An 18-year-old client who has reached 16 weeks of gestation was ...

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An 18-year-old client who has reached 16 weeks of gestation was recently diagnosed with pregestational diabetes. She attends her centering appointment accompanied by one of her girlfriends.
 
  This young woman appears more concerned about how her pregnancy will affect her social life than about her recent diagnosis of diabetes. Several nursing diagnoses are applicable to assist in planning adequate care. The most appropriate diagnosis at this time is:
  a. Risk for injury to the fetus related to birth trauma.
  b. Noncompliance related to lack of understanding of diabetes and pregnancy and requirements of the treatment plan.
  c. Deficient knowledge related to insulin administration.
  d. Risk for injury to the mother related to hypoglycemia or hyperglycemia.

Question 2

Diabetes in pregnancy puts the fetus at risk in several ways. Nurses should be aware that:
 
  a. With good control of maternal glucose levels, sudden and unexplained stillbirth is no longer a major concern.
  b. The most important cause of perinatal loss in diabetic pregnancy is congenital malformations.
  c. Infants of mothers with diabetes have the same risks for respiratory distress syndrome because of the careful monitoring.
  d. At birth the neonate of a diabetic mother is no longer in any risk.

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Answer to Question 1

ANS: B
Before a treatment plan is developed or goals for the outcome of care are outlined, this client must come to an understanding of diabetes and the potential effects on her pregnancy. She appears to have greater concern for changes to her social life than adoption of a new self-care regimen. Risk for injury to the fetus related to either placental insufficiency or birth trauma may come much later in the pregnancy. At this time the client is having difficulty acknowledging the adjustments that she needs to make to her lifestyle to care for herself during pregnancy. The client may not yet be on insulin. Insulin requirements increase with gestation. The importance of glycemic control must be part of health teaching for this client. However, she has not yet acknowledged that changes to her lifestyle need to be made, and she may not participate in the plan of care until understanding takes place.

Answer to Question 2

ANS: B
Congenital malformations account for 30 to 50 of perinatal deaths. Even with good control, sudden and unexplained stillbirth remains a major concern. Infants of diabetic mothers are at increased risk for respiratory distress syndrome. The transition to extrauterine life often is marked by hypoglycemia and other metabolic abnormalities.