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Self-Management:Diagnosis – Patient at risk for poor self-management due to deficient knowledge of glucose control	Interventions1. Educate on glucose monitoring and obtain return demonstration 2. Explain importance of hyperglycemia medication and regimen compliance3. Explain signs and symptoms of hypo/hyperglycemia, and normal glucose ranges

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Self-Management:Diagnosis – Patient at risk for poor self-management due to deficient knowledge of glucose control	Interventions1. Educate on glucose monitoring and obtain return demonstration 2. Explain importance of hyperglycemia medication and regimen compliance3. Explain signs and symptoms of hypo/hyperglycemia, and normal glucose ranges

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Risk for electrolyte imbalance r/t high glucose levels

Intervention 1: Monitor skin turgor

Intervention 2: Monitor serum electrolyte levels

Intervention 3: Monitor intake and output

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Nutrition for the mother with Gestational Diabetes

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Nutrition for the mother with Gestational Diabetes

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34 yr old gravida 1 para 0
No Hx of diabetes or heart disease
glucose 150
27 wks gestation and measuring at 32 wks
Nutrition:
nursing dx: At risk for altered nutrition related to poor glucose metabolism.
Related Data:
--Fundal measurement of 32 wks
at 27 wks gestation
-- glucose level of 150
Interventions:
1. Monitor glucose levels
2. CCD (carbohydrate controlled diet ) plan and dietary education
3.  Caloric intake of 2000-2500 calories/day (50%-60% complex carbohydrates and 10%-20% protein)

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Gestational DM Risks and Complications for the mother

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Gestational DM Risks and Complications for the mother

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Additional Lab Testing for Gestational Diabetes:

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Additional Lab Testing for Gestational Diabetes:

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·         Initial glucose challenge test (24-28 weeks)

·         Follow up glucose tolerance testing

·         Routine prenatal laboratory testing

o   Urinalysis and culture to check for UTI which is common in diabetic pregnancies (weeks 24 – 28)

o   Baseline renal function may be assessed with a 24-hour urine collection for total protein excretion and creatinine clearance.

o   Thyroid function test because of risk of coexisting thyroid disease.

·         Glycosylated hemoglobin A1c measured to asses recent glycemic control

o   Estimates your average blood sugar level over the previous 2 to 3months

o   Repeat test 6-12 weeks postpartum

Before the baby is born:

-          Ultrasound performed on the mother in the last few months of pregnancy to monitor the baby's size.

-          Lung maturity testing may be done on the amniotic fluid if the baby is going to be delivered more than a week before the due date.

After the baby is born:

-          Tests may show that the infant has low blood sugar and low blood calcium.

-          An echocardiogram may show an abnormally large heart, which can occur with heart failure.

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Gestational Diabetes: onset, Diagnostic testing, pharmacological 

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Gestational Diabetes: onset, Diagnostic testing, pharmacological 

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--Gestational Diabetes:
any degree of glucose intolerance w/onset or first recognition during pregnancy
usually diagnosed at 24-28 wks gestation
--Initially one hour glucose test—fasting:  (50g of carbs and blood drawn within an hour to test glucose levels): If further testing is needed a 2hr glucose test is administered

S/S:
--increase thirst
--frequent urination
--fatigue
—polyphasia
—dysuria

Diagnostic Treatment for Gestational Diabetes:
Diet therapy (calories between 2000-2500/day: 50%-60% carbohydrates & 10%-20% protein)
Glucose monitoring
Self monitoring to improve glycemic control
insulin
Glyburide (only one that does not cross placenta and most frequently prescribed)
—ultrasounds done more frequently
— non stress test (NST)
Pharmacological Treatment:
Glyburide:
--controls insulin levels as well as insulin
--if crosses placenta, only minimal amounts
--may not work as well in obese and severe hyperglycemic
--taken 30mins-hour before meals
--women should always carry sources of fast sugar with them
--infants at risk for birth injury or needing photo therapy

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Complications of infants born to mothers with gestational diabetes

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Complications of infants born to mothers with gestational diabetes

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·         Macrosomia

·         Obese in childhood or adolescents

·         Macromia babies are at risk for birth injuries

·         IUFD- intrauterine fetal distress

·         Hypoglycemia

·         Hypocalcemia

·         Hypomagnesemia

·         Polycytemia

·         Jaundice

·         Cardiomyopathy

·         Respiratory distress

·         Anencephaly

·         Spina bifida

·         Ventro-septal defect

·         Coartation of the aorta

·         DVT with renal vein thrombosis and hematuria

·         Hypotonia

·         Listless and lethargic at birth

·         May require IV dextrose infusions at birth

·         Also at an increased risk of metabolic syndrome and type II diabetes in child hood or early adulthood

·         Mother may have early breastfeeding difficulties due to decreased milk production