A pregnant client at 36 weeks gestation with gestational diabetes mellitus is admitted for blood glucose management. Her fasting blood glucose is 140 mg/dL and postprandial glucose is 180 mg/dL. What is the priority nursing intervention?

Immediate insulin administration with frequent monitoring is priority for poorly controlled GDM (fasting 140 mg/dL, postprandial 180 mg/dL). Other interventions (activity, education, consultation) are important but not immediate.

Core Nursing Explanation Key Concept Analysis: This question assesses the priority nursing intervention for a pregnant patient with Gestational Diabetes Mellitus (GDM) who presents with poorly controlled blood glucose levels at 36 weeks gestation. The core principle is prioritizing interventions based on immediate physiological risk. Uncontrolled hyperglycemia in the third trimester poses significant, immediate risks to both the fetus (macrosomia, birth trauma, hypoglycemia at birth) and the mother (polyhydramnios, preeclampsia, risk of cesarean delivery). The nursing process dictates that the most urgent physiological need must be addressed first.

Answer Rationale: The correct answer is ① Administer prescribed insulin and monitor blood glucose levels every 2 hours. The patient's lab values (Fasting: 140 mg/dL, Postprandial: 180 mg/dL) are significantly above the typical GDM management targets (fasting

Nursing Clinical Practice Guide Clinical Scenario: You are the nurse on the antepartum unit. Maria, a 36-week GDM patient, is anxious. Her fingerstick glucose readings have been high despite following her diet. The provider has written an order for "Humulin R 5 units subcut now, then sliding scale ac and hs. Monitor blood glucose q2h."

Nursing Intervention Strategy: 1. Assessment: Verify the order, check for allergies, and perform a focused assessment (vital signs, fetal heart rate via Doppler or monitor, signs of hyper/hypoglycemia). Assess the patient's knowledge and anxiety level. 2. Implementation: * Perform hand hygiene and don gloves. * Draw up the correct dose of insulin using an insulin syringe, with a second nurse verifying per policy (insulin is a high-alert medication). * Select an appropriate site (abdomen, avoiding a 2-inch radius around the umbilicus; rotate sites). * Administer the subcutaneous injection. * Immediately document the administration and the pre-dose blood glucose value. * Set a timer to re-check the blood glucose in 2 hours, and educate the patient on symptoms of hypoglycemia to report. 3. Evaluation & Education: After glucose levels begin to stabilize (trending downward), initiate diabetic diet education. Use visual aids for carbohydrate counting. Collaborate with the dietitian. Discuss safe exercise (e.g., walking). Plan for postpartum follow-up and breastfeeding benefits (lowers maternal glucose).

Patient Safety and Precautions: * Key Point! Hypoglycemia is the #1 acute risk of insulin therapy. Have a rapid-acting carbohydrate source (juice, glucose tablets) at the bedside. * Never massage the injection site after administering insulin, as this can alter the absorption rate. * Ensure the patient eats her meal after administering pre-meal (ac) insulin to prevent a dangerous drop in glucose.
Nursing Procedure & Medication Flow Blood Glucose Monitoring (q2h): 1. Gather supplies: glucometer, test strips, lancet, alcohol wipe, gauze. 2. Perform hand hygiene (patient and nurse). 3. Use the side of the fingertip. Allow alcohol to dry completely to prevent false low readings and stinging. 4. Apply the blood drop to the test strip as per device instructions. 5. Document the result, time, and any related interventions (insulin given, food intake).
Insulin Administration: * Types: Know the difference between rapid-acting (Lispro), short-acting (Regular), intermediate-acting (NPH), and long-acting (Glargine). Onset, peak, and duration matter for monitoring. * Mixing Insulin: If mixing NPH and Regular, draw up the Clear (Regular) before the Cloudy (NPH) to prevent contaminating the regular vial. * Storage: Unopened vials in the refrigerator. Opened vials can be kept at room temperature for 28-30 days (check manufacturer).
A Word from Your Senior Nurse "Managing GDM is a perfect example of how nurses are the bridge between orders and patient outcomes. That sliding scale insulin order isn't just a task—it's your tool to protect that baby from the risks of a sugary environment. Your vigilant q2h checks and your teaching empower the mother. On the NCLEX, they're testing if you understand that the most 'nursing' thing you can do is sometimes the most direct: give the medicine, watch closely, and keep them safe. In real life, that mindset saves lives and builds trust. You've got this!"