Introduction Ahigh-risk pregnancy is one that threatens the health or life of the mother orher fetus. It often requires specialized care from specially trained providers.
Some pregnancies become high risk as they progress, while some women are atincreased risk for complications even before they get pregnant for a variety ofreasons. (NationalInstituteofHealth, 2017)Thepurpose of this Assignment is to know and understand early and regular prenatalcare helps many women to have healthy pregnancies and deliveries withoutcomplications. Having a high-risk pregnancy means it’s more likely that motheror baby will have health problems during pregnancy, birth, or after delivery. Thereforethese could be very minor problems, but in some cases, a high-risk conditioncan be life threatening for a mother or her baby. That’s why we have tounderstand and determine ways that a high-risk pregnancy requires extramonitoring, care, kindness and proper treatment by a healthcare provider. (Babycenter, 2016) Inthis Assignment I will list out risk conditions during the antenatal period andfrom that I will take gestational diabetes to explain it, Signs & symptom,Pathophysiology, effect of the mother & baby, available treatments andnursing care discussed with nursing diagnosis and health education. Fora mother pregnant days are the one of the happiest days in her life.
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She isexciting waiting 9 months for so long to see her little baby. So being toldthat your pregnancy is high-risk can be a shock, and she is likely to feel amix of emotions. She might find it difficult to enjoy her pregnancy because sheis worried about her own health or her baby’s health. Risk Conditions Ø Abortion Ø Abruptio placenta Ø Disseminated intravascular coagulation Ø Ectopic pregnancy Ø Gestational diabetes Ø HELL syndrome Ø Hemolytic diseasesØ Hydatidiform moleØ Hyperemesis gravidarumØ Placenta previa Ø Pregnancy- induced hypertension Ø Sexually transmitted disease Ø TORCH infections (Traci C. Johnson, 2016) Gestational diabetesGestationaldiabetes, also known as gestational diabetes mellitus, GDM, or diabetes duringpregnancy, is diabetes that first develops when a woman is pregnant. Variouswomen can have healthy pregnancies if they manage their diabetes, following adiet and treatment plan from their health care provider. Uncontrolledgestational diabetes increases the risk for preterm labor and delivery,preeclampsia, and high blood pressure. (NationalInstituteofHealth, National Institute of Health, 2017) Sign and Symptoms Ø Sugar in urine (revealed in a test done in your doctor’s office)Ø Unusual thirstØ Frequent urinationØ FatigueØ NauseaØ Frequent vaginal, bladder, and skin infectionsØ Blurred vision(AmericanPregnancyAssociation, 2017) Etiology Duringnormal pregnancy, resistance to insulin action increases.
In most pregnancies,pancreatic beta cells are able to compensate for increased insulin demands, andnormoglycemia is maintained. In contrast, women who develop GDM have deficitsin beta-cell response leading to insufficient insulin secretion to compensatefor the increased insulin demands. Risk is increased by:Ø Age: due to age-related decreased pancreatic beta-cell reserve Ø Obesity: leads to increased insulin resistance, which is furthercompounded by pregnancy Ø Smoking: increases insulin resistance and decreases insulinsecretion Ø Polycystic ovarian syndrome: associated with insulin resistance andobesity Ø Nonwhite ancestryØ Family history of type 2 diabetes Ø Low-fiber and high-glycemic index diet Ø Weight gain as a young adult: correlates with risk Ø Lack of physical activity: exercise increases insulin sensitivityand may impact body weight Ø Prior GDM: GDM recurs in as many as 80% of subsequent pregnancies (epocrates, n.
d.) Pathophysiology Theexact pathophysiology of gestational diabetes is unknown. One main aspect ofthe basic pathology is insulin resistance, where the body’s cells fail to replyto the hormone insulin in the usual way. Several pregnancy hormones are thoughtto disrupt the usual action of insulin as it binds to its receptor, mostprobably by interfering with cell signaling pathways. (Mandal, 2014) Insulinis the primary hormone produced in the beta cells of the islets of Langerhansin the pancreas.
Insulin is key in the regulation of the body’s blood glucoselevel. Insulin stimulates cells in the skeletal muscle and fat tissue to absorbglucose from the bloodstream. In the presence of insulin resistance, thisuptake of blood glucose is prevented and the blood sugar level remains high.The body then compensates by producing more insulin to overcome the resistanceand in gestational diabetes, the insulin production can be up to 1.5 or 2 timesthat seen in a normal pregnancy. (Mandal, 2014)Duringearly pregnancy, increases in estrogens, progestin’s, and otherpregnancy-related hormones lead to lesser glucose levels, promotion of fatdeposition, delayed gastric emptying, and increased hunger. As gestationprogresses, nevertheless, postprandial glucose levels gradually increase asinsulin sensitivity steadily decreases.
For glucose controller to be maintainedin pregnancy, it is necessary for maternal insulin secretion to increasesufficiently to counteract the fall in insulin sensitivity. GDM occurs whenthere is insufficient insulin secretion to counteract the pregnancy-relateddecrease in insulin sensitivity. (Patry, 2004) Theglucose present in the blood crosses the placenta via the GLUT1 carrier toreach the fetus. If gestational diabetes is left unprocessed, the fetus isexposed to an excess of glucose, which leads to a rise in the amount of insulinproduced by the fetus.
As insulin stimulates growth, this means the baby thendevelops a larger body than is normal for their gestational age. Once the babyis born, the exposure to extra glucose is removed. However, the newborn stillhas increased insulin production, meaning they are susceptible to low bloodglucose levels. (Mandal, 2014) Effect of the mother Gestationaldiabetes affects the mother in late pregnancy, after the baby’s body has beenformed, but while the baby is busy growing. Because of this, gestationaldiabetes does not cause the kinds of birth defects sometimes seen in babieswhose mothers had diabetes before pregnancy.However,untreated or poorly controlled gestational diabetes can hurt your baby.
Whenyou have gestational diabetes, your pancreas works overtime to produce insulin,but the insulin does not lower your blood glucose levels. Although insulin doesnot cross the placenta, glucose and other nutrients do. So extra blood glucosegoes through the placenta, giving the baby high blood glucose levels. Thiscauses the baby’s pancreas to make extra insulin to get rid of the bloodglucose. Since the baby is getting more energy than it needs to grow anddevelop, the extra energy is stored as fat.
Thiscan lead to macrosomia, or a “fat” baby. Babies withmacrosomia face health problems of their own, including damage to theirshoulders during birth. Because of the extra insulin made by the baby’spancreas, newborns may have very low blood glucose levels at birth and are alsoat higher risk for breathing problems. Babies with excess insulin becomechildren who are at risk for obesity and adults who are at risk for type 2diabetes.
(AmericanDaibeticAssociation, 2016)Hypoglycemiastates to low blood sugar in the baby immediately after delivery.This problem occurs if the mother’s blood sugar levels have been consistentlyhigh, causing the fetus to have a high level of insulin in its circulation.After delivery, the baby continues to have a high insulin level, but it nolonger has the high level of sugar from its mother, resulting in the newborn’sblood sugar level becoming very low. (StanfordChildrensHealth, n.d.
) Respiratorydistress (difficulty breathing), too muchinsulin or excessive glucose in a baby’s system may slow down lung maturationand cause respiratory difficulties in babies. This is more likely if they areborn before 37 weeks of pregnancy. Womenwith gestational diabetes have a greater chance of needing a Cesarean birth(C-section), in part due to big infant size. Gestational diabetes may rise therisk of preeclampsia, a maternal condition characterized by high blood pressureand protein in the urine. (StanfordChildrensHealth, n.d.
) Treatments Treatmentfor gestational diabetes focuses on keeping blood glucose levels in the normalrange. Treatment may include:Ø Special diet management Eating the right kinds of food in healthy portions is one of thebest ways to control your blood sugar and prevent too much weight gain, whichcan put you at higher risk of complications. Doctors don’t advise losing weightduring pregnancy — your body is working hard to support your growing baby. Butyour doctor can help you set weight gain goals based on your weight beforepregnancy. Ø Exercise As an added bonus, regular exercise can help relieve some commondiscomforts of pregnancy, including back pain, muscle cramps, swelling,constipation and trouble sleeping. Exercise can also help get you in shape forthe hard work of labor and delivery.
Ø Daily blood glucose monitoring Follow-up blood sugar checks are also important. Having gestationaldiabetes increases your risk ofdeveloping type 2 diabetes later in life. Work with health care team to keep aneye on your levels. Maintaining health-promoting lifestyle habits, such as ahealthy diet and regular exercise, can help reduce your risk. Ø Insulin injections or prescription drugs If diet and exercise aren’t enough, you may need insulin injectionsto lower your blood sugar. Between 10 and 20 percent of women with gestationaldiabetes need insulin to reach their blood sugar goals. Some doctors prescribean oral blood sugar control medication, while others believe more research isneeded to confirm that oral drugs are as safe and as effective as injectableinsulin to control gestational diabetes.
Ø Close monitoring of baby An important part of your treatment plan is close observation ofyour baby. Your doctor may monitor your baby’s growth and development withrepeated ultrasounds or other tests. If you don’t go into labor by your duedate — or sometimes earlier — your doctor may induce labor. Delivering afteryour due date may increase the risk of complications for you and your baby. (Mayoclinic, 2017) Nursing Care plan NursingDiagnosis: Risk for Altered Nutrition: Less Than Body Requirements related to Inabilityto utilize nutrients appropriately. (Paul Martin, nurses lab , 2016) Intervention Rationale – Assess and record dietary pattern and caloric intake using a 24-hour recall.
– Assess understanding of the effect of stress on diabetes. Teach patient about stress management and relaxation measures – Teach the importance of regularity of meals and snacks (e.g.
, three meals or 4 snacks) when taking insulin. – To help in evaluating client’s understanding and/or compliance to a strict dietary regimen. – It is proven that stress can increase serum blood glucose levels, creating variations in insulin requirements. – Eating very frequent small meals improves insulin function.
NursingDiagnosis: Risk for Injury related to anemia (Martin, 2016) Interventions Rationale – Assess client for vaginal bleeding and abdominal tenderness. – Assess for any signs and symptoms of UTI. – Monitor for signs and symptoms of pre-term labor. Hydramnios may predispose the client to early labor. – Vascular changes associated with diabetes place client at risk for abruptio placenta.
– Early detection of UTI may prevent the occurrence of pyelonephritis, which can contribute to premature labor. – Over distention of the uterus caused by macrosomia. NursingDiagnosis: risk for injury related toChanges in circulation or elevated maternal serum blood glucose levels.
(Paul Martin, 2016) Intervention Diagnosis – Determine client’s diabetic control before conception. – Monitor fundal height each visit. – Assess fetal movement and fetal heart rate each visit as indicated. Encourage client to periodically record fetal movements beginning about 18 weeks’ gestation, then daily from 34 weeks’ gestation on. – Strict control (normal HbA1c levels) before conception helps reduce the risk of fetal mortality and congenital abnormalities. – Useful in identifying abnormal growth pattern (macrosomia or IUGR, small or large gestational age SGA/LGA). – Fetal movement and fetal heart rate may be negatively affected when placental insufficiency and maternal ketosis occur. Health Education Educatingabout the disease condition is an important tool in the health caresetting.
The more healthy habits patientcan adopt before pregnancy, the better. If patient had gestational diabetes,these healthy choices may also reduce your risk of having it in futurepregnancies or developing type 2 diabetes down the road. Loseexcess pounds before pregnancy. Doctorsdon’t recommend weight loss during pregnancy. But if patient is planning to getpregnant, losing extra weight beforehand may help her have a healthierpregnancy. Bygiving this information it will be very helpful for the patient if she want toget pregnant next time. She will beeducated that during pregnancy it is not good to lose weight but to eat healthyfoods. And she will reduce her weight before pregnancy if she is obese or fat.
This can focus on permanent changes to hereating habits. Motivating herself by remembering the long-term benefits oflosing weight, such as a healthier heart, more energy and improved self-esteem.(Mayoclinic, Mayo Clinic , 2017)Eathealthy foods.
We,nurses have to educate patient that during pregnancy healthy diet focuses onfruits, vegetables and whole grains — we have to advise her to take foods thatare high in nutrition and fiber and low in fat and calories — and limits highlyrefined carbohydrates, including sweets. No single diet is right for everywoman. So as she is diabetic we can also advise her to consult a registereddietitian or a diabetes educator to create a meal plan based on her currentweight, portion sizes, pregnancy weight gain goals, blood sugar level, exercisehabits, food preferences and budget. Educatingmore on healthy foods and diabetic meal plan in this way patient and her babywill be more healthy and free from pregnancy complications.
ExercisingEvenif patient is diabetic or not educating the patient to keep active. Teachingand giving more information about exercising before and during pregnancy canhelp protect her from developing gestational diabetes. Advise her aim for 30minutes of moderate activity on most days of the week.
Take a brisk daily walk.Ride your bike. Swim laps.
Ifshe can’t fit a single 30-minute workout into her day, several shorter sessionscan do just as much good. For example Park in the distant lot when she runerrands. Get off the bus one stop before she reach her destination. Telling herevery step she take increases chances of staying healthy. Forthe diabetic patients we should tell her to exercise. Because Regular physicalactivity plays a key role in her wellness plan before, during and afterpregnancy. We have to provide enough information that exercise lowers bloodsugar by stimulating body to move glucose into cells, where it’s used forenergy. Exercise also increases cells’ sensitivity to insulin, which means bodywill need to produce less insulin to transport sugar (Mayoclinic, Mayo Clinic, 2017) Medication.
Advisingthe patient about medication and follow up the appointments on days is the mostimportant advice. Educating the patientto take medication on time is necessary. Ifdiet and exercise aren’t enough, patient need insulin injections to lower yourblood sugar. Between 10 and 20 percent of women with gestational diabetes needinsulin to reach their blood sugar goals.
Some doctors prescribe an oral bloodsugar control medication, while others believe more research is needed toconfirm that oral drugs are as safe and as successful as injectable insulin tocontrol gestational diabetes. (Mayoclinic, Mayo Clinic, 2017) Soeven if it is oral medication or insulin injections we should tell the patientto take right dose on time. And explaining the medication dose, time, sideeffects to the patient is must otherwise patient might get into trouble withoutclear information’s.