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1-7. DIABETES MELLITUS

a. Maternal acidosis refers to a complex disorder of carbohydrates, fat, and protein metabolism caused primarily by a relative or complete lack of insulin secretion by the beta cells of the pancreas. Although there is an overall improvement in the perinatal outcome of the well-managed diabetic pregnancy, there is still a significant risk for neonatal morbidity. The most common cause of fetal death associated with diabetes is maternal acidosis. Possibilities of diabetes being present are:

(1) Birth of a large baby over nine pounds.

(2) Repetitive, spontaneous abortions.

(3) Unexplained stillbirth.

(4) Excessive amniotic fluid (Polyhydramnios).

b. Diabetic patients are at risk for developing preeclampsia. They also have a risk of a difficult delivery as a result of the large size of the baby.

c. Nursing implications are as follow.

(1) Test patient's urine for glucose with clinitest tabs as ordered by OB practitioner or physician.

(2) Administer oral hypoglycemic medications or insulin as ordered by the OB practitioner or physician.

(3) Teach the patient the left lateral-recumbent position to rest. This position improves intrauterine blood flow and may decrease the occurrence of preeclampsia.

(4) Apply all nursing implications learned for the care of an adult with diabetes.

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