Gestational Diabetes
when do we want to maintain euglycemic control with pregnant women when they have a risk for GD?
1-2 months before pregnancy
When are you most at risk for for eclampsia?
50% of cases happen antepartum.
What classifies a diagnosis of IUGR?
estimated fetal weight (EFW) below the 10th percentile. - very common with high BP/preeclampsia
A nurse is caring for a pregnant woman with preeclampsia receiving magnesium sulfate. Which assessment finding is most concerning?
a) Deep tendon reflexes 2+
b) Urine output 50 mL/hr
c) Respiratory rate of 10 breaths/min
d) Blood pressure 140/90 mmHg
c) Respiratory rate of 10 breaths/min
Rationale: Magnesium sulfate is a CNS depressant, and respiratory depression (<12 breaths/min) is a sign of toxicity. Other signs include absent deep tendon reflexes and decreased urine output (<30 mL/hr).
What is the antidote for magnesium sulfate toxicity?
a) Vitamin K
b) Naloxone
c) Calcium gluconate
d) Protamine sulfate
c) Calcium gluconate
Rationale: Calcium gluconate reverses magnesium sulfate toxicity.
What glycemic range is acceptable during labor?
Bonus 100: how do we treat the hyperglycemia and what safety protocols do we use for it?
80-110
Bonus: IV insulin, need a dual sign off
Name the diagnostic criteria of chronic htn with preeclampsia
Women w/ chronic HTN who develop new onset proteinuria or increased proteinuria and manifest other signs and symptoms:
↑ in liver enzymes or creatinine
Present w/ thrombocytopenia
Right upper quadrant pain and HAs, blurred vision or scotoma
May develop pulmonary edema/congestion
How does mag affect the baby?
A nurse is educating a pregnant client on the purpose of the glucose tolerance test (GTT). When is the initial screening typically performed?
a) 12-16 weeks
b) 20-22 weeks
c) 24-28 weeks
d) 30-32 weeks
c) 24-28 weeks
Rationale: The American College of Obstetricians and Gynecologists (ACOG) recommends screening for gestational diabetes between 24-28 weeks unless high risk, in which case earlier screening is warranted.
What is the cure for preeclampsia?
a) Magnesium sulfate
b) Antihypertensive therapy
c) Bed rest
d) Delivery of the fetus and placenta
d) Delivery of the fetus and placenta
Rationale: Preeclampsia resolves only after delivery of the placenta.
Explain how glucose and insulin move across the placenta.
The mother's glucose intake crosses the placenta to feed the baby and stimulate growth.
Insulin that the mother makes/subsidizes doesn't cross the placenta. The baby has to make their own insulin
What symptoms precede eclampsia?
blurred vision, photophobia, altered mental status
Metallic taste; “limp rag”
Sweating
Hypotension
Depressed to absent DTRs
Respiratory depression
6. A nurse is caring for a patient with preeclampsia and severe features. Which medication should the nurse anticipate administering?
a) Nifedipine
b) Labetalol
c) Magnesium sulfate
d) Metformin
c) Magnesium sulfate
Rationale: Magnesium sulfate is used for seizure prophylaxis in preeclampsia with severe features.
A home care nurse is visiting a pregnant client with a diagnosis of mild preeclampsia. What is the priority nursing intervention during the home visit?
1.) Monitor for fetal movement.
2.) Monitor the maternal blood glucose.
3.) Instruct the client to maintain complete bed rest.
4.) Instruct the client to restrict dietary sodium and any food items that contain sodium.
Monitor for fetal movement.
Rationale:A client with mild preeclampsia can be managed at home. The priority intervention of the home care nurse is to monitor for fetal movement. The expectant mother also is asked to keep a record of fetal movements. A maternal blood glucose would not provide specific data related to preeclampsia. Bed rest with bathroom privileges is prescribed; complete bed rest is not necessary. Urine should be checked for protein. Sodium restriction is not necessary
Name four risk factors for gestational diabetes.
Obesity
Sedentary lifestyle
Family hx. of Type II diabetes
Hx. of previous Gestational diabetes
Hx. of LGA infant
Polycystic ovary disease
What labs and what direction will they be with HELLP syndrome?
destruction and decrease of RBCs (travel through constricted vessels)
Elevated Liver Enzymes- ↓’d blood flow and liver damage
Low Platelets-from platelets accumulating at site of damaged vessels causing plt consumption and thrombocytopenia
What is the goal of labatelol treatment?
Bonus 100: what is labatelol contraindicated in?
NOT to normalize, but to achieve range 140-150’s/90-100’s
Bonus: avoid in asthma or heart failure. Can cause fetal bradycardia
9. Which lab finding is most concerning in a patient with HELLP syndrome?
a) Hemoglobin 12 g/dL
b) Platelet count 90,000/mm³
c) Serum creatinine 0.8 mg/dL
d) AST 20 IU/L
b) Platelet count 90,000/mm³
Rationale: A platelet count <100,000 suggests thrombocytopenia, a component of HELLP syndrome.
A patient with gestational hypertension asks if she can return to normal BP after pregnancy. What is the correct response?
a) "Gestational hypertension always resolves postpartum."
b) "Your BP should normalize by 12 weeks postpartum."
c) "You will need lifelong antihypertensive therapy."
d) "Your BP should return to normal within 24 hours of delivery."
b) "Your BP should normalize by 12 weeks postpartum."
Rationale: If BP remains elevated after 12 weeks, chronic hypertension is diagnosed.
Name 3 long term complications of untreated gestational diabetes affecting the newborn.
Metabolic syndrome, pre-diabetes, type II, impaired intellectual and psychomotor development, ↑risk for chronic illness
Name five severe features of preeclampsia.
BP > 160 mm Hg/110 mm Hg
Serum creatinine > 1.1 mg/dL or doubling of creatinine in absence of renal disease
Platelets < 100,000
↑ liver enzymes to 2x normal
New-onset cerebral or visual changes
Persistent epigastric pain esp in RUQ (LIVER PAIN)
Hyperreflexia, possible clonus
Oliguria
Peripheral edema - sacral edema
What five indicators are measured with a Biophysical Profile?
Reactive NST
Fetal breathing movements
Fetal movement
Fetal tone (fetal extension→fetal flexion)
Amniotic fluid volume (pocket that is at least 2 cms2cms) - looking fo ra pocket bc they want to know if theres olihydraminos. if they have that there is a risk for decels
What is the goal BP range when treating severe preeclampsia?
a) 120/80 mmHg
b) 110/60 mmHg
c) 140-150/90-100 mmHg
d) 160/110 mmHg
c) 140-150/90-100 mmHg
Rationale: BP should not be lowered too much, as placental perfusion may be compromised.
A nurse is educating a pregnant patient about gestational diabetes. Which statement indicates further teaching is needed?
a) "Gestational diabetes usually resolves after pregnancy."
b) "I should monitor my blood sugar closely after delivery."
c) "I have a higher risk of developing Type 2 diabetes later in life."
d) "Since my blood sugar is high, my baby will have high blood sugar too."
d) "Since my blood sugar is high, my baby will have high blood sugar too."
Rationale: Maternal glucose crosses the placenta, but maternal insulin does not. The baby produces excess insulin, leading to neonatal hypoglycemia after birth.