The nurse is caring for a multigravida client in active labor
Item 1 of 1
- History and Physical
A 40-year-old (G2-T1-P0-A0-L1) client at 38 weeks gestation was admitted after reporting an increased frequency of contractions and duration while at home. The client was 100% effaced on exam, and 10 cm dilated. She is having contractions every six to seven minutes lasting approximately 45 seconds.
The client was diagnosed with gestational diabetes and had difficulty with maintaining euglycemia because of the inability to adhere to the prescribed insulin schedule. The client has a history of alcohol use disorder and through outpatient treatment, she reports maintaining sobriety during her pregnancy. Periodic ethanol levels during her pregnancy were all zero.
- Laboratory
Drag one (1) condition and one (1) finding to fill in each blank of the following sentence
Drag one (1) condition and one (1) finding to fill in each blank of the following sentence
The neonate is at highest risk for
related to the client’s
Conditions
- microcephaly
- fetal alcohol syndrome
Assessments
- hyperglycemia
- ethanol level
Statistics
Subject/Lesson
Subject
Maternal & Newborn Health
Lesson
Labor/Delivery
Client Need
Test Plan
Health Promotion and Maintenance
Related Topic
Ante/Intra/Postpartum and Newborn Care
Item Type
Item Type
PrioritizeHypothesis
Explanation
The client’s newborn is at considerable risk for newborn hypoglycemia because of the client’s poorly controlled gestational diabetes. The most recent blood glucose showed hyperglycemia and needs to be corrected with a combination of prescribed regular insulin and dextrose infusions.
Fetal alcohol syndrome is a potential, but all indications show that the client has been abstaining from alcohol. Considering that the objective data shows maternal hyperglycemia, this is an actual problem putting the newborn at risk for hypoglycemia.
Early decelerations are thought to represent a vagal response during fetal head compression. Early decelerations are benign and not associated with an interruption of fetal oxygenation. Early decelerations would not cause microcephaly as microcephaly is associated with conditions such as fetal alcohol syndrome.
Related Videos
2 Key Topics
Gestational Diabetes
28.5 Infection & Complication Risks
Additional Info
Key facts regarding gestational diabetes –
- Insulin needs decrease during the first trimester and rapidly increase during the second and third.
- The glucose challenge test is administered between 24 and 28 weeks.
- A blood sample is taken 1 hour later. If the blood glucose concentration is 140 mg/dL or greater, a 3-hour oral glucose tolerance test (OGTT) is recommended.
- Gestational diabetes places the client at risk for developing diabetes mellitus later in life.
- The major fetal complications are macrosomia, leading to birth injuries or cesarean birth, and neonatal hypoglycemia. Macrosomia also places the client at risk for post-partum hemorrhage.
