'Gestational Diabetes Essay\r'

'The clinic RN reviews Amanda’s prenatal record earlier to performing a nursing assessment. Amanda has conductn comport twice, once at 35-weeks (twins) and once at 39-weeks (singleton). on the whole of these children argon alive and well. She has had one spontaneous abortion at 9-weeks gestation. 1.\r\nHow should the hold in record Amanda’s obstetric history using the G-T-P-A-L designation?\r\nA) 3-2-0-1-3.\r\nB) 3-1-1-1-2.\r\nC) 4-1-1-1-3.\r\nD) 4-2-1-0-2.\r\n represent answer(s): C\r\nThe have got notes that Amanda’s fasting 1 hr glucose screening level, which was done cardinal days previously, is 158 mg/dl. 2. The obligate recognizes that what information in the client’s history supports a diagnosis of gestational diabetes? A) maternalistic great-aunt has insulin dependent (Type 1) diabetes. B) Youngest child weighed 4300 grams at 39-weeks gestation.\r\nC) retrace of protein noted in urine specimen at hold prenatal visit. D) Client is 64 i nches large and weighed 134 prior to pregnancy. better answer(s): B\r\nFurther Glucose masking\r\nAmanda is scheduled for a 3 hour oral glucose tolerance test in 5 days, and is told to bugger off at the lab at 8:30 am. Amanda asks if there are any special book of instructions for the test in addition to fasting for 8 hours immediately prior to the test. 3.\r\nWhich instruction should the nurse give the client?\r\nA) entirely coffee or tea leaf is allowed once the fasting level has been drawn. B) Follow an discretionary diet and exercise pattern for at least 3 days before the test. C) Write crop up questions and call the laboratory for instructions the day before the test. D) Smoking in mode proportionalityn is allowed up until the fourth dimension the test begins.\r\n oppose answer(s): B\r\nAmanda asks the nurse wherefore she wasn’t tested for gestational diabetes until she was almost 28-weeks gestation. 4.\r\nThe nurse’s response should be found on the u nderstanding of which normal physiologic change of pregnancy? A) Maternal insulin crosses the placenta to regu lately fetal glucose levels throughout pregnancy. B) In the first trimester, estrogen and progesterone ca intake an growth in maternal fasting glucose levels. C) Hormonal changes in the second and third trimesters result in change magnitude maternal insulin resistance. D) Fetal insulin production join ons each trimester, forcing the stupefy’s body to produce more glucose.\r\nCorrect answer(s): C\r\nInterdisciplinary Client Care\r\nAmanda’s 3 hour Oral Glucose Tolerance political campaign omens that she does have gestational diabetes. The RN phones Amanda and arranges for her to roleplay with the CNM and perinatologist, as well as an RN diabetes educator and a registered dietitian (RD) the next day.\r\nThe perinatologist and CNM discuss gestational diabetes with Amanda and aft(prenominal) seeking input from Amanda, outline their suggested plan of care, which includes dietetic control and glucose self-monitor. aft(prenominal) the perinatologist and CNM leave, Amanda appears confused and asks the RN, â€Å"Does this mean I will always have diabetes?” 5.\r\nWhich response should the nurse give to the client?\r\nA) â€Å"You will need to be periodically evaluated for Type 2 diabetes for the rest of your life.” B) â€Å" at that place should be no problem as farsighted as you do not have to use insulin during this pregnancy.” C) â€Å"There is no need to talk well-nigh this now. We’ll discuss it at your first post dampenum visit.” D) â€Å" assure me what worries you about the possibility of developing Type 2 diabetes after your pregnancy ends.” Correct answer(s): A\r\nAfter all her questions are answered, Amanda is scheduled for a way out visit with the CNM in one week, and is escorted to the office of the registered dietician (RD). The RD discusses the need to control carbohydrates while maintaining an appropriate carbohydrate-protein-fat ratio to promote consistent weight gain (based on the woman’s body mass index), delay ketoacidosis, and encourage normoglycemia (euglycemia). Amanda is then introduced to the RN diabetes educator. She asks the nurse to wrap up what the RD told her about the content and timing of her meals. 6.\r\nWhich response should the nurse give to the client?\r\nA) Eliminate the bedtime snack if pyrosis develops after eating. B) Choose complex carbohydrates that are soaring in fiber content. C) Increase the percentage of protein in the diet if anemia develops. D) Vary timing of meals and snacks based on individual preferences.\r\nCorrect answer(s): B\r\nThe RN diabetes educator makes a plan of care to ascertain Amanda to monitor her glucose levels. The RN diabetes educator discusses the use of self-glucose monitoring and gives Amanda verbal and written guidance about optimal glucose levels at each glucose testing point throughout th e day. The nurse also provides instruction about normalization of the glucose monitor, fingerstick technique, and use of the monitor for testing. After reviewing the instructions and a successful return demonstration, the diabetes educator and Amanda agree to meet after Amanda’s prenatal appointment to reexamination on today’s teaching/learning. 7.\r\nWhich fingerstick line of descent glucose (FSBG) testing protocol should the diabetes educator recommend for Amanda? A) Only if symptoms of hypoglycemia or hyperglycemia occur. B) previous to eat (fasting) and two hours after each meal. C) Before and two hours after all meals, at bedtime, and during the night. D) Once periodic until glucose levels are stabilized, then weekly. Correct answer(s): B\r\nA Complication Occurs\r\nAmanda manages her gestational diabetes with diet. She experiences a few episodes of postprandial hyperglycemia, but does not have to go on insulin. At her 36-week prenatal visit, the CNM assesses Amanda and finds that there is no increase in fetal growth since the week before. When questioned further, Amanda tells the CNM that the baby has seemed to â€Å"slow down” a little the last few days. After consultation with the perinatologist, a biophysical indite (BPP) is scheduled and Amanda is admitted to the hospital’s antepartum unit. The antepartum RN performs a nonstress test (NST) as part of the BPP. 8.\r\nThe nurse recognizes which fetal amount of money rate (FHR) changes indicate a reactive nonstress test? A) Persistent late decelerations associated with three uterine contractions, lasting 40 to 60 seconds each in a 10 consequence period. B) An increase in the FHR baseline to 170 beatniks per minute, lasting for at least 20 transactions. C) Marked, presbyopic term FHR variability in response to contractions caused by nipple stimulation. D) Two episodes of acceleration (> 15 trounce/minute, lasting > 15 seconds) related to fetal front in a 20 min ute period.\r\nCorrect answer(s): D\r\nAmanda has a non-reactive Non-stress Test. She is taken to the ultrasound part for completion of the BPP and her total score is 6 (Fetal live Movements = 2, Gross Body Movements = 0, Fetal Tone = 2, activated Non-stress Test = 0, and Qualitative Amniotic Fluid deal = 2). Based on this score, the perinatologist recommends an amniocentesis be unblemished to assess for lung maturity prior to making a decision whether to induce delivery for Amanda the next day. 9.\r\nPrior to the amniocentesis, which action should the nurse take first? A) sell Rh immune globulin (RhoGAM) if client is Rh negative. B) embolden the client to the bathroom and ask her to empty her bladder. C) hand the away fetal monitor to evaluate uterine contractility. D) Clean the abdomen with betadine solution and sterile 4 by 4s. Correct answer(s): B\r\nAmanda and her fetus are monitored for two hours after the procedure and display no adverse effects so the external fetal monitor is discontinued. The amniocentesis reveals fetal lung maturity and an generalisation is scheduled for the next morning.\r\nAt 2 a.m. Amanda complains of change magnitude uterine discomfort. She is contracting every 10 minutes and while the antepartum nurse is in the room, Amanda’s membranes rupture spontaneously. 10.\r\nWhich action by the nurse takes antecedence?\r\nA) Notify the CNM and perinatologist of the changes in Amanda’s status. B) Transfer Amanda to the labor-delivery-recovery (LDR) suites. C) Reapply the external fetal monitor to evaluate the fetal heart rate. D) Start an intravenous line using an 18 gauge or larger intravenous catheter. Correct answer(s): C\r\n'