Gestational Diabetes Hesi Case Study - 2019

Which response should the nurse give to the client? select all that apply

"Hyperglycemia often presents as increased thirst and urination." This is accurate. Hyperglycemia manifestations include increased thirst and increased urination. "Hyperglycemia causes a headache and flushed, dry skin." This is accurate. Hyperglycemia symptoms include headache and flushed, dry skin.

Which information is most important for the nurse to discuss concerning the use of contraception while breast feeding?

- If a dose is taken more than 3 hrs late, a backup method of birth control must be used for the next 48 hrs - It is important to use another method of contraception prior to starting the Mini Pill ( Because the Mini Pill contains such a low dose of progestin, it should be taken at exactly the same time qd; if it is not, the risk of preg increases as much greater rate than if she had missed a estrogen-progestin pill BF'g can suppress fertility, but it is important to understand that as soon as there is a decline in bf'g, the contraceptive protection decreases and other non-pharm'l methods should be considered

At what rate should the nurse initially set the intravenous pump? (Enter numeric value only. If rounding is necessary, round to the tenth.)

12.5 (250 ml/20 units) Ratio and proportion method:2025 u/250 mL = 1 u/X mLCross-multiply: 2025X = 250X = 250/2025 = 12.510 mL/hourDimensional analysis method:25 20 u × 1 u/1 hr = 10 12.5 u/hour

How should the nurse record Danielle's obstetrical history using the G-T-P-A-L designation?

5-2-1-1-4 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 liveborn 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. Danielle's GTPAL is 5 (pregnancies counting current one)- 2 (infants born at 38 and 41 weeks) - 1 (twins born at 35 weeks) - 1 (spontaneous abortion at 10 weeks) - 4 (each twin and the 2 singletons, all living).

Which client should the charge nurse assign the LPN?

A multigravida who had an uncomplicated term delivery and is breastfeeding. Once the initial assessment is done, the LPN is qualified to care for this client because there are no complications expected.

The nurse's response should be based on what information?

An elevated glucose in labor increases the risk of neonatal hypoglycemia. Maternal glucose crosses the placenta and the fetus responds by making insulin. Over time, hyperplasia of the fetal pancreas occurs with subsequent hyperinsulinemia. When the maternal source of glucose disappears at delivery, the neonate's blood glucose level decreases rapidly in the presence of fetal hyperinsulinemia.

What should be the nurse's next action?

Contact the nursing supervisor. This is appropriate use of what is known as the chain of command. If a nurse has a problem, she should first discuss it with the charge nurse. If the nurse is still concerned, the next step is to contact the nursing supervisor. Depending on the supervisor's response, the nurse may or may not need to go up& the chain of command.

Prior to the amniocentesis, which action should the nurse take first?

Assist the client to the bathroom and ask her to empty her bladder. In late pregnancy, this should be done first to decrease the risk of accidental bladder puncture during the procedure. In early pregnancy the bladder should be full when an amniocentesis is done for genetic studies.

What should the nurse recommend to Danielle in regard to infant feeding?

Breastfeeding should be initiated immediately and done on demand. Breastfeeding that commences early and is done on demand (breastfeeding infants generally feed more often than formula-fed infants) helps decrease the risk of hypoglycemia and jaundice. Supplements of water and/or formula are not needed.

Which information does the nurse recognize in the client's history to support a diagnosis of gestational diabetes?

Child weighed 9 lbs (4.08 kg) at 41 weeks' gestation. Birth of an infant weighing more than 9 lbs (4.08 kg) 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.

Which responses should the nurse give to the client? select all that apply

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. Avoid foods high in refined sugars. Foods with refined sugars should be avoided to prevent hyperglycemia. Drink between 8 to 10 cups of fluids daily. Pregnant women should drink between 8 and 10 cups of fluid every day. Most of this fluid should be water, with avoidance of drinks devoid of nutrients, such as carbonated beverages, which may replace healthier drink or food options.

Which instruction should the nurse give the client?

Follow an unrestricted diet and exercise pattern for at least 3 days before the test. When the client follows an unrestricted diet and exercise pattern the test is a true determination of the body's ability to handle the glucose load given after the FBG is drawn.

The nurse's response should be based on the understanding of which normal physiologic change of pregnancy?

Hormonal changes in the second and third trimesters result in increased maternal insulin resistance. 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.

Where will the nurse expect to palpate the uterine fundus?

Midline at the umbilicus ( The uterine fundus should be midline at umbilicus after birth for 24 hrs. A fundus elevated above the umbilicus or shifted to the R or L may indicate blood in the uterus or a full bladder

The nurse's response should be based on which information?

Most women with gestational diabetes return to normal glucose levels after birth. Because the major source of insulin resistance, the placenta, is gone after birth, the woman with gestational diabetes usually returns to normal glucose levels and requires no insulin, oral hypoglycemics, or diabetic diet. Breastfeeding also decreases insulin needs because of the carbohydrates used in human milk production.

Which assessment information is most important for the nurse to validate with the laboring client before giving the medication?

Past or present history of opioid dependence. Stadol is an opioid agonist-antagonist. Respiratory depression, nausea, and vomiting occur less often with this group of drugs when compared with opioid agonists. However, because Stadol also acts as an antagonist, it is not suitable for women with a history of opioid dependence because it can precipitate withdrawal symptoms (abstinence syndrome) in both the mother and the neonate.

Which instructions should the diabetes educator include regarding fingerstick blood glucose (FSBG) monitoring?

Prior to breakfast (fasting) and before 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.

Which action by the nurse takes priority?

Reapply the external fetal monitor to evaluate the fetal heart rate. The response of the fetus to the rupture of the membranes should be evaluated immediately due to the risk of cord prolapse. The nurse will also assess and document the color, amount, viscosity, and odor of the amniotic fluid

Which immediate action should the nurse take?

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.

What action should the nurse take?

Request that the obstetrician change the prescription. The nurse should consult the obstetrician if the nurse believes a prescription should be altered. The nurse cannot reduce a medication dose without consulting the obstetrician, even at the client's request.

Which information should the nurse give about the RhoGam injection?

RhoGam is given to the mother within 72 hours of delivery, if the infant is Rh-positive. RhoGam is given to a mother who has Rh-negative blood and the infant is Rh-positive. It is given within 72 hours of delive

Which fetal heart rate (FHR) changes indicate a reactive nonstress test?

Two episodes of acceleration (greater than 15 beats/minute, lasting more than 15 seconds) related to fetal movement in a 20-minute period. This describes a reactive nonstress test. The test is based on the premise that the normal fetus with an intact central nervous system (CNS) will produce accelerations of the fetal heart rate in response to 90% of gross fetal body movements. When used as part of the BPP, a reactive test is worth 2 points, and a nonreactive test is worth 0 points.

Which newborn behavior indicates to the nurse that the infant has suffered a complication from the shoulder dystocia?

Unilateral absence of the 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.