Which of the following is a primary goal in the management of gestational diabetes?

B) Maintain blood glucose levels within the target range

A) Increase caloric intake to support fetal growth

B) Maintain blood glucose levels within the target range

C) Achieve rapid weight loss during pregnancy

D) Limit fluid intake to reduce swelling

Which dietary modification is most appropriate for a patient diagnosed with gestational diabetes?

C) Follow a balanced diet with controlled carbohydrate intake

A) Increase intake of simple carbohydrates

B) Consume frequent high-protein snacks

C) Follow a balanced diet with controlled carbohydrate intake

D) Eliminate all carbohydrates from the diet

What is the primary purpose of a follow-up appointment for a patient with gestational diabetes who is managing her condition with dietary and lifestyle changes?

B) To assess the patient's adherence to the dietary plan

A) To prescribe insulin therapy

B) To assess the patient's adherence to the dietary plan

C) To evaluate the need for hospitalization

D) To diagnose new medical conditions

During a follow-up appointment, a pregnant patient with gestational diabetes reports adhering to her dietary plan and regular exercise. Her fasting blood glucose levels have improved, but some postprandial readings are slightly above target. What is the most appropriate nursing action?

C) Encourage continued adherence to the plan and suggest consulting a dietitian

A) Instruct the patient to increase her exercise intensity immediately

B) Recommend reducing carbohydrate intake without consultation

C) Encourage continued adherence to the plan and suggest consulting a dietitian

D) Advise the patient to stop monitoring her blood glucose levels

Which dietary recommendation is most important for a patient with gestational diabetes to help stabilize postprandial blood glucose levels?

B) Eat smaller, more frequent meals

A) Increase intake of simple carbohydrates

B) Eat smaller, more frequent meals

What is the primary reason for ordering a hemoglobin A1c test for the patient in this case?

B) To evaluate the patient's average blood glucose control over the past 2-3 months.

A) To assess the patient's risk of developing anemia.

B) To evaluate the patient's average blood glucose control over the past 2-3 months.

C) To determine if the patient needs insulin therapy immediately.

D) To check for potential dehydration in the patient.

What dietary advice should the nurse give to a patient with iron deficiency anemia to enhance iron absorption?

A) Take iron supplements with orange juice.

B) Take iron supplements with milk.

C) Take iron supplements on an empty stomach.

D) Take iron supplements with a high-fiber meal.

A patient with mild iron deficiency anemia is advised to take iron supplements. Which of the following instructions should the nurse provide to enhance iron absorption?

B) Take the iron supplement with orange juice

A) Take the iron supplement with milk

B) Take the iron supplement with orange juice

C) Take the iron supplement with meals

D) Take the iron supplement at bedtime

When assessing a patient with anemia who reports feeling more energetic and having decreased dizziness after treatment, which of the following assessment findings would most likely indicate an improvement in their condition?

B) Capillary refill time decreased to 2 seconds

C) Blood glucose level spike to 150 mg/dL

D) Blood pressure increase to 140/90 mmHg

GESTATIONAL DIABETES - Nursing Case Study

Pathophysiology

• Primary mechanism: During pregnancy, the placenta produces hormones like human placental lactogen that increase insulin resistance. This means the body's cells don't respond well to insulin, leading to higher blood sugar levels.

• Secondary mechanism: The pancreas may struggle to produce enough insulin to overcome this resistance, resulting in elevated glucose in the bloodstream.

• Key complication: If not managed, gestational diabetes can cause complications such as macrosomia (large baby), which may lead to delivery challenges and increase the risk of cesarean section.

Patient Profile

Demographics:

29-year-old female, school teacher

History:

• Key past medical history: No significant past medical history

• Current medications: Prenatal vitamins

• Allergies: None known

Current Presentation:

• Chief complaint: Elevated blood sugar levels during routine prenatal screening

• Key symptoms: No significant symptoms, occasional fatigue

• Vital signs: Blood pressure 118/76 mmHg, heart rate 78 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F

Section 1

Initial Assessment Findings:

During her initial assessment, the patient presents as a well-appearing, 29-year-old female in her second trimester. She reports feeling generally healthy with occasional fatigue, which she attributes to her teaching job and pregnancy. The physical examination reveals a healthy appearing individual, with no notable distress. Her weight gain is within normal limits for her gestational age. The fetal heart rate is monitored and found to be within the normal range of 140-160 beats per minute, ensuring that the baby is currently unaffected by her condition.

The initial laboratory results are consistent with gestational diabetes. The oral glucose tolerance test (OGTT) indicates elevated blood glucose levels at fasting and one and two hours post-glucose load. Specifically, her fasting blood glucose level is 98 mg/dL (normal <95 mg/dL), one-hour post-glucose level is 180 mg/dL (normal <180 mg/dL), and two-hour post-glucose level is 160 mg/dL (normal <155 mg/dL). These findings confirm the diagnosis of gestational diabetes, emphasizing the need for dietary modifications and close monitoring of blood glucose levels.

The nursing plan of care includes educating the patient on maintaining a balanced diet with controlled carbohydrate intake, engaging in regular physical activity suitable for pregnancy, and monitoring her blood glucose levels at home using a glucometer. The patient is also instructed to record her blood glucose readings and report any significant changes or concerns. This education aims to empower the patient to actively participate in the management of her gestational diabetes, helping to minimize the risk of complications and ensure a healthy pregnancy outcome.

Section 2

Two weeks after her initial diagnosis, the patient returns for a follow-up appointment to assess her response to the dietary and lifestyle interventions. She reports that she has been diligently following the recommended dietary plan and has incorporated daily walks into her routine, which she finds refreshing and manageable given her teaching schedule. She mentions feeling slightly more energetic and has noticed a more consistent pattern in her energy levels throughout the day.

During the follow-up assessment, her vital signs remain stable, with a blood pressure reading of 118/76 mmHg and a heart rate of 76 beats per minute. Her current weight is appropriate for her gestational age, showing a modest increase that aligns with healthy pregnancy progression. The nurse reviews her self-monitored blood glucose log and notes that her fasting blood glucose levels have improved, averaging around 95-97 mg/dL. Postprandial readings are generally within the target range, though she occasionally records a reading slightly above the target.

The nurse provides positive reinforcement for her adherence to the management plan and discusses the importance of continued monitoring and adjustments as needed. Given the slight elevation in some postprandial glucose readings, the nurse recommends a follow-up appointment with a dietitian to fine-tune her meal plans further. Additionally, the nurse instructs the patient to continue monitoring her blood glucose levels and to report any significant deviations from her current pattern. This approach aims to maintain her control over gestational diabetes, fostering a stable environment for both mother and baby as they progress through the pregnancy.

Section 3

Three weeks after her follow-up appointment, the patient returns for another check-up. She continues to adhere to her dietary plan and daily walks, and she reports feeling generally well. However, she mentions experiencing a few episodes of dizziness and fatigue, particularly in the late afternoon. She has also noticed that her postprandial blood glucose levels have been slightly more variable, with a few readings reaching up to 145 mg/dL. Despite these fluctuations, her fasting glucose levels remain stable, averaging around 96 mg/dL.

During the assessment, her vital signs remain within normal limits, with a blood pressure of 116/74 mmHg and a heart rate of 78 beats per minute. Her weight gain continues to be appropriate for her gestational age. A physical examination reveals no significant findings, but the nurse decides to order a hemoglobin A1c test to gain a more comprehensive view of her glucose control over the past few weeks. The test results show a slightly elevated A1c level at 5.8%, which indicates that while her overall glucose control is close to target, there is room for improvement.

The nurse discusses these findings with the patient, emphasizing the importance of maintaining consistent blood glucose levels to prevent potential complications. The patient is encouraged to keep up her efforts with diet and exercise, and the nurse arranges for an appointment with the dietitian to address any dietary adjustments that may help stabilize her postprandial glucose levels. Additionally, the nurse advises the patient to monitor her symptoms of dizziness and fatigue closely, instructing her to rest and hydrate adequately. The patient is reassured and leaves the appointment feeling supported and motivated to continue managing her gestational diabetes effectively.

Section 4

Two weeks after her last appointment, the patient returns with a slight change in her condition. She reports that the dizziness has become more frequent and occurs not only in the late afternoon but sometimes in the morning. Additionally, she mentions feeling more fatigued throughout the day, despite maintaining her routine of daily walks and adhering to her dietary plan. Her blood glucose log shows that postprandial readings have become more erratic, with occasional spikes reaching up to 155 mg/dL, while fasting glucose levels remain stable around 98 mg/dL.

During the assessment, her vital signs continue to be within normal limits, with a blood pressure of 118/76 mmHg and a heart rate of 80 beats per minute. However, the nurse notes that the patient appears slightly pale and her capillary refill time is marginally prolonged, taking about 3 seconds. Given these findings, the nurse decides to order a complete blood count (CBC) to evaluate for potential anemia or other underlying issues contributing to the patient's symptoms.

The CBC results reveal a mild iron deficiency anemia, with hemoglobin levels at 10.8 g/dL and hematocrit at 32%. The nurse discusses these findings with the patient, explaining that anemia could be contributing to her fatigue and dizziness. The patient is advised to incorporate iron-rich foods into her diet and is started on an iron supplement. The nurse provides education on the importance of taking the supplement with vitamin C to enhance absorption and to avoid taking it with calcium-rich foods which can inhibit absorption. The patient feels relieved to have an explanation for her symptoms and is motivated to follow the new recommendations, with a follow-up appointment scheduled in two weeks to reassess her condition.

Section 5

Two weeks later, the patient returns for her follow-up appointment. She reports that she has been taking her iron supplements as directed and has incorporated more iron-rich foods, such as spinach and lean red meat, into her diet. She also mentions that she feels slightly more energetic and the dizziness has decreased in frequency, though not completely resolved. Her daily blood glucose monitoring shows some improvement, with fewer postprandial spikes, though occasional readings still reach up to 150 mg/dL.

During the assessment, the nurse observes that the patient's color has improved, and her capillary refill time has decreased to 2 seconds, indicative of better circulation. Her vital signs remain stable with a blood pressure of 116/74 mmHg and a heart rate of 78 beats per minute. The nurse performs another CBC, which shows a slight improvement in her hemoglobin level, now at 11.2 g/dL, and hematocrit at 33.5%. These results suggest that the patient's anemia is responding positively to the dietary changes and supplementation.

Encouraged by these improvements, the nurse discusses the importance of continuing the current regimen and schedules another follow-up appointment in four weeks. The nurse also reviews strategies to further stabilize the patient's blood glucose levels, emphasizing the importance of consistent meal timing and portion control, along with regular physical activity. The patient expresses confidence in her ability to manage her condition and is optimistic about her progress.