Patient Data

Exhibits

The nurse is reviewing nurses' notes to determine if there are any variations. Click to highlight the findings that would indicate the client has developed a complication related to pregnancy.

The client is a 32-year-old multigravida at 28 weeks' gestation, who presents to the obstetrician's office for a routine prenatal visit. Obstetrical history reveals she has given birth three times; once at 35 weeks (twins), once at 38 weeks (singleton) and once at 41 weeks (singleton). All of these children are alive and well. She had one spontaneous abortion at 10 weeks' gestation. Her fourth child weighed 9 pounds (4.08

Kg) at 41 weeks gestation.

Client is at 28 weeks. She has been receiving prenatal care since 8 weeks' gestation. Her fasting 1-hour glucose screening level, which was done 1 week prior, is 164 mg/dL (9.1 mmol/L). Her 3-hour oral glucose tolerance test results reveal a fasting blood sugar of 168 (9.3 mmol/L) and a two-hour postprandial of 220 mg/dL (12.2 mmol/L).

The laboratory results show a fasting 1-hour glucose screen level of 164 mg/dL and a fasting blood sugar level of 168 mg/dL from a 3-hour oral glucose tolerance test, both of which are above the normal range. Additionally, a two-hour postprandial glucose level of 220 mg/dL is also elevated. These findings suggest the possibility of gestational diabetes mellitus (GDM), a condition of glucose intolerance that arises during pregnancy.

According to the American Diabetes Association, GDM is diagnosed if two or more plasma glucose levels meet or exceed certain thresholds, which include a fasting glucose concentration of 95 mg/dL, a 1-hour glucose concentration of 180 mg/dL, and a 2-hour glucose concentration of 155 mg/dL. The patient's values surpass these thresholds, indicating that further evaluation and management for GDM may be necessary.