19.17 Spotlight Application
Ani and Elijah come in for a prenatal visit at 28 weeks. Ani is a G1P0 with the following medical, family, and social history:
Medical history:
- Not currently taking any over-the-counter medications or herbal preparations
- Negative history for STIs
- Denies any surgeries
- Denies any previous pregnancies
- Denies any history of medical conditions
Family history: Father has type 2 diabetes mellitus and mother has HTN.
Social history: Ani and Elijah live in a two-bedroom apartment on the second floor in a building with only a freight elevator. They have a small dog named Candy. Elijah works for a construction company and is 40 years old. Neither Ani nor Elijah smokes. Elijah does drink an occasional beer. Ani does not drink alcoholic beverages.
No current medications. Allergic to penicillin.
Prenatal Care
Ani has received regular prenatal care. Information from the current 28-week visit is described in the following Table.
| 28-Week Prenatal Visit | |
|---|---|
| Maternal and Fetal Data | BP: 124/74
Fundal Height: 29 cm FHR: 136 |
| Lab Results | 3-hour GTT
FBS: 110 mg/dL 1-hour glucose: 185 mg/dL 2-hour glucose: 149 mg/dL 3-hour glucose: 128 mg/dL |
| Provider’s orders | 28 Weeks’ Gestation
Provide glucose monitoring education Instruct in daily fetal movement counts |
1. The nurse discusses the results of the test with Ani and Elijah. Ani asks the nurse why her blood sugar is abnormal.
Select the most appropriate option to complete the following statement.
The nurse identifies the priority problem at this time as ________. .
a. Knowledge deficit regarding gestational diabetes
b. Increased risk for infection
c. Knowledge deficit regarding labor and birth
Answer: a
Rationale: The client is asking questions about the diagnosis. The nurse should provide teaching regarding gestational diabetes.
Question 2. The nurse prepares to discuss the importance of glucose control and possible complications regarding gestational diabetes with Ani and Elijah. What topics should the nurse include in the discussion at this time? Select all that apply.
a. Nutrition
b. How to monitor her blood glucose
c. Relaxation techniques
d. Expected range of the 2-hour postprandial glucose reading
e. Importance of daily fetal movement counts (FMC)
f. Preparing for a planned cesarean birth
g. Increased risk for genetic anomalies
h. Increased risk for pregnancy-induced hypertension
i. Importance of exercise to regulate glucose
Answers: a, b, d, e, h, i
Rationale: Nutrition education is the first level of glycemic control. Education on how to monitor fasting and 2-hour postprandial blood glucose readings and the expected range provide a measure of glycemic control. Daily FMCs provide reassurance of fetal well-being. Gestational diabetes is associated with an increased incidence of pregnancy-induced hypertension. Exercise helps regulate blood glucose. Relaxation techniques are included in childbirth education. Gestational diabetes (GD) does not necessarily require a planned cesarean birth if blood glucose levels are adequately controlled. GD diagnosed in the third trimester is not associated with an increased risk for congenital anomalies.
