CHAPTER 11 MATERNAL AND OBSTETRIC DISORDERS CASE STUDY 119

Ease Study 119

Name Class/Group Date
Group Members
INSTRUCTIONS All questions apply to this case study. Your responses should be brief and to the point. When
asked to provide several answers, list them in order of priority or significance. Do not assume information that
is not provided. Please print or write clearly. If your response is not legible, it will be marked as ? and you will
need to rewrite it.

Scenario
You are working as an RN in a large women's clinic. Y.L., a 28-year-old Asian woman, arrives for her regu-
larly scheduled obstetric appointment. She is in her 26th week of pregnancy and is a primigravida.
After examining the patient, the nurse-midwife tells you to schedule Y.L. for a glucose challenge test.
You review Y.L.’s chart and note she is 5 feet, 3 inches and weighs 143 pounds; her prepregnancy body
mass index (BMI) is 25. Her father has type 2 diabetes mellitus (DM), and both paternal grandparents had
type 2 DM. You enter the room to talk to Y.L.

1. What is the purpose of a glucose challenge test?

2. When is a glucose challenge test performed?

3. What instructions would you provide Y.L. regarding the test?

■ Ch rt View
ratory Test Results
Time of Test Value Normal Range
0730 109 mg/dL under 95 mg/dL
0830 213 mg/dL under 180 mg/dL
093 162 g/dL und r 153 mg/dL

4. Interpret the results of Y.L.'s test.

5. Y.L. is diagnosed with gestational diabetes mellitus (GDM). What is GDM?

529
 PART 2 PEDIATRIC, MATERNITY, AND PSYCHIATRIC CASES

G. List five risk factors for GDM. Place a star or asterisk next to those risk factors that Y.L. has.

CASE STUDY PROGRESS

Medical nutrition therapy is the primary treatment for the management of GDM. Because treatment
must begin immediately, you call the dietitian to come see Y.L. You also schedule Y.L. to meet with other
mem- bers of the DM management team later in the week.

7. What is the goal of medical nutrition therapy?

Maternal/0bstetric

8. Describe the usual diet used in treating GDM.

9. Why is medical nutrition therapy for a woman with GDM higher in fat and protein?

10. Women with GDM cannot metabolize concentrated simple sugars without a sharp rise in
blood glucose. Name five examples of simple sugars you would teach Y.L. to limit.

11. Complex carbohydrates (CHO) do not cause a rapid rise in blood glucose when eaten in
small amounts. Identify five foods from this group.

530
 CHAPTER J J MATERNAL AND OBSTETRIC DISORDERS CASE STUDY 119

CASE STUDY PROGRESS

During the meeting with the dietitian, Y.L. gives a diet history that is high in noodles and rice with little
protein. She informs the dietitian she is lactose intolerant but can have dairy products occasionally in
small portions.

12. Is it important that Y.L. take a calcium supplement along with her prenatal vitamins?

13. Y.L. is instructed to monitor her fasting blood glucose first thing in the morning and 2 hours
after every meal. What are the purposes of this request?

14. Y.L. is instructed to complete ketone testing using the first-voided urine in the morning.
What is the rationale for this request?

Maternal/0bstetric
15. Y.L. asks whether having gestational diabetes will hurt her baby. How would you respond?

16. At the conclusion of the visit, you need to evaluate your teaching. Which statement made by
Y.L. indicates that clarification is necessary?
a. “I will stay on the diabetic diet described by the dietitian'’
b. “I will monitor my glucose levels at least four times each day'’
c. “I need to stop exercising because I will need more carbohydrates'’
d. “I should immediately report any ketones in my urine'’

531