Gestational DM

Topics: Insulin, Diabetes mellitus, Blood sugar Pages: 7 (5016 words) Published: October 26, 2014

1.How should the nurse record Amanda's obstetrical history using the G-T-P-A-L designation? A) 3-2-0-1-3.INCORRECTThis does not reflect the client's obstetrical history. B) 3-1-1-1-2.INCORRECTThis does not reflect the client's obstetrical history. C) 4-1-1-1-3.CORRECTGravidity [G] is defined as the number of times pregnant, including the current pregnancy. Term [T] is defined as any birth after the end of the 37th week, and preterm [P] refers to any births between 20 and 37 weeks. Both term and preterm describe liveborn and stillborn infants. Abortion [A] is any fetal loss, whether spontaneous or elective, up to 20 weeks gestation. Living [L] refers to all children who are living at the time of the interview. Multiple fetuses such as twins, triplets, and beyond are treated as one pregnancy and one birth when recording the GTPAL. Amanda's GTPAL is 4 (pregnancies counting current one) - 1 (infant born at 39 weeks) - 1 (twins born at 35 weeks) - 1 (spontaneous abortion at 9 weeks) - 3 (each twin and the singleton, all living).    D) 4-2-1-0-2.INCORRECTThis does not reflect the client's obstetrical history.The nurse notes that Amanda's fasting 1 hour glucose screening level, which was done 2 days previously, is 158 mg/dl.2.The nurse recognizes that what information in the client's history supports a diagnosis of gestational diabetes? A) Maternal great-aunt has insulin dependent (Type 1) diabetes.INCORRECTFamily history of diabetes is not considered a risk factor unless it is a first degree relative. B) Youngest child weighed 4300 grams at 39 weeks gestation.CORRECTBirth of an infant over 9 pounds (~ 4.1 kg or 4100 grams) is a risk factor for gestational diabetes. Other risk factors include maternal age older than 25, obesity, history of unexplained stillborn, family history of Type 1 diabetes in a first-degree relative, strong family history of Type 2 diabetes, and history of gestational diabetes in a previous pregnancy. Ethnic groups at increased risk include Hispanic, Native-American, Asian, and African-American. C) Trace of protein noted in urine specimen at last prenatal visit.INCORRECTA trace of protein is normal during pregnancy and does not indicate that the client is at risk for gestational diabetes. D) Client is 64 inches tall and weighed 134 pounds prior to pregnancy.INCORRECTThis falls within the normal category for Body Mass Index (BMI) and does not constitute a risk for gestational diabetes.Further Glucose ScreeningAmanda is scheduled for a 3 hour oral glucose tolerance test in 5 days, and is told to arrive at the lab at 8:30 am. Amanda asks if there are any special instructions for the test in addition to fasting for 8 hours immediately prior to the test.3.Which instruction should the nurse give the client? A) Only coffee or tea is allowed once the fasting level has been drawn.INCORRECTThe client should refrain from eating or drinking anything during the test, although small sips of water are acceptable if the client is very thirsty. In addition, caffeine in any form should be avoided because it tends to increase glucose levels. B) Follow an unrestricted diet and exercise pattern for at least 3 days before the test.CORRECTBy following an unrestricted diet (including at least 150 g of carbohydrates) and regular exercise patterns, the test is a true determination of the body's ability to handle the glucose load given after the fasting blood glucose is drawn.   C) Write down questions and call the laboratory for instructions the day before the test.INCORRECTThe nurse should give pre-test instructions and answer any questions the client might have. D) Smoking in moderation is allowed up until the time the test begins.INCORRECTSmoking should be avoided at least 12 hours before, and then during the test due to the risk of false elevations in blood sugar level. In addition, smoking during pregnancy puts the fetus at risk for intrauterine growth restriction and other problems.Amanda asks the nurse why she wasn't tested...
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