NCP Intrapartal Diabetes Mellitus

Although most diabetic clients go to term with spontaneous labor, close management of the intrapartal period is necessary for optimal outcome.
This plan of care is to be used in conjunction with the first five plans of care in this chapter, concerning the three stages of labor, or with CP: Cesarean Birth, as indicated.

CLIENT ASSESSMENT DATA BASE

(Refer to CP: Diabetes Mellitus, Prepregnancy/Gestational and to the intrapartal assessment tool at the beginning of this chapter.)

Circulation

BP may be elevated.
History of ankle/leg edema.
Rapid pulse, pallor, diaphoresis (hypoglycemia).

Ego Integrity

Reports concerns regarding labor, impending delivery, and possible effects of diabetes on outcome
Anxious, irritable, increased tension

Elimination

Polyuria

Food/Fluid

May report episodes of hypoglycemia, glycosuria
Polydipsia, hunger (hyperglycemia)
Dependent edema
Ketonuria, elevated serum glucose

Sexuality

Large amount of amniotic fluid on rupture of membranes (suggests hydramnios)
Teaching/Learning
May have been hospitalized during the prenatal period for complications such as poor diabetic control, PIH, and preterm labor due to polyhydramnios

DIAGNOSTIC STUDIES

Serum Glucose: May or may not be elevated.
Glycosylated Hemoglobin (HbA1c): Reflects diabetic control during the preceding 5 wk.
Urinalysis: Reveals presence of glucose and ketones (hyperglycemia, ketoacidosis, and nutritional status) and albumin (PIH).
Ultransonography and Pelvimetry: Evaluates fetal size, and risk of macrosomia and shoulder dystocia.
Amniocentesis for lecithin to sphingomyelin (L/S) Ratio and Saturated Phosphatidyl choline (SPC): Determines fetal lung maturity. SPG levels are better predictors of lung maturity than L/S ratio.

NURSING PRIORITIES

1. Monitor client/fetal status and progress of labor.
2. Maintain normoglycemia (euglycemia).
3. Provide emotional support to the client/couple.
4. Promote successful delivery of an appropriate-for-gestational-age (AGA) infant.