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mellitus [IDDM] or non–insulin-dependen t diabetes mellitus [NIDDM]), or may develop during pregnancy (gestational diabe tes mellitus [GDM]). (This plan of care is to be used in conjunction with the Tr imesters and the High-Risk Pregnancy.) CLIENT ASSESSMENT DATA BASE Circulation Pedal pulse and capillary refill of extremities may be diminished or slowed (wit h diabetes of long duration). Edema, elevated BP (PIH). Elimination May have history of pyelonephritis, recurrent UTI, nephropathy Polyuria Food/Fluid Polydipsia, polyphagia. Nausea and vomiting. Obesity; excessive or inadequate we ight gain (client with GDM is usually obese; client with IDDM is not usually obe se before pregnancy). Abdominal tenderness. May report episodes of hypoglycemia, glycosuria. Safety Skin integrity/sensation of arms, thighs, buttocks, and abdomen may be altered f rom frequent injections of insulin. Visual impairment/retinopathy may be present . History of symptoms of infection and/or positive cultures for infection, espec ially urinary or vaginal. Sexuality Fundal height may be higher or lower than normal for gestational age (hydramnios , inappropriate fetal growth). History of large for gestational age (LGA) neonat e, hydramnios, congenital anomalies, unexplained stillbirth. Social Interaction Socioeconomic concerns/factors can increase risk of complications. Inadequate or lack of committed support system (may adversely affect diabetic control). Teaching/Learning Client’s own birth weight may have been 9 lb or more. May report recent problems/c hange in stability of diabetic control. Family history of diabetes, GDM, PIH, in fertility problem; LGA infant, history of neonatal death(s), stillbirth, congeni tal anomalies, spontaneous abortion, hydramnios, macrosomia (greater than 4000 g or 9 lb at birth). DIAGNOSTIC STUDIES Glucose Tolerance Test (GTT): Elevated above 140 mg/dL at 24–28 weeks’ gestation. Cl ients with specific risk factors are screened at first prenatal visit. (If scree ning result is positive, 3-hr glucose challenge or oral glucose tolerance test [ OGTT] test done to make diagnosis.) Glycosylated Hemoglobin (HbA1c): Reveals glu cose control over previous 4–8 wk. Levels greater than 8.5%, especially before pre gnancy, puts the fetus at risk for congenital anomalies. Random Serum Glucose Le vel: Determines immediate diabetic control.
Contraction Stress Test (CST). Hemoglobin (Hb)/Hematocrit (Hct): May reveal anemia. Oxytocin Challenge Tes t (OCT): Positive results indicate placental insufficiency. Verbalize understanding of individual treatment regimen and need for frequent s elf-monitoring. Thyroid Function Tests: Establish baseline and/or identify coexisting hypothyroidism or hyperthryoidism. Amniocentesis: Ascer tains fetal lung maturity using lecithin to sphingomyelin (L/S) ratio or presenc e of phosphatidylglycerol (PG). Estriol Level: Indicates level of p lacental function. Serial Ultrasonography: Determines prese nce of macrosomia or IUGR. Vaginal Culture: May be positive for Ca ndida albicans (Monilia infection). risk for less than body requirements Inability to ingest/uti lize nutrients appropriately [Not applicable. 3. 4. 2. Encourage client to periodically monitor weigh t at home between visits. Be free of signs/symptoms of ketoacidosis. DESIRED OUTCOMES/EVALUATION CRITERIA—CLIENT WILL: ACTIONS/INTERVENTIONS Independent Weigh client each prenatal visit. Uri ne Culture: Identifies asymptomatic UTI. Nonstress Test (NST): May demonstrate reduc ed fetal response to maternal activity. Maintain fasting serum glucose levels between 60–100 mg/dL and 1 hr p ostprandial no higher than 140 mg/dL. NURSING PRIORITIES 1. Achieve and maintain normoglycemia (euglycemia). NURSING DIAGNOSIS: Risk Factors May Include: Possibly Evidenced By: Nutrition: altered. Protein and Creatinine Clearance (24 hr): Ve rify level of kidney function. presence of signs/symptoms establi shes an actual diagnosis] Gain 24–30 lb prenatally. Glycosylated Albumin: Reflect s glucose control over last several days as possible screening test for GDM. RATIONALE Weight gain is the key index for deciding caloric adjustments. BPP Criteria: Assesses fetal well-being/maturity . Determine immediate and previous 8-wk diabetic control. . especially in diabetes of long duration. Aids in evaluatin g client’s understanding of and/or adherence to dietary regimen. Assess caloric intake and dietary pattern using 24-hr recall. Evaluate ong oing client/fetal well-being. or as appropriate for prepregn ancy weight. Triglyceri des and Cholesterol Levels: May be elevated.Urine Ketone Levels: Determines nutritional state. P rovide client/couple with appropriate information. Electrocardiogram (ECG): May reveal altered cardiovascular fu nction in diabetes of long duration.
g. Have client demonstrate proc edure.Review/provide information regarding any required changes in diabetic management . Adjustment of insulin frequency/dosage/type must then be con sidered. Nausea and vomiting may result in carbohydrate deficiency. Stress can elevate serum glucose levels. frequent meals avoid postprandial hyperglycemia and fasting/st arvation ketosis. Recommend monitoring urine for ketones on awakening and when a planned meal or s nack is delayed. switch from oral agents to insulin. Because pregnancy produces severe morning carboh ydrate intolerance. Insulin needs for the day can be adjusted based on periodic serum glucose readin gs. creating fluctuations in ins ulin needs. Note: Values obtained by reflectance meters may be 10%–15% lower/higher than p lasma values. causing inappropriate fetal weight gain..g. Review importance of regularity of meals and snacks (e. Provide information about stress management and relaxation. requiring close monitoring and adaptation. M etabolism and fetal/maternal needs change greatly during gestation. Note: Bedtime snack should contain both protein and complex ca rbohydrates to prevent nighttime hypoglycemia. with minimal carb ohydrates. self-mo nitoring of serum glucose levels at least 4 times/day (e.g. Note presence of nausea and vomiting. Assess unde rstanding of the effect of stress on diabetes.. 3 meals/3 or 4 snacks ) when taking insulin. causing maternal metabolism of fat. indicating need for an increase of carbohydrates or addition of an extra snack in the dieta ry plan (e. and reducing/changing time for ingesting carbohydrates. Reducing carbohydrates to less than 40% of the calories ingested decreases the degree of the postprandial glucose peak of hyperglycemia. the first meal of the day should be small. (Refer to CP: The High-Risk Pregnancy. before breakfast an d 2 hr after each meal). Small. use of Humulin insulin only. e. Presence of ketones during second half of pregnancy may reflect “accelerated starvation” as diminished effectiveness of insulin results in a catabolic state during fasting periods (e. Insufficient caloric intake is reflected by ketonuria. .g.. which may lead to metabolism of fats and development o f ketosis..) Teach client finger-stick method for self-monitoring of glucose. skipping meals). Research suggests antibodies against insulin ma y cross the placenta. The use of human insulin decreases the development of these antibodies..g. recurrent presence of ketonuria on awakening may be eliminated by a 3 AM glass of milk). especially in first trimester.
cardiac dysrhythmias. 6 P M—regular).0 unit/kg by 36 weeks’ gestation. and risk of permanent neurologi cal damage. Provide s opportunity to review management of both pregnancy and diabetic condition. as well as low le vels of the insulin antagonist human placental lactogen (HPL). Note: Althoug h some providers may choose to manage clients with GDM with oral agents. usually 4 times/day: 7:30 A M—NPH.8 unit/kg. Division o f insulin dosage considers maternal basal needs and mealtime insulin-to-food rat io. A mix of NPH and regular human insulin helps mimic the normal insulin release pattern of the pancreas. 10 AM—regular. Maternal effects of hyperglycemia can include hydramnios. Usi ng large amounts of simple carbohydrates to treat hypoglycemia causes serum gluc ose values to overshoot. and allows more freedom in meal scheduling. esp ecially for client with GDM.7 unit/kg of body weight. and type of insulin (e. Insulin needs in the first trimester are 0. and to plan for special needs during intrapartum and postpartum periods. 4 P M—NPH. it increases to 0.. owing to increased usage of glucose and glycogen by client and developing fetus. 0. A combination of complex carbohydrates and protein main tains normoglycemia longer and helps maintain stability of serum glucose through out the day.g. Ketoacidosis occu rs more frequently in second and third trimesters because of the increased resis tance to insulin and elevated HPL levels. neonatal hypoglycemia. inhibition of lung maturi ty. Prenatal metabolic needs change throughout the tri mesters. and adjustment is determined by weight gain and laboratory test results . . Hypoglycemia may be more sudden or severe in first trimester. and spontaneous termination of pregnancy. at 34 weeks’ gestation. macrosomia. and 1. 199 2) set dietary needs at 25 kcal/kg dependent on the client’s current pregnant weig ht.9 unit/kg. Note: New recommendations (Peterson & Peterson. Diet specific to the individual i s necessary to maintain normoglycemia and to obtain desired weight gain. Adjust diet or insulin regimen to meet individual needs. Between 1 8 and 24 weeks’ gestation. Total daily dosage is based on g estational age. minimizing “peak/valley” effect of serum glucose level. Instruct client to treat symptomatic hypoglycemia. Refer to registered dietitian to individualize diet and counsel regarding dietar y questions. may also cause fetal hyperinsulinemia. with an 8-oz gl ass of milk and to repeat in 15 min if serum glucose levels remains below 70 mg/ dL. UTI and/or vaginal infections. schedule. current maternal body weight. Collaborative Participate in/coordinate multispecialty care conference as appropriate. and serum glucose levels. hypertension. if it occurs. insulin is still the drug of choice. Discuss dosage. Sustained or intermittent pulses of hy perglycemia are mutagenic and teratogenic for the fetus during the first trimest er.Review/discuss signs and symptoms and significance of hypoglycemia or hyperglyce mia. In-dept h teaching promotes understanding of own needs and clarifies misconceptions.
The National Diabetes Data Group Classification. and 2-hr postprandial is less than 120 mg/dL.) Encourage client to periodically count/record fetal movements beginning about 18 weeks’ gestation. preprandial levels between 60 and 105 mg/dL. E. Fetal movement and FHR may be negatively affected when placental insuffic iency and maternal ketosis occur. RATIONALE Fetus is at less risk if White’s classification is A. explain classification and signific ance to client/couple. . ACTIONS/INTERVENTIONS Independent Determine White’s classification for diabetes. and gestational diabetes mellitus. ND: Injury. type II. Incidence of fetal and newborn abnormalities is decreased when FBS levels range between 60 and 100 mg/dL. Ascertain results of HbA1c every 2–4 wk. presence of signs/symptoms establishes an actual diagnosi s] Display normally reactive NST and negative OCT and/or CST. or C. 1-hr post prandial remains below 140 mg/dL. 1 and 2 hr postprandial) on init ial visit. NURSING DIAGNOSIS: Risk Factors May Include: Possibly Evidenced By: DESIRED OUTC OMES/EVALUATION CRITERIA—FETUS WILL: Injury. Infant morbidity is link ed to maternal hyperglycemia-induced fetal hyperinsulinemia. Assess fetal movement and FHR each visit as indicated. White’s classif ication has been used in conjunction with (1) evaluation of diabetic control or lack of control and (2) presence or absence of Pederson’s prognostically bad signs of pregnancy (PBSP). then daily from 34 weeks’ gest ation on. preprandial. Strict control (normal HbA1c levels ) before conception helps reduce the risk of fetal mortality and congenital anom alies. risk for fetal. The client with cla ssification D. with size appropriate for gestational age. mild/severe toxemia. Note client’s diabetic control before conception. has not yet had prognostic si gnificance in predicting perinatal outcomes. Be full-term. non–insulin-dependent). risk for fetal Elevated maternal serum glucose levels. or F who develops kidney or acidotic problems or PIH is at hig h risk. B. Serum glucose control takes 6 wk to stabilize. As a means of determining prognosis for perinatal outcome. impaired glu cose tolerance. (Refer to CP: Third Trime ster. which include acidosis. Provides accurate picture of average serum glucose control during the preceding 60 days. and pyeloneph ritis. Prepare for hospitalization if diabetes is not controlled. which includes diabetes mellitus (type I. changes in circul ation [Not applicable.Monitor serum glucose levels (FBS. insulin-dependent. then as indicated by client’s condition.
. Review procedure and rationale for periodic NSTs (e. Provide information and reinforce procedure for home blood glucose monitoring an d diabetic management. ND: Injury. particularly if poor control existed before pregnancy. Fetal activity and move ment are good predictors of fetal wellness. When maternal/placental functioning is impa ired before term. ri sk for fetal. increased blood pressure). small or larg e for gestational age [SGA/LGA]). Serum test for glycolysated albumin reflects glycemia over several days and may gain acceptance as screening tool for GDM because it does not invol ve potentially harmful glucose loading as does OGTT. risk for less than body requirements. weekly NST after 30 weeks’ gestation. CST assesses placental perfusion of oxygen and nutrients t o fetus. Irreparable CNS damage or fetal death can occu r as result of maternal ketonemia. Follow with OGTT if test results are positive. ND: Injury. depe nding on diagnosis of IDDM or GDM.) Review procedure and rationale for amniocentesis using L/S ratio and presence of PG.) Monitor for signs of PIH (edema. Decreased fetal/newborn mortality and morbidity complications and congenital anomalies are associated with optimal FBS levels between 70 and 96 mg/dL.g. (Refer to NDs: Knowledge Deficit [Learning Need]. Incidence of congenitally malformed infan ts is increased in women with high HbA1c level (greater than 8. Frequent monitoring is necessary to mai ntain this tight range and to reduce incidence of fetal hypoglycemia or hypergly cemia. Positive results indicate placental insufficiency. especially for client i n high-risk category (history of macrosomic infants. Verify AFP levels are obtained at 14–16 weeks’ gestation. risk for fetal. in which case fetus may need to be delivered surgically. These disorders negatively a ffect placental perfusion and fetal status. in the diabetic client. (Refer to CP: Second Trimester. Note fruity breath. fetal lung maturity is criterion used to determine whether sur vival is possible.. Helps client to make informed decisi ons about managing regimen and may increase cooperation. therefore. Hyperinsulinemia inhibits and interferes with surfactant prod uction. (Refer to CP: Third Trimester. it is especially important in this population because t he incidence of neural tube defects is greater in diabetic clients than in nondi abetic clients.Monitor fundal height each visit. as indicated. Monitor urine for ketones. Although AFP screen is reco mmended for all clients.) Collaborative Assess HbA1c every 2–4 wk. twiceweekly NST after 36 weeks’ gestation). Note: HbA1c is not sensitive enough as a screening t ool for GDM. and 2-hr postprandi al glucose level of less than 120 mg/dL. Nutriti on: altered. Discuss rationale/p rocedure for carrying out periodic OCT/CST beginning at 30–32 weeks’ gestation. Useful in identifying abnormal growth pattern (macrosomia or IUGR. or positive f amily history of GDM). proteinuria. testing for presence of PG is more ac curate than using L/S ratio. Assess glycolysated albumin level at 24–28 weeks’ gestation.5%) early in preg nancy or before conception. previous GDM. About 12%–13% of diabetic individuals develop hypertensive disorders owing to cardiovascular changes associated with diabetes. especially in the third trimester. Activity level decreases before alte rations in FHR occur. Provide information about possible effect of diabetes on fetal growth and develo pment.
risk for fetal. Facilitates tighter control of serum glucose levels. risk for less than body requirements.) Assess client for vaginal bleeding and abdominal tenderness. E. as appropriate. risk for maternal Changes in diabetic control.. NURSING DIAGNOSIS: Risk Factors May Include: Possibly Evidenced By: DESIRED OUTC OMES/EVALUATION CRITERIA—CLIENT WILL: Injury. 28. A total score of 8–10 is rea ssuring. Overdistension of uterus caused by macrosomia or hydramnios may Allows greater accuracy than urine testing because renal threshold for glucose i s lowered during pregnancy. Monitor for signs and symptoms of preterm lab or. amniotic fluid volume. Maintain normogl ycemia.) RATIONALE Client classified as D. (Refer to NDs: Nutrition: altered. fetal tone. . Assist as necessary with BPP assessment. and fetal body move ments. ACTIONS/INTERVENTIONS Independent Note White’s classification for diabetes.Prepare for ultrasonography at 8. placental separation). presence of signs /symptoms establishes in actual diagnosis] Remain normotensive. infection. tissue hypoxia.g. Knowledge deficit [Learning Need ]. 12. as indicat ed. Review periodic creatinine clearanc e levels. Assist client in learning home monitoring of blood glucose. Be free of complications (e. (Refer to ND: Injury. free of signs/symptoms of ketoacidosis. Assess degree of diabetic control (Peder son’s criteria). Vascular changes associated with diabetes place client at risk for abruptio plac entae. Assist with preparation for delivery of fetus vaginally or surgically if test re sults indicate placental aging and insufficiency. Assesses fetal well-being and adequacy of placental perfusion. For each criterion met. There is a sli ght parallel between renal vascular damage and impaired uterine blood flow. and a score of 0–3 is ominous. Macrosomia o ften causes dystocia with cephalopelvic disproportion (CPD). Perform NST and OCT/CST. abnormal blood profile/an emia. f etal breathing movements. Incidence of stillbirths increases significantly with gestation more than 36 wk. Alth ough estriol levels are not used as often now. Ultrasonography is useful in confirming gestation date and helps to evaluate IUG R. to be done a minimum of 4 times/day. or F is at higher risk for complications. The criteria include NST results. Obtain sequential serum or 24-hr urinary specimen for estriol levels a fter 30 weeks’ gestation. a score of 2 is given. Helps ensure positive outcome for neonate. Provi des a score to assess fetal well-being/risk. as is clien t with PBSP. falling levels may indicate decre ased placental functioning. predispose client to early labor. altered immune response [Not applicable. leading to possibility of IUGR and stillbirth. a score of 4–7 indicates need for further evaluation and retesting. 18. and 36–38 weeks’ gestation.
administer antibiotic as indicated. then double and may even quadruple as the pregnancy progresses. Helps prevent or treat pyelone phritis. Identify for hypoglycemic episodes occurring at home. if present. check for edema of extremities and dyspnea. Instruct in insulin administration. the diabetic client is prone to ex cess fluid retention and PIH. because hyperglycemia increases fetal urine output. when insulin requirements often double (may quadruple in t hird trimester). especially in second and third trimesters. Monitor client closely if tocolytic drugs are used to arrest labor. Obtain HbA1c every 2–4 wk. Because of vascular changes. In the presence of hypoglycemia. Assess for and/or monitor presence of edema. may possibly be associated with increased fetal cont ribution to amniotic fluid.Request that client check urine for ketones daily. Ketonuria indicates presence of starvation state.) Determine fundal height. helps d etermine times of day during which client is prone to hypoglycemia. signs and symptoms if UTI. Detects impending ketoacidosis. Hydramnios occurs in 6%–25% of pregnant diabetic clients. as indicated. depending on client’s needs or care setting. Determine nature of any vaginal discharge. which is caused by Candida albicans and may result in oral thrush in newborn. as required . Allows accur ate assessment of glucose control for past 60 days. either subcutaneously (SC) or with pump. Insulin requirements are decreased in first trime ster. which may negatively affect th e developing fetus. vomiting may lead to ketosi s. and to low levels of HPL. Assess for. Assess Hb/Hct on initial visit. . Tocolytic drugs may elevate serum glucose and insulin le vels. Candida vulvovaginitis can cause oral thrush in the newborn. Ensure that client is adept at self-administration. Hypoglycemic episodes occur most frequently in the first tri mester. owing to continuous fetal drain on serum glucose and amino acids. If glycosuria is present. Collaborative Monitor serum glucose levels each visit. Obtain urinalysis and urine culture. Highly mot ivated and capable clients may do well with a continuous subcutaneous insulin in fusion pump to more naturally meet insulin needs. Note: Some antibiotics might be contraindicated because of danger of te ratogenic effects. client is more likely to develop monilial vulvovaginitis. Identify for episodes of hyperglycemia. Early detection of UTI may prevent pyelonephritis. which is thought to contribut e to premature labor. The severity of the vascular changes before pregna ncy influences the extent and time of onset of PIH. Anemia may be present in cli ent with vascular involvement. and review with client. then duri ng second trimester and at term. Diet/insulin regulation is necessary for normoglycemia. (Refer to CP: Pregnancy-Induced Hyp ertension. ND: Fluid Volume deficit. Obtain culture of vaginal discharge.
development of preventable complications Participate in the management of diabetes during pregnancy. misinformation. statement of misc onception.Collect specimens for total protein excretion. Laser coagulation therapy may improve clien t’s condition and reduce optic fibrosis. which corrects hypogly cemic state.. . Progressive vascular changes may impair renal function in clients with severe or long-standing diabetes. femur length. prognosis. e. background retino pathy may progress during pregnancy. Owing to severe vascular involvement. and estimated fetal weight. administer glucagon SC if client is hospitali zed with insulin shock and is unconscious. 26.g. NURSING DIAGNOSIS: May Be Related To: Possibly Evidenced By: DESIRED OUTCOMES/EV ALUATION CRITERIA—CLIENT WILL: Knowledge deficit [Learning Need]. Follow with proteincontaining fluids/ foods. and in second and third trimesters if client is class D. illness. E. and cellular dehydration as water is drawn from the cell by a hypertonic concentrat ion of glucose within the serum. Glucagon is a naturally occurring substanc e that acts on liver glycogen and converts it to glucose. RATIONALE Clients with either preexisting diabetes or GDM are at risk for ineffective gluc ose uptake within the cells. requiring the client/couple to take a very active role. and insulin requirements. Informed decisions can be made only when there is a clear unde rstanding of both the disease process and the rationale for management. inaccurate follow-through of instructions. (Note: Hypertonic glucose [D50] administered IV may have negative e ffects on fetal brain tissue because of its hypertonic action. and self care treatment needs Lack of exposure to information. creatinine clearance. Schedule ophthalmologic examination during first trimester for a ll clients. unfamiliarity with information resources Questions. Prepa re client for ultrasonography at 8.) Protein helps su stain normoglycemia over a longer period of time. BUN. and ur ic acid levels. regarding diabetic condition. including relat ionships between diet. and activities involved in controlling diabetes. Start IV therapy with 5% dextrose. lack of recall. and 36–38 weeks’ gestation as indica ted. Demonstrate proficiency in self-monitoring and insulin administration. Client is at increased risk fo r CPD and dystocia due to macrosomia. Pregnancy alters insulin requirements drastical ly and necessitates more intense control. Determines fetal size using biparietal di ameter. Verba lize understanding of the procedures. 18. 12. excess utilization of fats/proteins for energy. laboratory tests. stress. ACTIONS/INTERVENTIONS Independent Assess client’s/couple’s knowledge of disease process and treatment. F. exercise. 8 oz skim milk when client is able to swallow.
Demonstrat e procedure. general feelings of well-being. Review reasons why oral hypoglycemic medications should be avoided. even though they may have been used by the class A client. but they double and then may quadruple during second and third trim esters. Caloric restriction with resulting ketonemia may cause fetal damage and inhibit optimal protein utilization. client’s diary can assist with evaluation and alteration of therapy. and the need for frequent readings (at least 4 times/day). Explain normal weight gain to client. Increased knowledge may decrease fear of the unknown. Discuss how client can recognize signs of infection. and any other pertinent thoughts. Although insulin does not cross the placenta. Provide information about action and adverse effects of insulin. then observe return demonstration by the client. risk for fetal. diet. Caution client not to treat self with OTC vaginal creams. (Refer to ND: Injury. necessitating a change in diabetic management. When reviewed by healthcare practitioner(s). Client needs to be assured that questions will be answered and problems dealt with immediate ly on a 24-hr–day basis. Choice of self-treatment m ay be inappropriate/mask infection. in which case exercise promotes ketoacidosis. Total gain in the first trimester should be 2. then 0. 20 min after meals). or nasal spray (experimental technique) as indicated. Provide information about need for regular daily mild exercise program (regularl y. un less excessive elevation of glucose is present. Warn against exercising if glucose exceeds 300 mg/dL. insulin pump.5– 4. In the first trimester. Review Hb/Hct levels. insulin requirement s are lower. Frequent blood glucose measurements allow client to recognize the impact of her diet and exercise on serum glucose levels and promote tighter control of glucose levels.Discuss importance of home serum glucose monitoring using reflectance meter. Encourage home mo nitoring between visits. Anemias are of greater concern in clients with preexistin g diabetes because elevated glucose levels replace oxygen in the Hb molecule. Prenatal metabolic changes c ause insulin requirements to change. may increase likelihood of participation. to control diabetes before pregnancy. this is not recommended during pregnancy. Provide information regarding the impact of pregnancy on the diabetic condition and future expectations. as indicated.) Regular exercise may decrease insulin requirements. and may help reduce fetal/maternal complications. exercise.5 lb.9 lb/wk thereafter. re sulting in reduced oxygen-carrying capacity. About 70% of clients diagnosed with GDM will develop NIDDM within 15 yr.8–0. Importa nt to seek medical help early to avoid complications. insulin dosage. oral hypoglycemic agents do and are potentially harmful to the fetus. while radical fluctuations i n physical activity can adversely affect glucose control. . Provide contact number s for health team members. Assist client t o learn administration by injection. Provide dietary information about sources of iron and the need for iron supplements. Although some clinical sources report use of oral agents in clients with GDM. Client should exercise after meals to help prevent hypoglycemia and to stabilize glucose excursion. reactions. Recommend client maintain a diary of home assessm ent of serum glucose levels.
Assist client/family to learn glucagon administration. then recheck glucose level in 15 min . tingling sensation. Use of glucagon in combination with milk can increase the serum glucose level witho ut the risk of rebound hyperglycemia. . such as 8 oz of milk. palpitati ons) with a serum glucose level under 70 mg/dL requires prompt intervention. Presence of symptoms of hypoglycemia (diaphoresis. Glucagon is also useful during periods of morning sickness/vomiting when food intake is curtailed and serum glucose levels fall. Instruct client to follow with protein source.
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