Diabetes Mellitus Prepregnancy_Gestational

Diabetes Mellitus Prepregnancy_Gestational -...

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Diabetes Mellitus Prepregnancy/Gestational This  disorder  of  carbohydrate  metabolism  of  variable  severity  may  be  preexisting  (pregestational  insulin- dependent diabetes mellitus [IDDM] or non–insulin-dependent diabetes mellitus [NIDDM]), or may develop during  pregnancy (gestational diabetes mellitus [GDM]).  (This plan of care is to be used in conjunction with the Trimesters and the High-Risk Pregnancy.) CLIENT ASSESSMENT DATA BASE Circulation Pedal pulse and capillary refill of extremities may be diminished or slowed (with diabetes of long duration).  Edema, elevated BP (PIH). Elimination May have history of pyelonephritis, recurrent UTI, nephropathy Polyuria Food/Fluid Polydipsia, polyphagia. Nausea and vomiting. Obesity; excessive or inadequate weight gain (client with GDM is usually obese; client with IDDM is not usually obese  before pregnancy). Abdominal tenderness. May report episodes of hypoglycemia, glycosuria. Safety Skin integrity/sensation of arms, thighs, buttocks, and abdomen may be altered from frequent injections of insulin. Visual impairment/retinopathy may be present. History of symptoms of infection and/or positive cultures for infection, especially urinary or vaginal. Sexuality Fundal height may be higher or lower than normal for gestational age (hydramnios, inappropriate fetal growth). History of large for gestational age (LGA) neonate, hydramnios, congenital anomalies, unexplained stillbirth. Social Interaction Socioeconomic concerns/factors can increase risk of complications. Inadequate or lack of committed support system (may adversely affect diabetic control). Teaching/Learning Client’s own birth weight may have been 9 lb or more. May report recent problems/change in stability of diabetic control. Family history of diabetes, GDM, PIH, infertility problem; LGA infant, history of neonatal death(s), stillbirth,  congenital anomalies, spontaneous abortion, hydramnios, macrosomia (greater than 4000 g or 9 lb at birth). DIAGNOSTIC STUDIES Glucose Tolerance Test (GTT):  Elevated above 140 mg/dL at 24–28 weeks’ gestation. Clients with specific risk  factors are screened at first prenatal visit. (If screening result is positive,  3-hr glucose challenge or oral glucose tolerance test [OGTT] test done to make diagnosis.) Glycosylated Hemoglobin (HbA 1c ):  Reveals glucose control over previous 4–8 wk. Levels greater than 8.5%,  especially before pregnancy, puts the fetus at risk for congenital anomalies.
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This note was uploaded on 02/01/2011 for the course PNR 182 taught by Professor Toole during the Spring '10 term at Orangeburg-Calhoun Technical College.

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Diabetes Mellitus Prepregnancy_Gestational -...

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