Question

Katie, age 30, is pregnant for the third time. Her first pregnancy, at age 27, resulted in a miscarriage at 10 weeks. Her second pregnancy, Jayson, weighed 12 pounds at birth. During that pregnancy she had an abnormal glucose tolerance test and was diagnosed with GDM.

- Katie is Native American, weighs 185 pounds and is 5’ 3”. She has glucosuria.

- Kakie has a family history of a first degree relative with diabetes.

a. Katie asks, "I have heard that all women with diabetes will have Cesarean births. Is that true?” Describe the response and the follow up teaching you would do with Katie to address her fears.

b. During the laboring process, the nurse notes that Sally's skin is pale, cool, and clammy. The nurse obtains the following vital signs: BP 128/68; P 110; RR 20. Sally states she feels okay but has a little headache. Should the nurse be concerned w/these symptoms or are they a normal response to the laboring process?

c. What would be the nurse's response to Katie’s situation in question b?

d. Why is gestational diabetes diagnosed at 24-28 weeks of gestation?

Answer 1

a.False

It is not indicated that all GDM patient should under go a C section. Each mother are unique and have different reasons for C sections.It doesn't means that there is no possibility for normal child birth. Womens cannot undergo or has complications in a normal delivery method are suggested for C section.

b.The symptoms like pale ,cool and clammy skin with headache indicates the patient is at risk of hypoglycemia because during labour process more amount of glucose is used by the body as a natural response to meet the needs.This fits for GDM clients as well where they at risk for drop in blood sugar levels during the labour process.

c.The nurse should respond immediately by

• Monitoring patient blood sugar levels to get the baseline data and plan for care
• Ensure there is infusion of Dextrose with normal saline to stabilize the blood glucose levels
• Monitor FHR,to avoid complications
• Inform the concerned obstetrician

d.It is recommended to do gestational diabetes diagnosis in second trimester in case 8f the women shows some positive results in first trimester, or increasing age ,family history.Moreover the hormonal changes are almost produced in excess in the women by second trimester leading to insulin resistance and enables to diagnose GDM.