Please respond to your peer’s posts, from an FNP perspective. To ensure that your responses are substantive, use at least two of these prompts:

• Do you agree with your peers’ assessment?
• Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
• Share your thoughts on how you support their opinion and explain why.
• Present new references that support your opinions.

Please be sure to validate your opinions and ideas with in text-citations and references in APA format. Substantive means that you add something new to the discussion, you aren’t just agreeing. Be respectful and thoughtful.This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion and should be correlated to the literature.Minimum of 100 words.

Tracie’s POST:

Review nationally recognized guidelines for at-risk pregnancy conditions such as pregnancy-induced hypertension, gestational diabetes, preterm labor, obesity, etc. What p Review nationally recognized guidelines for at-risk pregnancy conditions such as pregnancy-induced hypertension, gestational diabetes, preterm labor, obesity, etc. What prenatal monitoring criteria did you discover? Describe how this information will impact your care and monitoring of a pregnant woman? There are conditions and circumstances where a woman requires a higher level of care to manage her pregnancy.

There are many high-risk situations that can cause a mother the need to be closely monitored. A common risk is advanced maternal age. When a pregnant women is over the age of 35, she is considered advanced maternal age. This requires the doctor to monitor her a little more closely than younger women.

Gestation diabetes is one disease that can potentially develop during pregnancy. After the baby is born, the mother’s blood glucose usually goes back to normal. A risk factor for this is obesity. Gestational diabetes can be found in obese women early in pregnancy by doing a glucose tolerance test. For the most part, babies are healthy when born from a mother who has gestational diabetes. If it is not managed correctly it can lead to complications such as macrosomia.

Maintaining euglycemia during labor and delivery can minimize chances of acidosis and neonatal hypoglycemia. A mother with gestational diabetes should monitor her blood glucose levels with fasting checks and checks one to two hours after meals (Garrison, 2015). Conservative treatment consists of dietary and lifestyle changes and medical treatments can be done with insulin and Metformin (Garrison, 2015).

When lifestyle and dietary modifications fail, there may be an indication for pharmacologic therapy. Although insulin has been a well known first line therapy for gestational diabetes, other oral methods are now acceptable (Garrison, 2015). Oral options for management include metformin and glyburide. These medications have not been approved by the U.S. Food and Drug Administration for the treatment of gestational diabetes mellitus but they are both a pregnancy category B. Insulin is required in women who have uncontrolled blood glucose levels despite lifestyle modifications and use of oral medications. Insulin is also used in women who do not want to trial any oral medications while pregnant or cant keep a medication regimen (Garrison, 2015). Insulin is considered safe for use in pregnancy and it does not cross the placenta.

There is no consensus on the optimal approach to fetal surveillance in pregnancies complicated by gestational diabetes mellitus. The American College of Obstetricians and Gynecologists (ACOG) recommends that clinicians perform antenatal testing in accordance with local practice patterns. Such testing could include twice-weekly non-stress tests or weekly modified biophysical profiles beginning at 32 to 34 weeks of gestation (American Diabetes Association, 2018). Obese women may start testing earlier than 32 weeks. Being aware of the conditions that can affect a woman during pregnancy can aid in early screening.

Reference

American Diabetes Association. (2018, January). Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes- 2018. Retrieved from http://care.diabetesjournals.org/content/41/Supple…

Garrison, A. (2015, April). Screening, Diagnosis, and Management of Gestational Diabetes Mellitus. Retrieved from https://www.aafp.org/afp/2015/0401/p460.html

Charli’sPOST

Question 1: Review nationally recognized guidelines for at-risk pregnancy conditions such as pregnancy-induced hypertension, gestational diabetes, preterm labor, obesity, etc. What prenatal monitoring criteria did you discover? Describe how this information will impact your care and monitoring of a pregnant woman? There are conditions and circumstances where a woman requires a higher level of care to manage her pregnancy.

Hypertension

There are many types of hypertension that can occur during pregnancy. There is chronic hypertension, gestational hypertension, preeclampsia-eclampsia, and preeclampsia superimposed on chronic hypertension (Alabama Perinatal Excellence Collaboration, 2015). To focus in on preeclampsia, it is classified as a new onset of hypertension after 20 weeks of gestation with or without proteinuria and with a new onset of thrombocytopenia, renal insufficiency, imparted liver function, pulmonary edema, or cerebral or visual disturbances (Alabama Perinatal Excellence Collaboration, 2015). To monitor for preeclampsia, one of the first red flags is a blood pressure reading greater than 140/90 on two occasions of a woman that had a previously normal blood pressure. Other indicators are a blood pressure reading of 160/110 or greater, proteinuria greater or equal to 300 mg/24 hours or protein/creatinine ration 0.3 mg/dl, or a urine dipstick reading of greater or equal to 1+ (Alabama Perinatal Excellence Collaboration, 2015).

Women with preeclampsia are recommended to have serial assessments to monitor their symptoms and fetal movement daily, blood pressure readings daily or twice weekly in office, weekly proteinuria, weekly labs including CBC with platelet count, liver enzymes (AST, ALT), creatinine, bilirubin, and LDH. There should also be monitoring of the fetus including a non-stress test, biological profile, and amniotic fluid index to ensure the baby does not have growth restrictions or affects from the mother(Alabama Perinatal Excellence Collaboration, 2015).

Patients can be followed up with outpatient, but sometimes require inpatient monitoring if severe. A patient with new onset of visual changes, rapid weight gain, decreased fetal movement, persistent headache, shortness of breath, or right upper quadrant pain should go to the hospital for further workup (Norwitz, 2019). A blood pressure reading of 160/110 or higher that sustains longer than 15 minutes requires immediate evaluation at the hospital (Norwitz, 2019).

As a future provider, it is important to know the many effects that hypertension or preeclampsia can cause during a pregnancy. I did not realize that preeclampsia can still be diagnosed without proteinuria if there are other indicators such as a platelet count less than 100,000, impaired liver function, pulmonary edema, visual or cerebral disturbances such as a seizure, or serum creatinine greater than 1.1 mg/dL (Norwitz, 2019). Monitoring blood pressure during pregnancy is an easy intervention that can monitor for a significant condition.

References

APEC guidelines preeclampsia. (2015). Alabama Perinatal Excellence Collaboration. Retrieved from apecguidelines.org/wp-content/uploads/2016/07/preeclampsia-6-30-2015.pdf

Norwitz, E. (2019). Preeclampsia: Management and prognosis. UpToDate. Retrieved from https://www.uptodate.com/contents/preeclampsia-man…