Question

What nursing actions are priorities for teaching a newly diagnosed Gestational Diabetes patient? What are the Maternal and fetal risk with Gestational diabetes?

Answer 1

Nursing Interventions	Rationale
Assess and record dietary pattern and caloric intake using a 24-hour recall.	To help in evaluating client’s understanding and/or compliance to a strict dietary regimen.
Assess understanding of the effect of stress on diabetes. Teach patient about stress management and relaxation measures.	It is proven that stress can increase serum blood glucose levels, creating variations in insulin requirements.
Weigh the client every prenatal visit. Encourage the client to periodically monitor weight at home between visits.	Weight gain serves as an indicator for determining caloric adjustments.
Teach the importance of regularity of meals and snacks (e.g., three meals or 4 snacks) when taking insulin.	Eating very frequent small meals improves insulin function.
Provide information regarding any required changes in diabetic management; e.g., use of human insulin only, changing from oral diabetic drugs to insulin, self-monitoring of serum blood glucose levels at least twice a day (e.g., before breakfast and before dinner) and reducing/changing time for ingesting carbohydrates.	Metabolism and maternal/fetal needs fluctuates during the gestation period, requiring close monitoring and adaptation. The use of human insulin decreased the development of these antibodies. Reducing carbohydrates to less than 40% of the calories ingested reduces the degree of a postprandial peak of hyperglycemia. Because pregnancy provides severe morning glucose intolerance, the first meal of the day should be small, with minimal carbohydrates.
Discuss the type of insulin, dosage and schedule (e.g., usually 4 times/day: 7:30am-NPH; 10am-regular; 4pm-NPH; 6pm-regular).	The total daily dosage is based on gestational, current maternal body weight, and serum glucose levels. A mix of NPH and regular human insulin helps mimic the normal insulin release pattern of the pancreas, minimizing “peak/valley” effect of serum glucose level.
Monitor serum blood glucose levels (Fasting blood sugar, preprandial 1 and two hr postprandial) on the first visit, then as indicated by client’s condition.	Incidence of fetal and newborn abnormalities is decreased when fasting blood sugar levels range between 60 and 100 mg/dl, preprandial levels between 60 and 105 mg/dl, 1-hr postprandial remains below 140 mg/dl, and 2-hr postprandial is less than 120 mg/dl.
Ascertain results of HbA1c every 2-4weeks.	Provide an accurate picture of average serum glucose control during the preceding 60 days. Serum glucose control takes six weeks to normalize.
Coordinate multispecialty care conference as appropriate.	Provides an opportunity to review the management of both pregnancy and diabetic condition, and to plan for special needs during intrapartum and postpartum periods.
Refer to a registered dietician to individualize diet and counsel regarding dietary questions.	Diet-specific to the individual is necessary to maintain normoglycemia and to obtained desired weight gain. In-depth teaching promotes understanding of own needs and clarifies misconceptions, especially for a client with gestational diabetes.
Prepare for hospitalization if diabetes is not controlled.	Infant morbidity is linked to maternal hyperglycemia-induced fetal hyperinsulinemia.

Maternal Risk With Diabetes -

• Increased risk of Infections - Urinary Tract infections
• Big placenta
• Increased Chances of Pregnancy Induced Hypertension
• Placenta Previa
• Maternal hyperglycemia
• Polyhydramnios
• Pre labour Rupture Of Membranes
• Preterm Labour
• Abruptio Placenta

Fetal rIsks are-

• Fetal Hyperglycemia
• Macrosomia
• Shoulder dystocia
• Featal Death