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Hypoglycemia Hyperglycemia In The Pregnant Patient
 

Hypoglycemia Hyperglycemia In The Pregnant Patient

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    Hypoglycemia Hyperglycemia In The Pregnant Patient Hypoglycemia Hyperglycemia In The Pregnant Patient Presentation Transcript

    • Nursing 5263: Hypoglycemia and Hyperglycemia
      Presented by: Excalibur Group
      Daphney Jacques, Bridgette Jenkins, Opal Jobson-Cudjoe , Kelly miller
    • Objectives
      Distinguish between normal and abnormal blood glucose levels based on patient population
      Classify the different diagnosis associated with hypoglycemia/hyperglycemia based on patient age
      Compare the common causes of hypoglycemia/hyperglycemia based on patient population
    • Objectives
      Formulate the appropriate interventions for hypoglycemia/hyperglycemia management based on patient population
      Differentiate between the different medications used to manage the hypoglycemic/hyperglycemic patient.
      Predict immediate complications of hypoglycemia/hyperglycemia
    • Objectives
      State potential long term complications of uncontrolled blood sugar levels
      Determine the appropriate educational strategies to prevent hypoglycemia/hyperglycemia
    • NORMAL BLOOD GLUCOSE for PREGNANT WOMEN
      65mg/dl (fasting)
      <140 mg/dl (2 hr pp)
    • CLASSIFICATION OF DIABETES IN PREGNANT WOMEN (cdc.gov)
      Pregestational Diabetes
      Type I: primarily due to pancreatic islet beta cell destruction.
      Type II: most common type of diabetes that is a result of insulin resistance or insufficiency.
      Gestational Diabetes
      Any degree of glucose intolerance with the onset or first recognition occurring during pregnancy.
    • SCREENING FOR GESTATIONAL DIABETES (Lowdermilk, Perry, & Bobak)
      Screening should be done between 24-28 weeks gestation.
      Glucose Tolerance Test (GTT): 50 grams of glucose is consumed, blood is taken after 1 hour and sent to a laboratory for evaluation.
      • 140mg/dl or greater is considered as positive
      Oral Glucose Tolerance Test (OGTT) is done if the GTT is positive.
      • After a overnight fast, a fasting blood glucose level is drawn. Then 100 grams of glucose is consumed and blood is drawn at 1, 2 and 3 hour intervals.
      The patient is diagnosed with gestational diabetes if 2 or more values are met or exceeded:
      Fasting 105mg/dl
      1 hr 190mg/dl
      2 hr 165mg/dl
      3 hr 145mg/dl
    • HYPOGLYCEMIA IN PREGNACY
      Blood glucose: < 60mg/dl
      Causes: excess insulin, insufficient food, excessive exercise or work, vomiting or diarrhea.
    • SIGNS & SYMPTOMS OF HYPOGLYCEMIA
      Irritability
      Hunger
      Sweating
      Nervousness
      Dizziness
      Weakness
      Fatigue
      Headache
    • MANAGEMENT OF HYPOGLYCEMIA
      Check blood sugar when symptoms first appear (fingerstick)
      Eat 10-15 grams of simple carbs
      Recheck blood glucose 15 minutes after intake
      Notify healthcare provider if blood glucose remains low
      If patient is unconscious call 911
      If in hospital administer 50% dextrose or glucagon as ordered.
      Recheck blood sugar, send urine/blood to lab
    • HYPERGLYCEMIA IN PREGNACY
      Blood glucose > 200 mg/dl
      Causes: Insufficient insulin, excess or wrong kinds of food, infection, illness, injuries, emotional stress or insufficient exercise
    • SIGN & SYMPTOMS OF HYPERGLYCEMIA
      Thirst
      Nausea/Vomiting
      Abdominal pain
      Constipation
      Drowsiness
      Dim vision
      Increased urination
      Fruity breath
      Rapid, weak pulse
      Rapid breathing
    • MANAGEMENT OF HYPERGLYCEMIA
      Notify healthcare provider
      Administer insulin in accordance with blood glucose level (sliding scale)
      Give IV fluids (NS or 0.45 NS)
      Monitor blood & urine laboratory testing
    • MANAGEMENT OF DIABETES IN PREGNACY
      Diet
      • 2000-2500 daily, less if overweight or morbidly obese
      Exercise
      • Active women are encouraged to continue physical activity, sedentary are encouraged to get active. Walking is recommended
      Monitoring of blood glucose levels
      • Findersticks are done at home. Usually done upon waking (fasting) and after meals (postprandial)
      Insulin therapy: done on a individual basis to maintain normal blood glucose levels
      Close monitoring of fetus after 40 weeks until delivery
    • COMPLICATIONS OF DIABETES IN PREGNACY
      Congenital malformations
      Macrosomia: infant weight of 4,000-4,500 grams
      Intrauterine growth retardation (IUGR)
      Stillbirth
      Respiratory Distress Syndrome (RDS)
      Spontaneous abortion in early pregnancy
      Shoulder Dystocia
      Pregnancy induced hypertension (PIH)
      Infections (UTI’s, yeast infection)
      Ketoacidosis
    • PREVENTION
      Seek counseling before getting pregnancy
      Maintain a healthy weight
      Exercise regularly
      Eat healthy and balanced meals
      Seek prenatal care early in pregnancy
      Keep all prenatal appointments
      Follow regime prescribed by physician
    • REFERENCES
      CDC.GOV (2009). Information on gestational diabetes. Retrieved July 9, 2009, from: http://diabetes.niddk.nih.gov/dm/pubs/gestational/
      Lowdermilk, D., Perry, S., & Bobak, I. (1999). Maternity Nursing (5th. Ed). St. Louis: Mosby.
    • CASE STUDY
      Maria, a 40 y/o G4P3 at 29 weeks present to Labor & Delivery with c/o dizziness, headache, nausea and vomiting for 3 days. After interviewing Maria, you note that she has not had any prenatal care, has a h/o diabetes Her past obstetrical history includes delivery of a 4500 gram male complicated by shoulder dystocia. She weighs 312 pound. Her Bp 129/83, HR 82, RR 26 and Temp 98.8. A UA shows 3+ glucose, and negative ketones. Her accucheck is 179mg/dl.
    • CASE STUDY DISCISSION
      Questions
      1. What tests, if any, should be done to evaluate the Maria’s glucose tolerance? 2. How is the diagnosis of gestational diabetes mellitus (GDM) established? 3. What would be the best treatment and follow-up strategy for Maria?
      Discussion
      This patient has several risk factors for GDM. She is over the age of 30, has a history of GDM and is obese. All these place her at a greater risk for developing GDM. She needs to be referred to a dietician or diabetic counselor. She needs to continue prenatal care and started on insulin therapy. Maria should be followed closely for the remainder of the pregnancy. Birthing options (vaginal vs caesarean section) should be discussed with the patient. Maria should also be followed closely after delivering to assess for the development of Type II diabetes.