Exam 2: NR 509/ NR509 (New 2026/ 2027 Update) Advanced Physical Assessment Guide| Complete Q&A| Grade A| 100% Correct (Accurate Solutions)- Chamberlain

Exam 2: NR 509/ NR509 (New 2026/ 2027 Update) Advanced Physical Assessment Guide| Complete Q&A| Grade A| 100% Correct (Accurate Solutions)- Chamberlain Q. 1) A mother brings her two month old daughter in for an examination says "my daughter rolled over against the wall and now I have noticed that she has the spot soft on the top of her head, is there something terribly wrong?" The FNP's best response would be: ANSWERS "That soft spot is normal and actually allows for growth of the brain during the first year of your baby's life" Q. 2) During percussion the FNP knows that a dull percussion note elicited over a lung lobe. This most likely results from: ANSWERS Increased density of lung tissue Q. 3) The patient is unable to differentiate between sharp and dull stimulation to both sides of her face. The FNP suspects Damage to: ANSWERS The trigeminal nerve Q. 4) When examining the face, the FNP is aware that the two pairs of salivary gland's that are accessible to examination are the _____ glands ANSWERS Parotid and submandibular Q. 5) A patient comes to the clinic complaining of neck and shoulder pain and is unable to turn her head. The FNP suspects damage to cranial nerve ____ and proceeds with the examination by____ ANSWERS XI; asking the patient you should have her shoulders against resistance Q. 6) When examining a patient's cranial nerve function, the FNP remembers that the muscles in the neck that are innervated by CN XI are the: ANSWERS Sternomastoid and trapezius Q. 7) The patient's laboratory data reveal an elevated thyroxine level. The FNP would proceed with an examination of the _____ gland ANSWERS Thyroid Q. 8) A patient says that she has recently noticed a lump in the front of her neck below her "Adams apple" that seems to be getting bigger. During the assessment, the finding that leaves the FNP to suspect that this may not be a cancerous thyroid nodule is that the lump: ANSWERS Is mobile and not hard Q. 9) The FNP notices that the patient's submental lymph nodes are enlarged. In an effort to identify the cause of the node enlargement, the FNP would assess the patient's: ANSWERS Area proximal to the enlarged node Q. 10) The FNP is aware that the four areas in the body were lymph nodes accessible are the: ANSWERS Head and neck, arms, inguinal area, and axillae Q. 11) A 52-year-old patient describes the presence of occasional floaters or spots moving in front of his eyes. The FNP should know that floaters are usually not significant and are caused by: ANSWERS Condensed vitreous fibers Q. 12) The FNP is preparing to assess the visual acuity of a 16-year-old patient. How should the FNP proceed? ANSWERS Use the Snellen chart position 20 feet away from the patient Q. 13) A patient's vision is recorded as 20/30 when the Snellen eye chart is used. The FNP interprets these results to indicate that: ANSWERS The patient can read at 20 feet would a person with normal vision can read it 30 feet Q. 14) A patient is unable to read even the largest letters on the Snellen chart. The FNP should take which action next: ANSWERS Shorten the distance between the patient and the chart until it is seen and record that distance Q. 15) A patient's vision is reported as 20/80 in each eye. The FNP interprets this finding to mean that ANSWERS The patient has poor vision Q. 16) When performing the corneal light reflex assessment, the FNP notes that the light is reflected at 2 o'clock in each eye. The FNP should ANSWERS Consider this a normal finding Q. 17) The FNP is performing the diagnostic positions test. Normal findings would be which of these results? ANSWERS Parallel movement of both eyes Q. 18) During an assessment of the sclera of an African-American patient, the FNP would consider which of these an expected finding? ANSWERS The presence of small brown macules on the sclera Q. 19) A 60-year-old man is at the clinic for an examination. The FNP suspects that he has ptosis of one eye. How should the FNP check for this? ANSWERS Observe the distance between the palpebral fissures Q. 20) The FNP is doing an assessment on a 21-year-old patient and notices that his nasal mucosa appears pale gray and swollen. What would be the most appropriate question to ask the patient? ANSWERS Are you aware of having any allergies Q. 21) The FNP is palpating the sinus areas. If the findings are normal, then the patient should report which sensation? ANSWERS Firm pressure Q. 22) During an oral assessment of a 30-year-old African-American patient, the FNP notices bluish lips and a dark line along the gingival margin. What would the FNP do in response to these findings ANSWERS Proceed with assessment knowing that this is a normal finding Q. 23) During an assessment of a 20-year-old patient with a three day history of nausea and vomiting the FNP notices dry mucous and deep vertical fissures on the tongue. These findings are reflective of: ANSWERS Dehydration Q. 24) The FNP is reviewing the technique of palpating for tactile fremitus with a new graduate. Which statement by the graduate FNP reflects a correct understanding of tactile fremitus? Tactile fremitus: ANSWERS It's caused by sounds generated from the larynx Q. 25) The FNP student is reviewing physical assessment findings of the HEENT system associated with pregnancy. Which statement by the graduate FNP reflects a correct understanding of expected HEENT changes associated with pregnancy? During pregnancy: ANSWERS Bleeding from the gums Q. Miscarriage ANSWERS 20 weeks 200/1000 pregnancies Q. Ectopics ANSWERS 19/1000 pregnancies Q. Stillbirths ANSWERS 20 weeks 5/1000 pregnancies Q. Neonatal deaths ANSWERS 4/1000 pregnancies Q. Phases of Grief 1 (Davidson) ANSWERS "Shock and Numbness" -2 hours to 2 weeks -Denial/disbelief -Unable to think clearly/confused -Flat affect -Strong emotions - crying Q. Phase of Grief 2 (Davidson) ANSWERS "Searching and Yearning" -2 weeks-4 months -Anger, shame, guilt, fear, isolated, irritable -Why me? -Overwhelmed and all support has gone home -Sleep problems, aching arms, panic attacks, suicidal thoughts, headaches, palpitations, dreams, hallucinations, exhausted Q. Phase of Grief 3 (Davidson) ANSWERS "Disorientation" - overlaps with "Searching and Yearning" -about 5-9 months (most difficult phase) -Helpless, somatic issues, weight changes, disorganized, can't make decisions, sense of failure, unable to cope with usual life tasks -"I feel as though I'm going crazy" Q. Phase of Grief 4 (Davidson) ANSWERS "Reorganization/Resolution" -18 months and beyond -Return of joy, although may feel guilty at first, do not love the deceased any less -Sense of release, more energy and self-esteem -Find a meaning for, make sense of the loss, and incorporate into life (actualization) -Loss becomes "bittersweet" or shadow grief -Find a new normal in life and plan for the future Male grief -Feel powerless, useless, guilt, frustrated, fear, and anger -Finding tasks for them to do is often helpful Female grief -Loss of self-esteem, not special anymore -Hormone changes, emotionally labile -Empty, lonely, unable to feel joy for others' pregnancies -Feeling that life is unfair -Seeing/hearing babies brings back painful memories Benefits of Breastfeeding for Baby Reduced: -Otitis media, diarrhea, respiratory, and UTI -NEC -Insulin dependent diabetes -Juvenile rheumatoid arthritis -Some childhood cancers -Dental caries -MS -Allergies -Sudden Infant Death Syndrome (SIDs) -Crohn's Disease, UC -Some lymphomas -For girls, breast and ovarian cancer -Adult high cholesterol levels -Adult obesity Colostrum -Produced from pregnancy to first five days after birth -Low fat, high protein, high carbs, high in antibodies -Contains secretory IgA antibodies, lactoferrin, cytokines, and oligosaccharides to fight infection -Has laxative effect, helping to eliminate meconium and prevent jaundice -3x more concentrated than mature milk Immune factors in Human Milk -B12 binding protein -Bifidus factor -Fatty acids -Fibronectin -Gamma interferon -Mucins -WBCs Human Milk Content -Protein -Human milk more whey (water) than curds (cow's milk), so EASIER TO DIGEST - therefore, babies eat every 1.5-3 hours -Fat higher at end of feed -Carbohydrates -Vitamins and minerals -Hormones and enzymes Benefits of Breastfeeding for Mother -Exclusive breastfeeding prevents the return of menses: less iron loss, less chance of pregnancy -Requires no preparation, no refrigeration, or packaging -Uterus heals faster -Faster weight loss post-partum -Improved bone remineralization Contraindications to Breastfeeding -HIV in developed countries -Active, untreated TB -Active varicella -Taking antineoplastic, chemotherapeutic drugs -Diagnostic or therapeutic radioactive isotopes/materials (as long as they are in milk) -Street drugs or alcohol abuse -Infant has galactosemia (milk allergy) -Active herpes simplex breast lesions Maternal nutritional needs for Breastfeeding -Fluid intake to replace 720 ml milk produced per day by 2 weeks (24 oz. in 24 hours) -No special diet needed -500 extra calories over prepregnancy, or 200 more than pregnancy, for an average of 2700 kcal (ex. half a sandwich and a piece of fruit) Nipple preparation -No roughing up necessary -Avoid soap -Evaluation of areola(e): pinch test Physiology of Breastfeeding -PROLACTIN (milk production) - released from anterior pituitary -OCYTOCIN (milk release) - released from posterior pituitary Let Down Reflex (releasing milk) -May or may not be felt in first weeks -Early on, uterine cramping -Later - tingling, pins and needles, prickling or rushing sensation, leaking from opposite breast may be felt -Responds to stimuli: any baby's cry, looking at a baby's picture, after 1-3 hours Oxytocin BOMM Breastfeeding Orgasm Menstruation Mothering Milk production starts with... delivery of placenta First Nursing -Baby led -Talk to baby, stroke -Watch for readiness cues -Support breast in c hold or fingertip above areola to aim nipple toward roof of mouth -Finger between gums to break suction (don't pull baby off) Later Nursing -Position baby close -Hips and shoulders in straight line in front of mother (so baby does not have to turn head to reach breast) -Nose in front of nipple, nearly touching breast -Baby's cheeks and chin touch breast -Support back of neck and back (not back of head) -Place nipple on philtrum to stimulate suck Latch-On -Infant's lips flanged (fish lips) -At least 1-1.5 inches of breast tissue in baby's mouth Medications while breastfeeding -Antidepressants okay, but do not know the long-term effects -Vaccines okay -Mammograms okay -Heparin is okay -Insulin okay -Some psych meds not okay to breastfeed -No anti-cancer drugs Preterm Labor Uterine contractions and cervical changes between 20 and 37 weeks Preterm Birth -Birth before 37 completed weeks of pregnancy -About 90% of neonatal deaths (75% occur before 32 weeks gestation) Preterm labor: Demographic Risk Factors -Nonwhite race -Less than 17, greater than 35 years of age -Low SES -Unmarried -Less than HS education Preterm labor: biophysical risk factors -H/o PTL/birth -Repeated second trimester abortions -Grand multiparity (parity greater than 6) -Progesterone deficiency -Uterine anomalies or fibroids -Medical problems (Pre-eclampsia, GDM) -Small stature -Obesity Current Pregnancy Risks -Multiple gestation -Hydramnios -Bleeding -Placental abnormalities -Infections (UTIs, pyelonephritis, asymptomatic bacturia, BV, chorioamniocentesis) -Gestational HTN -PPROM (happens before 37 weeks) -Fetal anomalies -Anemia Preterm Labor: Behavioral and Psychosocial Risks -Poor nutrition -Smoking (10 cigs per day) -Substance abuse -Poor prenatal care -Long commutes -Excessive physical activity -Excessive stress Preterm labor: No risk factors 50% of women who give birth prematurely have no known risk factors Diagnosing preterm labor -Fetal fibronectin (glue like glycoprotein) -Attaches in the fetal sac to the uterine lining -Seen in cervico-vaginal secretions (1st trimester and first 1/2 of 2nd trimester) -If seen from 24-34 weeks - glue is disintegrating, predicts PTL Fetal Fibronectin Sensitivity/Specificity Sensitivity - Positive predictive value of 46% Specificity - Negative predictive value of 94% PT Dx: Endocervical length -If cervical length is 35 mm, there is an increased risk of preterm birth -Women who have a positive fetal fibronectin and decreased cervical length have a higher risk than women with only one marker PT Labor: Physical Findings -Uterine Contractions (painful or painless) *Educate: 4 contractions an hour, needs to rest, if going on later, call provider -Cervical changes (softening, effacement, dilation, shortening of cervical length) PT Labor: S/s -Contractions q10min or more often persisting for 1 hour or longer -Lower abdominal cramping (may be diarrhea) -Dull lower back pain -Menstrual-like cramps -Suprapubic pain or pressure -Pelvic pressure or heaviness -Urinary frequency -Change in vaginal discharge (brown mucous plug or amniotic fluid) -Feeling "something isn't right" -Symptoms may be attributed to other causes PTL lifestyle modifications -Sexual activity (no orgasms or nothing in vagina) -Riding long distances -Carrying heavy loads -Excessive amount of time standing -Heavy housework/physical work -Stair climbing -Lack of rest periods when tired Bedrest -Usually prescribed for patients with preterm labor -NOT an evidence-based intervention -Risks of bedrest: loss of muscle/weight loss, calcium loss and bone demineralization, glucose intolerance, constipation Bedrest nursing interventions -PT referral (encourage exercises) -Decrease isolation -Diversional activities -Help patient problem solve -Nutrition Corticosteroids -Given to mother to accelerate fetal lung maturity -Given between 24-34 weeks gestation -Associated with a decrease in intraventricular hemorrhage and NEC -Betamethasone -Bexamethasone Tocolytics -May be used to suppress contractions then discontinued -Maintenance therapy may be initiated (evidence does not support use) -Tocolytics may be used to delay delivery in order to give the mother corticosteroids (used to accelerate fetal lung maturity) Magnesium Sulfate Relaxes smooth muscle, CNS depressant, given IV (bolus), adverse reactions (flushing and sweating, N/V, dry mouth, drowsiness, visual disturbances, lethargy and dizziness, SOB and transient hypotension) Mg Sulfate: Discontinue if... RR 12 Pulmonary Edema Absent DTRs Chest pain Severe hypotension Altered LOC Extreme muscle weakness Urine output 30mL/hr Mag level of 10mEq/L or greater (therapeutic range is 4-6) *Mg sulfate antidote: calcium gluconate Idomethacin -Prostalglandin Inhibitor (NSAID) -Increases risk of PP hemorrhage -Risk of premature closure of the ductus ateriosus (treatment limited to 48h, not given if gestational age 32 weeks) Nifedipine -Calcium channel blocker (blocks calcium through the cell membrane) -Relaxes smooth muscle -Given PO -Fewer maternal side effects -Monitor BP Terbutaline -Beta-Adrenergic Agonists -Not used as much anymore -Given IV, SQ, or PO -Not for preterm labor -Used for external version (turn baby from breech position) -Used for hyper stimulation (uterine contractions too strong, too frequent, and last too long) PROM Rupture of amniotic sac at least one hour before onset of labor PPROM Rupture of amniotic sac before 37 weeks gestation (may be gush of fluid or slow leak) Risks or PPROM -Chorioamnionitis -Fetal complications (pneumonia, sepsis, meningitis) -Cord prolapse -Cord compression -Oligohydramnios Management of PPROM -Diagnosis (nitrazine or fern test) -Bedrest and hospitalization -Monitor for signs of infection -Antibiotics Placenta Previa Types Complete Marginal Low-Lying Placenta Placenta Previa Occurrence -1 in 200 pregnancies -Painless bright red vaginal bleeding during second or third trimester -Major implications for hemorrhage -Can lose of to 40% of blood volume without displaying signs of shock Expectant Mgmt for Placenta Previa -Bedrest with bathroom privileges, limited activities -Monitor V/S, CBC, and blood loss -Current type and screen -Monitor fetal well being -Provide emotional support and diversional activities -Be prepared for emergency C/S at anytime -Occurs in late 2nd/early 3rd trimester Abruptio Placentae -Premature separation of placenta from wall of uterus -Affects 1 in 75 to 1 in 226 pregnancies -Maternal and fetal outcomes Cord insertion and placental variations -Cord that doesn't insert in the placenta (inserts in membrane) - velamentous insertion of cord -Battledore (marginal) insertion -Risk of fetal hemorrhage increases Placenta succenturiate Additional lobe separated with long vessels Clotting disorders in pregnancy -Normal clotting: hemostatic systems stops flow of blood from injured vessels, fibrinolytic system, process through which fibrin is split into finbrinolytic degradation products and circulation is restored -Clotting problems: disseminated intravascular coagulation (DIC), correction of the underlying causes Prevalence of HTN disorders in pregnancy 6-8% of pregnancies More common in women 20 or 35 years of age HTN disorder complications -Placental abruption -Thrombocytopenia -DIC -Acute renal failure -Hepatic failure -Pulmonary edema -ARDS - high mortality rate -Aspiration pneumonia -Cerebral hemorrhage Chronic HTN HTN that is diagnosed before pregnancy or before 20th week of gestation OR during pregnancy and not resolved postpartum (first 12 weeks) Gestational HTN -BP increase for first time occurring after mid-pregnancy -No protein in urine -Some pts with develop preeclampsia -If BP returns to normal within 12 weeks postpartum, called transient HTN -If BP remains high after postpartum, the patient has chronic HTN Transient HTN -Pregnancy-induced HTN -Increased BP during pregnancy or the first 24 hours postpartum, without signs of preeclampsia or HTN -Transient HTN patients have an increased risk of developing chronic HTN Preeclampsia -Systemic syndrome - affects many body systems -Characterized by vasospasm and endothelial damage (all organ systems have decreased perfusion) -Endothelial damage stimulates use of blood clotting factors -Decreased organ perfusion Other Preeclampsia Effects -Vascular hemoconcentration -Third spacing of intravascular fluids -Exaggerated inflammatory response -Inappropriate endothelial activation -Activation of the coagulation cascade (results in formation of microthrombi - further decreases blood flow to organs) BP levels for preeclampsia -140/90 on at least 2 occasions at least 4 hours apart after 20 weeks -Previously normal BP Seizure precautions for preeclampsia Oxygen Suction Pad bed rails Severe preeclampsia 160/110 Platelets 100,000 Impaired liver f(x) Renal insufficiency Nursing care of severe preeclampsia -Administer Mg sulfate (4-6g bolus over 15-30 min, maintenance 1-3g/hr) -Maternal Fetal Assessments (VS, FHR, I&O restrict to 100-125cc/hr, proteinuria, DTRs) Eclampsia -Preeclampsia with seizures: may occur before other symptoms of preeclampsia, causes low blood oxygen for mother and fetus, risk of aspiration, stroke risk -Treated with Mg sulfate *Assume it's eclamptic until proven not to be After seizure activity ends -Assess fetal heart rate -Assess for signs of abruption -Assess for signs of imminent delivery -Delivery should not occur until the fetus has had time to recover -Postictal phase -O2 at 10L/min face mask -Suction as needed -Assess BP, pulse, respirations, and pulse ox q5min until stable -Note characteristics of seizure (presence of an aura, type and location of movements, start and stop time) HELLP Syndrome -Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP) Syndrome -20% of women with severe preeclampsia may develop HELLP syndrome -HELLP syndrome increase risk of adverse outcomes: placental abruption, renal failure, subcapsular hepatic hematoma, ruptured liver, recurrent preeclampsia, preterm delivery, fetal or maternal death Signs of HELLP syndrome -Platelet count must be 100,000 -AST and ALT are elevated Evidence of intravascular hemolysis (burr cells on peripheral smear, elevated bilirubin level) -Coagulation factor assays remain normal (PT, PTT, bleeding time) -Malaise -Epigastric or right upper quadrant pain -N/V -Pts may have only slight BP elevations or s/s of severe preeclampsia Lab changes for preeclampsia (Hgb and Hct, Platelets, Fibrinogen, Fibrin Split products, PT/PTT, Creatinine, BUN, Uric Acid, Cr Clearance, AST and ALT, LDH) -Hgb and Hct: may increase -Platelets: Unchanged or 100,000 -Fibrinogen: Decreased -Fibrin split products: absent/present -PT/PTT: unchanged -Creatinine: increased -BUN: increased -Uric acid: increased -Cr clearance: unchanged -AST and ALT: unchanged to minimal increase -LDH: Increased Labg changes for HELLP (Hgb and Hct, Platelets, Fibrinogen, Fibrin Split products, PT/PTT, Creatinine, BUN, Uric Acid, Cr Clearance, AST and ALT, LDH) -Hgb and Hct: decrease -Platelets: 100,000 -Fibrinogen: Decreased -Fibrin split products: present -PT/PTT: unchanged -Creatinine: increased -BUN: increased -Uric acid: increased -Cr clearance: decreased -AST and ALT: increased -LDH: increased What are anti-hypertensive drugs used for preeclampsia? -Hydralazine -Labetalol -Nifedipine -Methyldopa Indications for delivery (fetal) -Non-reassuring fetal monitor strip Failed non-stress test -Less than 8 biophysical profile -Oligohydramnios Indications for delivery (maternal) -Gestational age of 37 weeks for preeclampsia and gestational HTN -Thrombocytopenia -Deterioration of hepatic f(x) -Deterioration of renal f(x) -Suspected placental abruption -Persistent severe headache or visual changes -Persistent severe epigastric pain, N/V Alterations in Amniotic Fluid -36-38 weeks normal value is 1 liter -Volume decreases after 38 weeks -F(x) of amniotic fluid: protects fetus from injury, helps maintain constant body temperature, source of oral fluid, repository for waste, allows freedom of movement Amniotic Fluid Index Measurements -Normal AFI: 5-19 cm -Oligohydramnios: 5 cm -Polyhydramnios: 20 cm Gestational Diabetes Mellitus (GDM) Any degree of glucose intolerance with onset or first recognition during pregnancy Pathophysiology of GDM Insulin resistance occurs in pregnancy to facilitate energy delivery to fetus, possibly in response to placental hormones Role of placenta in GDM -Insulin resistance worsens with progress of pregnancy (increasing placental size) -Increased risk of GDM with multiple fetuses (increased total placental weight) -Rapid resolution of GDM with delivery of placenta Risk factors for GDM -Personal hx of GDM -Strong family hx of Type II DM -Obesity -Polycystic Ovary Syndrome -Prediabetes -Hx of macrosomia (infant over 10lbs) -Ethnicity (AA, hispanic, American Indian, Asian) Preconception counseling for Women with Diabetes -Should begin 3-6 months prior to conception -Assess diabetic control (A1C) and knowledge (A1C should be less than 7) -Counsel regarding risks *If high A1Cs, give birth control and get control over 3-6 months Preconception care for Diabetes (history) -Type of diabetes/# of years -Diabetes complications -Other comorbid conditions -OB history Preconception care for Diabetes (laboratory) -A1C -Kidney disease screening -Albumin: Cr ratio, Cr clearance -24-hr urine protein -Screening for thyroid disease Preconception care for Diabetes (assessment/management) -B/P, CV screening -Dilated retinal exam -Assess for autonomic neuropathy Preconception care for Diabetes (treatment/referral) -Diabetic retinopathy -Nephropathy -HTN -Neuropathy Diabetes screening during Pregnancy -High risk: first prenatal visit (hx of GDM, prediabetes, PCOS, hx of delivering baby weighing 4kg) -Universal screening: 24-28 weeks 1 hr Glucose Tolerance Test (GCT) -Done at 24-28 weeks -Fasting 126mg/dL = GDM dx -If positive (135-140mg/dL), then 3hr OGTT S/s of hyperglycemia (DKA) -Vomiting -Stomach pain -Rapid breathing -Increased pulse -Sleepiness -Dry mouth -Flushed face -Fruity breath S/s of hypoglycemia -Shaky -Sweaty -Headachy -Hungry -Confused -Dizzy -Grumpy Mgmt of Hypoglycemia for GDM "Rule of 15" -50-70mg/dL: 15 grams rapid-acting carbs -50-30mg/dL: give 30 grams rapid-acting carbs (recheck in 15 min) **Should be ordered glucagon Management of Severe Hypoglycemia for Type 1 DM -Glucagon injection to be administered if unconscious/cannot swallow -Teach family members/significant others infection technique (buttock, arm, thigh) Fetal Surveillance during Pregnancy -Non Stress Test (NST)/Amniotic Fluid Index (AFI) -GDM A1 (diet controlled) -GDM A2 (insulin or oral agents) **start at 28 weeks if h/o HTN, renal disease, fetal growth restriction **twice a week NSTs starting at 32 weeks -- biophysical profile (BPP) if NST abnormal Intrapartum care for GDM -Obtain blood glucose level upon admission -While in early labor and able to eat, checking fasting BG and check one hour after start of meals -Keep maternal BG levels between 70-110mg/dL to prevent or minimize hypoglycemia in the newborn Med Mgmt during Labor -Discontinue oral agents start of labor or day -Rare for women with GDM A1 to need insulin -Insulin delivery: drip, injection, continue pump -Intensive monitoring of glucose during labor Maternal complications -Increased risk for developing DM -C/S -Gestational HTN/preeclampsia -Polyhydramnios -Increased infection rate (UTIs = preterm labor) Fetal/Newborn complications -Macrosomia -Shoulder dystocia -Preterm delivery -Congenital anomalies -Risk of operative delivery -Hypoglycemia -Hyperbilirubinemia Why is it important to keep material BG levels between 70-110mg/dL for a mother with DM or GDM during labor? To prevent/minimize newborn hypoglycemia GDM Postpartum Care -Obtain at least one fasting and on 1-hr post prandial BG...target fasting BG 100mg/DL and post prandial 140mg/dL -Metformin may be prescribed postpartum to prevent-delay T2DM Postpartum Care - Preexisting DM Target BG Values: -Fasting/pre-meal: 80-100mg/dL -2 hours post meal 160mg/dL -Bedtime and 3am 120mg/dL Reduction in insulin Future Risk of GDM -Risk Factors: weight gain between pregnancies, maternal age 25 years, greater parity -Modest weight loss (7%): decreases risk of GDM in subsequent pregnancies, decrease risk of developing T2DM -Breastfeeding: long-term risk reduction for T2DM, decreased insulin requirements Postpartum screening after GDM 2-hr 75 gram OGTT: 6-12 weeks postpartum