Michelle Marks

9/25/2014
Nurs 320
Prof. Riley
Self Evaluation Week 3

Last week, I had a great experience in the labor and delivery unit. The patient that I
was assigned to was a Type 1 Diabetic who had been admitted for a repeat cesarean
birth. She was a young woman, 29 years old, married, with three children at her home
on the Big Island. All of her children were boys; the oldest was ten years old, the
second was seven years old, and the last one was two and a half years old. The child
she was delivering would be her first girl.
Due to her diabetes, the mother was having a cesarean birth, as she had with each of
her previous children. The physician scheduled this mother to deliver via cesarean at
38 weeks gestation in order to avoid baby from gaining too much weight while in utero
and to prevent possible complications that could be caused by the mothers diabetes.
The physician required that the mother travel to Oahu at 36 weeks gestation and be on
the island for the remaining two weeks preceding her cesarean.
After the cesarean, while the mother waited for baby to be evaluated and returned to
her, I was able to talk with the mother in her recovery room. She told me about her
diabetes and how she had been diagnosed at 14 years old after being very sick for
several weeks. We also discussed some of the struggles she had to deal with being
pregnant and diabetic. She told me how managing her blood glucose levels was very
difficult and she had to stay in contact with her Diabetes Educator frequently in order to

update her insulin needs. Luckily, the Diabetes Educator was located on the Big Island,
where the mother lived, and the mother was able to visit the educator or correspond by
email. Her prenatal appointments and extra care that she required was also covered by
the state insurance, HMSA Quest.
The state of Hawaii provided support for a patient with an illness. The medical
coverage for a diabetic, pregnant patient proved to be adequate in this situation. The
Big Island community had a local Diabetes Educator that was able to help this
patient. One of the downsides to being located on the Big Island, however, was the lack
of hospital resources available for this patient if she had gone into labor prior to her
required trip to Oahu. There is not a labor and delivery facility available for high risk
situations located on the Big Island.
During the first assessment, the baby had low blood glucose levels. It was at 33 mg/dl
and the desired range for newborns is 40 80mg/dl. This low blood glucose level was
concerning because it puts the baby at risk for hypothermia, respiratory distress and
inadequate neurologic, organ and tissue function. A care plan was developed that
focused on this particular baby and her needs regarding the diabetic mother. I
know that babies born to diabetic mothers may have hypoglycemia due to excess
amounts of insulin in their bloodstream (hyperinsulinemia). Four hours before the
scheduled cesarean, the mothers blood glucose level was at 284mg/dl and she gave
herself a bolus of insulin to bring it down. One hour prior to the cesarean, the mothers
glucose level had decreased to 170mg/dl. Because glucose crosses the placenta, baby
was getting the high levels of glucose when mothers sugar was at 284. Babys
pancreas had to produce excess insulin to bring her sugar levels to normal. The low

glucose level that was tested after birth may have been a result of the excess insulin
produced to counteract mothers high level.
Formula was given to the baby in order to bring up her glucose level. This nursing care
plan was successful because it was specific to the diabetic patient and had been proven
with evidence-based clinical guidelines.