Question

A 35 y.o. patient is G4 T4 P4 A1 L4, and has presented for routine prenatal care and is currently 32 weeks pregnant. While in the clinic, she told the nurse that she was recently diagnosed with Gestational Diabetes. Her vital signs this visit include : BP 120/70; T 97.4; P 87; R 22. On examination, she complained that she feels dizzy when laying supine in bed.

1. Explain the patient's GTPAL history (given the information listed above).
2. What is causing the dizziness when laying supine? What teaching will the nurse provide for the mother?
4. What causes gestational diabetes? Provide two nursing interventions to incorporate into this patient's care.

Answer 1

Ans:-

1).

		Explaination	Present Scenario
G	Gravidity	Number of times a woman is or has been pregnant, regardless of the pregnancy outcome	4 times the women has been pregnant including the current one )
T	Term Births	Term Deliveries (Full ) births (38 weeks or more)	4
P	Parity	Number of pregnancies reaching viable gestational age (including live and still births)	4
A	Abortion/ Miscarriage	Number of Abortions happened	1
L	Living children	Number of living children	4( 1 pair of twins )

4.)

Gestational diabetes is a type of diabetes that develops, or is first diagnosed, during pregnancy.Often times, gestational diabetes is a temporary disorder that occurs around the second trimester of pregnancy and disappears after a woman gives birth

Causes of Gestational Diabetics :

*the placenta produces hormones that interfere with the action of insulin, a hormone that helps sugar (or glucose) get from the bloodstream into cells. This means that sugar in the mother's bloodstream is less able to get into her own cells, leading to a rise in blood sugar. Usually, the fetus takes in this extra sugar, so the net result is typically that a women's blood sugar declines. But in some women, the placenta may put out too much of the insulin-blocking hormones, leading to an increase in the mother's blood sugar. If blood sugar levels rise to an abnormally high level, this is considered gestational diabetes.

*Some women may have prediabetes before they become pregnant (for example, because they are overweight or obese, which is a risk factor for the condition), and pregnancy exacerbates the condition, leading to gestational diabetes.

*Other women may have undiagnosed diabetes before they become pregnant, and they are diagnosed in pregnancy.

Changes in levels of the hormones estrogen and progesterone during pregnancy may further disrupt the body's balance of glucose and insulin.

Nursing Interventions	Rationale
Assess the client for vaginal bleeding and abdominal tenderness.	Vascular changes associated with diabetes place the client at risk for abruptio placenta
Determine fundal height; check for edema of extremities and dyspnea.	Hydramnios occurs in 6%-25% of pregnant diabetic clients. May be associated with an increased fetal contribution to amniotic fluid because hyperglycemia increases fetal urine output
Monitor for signs of PIH ( edema, hypertension, proteinuria)	About 12-13% of diabetic individuals develop hypertensive disorders owing to cardiovascular changes associated with diabetes. These disorders negatively affect placental perfusion and fetal status