1. Nursing 5263: Hypoglycemia and Hyperglycemia
Presented by: Excalibur Group
Daphney Jacques, Bridgette Jenkins, Opal Jobson-Cudjoe , Kelly miller

2. 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
3. Objectives
Formulate theappropriate interventions for hypoglycemia/hyperglycemia management based on patient population
Differentiate between the different medications used to manage the hypoglycemic/hyperglycemic patient.
Predict immediatecomplications of hypoglycemia/hyperglycemia
4. Objectives
State potential long term complications of uncontrolled blood sugar levels
Determine the appropriate educational strategies to prevent hypoglycemia/hyperglycemia
5. NORMAL BLOOD GLUCOSE for PREGNANT WOMEN
65mg/dl (fasting)
200 mg/dl
Causes: Insufficient insulin, excess or wrong kinds of food, infection, illness, injuries, emotional stress or insufficient exercise
12. SIGN & SYMPTOMS OF HYPERGLYCEMIA
Thirst
Nausea/Vomiting
Abdominal pain
Constipation
Drowsiness
Dim vision
Increased urination
Fruity breath
Rapid, weak pulse
Rapid breathing
13. 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
14. 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
15. 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 (UTIs, yeast infection)
Ketoacidosis
16. 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
17. 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.
18. 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.
19. CASE STUDY DISCISSION
Questions
1. What tests, if any, should be done to evaluate the Marias 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.