Criteria
Target maternal glucose during labor
70-110mg/dl
Symptoms of neonatal hypoglycemia, name 2
shakiness, poor feeding, lethargy, breathing issues, abnormal cry, and bluish or pale skin
How often is maternal BG checked on the Insulin Protocol
q1hr unless orders are different
What organ drives the insulin resistance in pregnant women?
Placenta
Signs and symptoms of Hypoglycemia, name 2
Headache, Dizziness, Rapid Pulse, Nausea, Tingling, Sweating, Tremors, Irritability, Numbness, Altered State
2
Intermittent EFM allowed in early labor with GDM insulin dependent patient
No.
IV#1 (Mainline) runs what fluids
Crystalloid
NS
LR
Pitocin
Magnesium
and anything else
Does Metformin qualify you to be on the Insulin Drip Protocol?
Yes. Any medication metformin or Insulin
You don't need orders for Insulin Drip Protocol if pt meets criteria T/F
False. You always need orders for insulin.
When is the insulin protocol started in the labor process
Active labor or NPO/Clear Liquids
Neonatal BG minimum accepted level in the first 4hrs of life
40mg/dl
IV#2 (Second Line) runs what fluids
Insulin and NS. NOTHING ELSE!
What medication in both GDM and none GDM pts raised BG levels? (This is for none labouring patients) Often seen antepartum.
Steroids
Once pt delivers what is the GDM PP regiment
Consult OB
Can CGM be used to monitor maternal BG levels in labor per Emory protocol?
No. Technically.
Fetal risks with maternal GDM if maternal BG isn't well controlled in labor
Fetal acidemia
Fetal Hyperglycemia
Crystalloid is run on the main line during Insulin Protocol. What maternal BG would prompt you to change the fluid to NS?
BG > 180 mg/dl
What hormone surge during labor causes a transient insulin resistance
Cortisol
Patients BG is less than 68mg/dl. What do you do?
Inform provider and implement Diabetes Hypoglycemia Protocol = D50W 25g (50ml) = thought sometimes if pt is asymptomatic MD may give pt some juice and retake BG in 30 min
What type of GDM qualifies for insulin drip protocol
Any GDM requiring medication; metformin or insulin
What occurs with fetal BG levels after birth if maternal BG stays high and not well controlled
At birth hyperglycemia followed by the "crash" hypoglycemia
Your patient needs a blood transfusion. What line do you use?
You start a 3rd IV line
What is the infant pathophysiology that causes the hypoglycemia shortly after birth
Infant produced excess insulin in response to the consistent maternal high BG. And after birth there isn't enough food/sugar to burn through and infant BG drops
Scheduled C/S patient comes in for preop, she is insulin dependent GDM. Nursing Care specific to her GDM?
Either Finger stick for baseline BG level or send a CMP for the BG level