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Gestational Diabetes Case Study

Norwitz: Obstetrics And Gynaecology At A Glance

Norwitz: Obstetrics And Gynaecology At A Glance

Correct answer: GDM refers to any form of glucose intolerance with the onset of pregnancy or first recognized during pregnancy, and complicates approximately 5% of all pregnancies. It likely includes some women who have undiagnosed pregestational diabetes. 2. Should everyone be screened for GDM? If so, at what gestational age should they be screened? Correct answer: Patients with GDM are typically asymptomatic. There is a small cohort of pregnant women in whom routine screening for GDM is not cost-effective. These are women under age 25 who have normal body mass index (BMI <25 kg/m2), no first-degree relatives with diabetes, no risk factors (such as a history of GDM, insulin resistance/PCOS [polycystic ovarian syndrome], a prior macrosomic infant, a prior unexplained late fetal demise, and women with persistent glycosuria), and who are not members of ethnic or racial groups with a high prevalence of diabetes (such as Hispanic, Native American, Asian, or AfricanAmerican). As such patients are rare, most experts and organizations recommend screening for GDM in all pregnant women. The ideal time to screen for GDM is 2428 weeks of gestation. For women at high risk of developing GDM (listed above), early screening for GDM is recommended at the first prenatal visit. If the early screen is negative, it should be repeated at 2428 weeks. 3. Her 1-hour GLT is 182 mg/dL. Does she have GDM? 4. All four values of her 3-hour GTT are elevated and her fasting glucose level is 127 mg/dL. How would you manage her GDM? How long would you allow her to try dietary restriction before adding a hypoglycemic agent? Correct answer: GDM poses little risk to the mother. Such women are not at risk of diabetic ketoacidosis (DKA), which is primarily a disease of absolute insulin deficiency. However, Continue reading >>

Oxford Academic Health Science Network | Case Study: Better Monitoring And Fewer Hospital Visits For Women Who Develop Diabetes During Pregnancy

Oxford Academic Health Science Network | Case Study: Better Monitoring And Fewer Hospital Visits For Women Who Develop Diabetes During Pregnancy

Case study: Better monitoring and fewer hospital visits for women who develop diabetes during pregnancy An innovative digital health system developed by researchers and engineers working with frontline clinicians is helping women who develop diabetes during pregnancy to better manage their condition and make fewer hospital visits. Oxford AHSN played a key role in establishing the proof of concept, spreading the pilot from a single hospital to multiple sites across a region of 3.3 million people. Feedback from testing with almost 2,000 women demonstrated the system to be safe, robust and user-friendly, bringing many benefits for patients and services alike. There were improvements in reliability, convenience and efficiency. It showed better glucose control and a reduction in clinic visits by eligible women of approximately 25%, freeing up hospital capacity and improving efficiency. One unit estimated the time saving as an hour each day. The product has now secured an industry partner opening-up possibilities for accelerated spread and commercialisation across the UK and beyond. Gestational diabetes mellitus (GDm) affects about one in ten pregnancies, approximately 100,000 women across England every year and numbers are rising. It can lead to complications for mother and baby. Careful monitoring of blood glucose levels is vital for successful management. Conventional treatment involves a combination of paper diaries (completed up to six times a day) and fortnightly check-ups in hospital where medication and diet are adjusted if necessary. These hospital visits are time-consuming and can be stressful for women in the latter stages of pregnancy. It can also be difficult for hospital staff to respond as quickly as they would like to changes in patients condition. Patients c Continue reading >>

Gestational Diabetes Hesi Case Study

Gestational Diabetes Hesi Case Study

The patient has given birth twice, once at 35 weeks (twins) and once at 39 weeks (singleton). All of these children are alive. She had one spontaneous abortion at 9 weeks' gestation. How would you record the GTPAL? 4-1-1-1-3. Gravidity is defined as the number of times pregnant, including the current pregnancy. Term is defined as any birth after the end of the 37th week, and preterm refers to any births between 20 and 37 weeks. Both term and preterm describe liveborn and stillborn infants. Abortion is any fetal loss, whether spontaneous or elective, up to 20 weeks gestation. Living refers to all children who are living at the time of the interview. Multiple fetuses are treated as one pregnancy and one birth; each are counted as living. The nurse recognizes that what information in the client's history supports a diagnosis of gestational diabetes? Youngest child weighed 4300g at 39 weeks' gestation. Birth of an infant weighing more than 9# is a RF for gestational diabetes. The patient is scheduled for a 3-hour oral glucose tolerance test in 5 days and is told to arrive at the lab at 8:30am. Which instruction should the nurse give? Follow an unrestricted diet and exercise pattern for at least 3 days before the test. When the client follows an unrestricted diet and exercise pattern the test is a true determination of the body's ability to handle the glucose load given after the FBG is drawn. The patient asks why she wasn't tested for GDM until she was at almost 28 weeks gestation. The Nurse's response should be based on the understanding of which normal physiologic change? Hormonal changes in the second and third trimesters result in increased maternal insulin resistance. Increased levels of hormones increase insulin resistance b/c they act as insulin antagonists. This se Continue reading >>

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An Error Occurred Setting Your User Cookie

An Error Occurred Setting Your User Cookie This site uses cookies to improve performance. If your browser does not accept cookies, you cannot view this site. There are many reasons why a cookie could not be set correctly. Below are the most common reasons: You have cookies disabled in your browser. You need to reset your browser to accept cookies or to ask you if you want to accept cookies. Your browser asks you whether you want to accept cookies and you declined. To accept cookies from this site, use the Back button and accept the cookie. Your browser does not support cookies. Try a different browser if you suspect this. The date on your computer is in the past. If your computer's clock shows a date before 1 Jan 1970, the browser will automatically forget the cookie. To fix this, set the correct time and date on your computer. You have installed an application that monitors or blocks cookies from being set. You must disable the application while logging in or check with your system administrator. This site uses cookies to improve performance by remembering that you are logged in when you go from page to page. To provide access without cookies would require the site to create a new session for every page you visit, which slows the system down to an unacceptable level. This site stores nothing other than an automatically generated session ID in the cookie; no other information is captured. In general, only the information that you provide, or the choices you make while visiting a web site, can be stored in a cookie. For example, the site cannot determine your email name unless you choose to type it. Allowing a website to create a cookie does not give that or any other site access to the rest of your computer, and only the site that created the cookie can read it. Continue reading >>

Diabetes Complicating Pregnancy

Diabetes Complicating Pregnancy

Diabetes with Pregnancy Patient Encounter A 33-year old G2P1 female presented for her routine prenatal visit at 30 weeks gestation to see her obstetrician. With this pregnancy, her first prenatal visit was at 20 weeks and she has sporadically kept her appointments up to this visit. To note, her previous pregnancy two years ago was an uncomplicated vaginal delivery at 38 weeks gestation. The baby weighed 4.2kg at delivery and was complicated by shoulder dystocia. She had minimal general medical care between the pregnancies. At the patient’s 28 week visit, her prenatal surveillance included an abnormal 1-hr glucose challenge test. She returned for a follow up 3-hr OGTT, which revealed abnormal findings; these results were shared with the patient at the 30 week visit. Upon questioning, the patient admitted that there is a family history of diabetes in several of her relatives; however, she has never been tested for diabetes. The patient’s evaluation also demonstrated a body mass index (BMI) of 34, BP 130/78 and fetal heart tones at 148 BPM. Based on these results, the obstetrician diagnosed the patient with gestational diabetes mellitus (GDM) and established a plan of care for the duration of her pregnancy. This plan of care included nutritional counseling with monitoring of her blood glucose as well as possible medical intervention, if glycemic control could not be established. Additionally, the plan called for increased antenatal surveillance based on glycemic control Coding: ICD-9 to ICD-10 In ICD-9-CM, gestational diabetes mellitus codes to 648.83, Abnormal glucose tolerance of mother, antepartum condition or complication. In ICD-10, this condition maps to code O24.410, Gestational diabetes mellitus in pregnancy, diet controlled. Note the change in terminology betw Continue reading >>

Case Study: Gestational Diabetes

Case Study: Gestational Diabetes

With diabetes reaching epidemic proportions, the evidence suggests that early treatment to maintain optimum glucose levels will reduce the future burden of complications. This is especially so for diabetes in pregnancy, which can affect both mother and child. This case study is examining how to help pregnant women with diabetes, in partnership with their health practitioners, to use clinical decision-systems in conjunction with self-testing of blood glucose to manage both lifestyle and appropriate pharmacotherapy. During pregnancy, the body produces hormones and some of these hormones can have a blocking effect on insulin. Gestational diabetes is a condition in which a hormone produced by the placenta prevents the body from using insulin effectively. As a consequence, the level of glucose in the blood remains high. To compensate the increased amount of glucose in the blood, the body should produce more insulin. Occasionally, the amount of insulin produced is not enough to transport the glucose into the cells, or the body cells become more resistant to insulin. This condition is known as gestational diabetes mellitus and it can be defined as carbohydrate intolerance. Although any woman can develop GDM during pregnancy, some of the factors that may increase the risk include: being overweight or obese, sedentary lifestyle, poor diet, family history of diabetes or having given birth previously to infants who are large for gestational age (LGA), age (women who are older than 25 are at a greater risk of developing gestational diabetes than younger women) and prediabetes (impaired glucose tolerance). Besides these factors, specific ethnicities of women have long been considered as a risk factor for developing GDM, women of South Asian heritage are disproportionately affected. Continue reading >>

Case Study: A 34-year-old Woman In Her Second Pregnancy At 24 Weeks Gestation

Case Study: A 34-year-old Woman In Her Second Pregnancy At 24 Weeks Gestation

Case Study: A 34-Year-Old Woman in Her Second Pregnancy at 24 Weeks Gestation A 34-year-old Hispanic-American woman who is in her second pregnancy and has had one live birth and no abortions is seen for prenatal care at 24 weeks gestation. Her weight is 220 lb, and her blood pressure is 130/80 mmHg. Uterine size is appropriate for gestational age. The patient's past obstetric history includes the spontaneous vaginal delivery of a 9 lb, 8 oz. male infant at 40 weeks gestation, 8 years ago in Mexico. The patient reports that the child is doing well. Her family history reveals that her mother has type 2 diabetes mellitus. A urine dipstick shows 3+ glycosuria and negative ketones. 1. What tests should be done to evaluate the patient'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? This patient presents with several risk factors for GDM, defined as carbohydrate intolerance of varying degrees of severity with onset or first recognition during pregnancy, regardless of whether insulin is used for treatment or the condition persists after pregnancy. She is over 30 years of age, from an ethnic group at increased risk for type 2 diabetes mellitus, is obese, and has a first-degree relative with type 2 diabetes. The findings of significant glycosuria should prompt the performance of a glucose determination before the patient leaves the clinic. The usual approach to screening would be a 50-g oral glucose load administered to the patient between 24 and 28 weeks gestation when the "diabetigenic stress" of pregnancy is present. A positive test is a venous plasma glucose value 1 hour later of > 140 mg/dl. This would lead to a 100-gm oral glucose tolerance test (OGTT) with the diag Continue reading >>

Hesi Gestational Diabetes- Amanda Garrison

Hesi Gestational Diabetes- Amanda Garrison

HESI Gestational Diabetes- Amanda Garrison The patient has given birth twice, once at 35 weeks (twins) and once at 39 weeks (singleton). All of these children are alive. She had one spontaneous abortion at 9 weeks' gestation. How would you record the GTPAL? 4-1-1-1-3. Gravidity is defined as the number of times pregnant, including the current pregnancy. Term is defined as any birth after the end of the 37th week, and preterm refers to any births between 20 and 37 weeks. Both term and preterm describe liveborn and stillborn infants. Abortion is any fetal loss, whether spontaneous or elective, up to 20 weeks gestation. Living refers to all children who are living at the time of the interview. Multiple fetuses are treated as one pregnancy and one birth; each are counted as living. The nurse recognizes that what information in the client's history supports a diagnosis of gestational diabetes? Youngest child weighed 4300g at 39 weeks' gestation. Birth of an infant weighing more than 9lb is a RF for gestational diabetes. The patient is scheduled for a 3-hour oral glucose tolerance test in 5 days and is told to arrive at the lab at 8:30am. Which instruction should the nurse give? Follow an unrestricted diet and exercise pattern for at least 3 days before the test. When the client follows an unrestricted diet and exercise pattern the test is a true determination of the body's ability to handle the glucose load given after the FBG is drawn. The patient asks why she wasn't tested for GDM until she was at almost 28 weeks gestation. The Nurse's response should be based on the understanding of which normal physiologic change? Hormonal changes in the second and third trimesters result in increased maternal insulin resistance. Increased levels of hormones increase insulin resistance Continue reading >>

An Unusual Case Of Gestational Diabetes Mellitus

An Unusual Case Of Gestational Diabetes Mellitus

A 29 year old Asian woman, a nurse by profession, presented to our diabetes clinic at six weeks in her first pregnancy in June 2000. Her body mass index was 23 and blood pressure was 130/80 mm Hg. There was no relevant past medical history. There was a strong family history of type 2 diabetes as both her parents were diabetic and one sister had gestational diabetes and later developed type 2 diabetes. Our patient was worried about her glycaemic status and to allay her fears, a 75 g oral glucose tolerance test (OGTT) was performed. The fasting plasma glucose was 6.3 mmol/l and two hour value was 8.1 mmol/l. On the basis of the World Health Organisation 1999 diagnostic criteria, gestational diabetes mellitus was diagnosed and necessary dietary advice given.1 Unfortunately, the pregnancy terminated in abortion at 10 weeks. Eight weeks after the abortion a 75 g OGTT was repeated, which was normal. She was advised to follow a normal diet and to undergo an OGTT as soon as the next pregnancy was detected. She conceived again in February 2001 and underwent a 75 g OGTT at six weeks’ gestation. The fasting value was 5.7 mmol/l and two hour value was 10 mmol/l. Glycated haemoglobin (HbA1c) done at the same time was 6.6% (reference range 6.6%–8.3%). The diagnosis of gestational diabetes mellitus was made and insulin therapy in the form of twice daily injections of human biphasic isophane insulin (Huminsulin 30/70, Eli Lilly) was started. Follow ups were done at intervals of 2–4 weeks depending on the glycaemic control achieved. Her average fasting and two hour plasma glucose values were 4.3 mmol/l and 6.8 mmol/l respectively with average HbA1c being less than 6.5%. The insulin doses needed increasing with advancing pregnancy. At the end of the pregnancy, the daily insulin dos Continue reading >>

Case Study For Nursing - Gestational Diabetes Mellitus - Medicine Bibliographies - In Harvard Style

Case Study For Nursing - Gestational Diabetes Mellitus - Medicine Bibliographies - In Harvard Style

Not logged in. Log in or create an account These are the sources and citations used to research Case Study for nursing - Gestational Diabetes Mellitus. This bibliography was generated on Cite This For Me on Introduction to maternity & pediatric nursing Your Bibliography: Leifer, G. (2011). Introduction to maternity & pediatric nursing. 6th ed. St. Louis, Mo.: Mosby/Elsevier. Your Bibliography: Marieb, E. and Hoehn, K. (2013). Human Anatomy & Physiology. 9th ed. Illinois: Pearson. Child and family health nursing in Australia and New Zealand 2012 - Lippincott Williams & Wilkins - Sydney Your Bibliography: Haley, C. (2012). Child and family health nursing in Australia and New Zealand. Sydney: Lippincott Williams & Wilkins. The Baby Friendly Initiative | Research | Interventions that promote breastfeeding | Review of skin-to-skin contact Your Bibliography: Unicef.org.uk. (2015). The Baby Friendly Initiative | Research | Interventions that promote breastfeeding | Review of skin-to-skin contact. [online] Available at: [Accessed 24 May 2015]. Your Bibliography: National women's health. (2010). Maternity Services induction of labour. [online] Available at: [Accessed 23 May 2015]. In-text: (National Womens Health, ADHB, 2013) Your Bibliography: National Womens Health, ADHB. (2013). Gestational Diabetes Mellitus. [online] Available at: [Accessed 24 May 2015]. Your Bibliography: Southern cross. (2012). Diabetes (symptoms diagnosis treatment). [online] Available at: [Accessed 23 May 2015]. Your Bibliography: Aotea pathology. (2014). Complete Blood Count. [online] Available at: [Accessed 24 May 2015]. Your Bibliography: Taranaki med lab. (2015). Taranaki Med Lab | Test Guide. [online] Available at: [Accessed 24 May 2015]. Continue reading >>

Type 2 Diabetes Case Study Examples

Type 2 Diabetes Case Study Examples

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Putting Prevention Into Practice

Putting Prevention Into Practice

Screening for Gestational Diabetes Mellitus KENNETH W. LIN, MD, Medical Officer, U.S. Preventive Services Task Force Program, Agency for Healthcare Research and Quality CECILI K. SESSIONS, MD, MPH, General Preventive Medicine Residency, Uniformed Services University of the Health Sciences Am Fam Physician.2009Jul15;80(2):185-186. A 29-year-old woman at 20 weeks' gestation visits your office for a routine prenatal examination. This is her second pregnancy, and she has gained 15 lb (6.8 kg). According to her medical record, the patient's prepregnancy body mass index (BMI) was 27 kg per m2. She mentions that her father was recently diagnosed with diabetes, and she asks whether she should be tested for diabetes. Based on the U.S. Preventive Services Task Force (USPSTF) recommendation on screening for gestational diabetes mellitus, what is the most appropriate approach to this patient? A. Screen for gestational diabetes at this visit with a one-hour oral glucose challenge test. B. Schedule a three-hour oral glucose tolerance test at her 24-week visit. C. Explain the risk factors for gestational diabetes, and discuss potential benefits and harms of screening. D. Do not screen for gestational diabetes because she did not have gestational diabetes with her first pregnancy or pregestational diabetes. E. Do not screen for gestational diabetes because a false-positive test could cause prolonged psychological harm. Which one of the following statements is the best assessment of the patient's risk of gestational diabetes? A. She is at increased risk if she is white. B. Her age puts her at lower risk of gestational diabetes. C. She is not at increased risk because she did not have gestational diabetes in her previous pregnancy. D. Her age and prepregnancy BMI increase her risk of ge Continue reading >>

Hesi Case Studies--obstetric/maternity-gestational Diabetes (amanda Garrison)

Hesi Case Studies--obstetric/maternity-gestational Diabetes (amanda Garrison)

12. The nurse's response should be based on what information? An elevated glucose in labor increases the risk of neonatal hypoglycemia 13. What assessment information is most important for the nurse to validate with the laboring client before giving the medication? Past or present history of opioid dependence 14. Amanda tells the nurse that she would like to receive one-half of the prescribed dose of butorphanol tartrate (Stadol) because the last time she was given that medication she felt like she was floating and then experienced some confusion. What should the nurse do? Request that the provider change the prescription 15. The charge nurse refuses, telling the nurse that "there just isn't anyone else." What should the nurse do next? 16. The nurse and perinatologist recognize these signs as an indication of shoulder dystocia. What should the nurse do immediately? Reposition the client using McRobert's maneuver 17. The nurse should recognize that which newborn behavior indicates that the infant has suffered a complication from the shoulder dystocia? 18. What should the nurse recommend to Amanda in regard to infant feeding? Breastfeeding should be initiated immediately and done on demand 19. Which client should the charge nurse assign the LPN? A multigravida who had an uncomplicated term delivery and is breastfeeding 20. As the charge nurse is going down the hall to tell the nurses about the new admissions, she hears one nurse giving misinformation about the Rubella vaccine to a client and her husband. What action should the charge nurse take? Speak to the nurse in the hall so the nurse can correct the information for the client 21. Where will the nurse expect to palpate the uterine fundus? 22. Amanda asks the nurse why the insulin was discontinued after the baby was b Continue reading >>

"using Smartphones For Accountable Care And Evidence-based Decision Mak" By Nilmini Wickramasinghe, Say Yen Teoh Et Al.

Better managing diabetes has become a global priority, especially given the exponential increase in the number of diabetes patients and the financial implications of treating this silent epidemic. In this paper, we focus on how it might be possible to use a mobile technology solution to support and enable superior diabetes monitoring and management. To test this solution, we examined the context of gestational diabetes and adopted a non-blinded randomized control trial with two-arm cross over applied to a private hospital in Victoria, Australia. Further, we use an accountable care system as the theoretical lens and, from this, develop a conceptual framework to bridge evidence-based management with technologies. Theoretically, we unpack McCleallan, McKethan, Lewis, Roski, and Fishers (2010) study with our conceptual framework that comprises providers for information (evidence-based management) and technology (smartphone). We enhance Muhlestein, Croshaw, Merrill, Pena, and James (2013) accountable care paradigm with three concepts: 1) quality of life, 2) evidence-based management, and 3) affordable care. From the perspective of practice, far-reaching implications have arisen particularly for hospital management pertaining to the cost and quality of care issues. In particular, it appears that adapting mobile technology solutions such as smartphones to support various aspects of care and patient-clinician interactions is a prudent choice to minimize costs and yet provide high-quality care. Wickramasinghe, Nilmini; Teoh, Say Yen; and Mercieca, Paul (2015) "Using Smartphones for Accountable Care and Evidence-based Decision Making in Managing Gestational Diabetes: An Australian Case Study," Communications of the Association for Information Systems: Vol. 37 , Article 33. Avail Continue reading >>

Case Study: Eft In Diabetic And Non-diabetic Pregnancies

Case Study: Eft In Diabetic And Non-diabetic Pregnancies

Case Study: EFT in Diabetic and Non-Diabetic Pregnancies Dr. Ravi Gunatilake published a recent article in Obesity: A Research Journal. The article provided extensive insight into the impact that gestational diabetes has on a babys weight. Below are the highlights of the case study. There has been evidence that the metabolic environment of a mother can affect fetal metabolism. In cases of mothers with diabetes, it has been found that babies are at risk of unhealthy weight, increased insulin resistance, inflammation, and low oxygen levels in the blood. In studies with adults, epicardial and visceral fat thickness have been used as tools for predicting these types of metabolic and cardiovascular risks. Fetal epicardial fat thickness (EFT) is a visceral fat deposit located between the heart and pericardium (the membrane enclosing the heart). Researchers have predicted that fetal EFT would be associated with fetal abdomen circumference, glycemia, and birth weight. In this retrospective cross-sectional study, the authors, including Dr. Gunatilake, reviewed charts of patients with fetal echocardiograms performed from 2008 to 2012. Participants were randomly selected in an effort to find 28 subjects with previous maternal history of diabetes and 28 non-diabetic pregnant patients. The echocardiograms within this study were all taken in the second trimester, between 20 and 28 weeks in the pregnancy. Measurement of the EFT was taken by two investigators that were blind to the medical history of the patient. Along with the EFT, other measurements were collected to determine altered fetal metabolism. These markers included: maternal BMI, estimated fetal weight, birth weight, fetal abdominal circumference, and subcutaneous fat thickness. As a result of this study, researchers found Continue reading >>

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