Chapter l Obstetrical Cases 17 GWS SET CASE #5 LISA LAWRENCE Learning Objectives 1. Explain the diagnosis and treatment of the gestational diabetic. 2. Identify signs and symptoms of hypoglycemia and hyperglycemia. 3. Differentiate between NPH and regular insulin. 4. Explain blood sugar changes and insulin needs throughout pregnancy
and postpartum. 5. Identify common complications of the gestational diabetic and her baby, as well as appropriate assessments and interventions. NEWSY RASS HET...ARE . . . Lisa Lawrence is a 32-year-old primipara. According to her EDC she is 24 weeks
gestation. During this pregnancy she has experienced no complications except that her
pre-pregnant weight was above normal. Her family history indicates that her maternal
aunt and maternal grandmother have Type II or non-insulin dependant diabetes mellitus
(NIDDM). There is no known history of birth defects or other chronic illness in the family.
During her examination today she is told that her routine glucose challenge test was
positive and that she will need to return for a 3-hour glucose tolerance test to rule out
gestational diabetes. Lisa asks, "Does this mean I have to take those pills my aunt and
grandma do?" Focus Questions 1. How would the nurse respond to Lisa? . explain to the patient that we should complete a 3 hour GTT to confirm if she has
gestational diabetes. If it comes back that the patient has it, explain we can control with
insulin and diet
2. How would the nurse prepare Lisa for the 3-hour GTT? - The patient will have to drink 75g glucose solution, then a venous blood sample will be
taken 1-3 hr after to determine her glucose levelsThis study source was downloaded by 100000816392744 from CourseHero.com on 07-06-2021 03:35:05 GMT -05:00
https://www.coursehero.com/file/85481141/Gestational-Diabetes-Case-Study-5-Copydocx/This study resource was
shared via CourseHero.com " Lisa's test shows that she has gestational diabetes. Since her blood sugars are high
and uncon trolled, the physician has started her on 15 u. Humulin NPH insulin and 5 u.
Humulin regular insulin this morning and a 2,000 calorie diabetic diet. Evening blood
sugars (5 P.M.) are to be reported to the physician for an evening insulin order. The
physician explains that she may be 18 Unfolding Case Studies: Experiencing the Realities of Clinical Nursing Practice on insulin for the rest of her pregnancy. Later, Lisa asks the nurse, "How long do I have to fol low these rules?" Focus Questions 1. How should the nurse explain Lisa's insulin needs throughout her pregnancy and postpartum? Explain that in early pregnancy it might be necessary to take insulin and later on may need to increase intake to keep up with glucose control
2. Explain how the nurse will teach Lisa to administer two types of insulin (NPH 15 u. and regular 5u.) together. Explain to patient you will draw up 15 units of air into need and push in vial of NPH, then draw 5 units of air and push into regular vial
Draw 5 units of regular making sure their are no air bubbles and then 15 of NPH with a total of 20units 3. What kinds of insulin have been ordered? How are they different and why are they both ordered? Humulin which is short acting and onset of 30-60min and lasts 5-8hr
Humulin NPH is long acting and has an onset within 1-2 hr and lasts 18-24 hrThis study source was downloaded by 100000816392744 from CourseHero.com on 07-06-2021 03:35:05 GMT -05:00
https://www.coursehero.com/file/85481141/Gestational-Diabetes-Case-Study-5-Copydocx/This study resource was
shared via CourseHero.com
and postpartum. 5. Identify common complications of the gestational diabetic and her baby, as well as appropriate assessments and interventions. NEWSY RASS HET...ARE . . . Lisa Lawrence is a 32-year-old primipara. According to her EDC she is 24 weeks
gestation. During this pregnancy she has experienced no complications except that her
pre-pregnant weight was above normal. Her family history indicates that her maternal
aunt and maternal grandmother have Type II or non-insulin dependant diabetes mellitus
(NIDDM). There is no known history of birth defects or other chronic illness in the family.
During her examination today she is told that her routine glucose challenge test was
positive and that she will need to return for a 3-hour glucose tolerance test to rule out
gestational diabetes. Lisa asks, "Does this mean I have to take those pills my aunt and
grandma do?" Focus Questions 1. How would the nurse respond to Lisa? . explain to the patient that we should complete a 3 hour GTT to confirm if she has
gestational diabetes. If it comes back that the patient has it, explain we can control with
insulin and diet
2. How would the nurse prepare Lisa for the 3-hour GTT? - The patient will have to drink 75g glucose solution, then a venous blood sample will be
taken 1-3 hr after to determine her glucose levelsThis study source was downloaded by 100000816392744 from CourseHero.com on 07-06-2021 03:35:05 GMT -05:00
https://www.coursehero.com/file/85481141/Gestational-Diabetes-Case-Study-5-Copydocx/This study resource was
shared via CourseHero.com " Lisa's test shows that she has gestational diabetes. Since her blood sugars are high
and uncon trolled, the physician has started her on 15 u. Humulin NPH insulin and 5 u.
Humulin regular insulin this morning and a 2,000 calorie diabetic diet. Evening blood
sugars (5 P.M.) are to be reported to the physician for an evening insulin order. The
physician explains that she may be 18 Unfolding Case Studies: Experiencing the Realities of Clinical Nursing Practice on insulin for the rest of her pregnancy. Later, Lisa asks the nurse, "How long do I have to fol low these rules?" Focus Questions 1. How should the nurse explain Lisa's insulin needs throughout her pregnancy and postpartum? Explain that in early pregnancy it might be necessary to take insulin and later on may need to increase intake to keep up with glucose control
2. Explain how the nurse will teach Lisa to administer two types of insulin (NPH 15 u. and regular 5u.) together. Explain to patient you will draw up 15 units of air into need and push in vial of NPH, then draw 5 units of air and push into regular vial
Draw 5 units of regular making sure their are no air bubbles and then 15 of NPH with a total of 20units 3. What kinds of insulin have been ordered? How are they different and why are they both ordered? Humulin which is short acting and onset of 30-60min and lasts 5-8hr
Humulin NPH is long acting and has an onset within 1-2 hr and lasts 18-24 hrThis study source was downloaded by 100000816392744 from CourseHero.com on 07-06-2021 03:35:05 GMT -05:00
https://www.coursehero.com/file/85481141/Gestational-Diabetes-Case-Study-5-Copydocx/This study resource was
shared via CourseHero.com
