ch 29 evolve
For which condition should the nurse be alert after administering terbutaline (Brethine) to a pregnant client with diabetes mellitus?
ketoacidosis terbutaline is a tocolytic to stop perterm labor. It may lead to hyperglycemia and cause ketoacidosis
The blood glucose level of a pregnant client is 325 mg/dl. Which test should be performed on the patient to assess the risk of maternal or intrauterine fetal death?
ketones in urine DKA can lead to fetal death and can occur if BG rises above 200, and can be confirmed by ^
What is the priority assessment in evaluating a pregnant woman with severe nausea and vomiting?
ketonuria
The nurse is caring for a pregnant client with type 2 diabetes. What does the nurse teach the client about glucose metabolism in the first trimester?
maternal glucose levels are affected by nausea and cravings
what are maternal and neonatal risks associated with gestational diabetes
maternal preeclampsia and fetal macosomia
The nurse is teaching a client diagnosed with phenylketonuria (PKU) about foods to be avoided in the daily diet. Which foods can have an adverse effect on the mother and fetus?
milk eggs nuts must avoid ^ before conception and throughout pregnancy, and have a modified diet that excludes high-protein foods
what condition is a client at risk in EARLY pregnancy due to poorly controlled hyperglycemia
miscarriage
breastfeeding and PKU mom
not advised because phenylalanine levels will be high in breast milk
The nurse is caring for a diabetic client who is breastfeeding her infant. Within what time frame following childbirth do the client's insulin requirements return to prepregnancy levels?
on completion of weaning the infant -maternal glucose is used up during lactation; therefore the bf mother's insulin requirement remains low
What does the nurse instruct a pregnant client who is diabetic to do r/t to exercise?
perform exercises with a partner, exercise, eat meals and take insulin at the same time every day, and if contractions occur - stop exercising, drink 2-3 glasses of water and lie down on her side for an hour
A client who is pregnant already has type 2 diabetes What does the nurse would categorize this client as having?
pregestational DM
primary goal of hyperemesis gravidarum
reverse fluid, electrolyte and acid-base imbalances
which diagnostic test used to identify NTDs at 16 weeks
serum-alpha fetoprotein -performed between 16 and 18 weeks
The nurse finds that the blood pH of a pregnant client who is diabetic is 6.5. What should the nurse administer to normalize the client's blood pH?
sodium bicarb 6.5 = acidosis, revert with alkaline soln
The nurse is caring for a pregnant client prescribed levothyroxine for hypothyroidism. The client is also prescribed an iron supplement. What information does the nurse provide the client about taking these medications?
take the two m eds at different times of the day at least 4 hours apart
if nurse suspects clients belongs to class R of pregestational diabetes this means
the client has symptoms of diabetic retinopathy -dilated eye exam test would confirm
A client with poorly controlled diabetes who is in the third trimester of pregnancy should visit the clinic how often
twice a week
macrosomia
birth weight of more than 4000 g
most important factor affecting pregnancy outcome with pregestational diabetes
degree of glycemic control during pregnancy
A nurse is working with a diabetic client who recently found out she is pregnant. In coordinating an interdisciplinary team to help manage the client throughout the pregnancy, the nurse would include whom?
dietician perinatologist nephrologist internal medicine practitioner
when a pregnany women with DM experiences hypoglyecemia while hospitalized, she should
eat 5 or 6 hard candies or drink 8 oz of milk
The nurse is caring for a client in early pregnancy with hyperemesis. What changes in diet will benefit this client?
eating a high protein snack at bedtime may help client overcome protein deficiency r/t hyperemesis
if methimazole is taken in first trimester of pregnancy to treat hyperthyroidism, what are possible side effects
facial anomilies esophageal atreisa developmental delays in fetus
The nurse is caring for a client in the first trimester of pregnancy who is prescribed propylthiouracil (PTU) for hyperthyroidism. What are the side effects of this medication?
hepatic toxicity PTU is only used in first trimester of pregnancy
techniqe to injust insulin
-45 to 90 degree angle -inject slowly -cover with sterile gauze -gentle pressure
interventions for a pregnancy client experiencing thyroid storm following delivery of a baby
-administer oxygen -antipyretics -PTU -IV fluids to reduce hypotension
What are the manifestations associated with hypoglycemia?
-decreased BG -impaired brain function: dizziness and blurred vision -excessive hunger
The nurse is caring for a diabetic client who is pregnant. What does the nurse instruct the client about self-care during illness?
-drink as much fluid as possible to prevent dehydration -obtain as much rest as possible -check BG at regular intervals to identify hypoglycemia -seek emergency treatment if BG exceed 200
features of White's classification of diabetes in pregnancy
-duration of diabetes in the client -age at which diabetes diagnosed -involvement of the eye and kidneys
to assess a client for GDM using oral glucose tolerance test :
-first draw blood sample for a fasting blood glucose level before test begins -client eats an unrestricted diet 3 days before test -avoid caffeine for 12 hours before test -
a pregestational insulin-depended pregnant diabetic is going out of state. She should bring with her:
-glucose tablets -insulin -blood glucose meter
risks to the fetus in LATER pregnancy states and birthing process with a mother with poorly controlled Gestational DM
-macrosomia -shoulder dystocia -facial nerve injury -infant hypoglycemia
metabolic changes assoc with pregnancy
-maternal production of insulin increases during first trimester -fasting blood glucose levels will decrease during first trimester -there is enough glucose for the fetus during the second trimester
pregnant women with untreated hypothyroidism are at risk for
-miscarriage -gestational htn -placental abruption -stillbirth -preeclampsia -LBW -preterm
what are the potentially fatal complications associated with diabetes
-neuropathy -nephropathy -atherosclerosis
complications associated with polyhydramnios
-placental abruption -uterine dysfunction -postpartum hemorrhage
Which obstetric or medical complications should the nurse be alert for when providing care to a pregnant client with diabetes mellitus?
-preeclampsia -hypoglycemia (in first tri) -hydramnios (due to hyperglycemia) -monilial vaginitis (alteration in normal resistance of body to vaginal infection)
rapid and short acting insulins
-regular -lispro -aspart
nonpharmacologic ways to alleviate problems r/t hyperemesis gravidarum
-rest in environemnt free from odors
some women can control gestational DM by
Dietary management alone; involving distributing nutrient requirements over three meals and two or three snacks -Small frequent meals over a 24-hour period help decrease the risk for hypoglycemia and ketoacidosis.
Which assessment finding does the nurse recognize as an indicator for early screening for gestational diabetes mellitus (GDM)?
The client had a previous stillbirth or macrosomic infant
In which pregnant client does the nurse identify the need to screen for undiagnosed homozygous maternal phenylketonuria (PKU)?
a client who has given birth to a microcephalic infant toxic accumulation of phemylalanine hydrolase interferes with brain development
What is the pathologic change associated with diabetic ketoacidosis?
cellular dehydration from osmotic diuresis
if client belongs to class F of pregestational DM, this means
client has nephropathy, and should be referred for a renal function test
the most important cause of perinatal loss in diabetic pregnancy is
congenital malformations, and diabetic mothers at increased risk for infants with RDS