A woman is at 32 weeks' gestation. Her fundal height measurement at this clinic appointment is 26 centimeters. After reviewing her ultrasound results, the health care provider asks the nurse to schedule the client for a series of ultrasounds to be done every 2 weeks. The nurse should ensure that the client understands that the main purpose for this is to:
Select one:

Choice A Reason: Insulin needs decrease in the first trimester, but increase in the second trimester as the woman's body becomes more insulin-resistant. This is because this statement describes the typical patern of insulin requirements during pregnancy for women with pre-existing diabetes. Insulin needs decrease in the first trimester due to increased insulin production by the pancreas, increased insulin sensitivity by the tissues, and increased risk of hypoglycemia due to nausea and vomiting. Insulin needs increase in the second trimester due to increased levels of placental hormones such as human placental lactogen (hPL), which antagonize insulin action and cause insulin resistance.

Choice B Reason: Vascular disease that always accompanies diabetes slows fetal growth. This is an incorrect answer that makes a false and exaggerated claim about diabetes and fetal growth. Vascular disease does not always accompany diabetes, but it can be a complication of long-term or poorly controlled diabetes that affects blood vessels and circulation. Vascular disease can affect fetal growth by reducing placental perfusion and oxygen delivery, but it is not the only factor that influences fetal growth. Other factors include maternal nutrition, genetics, infections, or anomalies.

Choice C Reason: The risk of ketoacidosis decreases during the length of the pregnancy. This is an incorrect answer that contradicts the evidence and guidelines on diabetes and ketoacidosis during pregnancy. Ketoacidosis is a metabolic emergency where high levels of ketones accumulate in the blood due to insufficient insulin or excessive glucose utilization, which causes acidosis, dehydration, electrolyte imbalance, and coma. Ketoacidosis can occur in women with diabetes during pregnancy due to infection, stress, starvation, or inadequate insulin therapy. The risk of ketoacidosis does not decrease during the length of the pregnancy, but rather increases in the second and third trimesters due to increased insulin resistance and glucose production.

Choice D Reason: The baby is likely to have a congenital abnormality because of the uncontrolled diabetes. This is an incorrect answer that implies a negative and deterministic outcome for the baby. Congenital abnormalities are structural or functional defects that are present at birth, which can affect various organs or systems in the baby.

Congenital abnormalities can be caused by genetic or environmental factors, or a combination of both. Diabetes can increase the risk of congenital abnormalities, especially if the blood glucose levels are high during the first trimester, when organogenesis occurs. However, the risk of congenital abnormalities is not inevitable or predictable, and it can be reduced by maintaining good glycemic control before and during pregnancy.

Choice A Reason: Moderate amounts of deep red lochia. This is not a finding that would warrant further investigation, but rather a normal finding for the early postpartum period. Lochia is the vaginal discharge that occurs after delivery, which consists of blood, mucus, and tissue from the uterus. Lochia is usually deep red in color and moderate in amount for the first few days after delivery.

Choice B Reason: Sweating while afebrile. This is not a finding that would warrant further investigation, but rather a common occurrence in the postpartum period. Sweating is a mechanism of thermoregulation that helps the body eliminate excess fluid and electrolytes that were retained during pregnancy. Sweating does not necessarily indicate fever or infection.

Choice C Reason: Voiding 350 mL of blood-tinged urine. This is not a finding that would warrant further investigation, but rather an expected outcome for the postpartum period. Voiding large amounts of urine is normal in the postpartum period, as the body eliminates the excess fluid that was accumulated during pregnancy. Blood-tinged urine may be due to trauma or irritation of the urinary tract during labor or delivery, which usually resolves within a few days.

Choice D Reason: Heart rate of 115 beats/minute. This is because a heart rate of 115 beats/minute is higher than the normal range for an adult, which is 60 to 100 beats/minute. A high heart rate may indicate postpartum hemorrhage, infection, pain, anxiety, or dehydration. The nurse should further assess the client for other signs and symptoms of these conditions and notify the physician if necessary.