress or insufficient
exercise
12. SIGN & SYMPTOMS OF HYPERGLYCEMIA
Thirst
Nausea/Vomiting
Abdominal pain
Constipation
Drowsiness
Dim vision
Increased urination
Fruity breath
Rapid, weak pulse
Rapid breathing
13. MANAGEMENT OF HYPERGLYCEMIA
Notify healthcare provider
Administer insulin in accordance with blood glucose level (sliding
scale)
Give IV fluids (NS or 0.45 NS)
Monitor blood & urine laboratory testing
14. MANAGEMENT OF DIABETES IN PREGNACY
Diet
Exercise
Monitoring of blood glucose levels
Insulin therapy: done on a individual basis to maintain normal
blood glucose levels
Close monitoring of fetus after 40 weeks until delivery
15. COMPLICATIONS OF DIABETES IN PREGNACY
Congenital malformations
Macrosomia:infant weight of 4,000-4,500 grams
Intrauterine growth retardation (IUGR)
Stillbirth
Respiratory Distress Syndrome (RDS)
Spontaneous abortion in early pregnancy
Shoulder Dystocia
Pregnancy induced hypertension (PIH)
Infections (UTIs, yeast infection)
Ketoacidosis
16. PREVENTION
Seek counseling before getting pregnancy
Maintain a healthy weight
Exercise regularly
Eat healthy and balanced meals
Seek prenatal care early in pregnancy
Keep all prenatal appointments
Follow regime prescribed by physician
17. REFERENCES
CDC.GOV (2009). Information on gestational diabetes. Retrieved July
9, 2009, from:
http://diabetes.niddk.nih.gov/dm/pubs/gestational/
Lowdermilk, D., Perry, S., & Bobak, I. (1999). Maternity
Nursing (5th. Ed). St. Louis: Mosby.
18. CASE STUDY
Maria, a 40 y/o G4P3 at 29 weeks present to Labor & Delivery
with c/o dizziness, headache, nausea and vomiting for 3 days. After
interviewing Maria, you note that she has not had any prenatal
care, has a h/o diabetes Her past obstetrical history includes
delivery of a 4500 gram male complicated by shoulder dystocia. She
weighs 312 pound. Her Bp 129/83, HR 82, RR 26 and Temp 98.8. A UA
shows 3+ glucose, and negative ketones. Her accucheck is
179mg/dl.
19. CASE STUDY DISCISSION
Questions
1. What tests, if any, should be done to evaluate the Marias
glucose tolerance? 2. How is the diagnosis of gestational diabetes
mellitus (GDM) established? 3. What would be the best treatment and
follow-up strategy for Maria?
Discussion
This patient has several risk factors for GDM. She is over the age
of 30, has a history of GDM and is obese. All these place her at a
greater risk for developing GDM. She needs to be referred to a
dietician or diabetic counselor. She needs to continue prenatal
care and started on insulin therapy. Maria should be followed
closely for the remainder of the pregnancy. Birthing options
(vaginal vs caesarean section) should be discussed with the
patient. Maria should also be followed closely after delivering to
assess for the development of Type II diabetes.
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