NCM 1028

kLGLS1A1ICNAL CCNDI1ICNS
knLUMA1IC nLAk1 DISLASL DIA8L1LS
MLLLI1US SU8S1ANCL A8USL
nIV]AIDS kh SLNSI1I2A1ICN ANLMIA
CAkDICVASCULAk DISLASL IN kLGNANC
neart d|sease occurs |n approx|mate|y 1 percent of pregnant
women
It |s f|rst as a cause of materna| deaths among the d|sorders
|nc|denta| to pregnancy and fourth after hemorrhage
preec|amps|a and |nfect|on as a cause of a|| materna| deaths
kheumat|c heart d|sease |s the most preva|ent type
Congen|ta| heart d|sease accounts for approx|mate|y one
fourth of the cases
A number of factors |nc|ud|ng her response to phys|ca|
act|v|ty a h|story of heart fa||ure the type of heart d|sease
that she has and her age are used |n est|mat|ng how a
part|cu|ar woman w||| fare dur|ng pregnancy and |abour
A person whose heart d|sease causes no ||m|tat|on of norma|
phys|ca| act|v|ty w||| usua||y go through a norma| pregnancy
and de||very w|thout notab|e d|ff|cu|ty prov|ded that she
avo|ds undue phys|ca| act|v|ty has suff|c|ent rest avo|ds
|nfect|ons and |s under the care of an obstetr|c|an and a
card|o|og|st who are on the a|ert for s|gns of ear|y heart
fa||ure
Such a person w||| not face an apprec|ab|y |ncreased r|sk and
her heart d|sease w||| not be affected by the pregnancy
1he woman whose phys|ca| act|v|ty |s ||m|ted to some extent
because |t causes undue fat|gue shortness of breath heart
pa|p|tat|on or heart pa|n but who has never exper|enced
heart fa||ure w||| se|dom suffer heart fa||ure |f she fo||ows a
str|ct reg|men out||ned by her phys|c|ans throughout the
pregnancy the |abour and the puerper|um (the per|od
|mmed|ate|y after ch||db|rth) and |f she does not exper|ence a
comp||cat|on of pregnancy or of her heart d|sease
A d|seased heart a|though ab|e to carry the |oad put on |t by
pregnancy may not be ab|e to stand up under an add|t|ona|
burden
1h|s |s part|cu|ar|y true |f the pregnant woman ga|ns an
excess|ve amount of we|ght |f she deve|ops preec|amps|a
k|dney d|sease pu|monary d|sease or an |nfect|on or |f she
overworks phys|ca||y |s sub[ected to sudden severe emot|ona|
stress or becomes anem|c
1he poss|b|||ty that a woman w|th ser|ous heart d|sease w|||
have heart fa||ure |s greater |f she |s over 3S years of age
More than ha|f of the women who have suffered from
heart fa||ure before they became pregnant do so aga|n
dur|ng pregnancy usua||y between the f|fth and the n|nth
month when pregnancy throws the greatest work|oad on
the heart
8ecause so many women w|th a h|story of prev|ous heart
fa||ure have d|ff|cu|t|es dur|ng pregnancy many
obstetr|c|ans and card|o|og|sts restr|ct the phys|ca| act|v|ty
of such women and try to keep them |n the hosp|ta| and
under c|ose med|ca| surve|||ance
Some women w|th ser|ous heart d|sease are kept |n bed |n the
hosp|ta| throughout the course of the pregnancy and thus
avo|d heart fa||ure
Card|ac surgery dur|ng the f|rst few months of pregnancy
a|though a hazardous procedure has |essened the necess|ty
for pro|onged bed rest |n some cases and mater|a||y |mproved
the prognos|s |n others
Jomen w|th ser|ous heart d|sease often de||ver
premature|y and the|r |abours are often short and the|r
de||ver|es easy
1here |s an |ncrease |n feta| morta||ty because many
pregnanc|es are |nterrupted and because many of the
bab|es of women w|th heart d|sease are born
premature|y
8ab|es who are not born premature|y are not notab|y
d|fferent from those of norma| mothers
knLUMA1IC nLAk1 DISLASL
An |nf|ammatory d|sease pr|mar||y affect|ng connect|ve t|ssue
espec|a||y card|ac va|ves
A Norma| phys|o|og|ca| a|terat|on of pregnancy that |ncrease
card|ovascu|ar stress
1 Increase |n oxygen requ|rements
2 Increase |n card|ac output
3 Increase |n p|asma vo|ume
4 Je|ght ga|n
S nemodynam|c changes dur|ng de||very
8 As norma| pregnancy advances card|ovascu|ar system |s
unab|e to ma|nta|n adequate output to meet |ncreas|ng
demands
CLASSIIICA1ICN CI CAkDICVASCULAk DISLASL
CLASSIIICA1ICN nSICAL AC1IVI1
I Not ||m|ted no d|scomfort from norma| act|v|ty No
ang|na| pa|n
II Is s||ght|y ||m|ted ord|nary act|v|ty prec|p|tates
fat|gue dyspnea and ang|na| pa|n
III Is marked|y decreased |ess than norma| act|v|ty
prec|p|tates excess|ve fat|gue dyspnea and ang|na|
pa|n
IV Severe|y restr|cted as symptoms of card|ac
|nsuff|c|ency are present at rest
C Increased |nc|dence of prematur|ty and |ow b|rth we|ght |s
|nd|cat|ve of the |nab|||ty of the heart to meet the demands of
the grow|ng fetus
ASSLSSMLN1
C||n|ca| man|festat|ons |nd|cat|ve of card|ac decompensat|on are
those of |mpend|ng Congest|ve neart Ia||ure (CnI)
1 Irequent cough
2 rogress|ve genera| edema
3 rogress|ve dyspnea
4 Lxcess|ve fat|gue for |eve| of act|v|ty
S Dysrhythm|a
6 Congested |ung sounds
7 Card|ac decompensat|on |ncreases w|th |ength of gestat|on
28 to 32 weeks has h|ghest |nc|dence of CnI
1kLA1MLN1
1 Management of the pregnant c||ent
a Good nutr|t|ona| |ntake may requ|re decrease |n ca|or|es to
avo|d excess|ve we|ght ga|n
b Iron supp|ement
c I|u|d and sod|um are usua||y not restr|cted
d D|uret|cs on|y |f card|ac d|sease |s severe
e May be hosp|ta||zed at 28 to 32 weeks due to |mpend|ng CnI
f If coagu|at|on prob|ems occur hepar|n |s ut|||zed because |t
does not cross the p|acenta
g rophy|act|c pen|c||||n to prevent |nfect|on
2 Management of the c||ent dur|ng |ntrapartum
a Vag|na| |ow forceps de||very preferred
b keg|ona| or |oca| anesthes|a genera||y ut|||zed for de||very
c Cont|nuous mon|tor|ng of fetus and mother
d Supp|ementa| oxygen
3 Management of the c||ent dur|ng postpartum
a 8ecause of dramat|c changes |n the hemodynam|c system
the postpartum per|od |s the t|me of |ncreased r|sk for CnI
|n the mother
b C||ent |s treated symptomat|ca||y accord|ng to status of
card|ovascu|ar system
NUkSING IN1LkVLN1ICN
Goa| to ossist c/ient to mointoin homeostosis durinq preqnoncy
1 Jr|tten |nformat|on regard|ng nutr|t|ona| needs
2 Nurs|ng assessment to |dent|fy ear|y symptoms of CnI
3 Irequent rest per|ods may be conf|ned to bed the |ast
tr|mester
4 Decrease stress by keep|ng c||ent |nformed of progress
Goa| to ass|st c||ent to ma|nta|n homeostas|s dur|ng |ntrapartum
1 C|ose observat|on of pu|monary funct|on dur|ng |abor
2 Lva|uate |nformat|on from cont|nuous feta| and materna|
mon|tor|ng
3 D|scourage push|ng dur|ng |abor to prevent Va|sa|va
maneuver and |ncrease card|ac stress
4 os|t|on on |eft |atera| s|de w|th head and shou|ders
e|evated
S repare c||ent for |ow forceps vag|na| de||very
6 rov|de pa|n re||ef as |nd|cated
a a|n |ncreases carda|c work
b Lva|uate effects of ana|ges|a on fetus
Goa| to mointoin homeostosis in postporto/ period
1 Assessment of pu|monary and card|ac adaptat|on to
changes |n hemodynam|cs
2 Ma|nta|n sem|Iow|er's pos|t|on or |eft |atera| pos|t|on
w|th the head e|evated
3 Gradua| progress|on of act|v|t|es depend|ng on card|ac
status as |nd|cated by
a u|se rate
b kesp|ratory status
c Act|v|ty to|erance
4 rogress|ve ambu|at|on as soon as poss|b|e to prevent
venous thrombos|s
S Ass|st mother and fam||y to prepare for d|scharge
NUkSING DIAGNCSIS
otent|a| Comp||cat|ons CnI feta| dem|se
Iear r]t uncerta|n status of se|f pregnancy and |nfant
Act|v|ty Into|erance r]t |nab|||ty to ma|nta|n adequate card|ac
funct|on due to |ncreased demands of pregnancy
otent|a| A|terat|on |n 1|ssue erfus|on (|nfant and mother)
secondary to decreased oxygenat|on
Impa|red nome Ma|ntenance r]t |nab|||ty to ma|nta|n ro|e status |n
fam||y dur|ng pregnancy and after de||very
otent|a| A|tered nea|th Ma|ntenance r]t |nadequate know|edge of
comp||cat|ons d|et med|cat|ons |nfect|on and act|v|t|es
DIA8L1IS MLLLI1US
A comp|ex mu|t|system d|sease character|zed by the absence or a
severe decrease |n the secret|on of |nsu||n
A athophys|o|ogy
1 1he pr|mary funct|on of |nsu||n |s to decrease the b|ood
g|ucose |eve|
a Necessary for transport of g|ucose |nto the musc|e
b kegu|ates the rate of carbohydrate metabo||sm
c romotes convers|on of g|ucose to g|ycogen for storage
2 Insu||n |s secreted by the beta ce||s |n the |s|ets of Langerhans
|n the pancreas
3 1he body uses carbohydrates for energy Lffect|ve ut|||zat|on
depends on
a Adequate |ntake of carbohydrate
b Ava||ab|e |nsu||n to fac|||tate the movement of the
g|ucose |nto the ce||
c Adequate reserves of g|ucagon
4 If carbohydrates are not ava||ab|e to be ut|||zed for energy then
the ce|| w||| beg|n to ox|d|ze the fats and prote|n stores
a 8reakdown of the fat resu|ts |n the product|on of ketone
bod|es
b rote|n |s wasted dur|ng |nsu||n def|c|ency rote|n |s
broken down and converted to g|ucose by the ||ver thus
contr|but|ng to the |ncrease |n c|rcu|at|ng g|ucose
c Jhen fats are used for the pr|mary energy source the
serum ||p|d |eve| r|ses and contr|butes to the acce|erated
deve|opment of atherosc|eros|s seen |n the d|abet|c c||ent
S Jhen the c|rcu|at|ng g|ucose cannot be ut|||zed for energy the
|eve| of the serum g|ucose w||| |ncrease (hyperg|ycem|a)
a nyperg|ycem|a w||| cause an |ncrease |n the osmot|c
grad|ent water moves out of the ce|| |nto the c|rcu|at|ng
vo|ume to decrease the osmo|ar|ty 1h|s resu|ts |n an
|ncrease |n ur|nary output
b 1he |ncrease |n the c|rcu|at|ng g|ucose exceeds the rena|
thresho|d and g|ucose sp|||s |nto the ur|ne
6 athophys|o|og|c bases for symptoms
a o|yur|a due to teh |ncreased serum osmo|ar|ty there |s
more c|rcu|at|ng vo|ume water |s not reabsorbed from
the rena| tubu|es and there |s a s|gn|f|cant |ncrease |n
ur|ne output
b o|yd|ps|a |ncreased |oss of f|u|ds prec|p|tates
dehydrat|on caus|ng th|rst
c o|yphag|a t|ssue breakdown and wast|ng cause
hunger
d Je|ght |oss (IDDM) g|ucose |s not ava||ab|e to the ce||s
body beg|ns to break down fat and prote|n stores for
energy
CLINICAL IMLICA1ICNS CI DIA8L1LS IN kLGNANC
1 Lffects of pregnancy on d|abetes
a Dur|ng the f|rst tr|mester of the pregnancy there |s an
|ncrease |n feta| need for g|ucose and am|no ac|ds th|s
|owers the materna| b|ood g|ucose and decreases her
need for add|t|ona| |nsu||n
b Dur|ng the second and th|rd tr|mester the need for
|nsu||n w||| |ncrease due to |nsu||n antagon|sm by
p|acenta| hormones
2 Lffects of d|abetes on pregnancy
a Increase s|ze and number of |s|ets f Langerhans |n the
1ype II c||ent
b Increased tendency toward the deve|opment of metabo||c
ac|dos|s due to an |ncrease |n metabo||c rate and a
decrease |n carbon d|ox|de comb|n|ng power
c |acenta| |nf|uence on |nsu||n decreases the effect|veness
of the |nsu||n
d Ieta| antagon|sts decrease the ut|||zat|on of g|ucose
e Decreased g|ucose to|erance secondary to decrease |n
anter|or p|tu|tary act|v|ty
3 Inf|uence of pregnancy on d|abet|c contro|
a Decrease |n |nsu||n requ|rements dur|ng the f|rst tr|mester
of pregnancy
b Increase |n |nsu||n requ|rements dur|ng the second and
th|rd tr|mester of pregnancy to as much as 70 percent to
100 percent over prepregnancy amounts
c Vom|t|ng w||| decrease carbohydrate |ntake and prec|p|tate
the deve|opment of an ac|dot|c state
d 1endency to |ntens|fy the ex|st|ng comp||cat|ons of
d|abetes
e resence of g|ucosur|a due to a norma| |ower|ng of the
rena| thresho|d dur|ng pregnancy may |nterfere w|th the
|nterpretat|on of the contro| parameters for the d|abetes
f Ur|ne tests are not re||ab|e |nd|cators for d|abet|c contro|
dur|ng pregnancy
4 Mon|tor|ng feta| and mother we||be|ng dur|ng pregnancy |abor
and de||very
a Antepartum
1 Assess mother's d|abet|c cond|t|on accord|ng to wh|te's
c|ass|f|cat|on
JnI1L'S CLASSIIICA1ICN CI DIA8L1LS IN kLGNANC
CLASS DLSCkI1ICN
A Abnorma| g|ucose to|erance norma| fast|ng g|ucose |eve|
chem|ca| d|abetes
Comp||cat|ons |arge baby |ntrapartum feta| death
8 Cnset after age 20 d|abet|c for |ess than 10 years
Comp||cat|ons hydram|nos excess|ve materna| we|ght ga|n
preec|amps|a |arge baby |ntrapartum feta| death
C D|abetes beg|nn|ng |n ado|escence after age 10 before age 20
Comp||cat|ons a|| of above but |ncreased r|sk factor
D D|abet|c of |ong durat|on over 20 years onset before age 10
ev|dence of vascu|ar d|sease
Comp||cat|ons |ntrauter|ne feta| death neonata| death
L Not |n c||n|ca| use
I D|abetes w|th nephropathy |nc|ud|ng cap|||ary
g|omeru|osc|eros|s py|onephr|t|s
2 Jeek|y or b|week|y b|ood g|ucose |eve|s to ma|nta|n
opt|mum |eve| of contro|
3 1h|rd tr|mester eva|uat|on of feta|]p|acenta| funct|on by
determ|n|ng twentyfourhour ur|nary estr|o| |eve|s
4 36 to 38 weeks' gestat|on oxytoc|n cha||enge tests to
determ|ne ab|||ty of fetus to w|thstand stress
S Amn|ocentes|s to obta|n f|u|d samp|es to determ|ne L]S
rat|o (|ec|th|n sph|ngomye||n)
b Intrapartum
1 As |ong as there |s ev|dence of adequate
p|acenta| funct|on and the |nfant's response to
stress |s appropr|ate the pregnancy |s a||owed
to progress to term w|th an ant|c|pated vag|na|
de||very
2 Dur|ng |abor b|ood g|ucose |eve|s are
ma|nta|ned w|th IV g|ucose and regu|ar |nsu||n
3 Ieta| mon|tor|ng dur|ng |abor
c ostpartum
1 Lndocr|ne and metabo||c changes w|||
occur rap|d|y after de||very
2 Insu||n requ|rements for mother w||| be
marked|y decreased and w||| gradua||y
|ncrease over next few weeks
3 Mother must go through a per|od of
d|abet|c reregu|at|on
S resence of d|abetes pred|sposes the c||ent to an |ncreased
|nc|dence of
a 1oxem|a
b nymorrhage
c o|yhydramn|os
d Vag|na| and ur|nary tract |nfect|ons
e remature de||very
f Intrauter|ne death |n th|rd tr|mester
g Comprom|sed newborn
1 kesp|ratory D|stress Syndrome
2 nypog|ycem|a
3 nyperb|||rub|nem|a
4 Congen|ta| anoma||es
NUkSING IN1LkVLN1ICN
Goa| to return serum q/ucose to normo/ /eve/
1 In|t|a||y adm|n|ster regu|ar |nsu||n on a proport|ona| bas|s
accord|ng to need
2 Ma|nta|n adequate f|u|d |ntake
3 Lva|uate serum e|ectro|ytes
4 Lva|uate for c||n|ca| man|festat|ons of hypog|ycem|a and
hyperg|ycem|a
Goa| to evo/uote c/ients understondinq of diobetes p/on ond
imp/ement o teochinq reqimen
1 Assess current |eve| of know|edge regard|ng d|abetes
2 Lva|uate cu|tura| and soc|oeconom|c parameters
3 Lva|uate c||ent and fam||y regard|ng appropr|ate t|me
to |n|t|ate teach|ng program
4 Lva|uate c||ent's support system (fam||y s|gn|f|cant
others)
S Adm|n|strat|on of |nsu||n
a Correct |n[ect|on techn|ques
b kotate |n[ect|on s|tes
c S|gns and symptoms of hypog|ycem|a
d Check exp|rat|on date on the |nsu||n
e Durat|on and peak act|on of prescr|bed
|nsu||n
f A||ow for amp|e pract|ce t|me
g Adm|n|ster at the same t|me each day
6 Cra| hypog|ycem|a agents
a 1ake med|cat|on as schedu|ed do not sk|p or add dose
b S|gns and symptoms of hypog|ycem|a
c Ant|c|pate change |n med|cat|on w|th pregnancy
7 Lxerc|se
a Lstab||sh and exerc|se program
b Avo|d sporad|c exerc|se
c ke|terate the phys|c|an's |nstruct|ons regard|ng ad[ustment of
|nsu||n and food |ntake to meet |ncreased act|v|ty
8 D|et
a kegu|ar|y schedu|ed mea|t|mes
b 1each and re|nforce understand|ng of food groups and
ba|anced nutr|t|on
c Incorporate fam||y tendenc|es and cu|tura| patterns |nto
prescr|bed d|etary reg|men
d rov|de c||ent and fam||y w|th wr|tten |nstruct|ons
regard|ng d|etary needs
Infect|on contro|
a keport |nfect|ons prompt|y
b Insu||n requ|rements may |ncrease w|th severe
|nfect|ons
c Increased prob|ems w|th vag|n|t|s and sk|n |rr|tat|on
d Avo|d exposure to |nfect|on
10 Avo|d |n[ury
a Decreased hea||ng capab|||t|es espec|a||y |n |ower
extrem|t|es
b Ma|nta|n adequate b|ood supp|y to extrem|t|es avo|d
t|ghtf|tt|ng c|oth|ng around the |egs
c roper foot care
Goa| to mointoin contro/ of diobetic condition in the postoperotive
1 IV f|u|ds and regu|ar |nsu||n unt|| c||ent |s ab|e to take C
f|u|ds
2 Cbta|n b|ood sugar |eve| 4 to 6 t|mes a day to determ|ne
f|uctuat|ons
3 After g|ucose |eve|s stab|||ze the c||ent can usua||y resume
h|s preoperat|ve d|abet|c med|cat|ons
4 Cbserve for hypog|ycem|a |mmed|ate|y postoperat|ve|y
S Avo|d ur|nary b|adder catheter|zat|on
6 Lva|uate per|phera| c|rcu|at|on and prevent sk|n
breakdown
7 8e a|ert to deve|opment of postoperat|ve |nfect|ons
Goa| to identify c/inico/ monifestotions chorocteristic of uk4 to
ossist c/ient to return to homeostosis
1 Lstab||sh an IV access
2 Ant|c|pate rap|d |nfus|on of norma| sa||ne or p|asma
expanders |n|t|a||y then ma|ntenance rate Adm|n|ster
w|th caut|on |n c||ents w|th card|ac cond|t|on
3 Adm|n|ster |nsu||n IV dur|ng the acute phase then
subcutaneous as b|ood g|ucose beg|ns to decrease
4 Irequent mon|tor|ng of v|ta| s|gns
S Irequent ur|ne checks for sugar and acetone
6 nour|y ur|ne measurements do not adm|n|ster
potass|um |f ur|ne output |s |ow or dropp|ng
7 Mon|tor b|ood g|ucose |eve|s frequent|y
8 May ut|||ze card|ac mon|tor
Mon|tor serum e|ectro|ytes part|cu|ar|y potass|um
|eve|s
a nyperka|em|a may occur |n|t|a||y |n response to
the ac|dos|s
b nypoka|em|a occurs about 4 to 6 hours after
treatment and the ac|dos|s |s reso|v|ng
10 Lva|uate ac|dbase status
Goa| to identify the c/inico/ monifestotions chorocteristic of
nnNk to ossist c/ient to return to homeostosis
1 Lstab||sh an IV access
2 IV |nfus|on to rehydrate c||ent norma| sa||ne |s
frequent|y used
3 Low dose |nsu||n IV |n|t|a||y to decrease b|ood g|ucose
s|ow|y
4 Lva|uate ur|ne output
S Lva|uate serum g|ucose |eve|
6 Lva|uate ac|dbase status
7 Support the card|ovascu|ar system
8 Assess c||ent for presence of other chron|c hea|th
prob|ems
Goa| to ossist c/ient to understond imp/icotions of diobetes ond
/onqterm heo/th core mointenonce
1 Ma|nta|n opt|mum we|ght
2 kema|n on |ongterm med|ca| care
3 Not|fy a|| hea|th care prov|ders of d|agnos|s of d|abetes
wear a med|ca| a|ert |dent|f|cat|on
4 kecogn|ze prob|ems of the card|ovascu|ar system
a er|phera| vascu|ar d|sease
b Decreased hea||ng
c Increased r|sk of stroke
d Increased r|sk of MI
e resence of ret|nopathy
f Increased r|sk of rena| d|sease
S kecogn|ze prob|ems of per|pherra| neuropathy
6 Ass|st c||ent to understand prob|ems d|abetes |mposes on
pregnancy and the subsequent deve|opment of a h|gh
r|sk pregnancy
7 Ass|st c||ent to understand the prob|em of |ncreased
suscept|b|||ty to |nfect|on
8 Ass|st c||ent to understand the prob|ems of decreased
fert|||ty due to the d|abet|c state
Goa| %preqnoncy) to ossist the c/ient to mointoin homeostosis
throuqhout preqnoncy
1 revent |nfect|on
2 Irequent eva|uat|on of g|ucose |eve|s
3 hys|c|ans w||| change c||ent from ora| hypog|ucem|c
agents to regu|ar |nsu||n
4 Ma|nta|n opt|mum |eve|s of we|ght ga|n may be |nduced
for |abor or have cesarean sect|on |f comp||cat|ons are
ev|dent
Goa| %preqnoncy) to ossist the c/ient to mointoin homeostosis
throuqhout /obor ond de/ivery
1 IV DSJ and |nsu||n or k|nger's |actate to ma|nta|n
homeostas|s dur|ng |abor
2 Ieta| mon|tor|ng to |dent|fy ear|y stages of feta| d|stress
3 kray pe|v|metry to |dent|fy cepha|oper|v|c d|sproport|on
(CD)
4 Increased |nc|dence of dystoc|a due to |arge |nfants
S Irequent eva|uat|on of serum g|ucose |eve|s (every 2 to 3
hours)
Goa| %preqnoncy) to ossist the c/ient to return to homeostosis
durinq the postporto/ period
1 Ant|c|pate f|uctuat|on |n |nsu||n requ|rements due to
a Loss of feta| |nsu||n
b kemova| of p|acenta| |nf|uence on |nsu||n
c Changes |n metabo||c act|v|ty
2 Lva|uate for g|ycosur|a
3 Lva|uate serum g|ucose |eve|s
4 revent postparta| |nfect|on
NUkSING DIAGNCSIS
D|abetes Me|||tus
A|tered nea|th Ma|ntenance r]t |nadequate know|edge regard|ng
se|f care (d|et we|ght contro| exerc|se mon|tor|ng b|ood sugar
med|cat|ons prevent|ve hea|th care)
otent|a| for In[ury r]t decreased sensat|on decreased v|sua| acu|ty
and hypohyperg|ycem|a m|cro and macro vascu|ar damage
Anx|ety]Iear r]t d|agnos|s and potent|a| a|terat|ons |n ||fe sty|e
potent|a| comp||cat|on
otent|a| Ineffect|ve Cop|ng (fam||y and |nd|v|dua|) r]t m|crovascu|ar
d|sease and neuropathy
otent|a| Noncomp||ance r]t comp|ex|ty of treatment and prognos|s
of cond|t|on
NUkSING DIAGNCSIS
D|abetes |n regnancy
Anx|ety r]t effects of d|abetes on |nfant
otent|a| for Infect|on r]t a|terat|ons |n b|ood sugar and comprom|sed
|mmune response
otent|a| A|tered nea|th Ma|ntenance r]t |nadequate know|edge
regard|ng |nfant care se|f care and |mp||cat|ons for future pregnanc|es
NUkSING DIAGNCSIS
Infant of D|abet|c Mother
otent|a| A|terat|on I|u|d Vo|ume Def|c|t r]t a|terat|ons |n
b|ood sugar
otent|a| for In[ury r]t hypog|ycem|a