Question

Case Studies Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations 1. Maria is a Hispanic 30-year-old at 26 weeks gestation. She had her GTT done last week and it was elevated at 159 md/dL. She appears anxious and asks, “Does this mean I am a diabetic now?" A. Discuss the management of care for the remainder of Maria's pregnancy, B. Will she require any modifications to standard care for her labor and delivery? C. Discuss the dietary measures related to blood sugar control.

Answer 1

1.Management of care for rest of maria's pregnency:

Glucose monitoring should be done 4 times a day. The first check is done fasting and remainder 1-2 hrs after each meal.

Diet and exercise are the first line therapy for women with GDM.

If metabolic goals are not met within 2 weeks then put the patient on Insulin.

Dose of Insulin is 0.7-1 unit/kg /day in divided doses.

Oral hypoglycemic drugs are not used un pregnency except for metformin and glyburide.

Fetal surveillance should began between 32-34 weeks in stable diabetes and at 28 weeks for growth restricted fetuses.

Overt diabetes and GDM patients on insulin are admitted on 34 weeks and antipartum monitering done 3 times a week.

Patient should be advised to moniter fetal kick count from 3 rd trimester onwards.

2.Standard of care during labour and delivery:

Induction of labor is safe in diabetic female.

Preferred mode of delivery is Vaginal delivery.

Dextrose 5% solution used with fixed dose insulin to drip with glucose infusion and dose titrated as per blood sugar level.

For patient with diet controlled GDM avoiding dextrose in Iv fluid normally maintains excellent blood glucose controls.

Monitering of blood glucose to be done every 2-4 hours in latent phase and 1-2 hours in active phase of labor.

3.Dietery measures related to blood sugar control:

Eat smaller meals multiple times rather that eating too much in single sittings.

Recommended dietry intake is as follows:

If BMI is <25:3000kcal/day

25-30: 2500kcal/day

>30: 1500-2500 kcal/day.

The total calorie requirement should consists of 40% carbohydrate, 20% protein and 40% unsaturated fats.

Moderate amount of lean proteins and healthy fats is recommended.

Plenty of whole fruits, vegetables and fibres recommended.

This diet has to be accompanied by 30 minutes of kild to moderate exercise.