Gestaitional Diabetes - bootcamp cheat sheets

Question 1

you are a nurse, you got this.

Question 2

what Is diabetes mellitus?

Answer 2

impaired glucose metabolism
- glucose can’t reach the cells, which then the cells starve and glucose builds up inside the bloodstream

Question 3

what is GDM?

Answer 3

higher levels of placental hormones ( estrogen, progesterone ) and cortisol in the 2nd and 3rd trimester -> increases insulin resistance -> increase circulating glucose (hyperglycemia)

Question 4

typically GDM resolves in what?

Answer 4

postpartum- usually after delivery the baby

Question 5

what are some risk factors for a patient to develop GDM?

Answer 5

overweight
history of GDM
previous GDM in pregnancy
maternal age >25
hispanic/balck
first degree relative with diabetes

Question 6

what are your classical manifestations for a patient with diabetes?

what are the 2 for a patient with GDM in pregnancy tho?

Answer 6

3 p’s
polyuria
polyphagia
polydipsia

increase fundal heigh
either from macrosomia and polydramnios

Question 7

when are patients usually screen for GDM?
during what weeks?

Answer 7

24-28 weeks gestation

Question 8

how is GDM diagnosed?

Answer 8

a positive screening result for a two step oral glucose challenge test

Question 9

non-fasting 1 hour oral glucose challenge test
- if it comes out positive

a fasting 2 hour challenge glucose test is preofmed

Question 10

the number one priority for a patient with diabetes during pregnancy is what?

Answer 10

maintain tight glycemic control to ensure maternal and fetal well-being and prevent complications like spontaneous abortion and neural tube defects

Question 11

GDM can cause what 2 major complications?

Answer 11

spontaneous abortions
neural tube defects

Question 12

GDM is treated with _____and ____first then we usually give insulin

Answer 12

diet and exercise

Question 13

exercise should be how many minutes per day?

Answer 13

30-60min daily

Question 14

divide daily calories needs between 3 meals and 2-3 snacks ( never skip meals )

• eat high fiber, complex carbohydrates (brown rice) and limit simple sugars (white bread, candy )

consult with a registered dietician

Question 15

blood sugar management
- blood glucose leaves are monitored to evaluate whether blood sugar can be controlled with diet and exercise alone.

• teach client to monitor blood glucose as prescribed ( usually four times daily )

when should they measure post-prandial glucose ___hr ___eating

Answer 15

1-2hours after eating

Question 16

if hyperglycemia persists despite healthy diet and exercise
- insulin may be come necessary for these patients

• increase doses of insulin will be required during pregnancy for clients who have T1DM

Question 17

monitor for signs of hypoglycemia, give me some examples

and if they become hypoglceymica, what do we give?

Answer 17

shaking, clammy, confused

15 grams of carbohydrate and recheck glucose in 15minutes

Question 18

monitor maternal and fetal well-being

uncontrolled hyperglycemia in pregnancy can cause several maternal and fetal complications. which include?

Answer 18

spontaneous abortions
neural tube defects
intrauterine growth resitrciton
macrosomia - big baby

Question 19

some maternal complications when it comes to have gdm include?

Answer 19

preeclampsia
frequent uti - since that glucose can increase in bacteria growth

Question 20

assess for complications
monitor blood glucose as prescribed
perform early and frequent fetal surveillance
- ultrasound measurement to assess fetal growth and amniotic fluid volumes

• non stress tests, and biophysical profiles to assess fetal well-being

Question 21

during labor, strict glycemic control is necessary to reduce the risk for a newborn to go into?

Answer 21

hypoglycemia

Question 22

when a patient is about to go into labor, how often are we monitoring maternal blood glucose levels?

Answer 22

every hour

Question 23

we may need to administer iv fluids with dextrose and insulin as needed to maintain a normal?

Answer 23

glucose level during labor

Question 24

clients with gdm are at risk for birth complications of macrosomia ( big baby ), which puts them at risk for ?

Answer 24

postpartum hemorrhage
- uterine over distention and increases risk for uterine atony

Question 25

if they are also at risk for delivering a big baby, they may have birth injuries like a perineal lacerations and shoulder dysotica

Question 26

after birth, assess newborn blood glucose and monitor for complications due to GDM - assess newborn blood glucose per facility policy - place heel warmer on newborn to improve blood flow and prevent false low results - obtain blood sample from the ___

Answer 26

lateral heel

Question 27

hypoglycemia less than ____ in the first 72 hours of life requires interventions. what if the baby is alert, what might we consider to increase their sugar ? (2)

Answer 27

45 breastfeeding, oral feedings

Question 28

if the newborn can not be feed or hypoglycemia persists, what do we do?

Answer 28

treat with iv dextrose instead

Question 29

how does hypoglycemia look like on a newborn?

Answer 29

persistent jitters or tremors hypothermia respiratory distress ( tachypnea, grunting )

Question 30

Screen for GDM between __-__ weeks gestation using a _____ (fasting or nonfasting?) 1-hour oral glucose challenge test. Teach clients diagnosed with GDM to first manage blood sugars with _____ and _____. Divide daily caloric needs between _____ meals and _____ to _____ snacks. Monitor the postpartum client for uterine _____ and teach clients to report signs of preeclampsia, including BP ≥___/___, headaches, and ______ changes. If the newborn has persistent jitters or hypothermia, assess for _____, but first, prevent falsely low glucose values by warming the newborn’s _____. If a newborn has hypoglycemia and is alert, treat with oral feedings. Treat persistent hypoglycemia with ____.

Answer 30

24-28weeks non-fasting 1 hour oral then do a fasting test if positive diet and exercise 3 meals 2-3 snacks atony 140/90, headaches and vision changes glucose, lateral heel iv dextrose