High-Risk Pregnancy Collaborative Activity

Why is the two-step glucose screening test important during pregnancy?

• Detects gestational diabetes mellitus (GDM)

• Helps prevent maternal and fetal complications from hyperglycemia

• Guides dietary and medical management to control blood sugar

• Early detection reduces risk for macrosomia, neonatal hypoglycemia, and preeclampsia

What education should the nurse provide before the 1-hour glucose screening test?

• Do not fast; eat normal diet before test

• Avoid caffeine and smoking 12 hours prior

• Inform patient that a sweet glucose drink (50 g) will be given, and blood will be drawn 1 hour later

• Bring a snack for after the test to avoid dizziness

Meghan’s 1-hour glucose test was 140 mg/dL. What education and next step should the nurse provide?

• Test is borderline or elevated, requiring a 3-hour oral glucose tolerance test (OGTT)

• Meghan should fast for 8–14 hours before the 3-hour test

• Blood will be drawn fasting, then hourly for 3 hours after a 100 g glucose load

• Test diagnoses GDM if two or more values are above normal limits

Meghan’s 3-hour glucose tolerance test was 154 mg/dL. She potentially has what condition?

• Gestational diabetes mellitus (GDM)

• Related to elevated serum glucose due to hormonal insulin resistance in pregnancy

What signs and symptoms are associated with gestational diabetes?

• Polyuria, polydipsia, polyphagia

• Fatigue, blurred vision

• Recurrent infections (yeast, UTIs)

• Large-for-gestational-age fetus (macrosomia)

What nursing interventions are appropriate for a patient with GDM?

Intervention:

• Monitor blood glucose and urine for ketones

• Encourage dietary modifications (complex carbs, balanced protein/fat)

• Teach home glucose monitoring

• Administer insulin if prescribed

• Monitor fetal growth and movement
  Rationale:

• Promotes glycemic control, prevents complications, and supports fetal well-being

What self-care education should the nurse provide for a patient with GDM?

• Eat 3 meals and 2–3 snacks/day; avoid skipping meals

• Exercise moderately (e.g., walking after meals)

• Monitor blood glucose four times daily (fasting and after meals)

• Report signs of hyperglycemia or hypoglycemia

• Understand need for postpartum glucose recheck (6–12 weeks) due to risk of Type 2 diabetes

Meghan later presents with painless, bright red vaginal bleeding and no uterine tenderness. What condition is suspected?

Placenta previa

What are key assessment findings for placenta previa?

• Painless, bright red vaginal bleeding

• Soft, relaxed, non-tender uterus

• Normal FHR pattern

• High fundal height (placenta in lower uterine segment)

What should be the nurse’s next action after obtaining Meghan’s vital signs?

• Do not perform vaginal exams (can cause hemorrhage)

• Notify provider immediately

• Initiate continuous fetal monitoring

• Maintain IV access and assess blood loss

What is the recommended treatment for placenta previa?

• Bed rest and avoid vaginal insertion (no sex, exams)

• Monitor bleeding, FHR, and VS

• Administer corticosteroids (Betamethasone) to enhance fetal lung maturity if <34 weeks

• Prepare for cesarean birth if bleeding is severe or placenta covers cervical os

What health teaching should the nurse provide for placenta previa?

• Avoid sexual intercourse or inserting anything into the vagina

• Report any bleeding immediately

• Monitor fetal movements daily

• Rest on side to improve placental perfusion

• Keep prenatal appointments for serial ultrasounds

What complications can result from placenta previa?

• Maternal hemorrhage or shock

• Preterm birth or fetal distress

• Placenta accreta (abnormal adherence)

Which of Meghan’s medications should the nurse question before discharge?

Lisinopril (ACE inhibitor) — contraindicated in pregnancy
Rationale: Can cause fetal renal failure, growth restriction, and death

Why is Methergine contraindicated in hypertensive patients like Meghan?

• Causes vasoconstriction and increased BP

• May lead to stroke or eclampsia in hypertensive women

What is fetal kick count and how should Meghan perform it?

• Method to assess fetal movement and well-being
  Education:

• Perform daily at same time (preferably after meals)

• Lie on left side in a quiet place

• Count 10 movements within 2 hours

• Report fewer than 10 kicks in 2 hours, or no movement during usual active times