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Nursing Management Of Diabetes In Pregnancy

Nursing Care Plan For Diabetes

Nursing Care Plan For Diabetes

Diabetes is really prevalent. Just recall all the patients you saw today and theres probably a handful of them who are diabetic. According to the National Center for Chronic Disease Prevention and Health PromotionDivision of Diabetes Translation, up to 30.3 million people in the United States have diabetes. Because of how prevalent it is, nurses need to be highly knowledgeable and skilled when it comes to educating and caring for their patients. That includes preparing the right nursing care plan for diabetes. Diabetes ordiabetes mellitusis a metabolic disease where blood glucose levels are abnormally high. Symptoms of high blood glucose levels include: In general, there are three types of diabetes and each one varies in terms of treatment and management. Type 1 diabetes is also called insulin-dependent and juvenile-onset diabetes. This type of diabetes often begins early in childhood. Its an autoimmune disorder where the bodys immune system attacks its own pancreas, inhibiting its capacity to produce insulin. Type 2 diabetes accounts for the 95% of diabetes cases in the US. Onset is usually late in adulthood. It happens when the pancreas is unable to produce adequate insulin to meet the bodys needs or when the bodys cells become resistant to it. Type 2 diabetes can be managed with lifestyle and diet changes as well as intake of oral hypoglycemic agents (OHAs). Gestational diabetes is characterized by pregnancy-induced insulin resistance. It affects roughly 2% to 10% of pregnancies. Diabetic patients need complex nursing care. Here are some of the most important NCPs for diabetes: 1. Deficient knowledge regarding disease process, treatment, and individual care needs verbal statements of concerns or misconceptions improper or inadequate follow-through of instructions de Continue reading >>

Nursing Interventions In The Management Of Gestational Diabetes In Prenatal Care Patients

Nursing Interventions In The Management Of Gestational Diabetes In Prenatal Care Patients

JavaScript is disabled for your browser. Some features of this site may not work without it. Nursing Interventions in the Management of Gestational Diabetes in Prenatal Care Patients Ogbunugafor, Chioma; Nanyunja, Immaculate (2018) Gestational Diabetes Mellitus (GDM) accounts for 90-95% of all cases of diabetes in pregnancy. Family history, obesity and insulin resistance are some of the risk factors of GDM. GDM complications that affect the mother, baby and infant can be long-term or short-term. The purpose of this thesis is to describe the nursing interventions in the management of GDM in prenatal care patients. The method used in this thesis is a literature review with an inductive qualitative content analysis. To gather important literature that is up-to-date, two databases were searched. These are Laurea FINNA and Sage Premier 2012, and a total number of 24 articles accepted. Four main categories in the management of GDM were derived from the data ana-lysed. These include; self-care management, medication, education and training, and social support. It was deduced from the data that there is a distinct lack of know-ledge amongst pregnant women with GDM on how to implement a self-care manage-ment plan in their daily living. As a result, depression, stress, anxiety and eating dis-orders arise. In conclusion, effective management and reduction in the prevalence of GDM is through self-care management. A well-balanced diet through the Medical Nutrition Therapy (MNT) is a chief foundation of managing GDM. Nurses play an important role in counseling and educating women with GDM by providing indepth information on nutrition as stated by a clinical dietician. Nurses require further education and train-ing on the general knowledge, management and prevention of GDM. Aspects s Continue reading >>

Gestational Diabetes In Primary Care

Gestational Diabetes In Primary Care

Home > Gestational diabetes in primary care By Dr Bernadette L. Carpenter, CMT1 endocrinology and Professor Neil Munro, Visiting professor of primary care diabetes - Gestational diabetes is common, affecting one-in-20 pregnancies and is associated with increased obesity - High-risk mothers should be tested for gestational diabetes at 24-28 weeks gestation with a two-hour oral glucose tolerance test (OGTT) - Management of gestational diabetes during pregnancy has been updated - new National Institute for Health and Care Excellence (NICE) guidance was issued in 2015. The prevalence of gestational diabetes is increasing due to the obesity epidemic and increasing maternal age, and is causing a significant burden on both primary and secondary care with up to 5% of pregnancies affected (1,2). Gestational diabetes is a significant complication in pregnancy, which can lead to delivery problems due to large babies (macrosomia), neonatal hypoglycaemia and maternal pre-eclampsia. It is important for primary care providers, including practice nurses, to be up-to-date with current diagnostic criteria, treatment and management of these women to reduce adverse outcomes. In addition, women who have gestational diabetes will have a 7% lifetime risk of developing type 2 diabetes in the future, as pregnancy unmasks susceptibilities to insulin resistance (3). Early identification and careful follow-ups of women with gestational diabetes can help to modify preventable risks factors and reduce their risk of type 2 diabetes and its long-term complications. The diagnosis criteria for gestational diabetes is different from ordinary diabetes and those mothers with positive glycosuria urine dip-stick tests and in high-risk groups should be formally tested. Gestational diabetes is defined as gluc Continue reading >>

Management Of Gestational Diabetes In Primary Care

Management Of Gestational Diabetes In Primary Care

Management of gestational diabetes in primary care Written by: David Morris | Published: 03 June 2013 Understanding gestational diabetes is important to primary care nurses, not only because of a need to be aware of complications that can arise during pregnancy but because of the future risk of type 2 diabetes in the mother-more than seven times that of women who have not had a previous diagnosis of gestational diabetes.1 The classic definition of gestational diabetes is glucose intolerance with onset or first recognition in pregnancy. Leaving aside women with a diagnosis of type 1 or type 2 diabetes before conception, the current prevalence of gestational diabetes is nine per cent, and the problem is growing, driven principally by increasing obesity.2 The 2008 NICE guideline on gestational diabetes recommends a selective approach to screening based on risk factors.3 The strongest predictor for gestational diabetes is having the condition in a previous pregnancy, and for these women NICE advises early blood glucose self-monitoring or an oral glucose tolerance test (OGTT) at 16-18 weeks of gestation, repeated at 28 weeks of gestation if the first OGTT is normal. For women with other risk factors for gestational diabetes, an OGTT between 24 and 28 weeks of gestation is advised.3 NICE recommends using the WHO diagnostic criteria for gestational diabetes. Please login or register to read the rest of the article and to have access to downloads and comments. What do you think? Leave a comment below or tweet your views to @IndyNurseMag This material is protected by MA Healthcare Ltd copyright. To understand how we process, use & safeguard your data, please see our Privacy Policy Thank you for registering for Independent Nurse. In addition to this service, Independent Nurse an Continue reading >>

[full Text] Monitoring And Managing Mothers With Gestational Diabetes Mellitus: A | Nrr

[full Text] Monitoring And Managing Mothers With Gestational Diabetes Mellitus: A | Nrr

Editor who approved publication: Dr Cindy Hudson Diane C Berry,1 Quinetta B Johnson,2,3 Alison M Stuebe2,3 1The University of North Carolina School of Nursing, 2Women's Primary Health Care, The University of North Carolina School of Medicine, Division of Maternal Fetal Medicine, 3The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA Abstract: Women diagnosed with gestational diabetes mellitus (GDM) must work in partnership with their health care team to improve both maternal and fetal outcomes. This team may include physicians, midwives, nurse practitioners, physician assistants, registered nurses, certified diabetes educators, and registered dietitians. Management should include medical nutrition therapy, self-monitoring of blood glucose with tight control, and exercise to prevent postprandial hyperglycemia. Approximately 80% of women diagnosed with GDM are well controlled with medical nutrition therapy, self-monitoring of blood glucose, and exercise; however, approximately 20% require medication to bring their blood glucose levels under control during pregnancy. The risk of developing type 2 diabetes mellitus decreases dramatically for women who engage in interventions to lose weight postpartum, improve their nutrition and increase their physical activity. Therefore, postpartum women with GDM should be retested and reclassified at 6 weeks postpartum and strongly encouraged to lose weight through proper nutrition and exercise. Keywords: gestational diabetes mellitus, medical nutrition therapy, self-monitoring of blood glucose, exercise, medication, type 2 diabetes This paper reviews the state of the science on monitoring and managing women diagnosed with gestational diabetes mellitus (GDM) during pregnancy to improve outcomes f Continue reading >>

Nursing Care Of The Pregnant Woman With Diabetes Mellitus.

Nursing Care Of The Pregnant Woman With Diabetes Mellitus.

Nursing care of the pregnant woman with diabetes mellitus. The woman with diabetes who becomes pregnant faces increased risk of morbidity,urinary tract infections, vaginitis, difficult delivery, hemorrhage, cesareansection, preeclampsia, and hydramnios. Chronic disease alone produces emotionaltension. Added to this she has increased general life stresses such as addedfinancial responsibility, increases time commitments, and changes in lifestyledemands. The infant of the diabetic is often large for dates, faces respiratorydistress syndrome with early delivery, may experience hypoglycemia, and may have fetal anomalies. Clinical specialists of nursing, consulting and workingtogether, can develop a plan of nursing care for the pregnant woman withdiabetes. Because the pregnant diabetic woman faces the usual adjustments topregnancy plus problems dealing with a chronic condition of diabetes, nursingcare should combine consideration of the physical, emotional and educationalneeds. In view of the many health team members providing care to the pregnantdiabetic, one central figure with continued interaction can decreasefragmentation and provide continuity of care. Continue reading >>

Reducing Barriers To Glucose Control In Patients With Gestational Diabetes

Reducing Barriers To Glucose Control In Patients With Gestational Diabetes

Reducing barriers to glucose control in patients with gestational diabetes Author: Preventing adverse outcomes may hinge on your ability to identify and overcome barriers that prevent some pregnant women from managing their diabetes properly. According to the Centers for Disease Control and Prevention (CDC), 9.2% of pregnant women develop gestational diabetes mellitus (GDM) as a serious complication during pregnancy. A positive glucose tolerance test in the second trimester can be a shock for an expectant woman. Poor glucose control can lead to poor outcomes for both mother and fetus. A woman carrying a large fetus is more likely to require surgical delivery and faces a longer recovery. Whats more, although GDM usually goes away after delivery, it increases the womans risk for developing type 2 diabetes later in life. For the fetus, placental glucose permeability causes extra fat storage; the fat fetus is at high risk for delayed lung development, premature delivery, and hypoglycemia immediately after birth. Also, the fetus stands a higher chance of suffering shoulder trauma during natural labor. A pregnant woman needs time and effective mechanisms to cope with the diagnosis of GDM and the lifestyle changes shell need to make. But the sooner she starts controlling her blood glucose, the lower the odds that GDM will harm her or her fetus. Nurses working with women who have GDM can help reduce negative outcomes by using the nursing process to assess the patient for barriers to managing GDM and achieving good glycemic control. The most common barriers are: patients lack of knowledge about diabetes and its long-term effects on the mother and fetus patient nonadherence, such as difficulty self-monitoring blood glucose because of the need for multiple blood samples and compl Continue reading >>

Monitoring And Managing Mothers With Gestational Diabetes Mellitus: A Nursing Perspective

Monitoring And Managing Mothers With Gestational Diabetes Mellitus: A Nursing Perspective

Editor who approved publication: Dr Cindy Hudson Diane C Berry,1 Quinetta B Johnson,2,3 Alison M Stuebe2,3 1The University of North Carolina School of Nursing, 2Women's Primary Health Care, The University of North Carolina School of Medicine, Division of Maternal Fetal Medicine, 3The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA Abstract: Women diagnosed with gestational diabetes mellitus (GDM) must work in partnership with their health care team to improve both maternal and fetal outcomes. This team may include physicians, midwives, nurse practitioners, physician assistants, registered nurses, certified diabetes educators, and registered dietitians. Management should include medical nutrition therapy, self-monitoring of blood glucose with tight control, and exercise to prevent postprandial hyperglycemia. Approximately 80% of women diagnosed with GDM are well controlled with medical nutrition therapy, self-monitoring of blood glucose, and exercise; however, approximately 20% require medication to bring their blood glucose levels under control during pregnancy. The risk of developing type 2 diabetes mellitus decreases dramatically for women who engage in interventions to lose weight postpartum, improve their nutrition and increase their physical activity. Therefore, postpartum women with GDM should be retested and reclassified at 6 weeks postpartum and strongly encouraged to lose weight through proper nutrition and exercise. Keywords: gestational diabetes mellitus, medical nutrition therapy, self-monitoring of blood glucose, exercise, medication, type 2 diabetes This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Continue reading >>

Nursing Management In Diabetes During Pregnancy

Nursing Management In Diabetes During Pregnancy

Your browser does not support the NLM PubReader view. Go to this page to see a list of supporting browsers. Nursing Management in Diabetes during Pregnancy J Korean Diabetes. 2015 Sep;16(3):198-204. J Korean Diabetes. 2015 Sep;16(3):198-204. Korean. Published online September 30, 2015. Copyright 2015 Korean Diabetes Association Nursing Management in Diabetes during Pregnancy Department of Nursing, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea. Corresponding author: Jeong Eun Park. Department of Nursing, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, 17, Seoae-ro 1-gil, Jung-gu, Seoul 04619, Korea, Email: [email protected] Received July 27, 2015; Accepted August 14, 2015. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The ongoing epidemics of obesity and diabetes have led to higher incidence of gestational diabetes mellitus and pregestational diabetes. GDM is diabetes diagnosed in the second or third trimester of pregnancy that is not clearly overt diabetes. Therefore, women in whom diabetes is detected in the first trimester would be classified as having type 2 diabetes. Women with GDM should be screened for persistent diabetes or prediabetes at 6~12 weeks postpartum. All women of childbearing age with diabetes should be counseled about the importance of strict glycemic control prior to conception. During pregnancy, treatment with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers is contraindicated because their ability to cause Continue reading >>

4 Gestational Diabetes Mellitus Nursing Care Plans

4 Gestational Diabetes Mellitus Nursing Care Plans

Assess and record dietary pattern and caloric intake using a 24-hour recall. To help in evaluating clients understanding and/orcompliance to astrict dietary regimen. Assess understanding of the effect of stress on diabetes . Teach patient about stress management and relaxation measures. It is proven that stress can increase serum blood glucose levels, creating variations in insulin requirements. Weigh the client every prenatal visit . Encourage the client to periodically monitor weight at home between visits. Weight gain serves as anindicator for determining caloric adjustments. Observe for thepresence of nausea and vomiting, especially during the first trimester. Nausea and vomiting may be brought about by adeficiency in carbohydrates, which may result inthemetabolism of fats and development of ketosis. Teach the importance of regularity of meals and snacks (e.g., three mealsor 4 snacks) when taking insulin . Eating very frequent small meals improves insulin function. Teach and demonstrate client to monitor sugar using a finger-stick method. Insulin needs for the day can be adjusted based on periodic serum glucose readings. Note: Values obtained by reflectance meters may be 10-15% lower/higher than plasma levels. Provide information regarding any required changes in diabetic management; e.g., use of human insulin only, changing from oral diabetic drugs to insulin, self-monitoring of serum blood glucose levels at least twice a day (e.g., before breakfast and before dinner) and reducing/changing time for ingesting carbohydrates. Metabolism and maternal/fetal needs fluctuatesduring the gestation period, requiring close monitoring and adaptation. Research suggest antibodies against insulin may cross the placenta , causing inappropriate fetal weight gain. The use of human Continue reading >>

Diabetes Mellitus

Diabetes Mellitus

Melvin, a 32-year- old,always complains of his increasing need for water. He also feels an increasing need to urinate almost every now and then,and always feels hungry. There is tingling on his extremities and numbness. His once clear vision is now experiencing cloudiness. He already feels tired just a few hours after waking up even though he does not have any job and only stays at home. The wound on his right knee has been there weeks but no improvement is seen. 11 Nursing Management The major sources of the glucose that circulates in the blood are through the absorption of ingested food in the gastrointestinal tract and formation of glucose by the liver from food substances. Diabetes mellitus is a group of metabolic diseases that occurs with increased levels of glucose in the blood. Diabetes mellitus most often results in defects in insulin secretion, insulin action, or even both. The classification system of diabetes mellitus is unique because research findings suggest many differences among individuals within each category, and patients can even move from one category to another, except for patients with type 1 diabetes. Diabetes has major classifications that include type 1 diabetes, type 2 diabetes, gestational diabetes, and diabetes mellitus associated with other conditions. The two types of diabetes mellitus are differentiated based on their causative factors, clinical course, and management. Diabetes Mellitus has different courses of pathophysiology because of it has several types. Insulin is secreted by beta cells in the pancreas and it is an anabolic hormone. When we consume food, insulin moves glucose from blood to muscle, liver, and fat cells as insulin level increases. The functions of insulin include the transport and metabolism of glucose for energy, sti Continue reading >>

12. Management Of Diabetes In Pregnancy

12. Management Of Diabetes In Pregnancy

For guidelines related to the diagnosis of gestational diabetes mellitus (GDM), please refer to Section 2. Classification and Diagnosis of Diabetes. Recommendations Provide preconception counseling that addresses the importance of tight control in reducing the risk of congenital anomalies with an emphasis on achieving A1C <7%, if this can be achieved without hypoglycemia. B Potentially teratogenic medications (ACE inhibitors, statins, etc.) should be avoided in sexually active women of childbearing age who are not using reliable contraception. B GDM should be managed first with diet and exercise, and medications should be added if needed. A Women with pregestational diabetes should have a baseline ophthalmology exam in the first trimester and then be monitored every trimester as indicated by degree of retinopathy. B Due to alterations in red blood cell turnover that lower the normal A1C level in pregnancy, the A1C target in pregnancy is <6% if this can be achieved without significant hypoglycemia. B Medications widely used in pregnancy include insulin, metformin, and glyburide; most oral agents cross the placenta or lack long-term safety data. B Diabetes in Pregnancy The prevalence of diabetes in pregnancy has been increasing in the U.S. The majority is GDM with the remainder divided between pregestational type 1 diabetes and type 2 diabetes. Both pregestational type 1 diabetes and type 2 diabetes confer significantly greater risk than GDM, with differences according to type as outlined below. Preconception Counseling All women of childbearing age with diabetes should be counseled about the importance of strict glycemic control prior to conception. Observational studies show an increased risk of diabetic embryopathy, especially anencephaly, microcephaly, and congenital Continue reading >>

Nurse-based Management In Patients With Gestational Diabetes.

Nurse-based Management In Patients With Gestational Diabetes.

1. Diabetes Care. 2003 Apr;26(4):998-1001. Nurse-based management in patients with gestational diabetes. Garca-Patterson A(1), Martn E, Ubeda J, Mara MA, Adelantado JM, Ginovart G, deLeiva A, Corcoy R. (1)Endocrinology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University Barcelona, Barcelona, Spain. OBJECTIVE: To compare the rate of insulin treatment and perinatal outcome inwomen with gestational diabetes mellitus (GDM) under endocrinologist-based versusdiabetes nurse-based metabolic management.RESEARCH DESIGN AND METHODS: In a retrospective analysis, maternalcharacteristics, rate of insulin treatment, and perinatal outcome of patientswith GDM delivering between 1 January 1995 and 30 June 1997 (n = 244) receivingendocrinologist-based care were compared with those delivering between 1 July1997 and 31 December 1999 (n = 283) who received diabetes nurse-based care. Thediabetes nurse's role was similar to that of an advanced practice nurse in theU.S. There were no changes in the metabolic goals and instruments or in obstetricand neonatal management. Quantitative data were compared with the Mann-Whitney U test and categorical data, with Fisher's exact test.RESULTS: Maternal characteristics (age, BMI, family history of diabetes, priorglucose intolerance, gestational age, and blood glucose at diagnosis of GDM) did not differ between groups treated during the two periods. Rates of insulintreatment and perinatal outcome (hypertension, preterm delivery, cesareansection, low Apgar score, macrosomia, small- and large-for-gestational-agenewborns, obstetric trauma, major malformations, hypoglycemia, hypocalcemia,polycythemia, jaundice, respiratory distress, and mortality) were also similar inboth groups.CONCLUSIONS: Comparison of periods of endocrinologist-based a Continue reading >>

Nurses Help Pregnant Women With Gestational Diabetes

Nurses Help Pregnant Women With Gestational Diabetes

Nurses help pregnant women with gestational diabetes Among women with gestational diabetes mellitus, referral to a telephone-based nurse management program was associated with lower risk of high baby birth weight and increased postpartum glucose testing, according to a study. Investigators for the Kaiser Permanente Northern California Division of Research examined the associations between referral to telephone-based nurse consultation and outcomes in 12 Kaiser Permanente medical centers with variation in the percentage of patients referred to telephonic nurse management. The investigators used data from the Kaiser Permanente Northern California GDM registry to identify women who had pregnancy complicated by GDM from 1997 through 2006. They restricted their cohort to women with GDM according to the National Diabetes Data Group criteria. During the study period, 96% of all pregnant women without preexisting diabetes who delivered an infant were screened for GDM. The researchers excluded women who delivered multiple births due to their increased risk of perinatal complications. Overall, researchers identified 11,435 women with GDM at the 12 medical centers, of whom 44.5% were referred to the perinatal service center. Compared with women from Kaiser Permanente medical centers where the annual proportions of referral to nurse management were less than 30%, women who delivered in medical centers with an annual referral proportion greater than 70% were less likely to have a high birth-weight infant without increasing the risk of having a low birth-weight infant, said Assiamira Ferrara, MD, PhD, the studys lead author and a research scientist with the Kaiser Permanente Northern California Division of Research. In addition, they were more likely to have postpartum glucose testi Continue reading >>

Navigating Gestational Diabetes

Navigating Gestational Diabetes

Diabetes is a growing epidemic that affects adults and children, including 7.2 million people who are undiagnosed. In 2015, about 9.4% (30.3 million) of Americans had diabetes (Centers for Disease Control and Prevention, 2017). As rates of obesity and type 2 diabetes rise, so does the risk for gestational diabetes mellitus (GDM). While its hard to pinpoint the exact prevalence of GDM, estimates suggest that it affects as many as 14% of pregnancies in the United States each year (DeSisto, Kim, & Sharma, 2014). While the diagnosis of GDM can be scary for moms, it can usually be managed under the care and guidance of their health care team. We recently sat down with Allison Penny, a mother of two who was diagnosed with GDM with both of her pregnancies. We asked Allison questions on how she was able to navigate her diagnosis and what advice she would give to mothers in a similar situation. How did you feel when you were told you had diabetes with your first pregnancy? I was surprised, but my healthcare provider assured me it was pretty common. They also told me that the diabetes goes away after the baby is born for most women. When I was diagnosed during my second pregnancy, I was a bit more worried. This pregnancy was unexpected, but thankfully I was already working out and trying to get into shape, and I was able to continue with my workouts. I was definitely more cautious with diet and working out the second time around. My first vaginal birth was complicated and scary, and I think a lot of it had to do with the large size of the baby. Larger babies are a definite risk with GDM. What concerns did you have following your diagnosis? By the time I found out, I had been fulfilling all my cravings So I had concerns about limiting junk and controlling my diet for both my baby Continue reading >>

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