A pregnant client at 32 weeks gestation with gestational dia… | 마이메르시 MyMerci
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Maternal Newborn Health
문제

A pregnant client at 32 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. Which nursing intervention should be the priority?

해설
Fetal surveillance is the priority intervention when maternal blood glucose levels are poorly controlled in gestational diabetes. Other options are important but not immediate priorities compared to assessing fetal well-being.
같은 주제 다음 문제A nurse is assessing a pregnant client at 32 weeks gestation with gestational diabetes mel…

심화 해설

Understanding the Clinical Scenario

The client is at 32 weeks gestation with gestational diabetes mellitus (GDM) and presents with a fasting blood glucose of 140 mg/dL and a postprandial glucose of 180 mg/dL. These values are significantly elevated above the typical GDM targets (fasting

임상 시나리오

Clinical Scenario

A 32-week pregnant client with gestational diabetes mellitus (GDM) is admitted with a fasting blood glucose of 140 mg/dL and a postprandial glucose of 180 mg/dL. Both values significantly exceed target ranges (fasting ≤95 mg/dL, 1-hour postprandial ≤140 mg/dL), indicating poorly controlled GDM.

Priority Nursing Intervention

The immediate priority is to assess fetal well-being. Poorly controlled GDM increases the risk of placental insufficiency, fetal hypoxia, and stillbirth. A non-stress test (NST) is a non-invasive method to evaluate fetal oxygenation and neurological status by monitoring fetal heart rate reactivity.

Rationale for Prioritization
  • Fetal assessment takes precedence over medication administration in this scenario because the elevated glucose levels pose a direct threat to the fetus, and the NST provides immediate data on fetal status.
  • Insulin administration will be necessary but follows the initial fetal evaluation to ensure the fetus is not already in distress.
  • Bed rest and increased carbohydrate intake are not indicated; bed rest has no proven benefit for GDM, and more carbohydrates would exacerbate hyperglycemia.
Clinical Practice Guidelines
  • Fetal Surveillance: For GDM with poor glycemic control, antenatal testing (NST or biophysical profile) typically begins at 32-34 weeks or earlier if indicated.
  • Glycemic Targets: Aim for fasting

핵심 개념

  • Non-Stress Test (NST) — A prenatal test assessing fetal heart rate in response to fetal movement to evaluate oxygenation and neurological status, commonly indicated in high-risk pregnancies like poorly controlled GDM.
  • Gestational Diabetes Mellitus (GDM) — Glucose intolerance with onset or first recognition during pregnancy, associated with increased risks of fetal macrosomia, stillbirth, and neonatal hypoglycemia.
  • Fasting Blood Glucose Target in GDM — Typically recommended to be ≤95 mg/dL; a value of 140 mg/dL indicates significant hyperglycemia requiring immediate intervention and fetal evaluation.
  • Postprandial Glucose Target in GDM — Usually targeted at ≤120-140 mg/dL 1-2 hours after meals; a level of 180 mg/dL suggests poor glycemic control and potential fetal risk.
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