Hypoglycemia/Hyperglycemia in the Pregnant Patient
Instructor for this Module is Bridgette Jenkins RN, BSN. Please send all questions regarding this module to her at bjenkins@twu.edu
Required Readings:
Power Point Module 2:
Case Study for discussion: Please review the case study below. Setup a time for your group to meet on Yahoo IM and discuss. You may start with a blog discussion but I recommend you all meet in "real time" to compose your findings. When you have finished your discussion, please submit a summary, in an essay format to me, your instructor -via email.
Case Study
Maria, a 40 y/o G4P3 at 29 weeks present to Labor & Delivery with c/o dizziness, headache, nausea and vomiting for 3 days. After interviewing Maria, you note that she has not had any prenatal care, has a h/o diabetes Her past obstetrical history includes delivery of a 4500 gram male complicated by shoulder dystocia. She weighs 312 pound. Her Bp 129/83, HR 82, RR 26 and Temp 98.8. A UA shows 3+ glucose, and negative ketones. Her accucheck is 179mg/dl.
Questions
1. What tests, if any, should be done to evaluate the Maria’s glucose tolerance?
2. How is the diagnosis of gestational diabetes mellitus (GDM) established?
3. What would be the best treatment and follow-up strategy for Maria?
Discussion
This patient has several risk factors for GDM. She is over the age of 30, has a history of GDM and is obese. All these place her at a greater risk for developing GDM. She needs to be referred to a dietician or diabetic counselor. She needs to continue prenatal care and started on insulin therapy. Maria should be followed closely for the remainder of the pregnancy. Birthing options (vaginal vs caesarean section) should be discussed with the patient. Maria should also be followed closely after delivering to assess for the development of Type II diabetes.
