Chapter 22 Complications Occurring During Labor and Delivery: Maternity Newborn and Women's Health Nursing A Case-Based Approach O'Meara

Chapter 22 Complications Occurring During Labor and Delivery: Maternity Newborn and Women's Health Nursing A Case-Based Approach O'Meara 2 | Page 1. Preconception counseling is critical to the outcome of diabetic pregnancies because poor glycemic control before and during early pregnancy is associated with a. Frequent episodes of maternal hypoglycemia b. Congenital anomalies in the fetus c. Polyhydramnios d. Hyperemesis gravidarum - ANSWER-ANS: B Feedback A Frequent episodes of maternal hypoglycemia may occur during the first trimester (not before conception) as a result of hormone changes and the effects on insulin production and usage. B Preconception counseling is particularly important because strict metabolic control before conception and in the early weeks of gestation is instrumental in decreasing the risks of congenital anomalies. C Hydramnios occurs about 10 times more often in diabetic pregnancies than in nondiabetic pregnancies. Typically, it is seen in the third trimester of pregnancy. D Hyperemesis gravidarum may exacerbate hypoglycemic events as the decreased food intake by the mother and glucose transfer to the fetus contribute to hypoglycemia. 2. In assessing the knowledge of a pregestational woman with type 1 diabetes concerning changing insulin needs during pregnancy, the nurse recognizes that further teaching is warranted when the patient states a. "I will need to increase my insulin dosage during the first 3 months of pregnancy." b. "Insulin dosage will likely need to be increased during the second and third trimesters." c. "Episodes of hypoglycemia are more likely to occur during the first 3 months." d. "Insulin needs should return to normal within 7 to 10 days after birth if I am bottle feeding." - ANSWER-ANS: A Feedback A Insulin needs are reduced in the first trimester due to increased insulin production by the pancreas and increased peripheral sensitivity to insulin. B This statement is accurate and signifies understanding. Insulin resistance begins as early as 14 to 16 weeks of gestation and continues to rise until it stabilizes during the last few weeks of pregnancy. 3 | Page C This statement is correct. During the first trimester maternal blood glucose levels are reduced and the insulin response to glucose is enhanced therefore this is when an episode of hypoglycemia is most likely to occur. D For the non-breastfeeding mother insulin levels return to normal within 7 to 10 days. Lactation utilized maternal glucose, therefore the mother's insulin requirements will remain low during lactation. On completion of weaning the mother's prepregnancy insulin requirement is reestablished. 3. Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. The nurse identifies that the fetus is at greatest risk for a. Macrosomia b. Congenital anomalies of the central nervous system c. Preterm birth d. Low birth weight - ANSWER-ANS: A Feedback A Poor glycemic control later in pregnancy increases the rate of fetal macrosomia. B Poor glycemic control during the preconception time frame and into the early weeks of the pregnancy is associated with congenital anomalies. C Preterm labor or birth is more likely to occur with severe diabetes and is the greatest risk in women with pregestational diabetes. D Increased weight, or macrosomia, is the greatest risk factor for this woman. 4. In terms of the incidence and classification of diabetes, maternity nurses should know that a. Type 1 diabetes is most common. b. Type 2 diabetes often goes undiagnosed. c. There is only one type of gestational diabetes. d. Type 1 diabetes may become type 2 during pregnancy. - ANSWER-ANS: B Feedback A Type 2, sometimes called adult onset diabetes, is the most common. 4 | Page B Type 2 often goes undiagnosed, because h