Peds Diabetes Case Study

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1. How should the nurse record Amanda's obstetrical history using the G-T-P-A-L designation? A) 3-2-0-1-3. INCORRECT This does not reflect the client's obstetrical history. B) 3-1-1-1-2. INCORRECT This does not reflect the client's obstetrical history. C) 4-1-1-1-3. CORRECT Gravidity [G] is defined as the number of times pregnant, including the current pregnancy. Term [T] is defined as any birth after the end of the 37th week, and preterm [P] refers to any births between 20 and 37 weeks. Both term and preterm describe liveborn and stillborn infants. Abortion [A] is any fetal loss, whether spontaneous or elective, up to 20 weeks gestation. Living [L] refers to all children who are living at the time of the interview. Multiple fetuses such as twins, triplets, and beyond are treated as one pregnancy and one birth when recording the GTPAL. Amanda's GTPAL is 4 (pregnancies counting current one) - 1 (infant born at 39 weeks) - 1 (twins born at 35 weeks) - 1 (spontaneous abortion at 9 weeks) - 3 (each twin and the singleton, all living). D) 4-2-1-0-2. INCORRECT This does not reflect the client's obstetrical history. The nurse notes that Amanda's fasting 1 hour glucose screening level, which was done 2 days previously, is 158 mg/dl. 2. The nurse recognizes that what information in the client's history supports a diagnosis of gestational diabetes? A) Maternal great-aunt has insulin dependent (Type 1) diabetes. INCORRECT Family history of diabetes is not considered a risk factor unless it is a first degree relative. B) Youngest child weighed 4300 grams at 39 weeks gestation. CORRECT Birth of an infant over 9 pounds (~ 4.1 kg or 4100 grams) is a risk factor for gestational diabetes. Other risk factors include maternal age older than 25, obesity, history of unexplained stillborn, family history of Type 1 diabetes in a first-degree

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