Excellence in Care: Diabetes and Pregnancy

Transcription

1 Excellence in Care: Diabetes and Pregnancy Laura Abbey RN, BSN, MA, CDE INDEPENDENT STUDY Health Professions Institute for Continuing Education Austin Community College

2 The Austin Community College Health Professions Institute, Continuing Education 5930 Middle Fiskville Road, Austin, TX INDEPENDENT STUDY: Excellence in Care: Diabetes and Pregnancy Description and Purpose: Laura Abbey RN, BSN, MA, CDE appears with Alyssa Monacelli RN, BSN, instructor and coordinator with the Health Professions Institute of Austin Community College (ACC), to discuss current clinical management of diabetes and provide an overview on current medications used to treat the disease. Ms. Abby is the Diabetes Center Program Coordinator at St. David s Medical Center in Austin, Texas and brings over 15 years of nursing experience in the field of diabetes education. The purpose of this activity is to enrich the participant s contribution to quality healthcare and the pursuit of professional career goals by providing current and updated information on gestational diabetes and how nurses can assist clients in the management of the disease throughout the gestational period. This offering is a self-paced learning activity developed to meet the individual needs of nurses, social workers, and emergency medical services personnel requiring continuing education for relicensure. Goals and Objectives: Upon completion of this activity, the student will be able to: 1. Define Gestational Diabetes Mellitus (GDM). 2. Identify risk factors for GDM. 3. Discuss the classifications of Diabetes during pregnancy. 4. Describe recommendations for treatment of GDM including medical nutrition therapy. 5. Explain the types of devices available for insulin delivery. 6. Discuss how to manage diabetic ketoacidosis (DKA). 7. Identify postpartum prevention of Type 2 diabetes. 8. Explore resources available for current information related to diabetes and GDM. Requirements for Successful Completion: The packet you have received contains a pre-test, DVD, post-test and a program evaluation. To successfully complete this activity and earn continuing education the participant must: 1. Complete the pre-test 2. View the DVD 3. Complete the post-test (score an 80 or more) 4. Use your computer to locate two (2) additional professional websites where nurses can go to obtain current information about Gestational Diabetes Mellitus (GDM). 4. And, complete the evaluation

3 NOTE: Following the viewing of the DVD and completing the accompanying documents, questions may be addressed by contacting Elizabeth or eahuss@austincc.edu Submit all of the documents (pre/post-test, resources assignment, and evaluation) along with your completed Registration Form (check or credit card), and payment to: Austin Community College Health Professions Institute Attn: Online Nursing Videos 5930 Middle Fiskville Rd. Austin, TX Fax: Within two business weeks from receipt of your material at ACC, your certificate of completion will be available (to be mailed, fax, or picked up at the above address your choice). Upon successful completion participants will be awarded a certificate of successful completion worth 2.0 contact hours. Austin Community College is an approved provider of continuing nursing education by the Texas Nurses Association, an accredited approver by the American Nurses Credentialing Center s Commission on Accreditation. Contact hours for programs applicable to social work are approved for CEU s by the Texas State Board of Social Worker Examiners. This program is worth 2.0 contact hours or 0.2 continuing education units (CEU s). Continuing education for Emergency Medical Personnel is approved by the Texas Department of State Health Services. This program is worth 2.0 TDH (P) contact hours. Disclosure to Attendees: The presenters and planning committee members for this offering have completed Conflict of Interest forms and it has been determined that no conflict of interest exists or has been indentified in relation to this offering. Commercial Support: This offering has not received any commercial support. Non-endorsement of products: The discussion of generic or brand name items or medications does not constitute endorsement by the American Nurses Credential Center s Commission on Accreditation (ANCC), the Texas Nurses Association (TNA) or Austin Community College. Off-Label Use: Off-label use of medications refers to the prescribing of medications to treat a condition for which the medication has not been approved by the Food and Drug

4 Administration. Medications presented in this activity will only be discussed in the context of their Federal Drug Administration (FDA) approval. Expiration: This continuing nursing education activity (Diabetes and Pregnancy) will expire on June 1, 2013.

5 Printed Name: Date: Address (where you would like to receive your certificate of completion): City: State: Zip code: Birth Year: Birth Month: Instructions: Complete this pre-test PRIOR to watching the video. Choose the best answer by circling the letter corresponding to your choice. Submit your post-test, completed evaluation, completed registration, and payment to: Austin Community College Health Professions Institute Attn: Online Nursing Videos 5930 Middle Fiskville Rd. Austin, TX Fax: Instructions: Choose the best answer Pre-Test: Diabetes and Pregnancy 1. Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance first recognized during pregnancy. According to the video, the onset is usually identified during what gestational period? a weeks b weeks c weeks d weeks 2. Risks factors for GDM are similar to risk factors for Type II diabetes and include: a. Ethnicity, History of still birth b. BMI >25, History of GDM c. Family History, History of Polycystic Ovarian Syndrome d. All of the above are risk factors

6 Pre-Test Diabetes and Pregnancy Con t 3. High risk candidates for GDM include women having: a. one (1) risk factor b. no identified risk factors other than being pregnancy c. two (2) or more risk factors d. None of the above 4. According to the video, the literature suggests that pre-existing diabetic women who are on long-acting insulin (Lantis) should be placed on regular insulin during pregnancy. a. True b. False 5. There are two (2) types of GDM. Type A2 maintenance requires: a. Insulin administration or other medications; diet modification and meal planning b. Diet modification only c. Physical activity only d. Diet modification and physical activity only 6. Complications associated with poorly controlled GDM include: a. hypertension b. pre-eclampsia c. increased risk for developing type 2 diabetes d. all of the above 7. Complications for the baby of uncontrolled GDM include: a. Low birth weight; hyperglycemia; RDS b. Low birth weight; hypoglycemia; RDS c. Macrosomia; hypoglycemia; hyperbilirubinemia d. Macrosomia; hyperglycemia; hypobilirubinemia 8. Hypoglycemia unawareness, which occurs in diabetics, is defined as: a. Loss of the ability to recognize hyperglycemia symptoms b. Loss of the ability to recognize hypoglycemic symptoms c. Increased unawareness of hyperglycemic episodes d. Increased awareness of hypoglycemic episodes

7 Pre-Test Diabetes and Pregnancy Con t 9. American Diabetic Association (ADA) recommends the following prior to becoming pregnant for individuals with diabetes: a. No additional recommendations are made for individuals with pre-existing diabetes prior to pregnancy b. Evaluation for complication associated with exiting diabetes c. Family, planning, Normal blood glucose levels without hypoglycemia, prenatal care d. Both b and c 10. One major disadvantage associated with administration of oral hypoglycemic agents during pregnancy is that most of these agents have not been approved by the FDA for GDM. a. True b. False 11. When is a glucose challenge test is performed to screen pregnant women for GDM? a weeks b week c weeks d. Never 12. Medical nutrition therapy for women with GDM includes all of the following except: a. Appropriate weight gain; Normoglycemia b. A Carbohydrate controlled meal plan c. Avoiding foods high in saturated fat d. limit water intake and incorporate high glycemic index foods 13. Protocol for managing DKA (diabetic ketoacidosis) during pregnancy includes all of the following: a. Correcting volume depletion; continuous fetal monitoring b. Insulin infusion; blood glucose monitoring c. Correcting electrolyte imbalances; treat precipitating factors d. All of the above are part of a DKA protocol for pregnant women

8 Pre-Test Diabetes and Pregnancy Con t 14. Women with GDM are at increased risk of developing diabetes one (1) to two (2) years following delivery. a. True b. False 15. Benefits for breast feeding in women with GDM following delivery include all of the following except: a. Breast feeding is thought to help the pancreas improve function following delivery b. Assist mother in burning calories and promoting weight loss c. Promote lower cholesterol levels in mom and baby d. May lower the baby s risk for diabetes

9 Written: Pre-Test Excellence in Care: Diabetes and Pregnancy Program Outline DVD Presentation: I. Introduction to Gestational Diabetes Mellitus (GDM) A. Statistical review of incidence of GDM B. Definition of GDM II. Risk Factors for Developing GDM III. Classifications of Diabetes during Pregnancy A. Women with no preexisting Diabetes b. Women with Preexisting Diabetes IV. Complications of Uncontrolled Diabetes during Pregnancy V. Treatment for GDM A. American Diabetes Association Recommendations B. Recommendations for Women with Preexisting Diabetes before Pregnancy C. Insulin vs. Oral Hypoglycemic Medications D. Screening for GDM E. Treatment Plan- Medical Nutrition Therapy VI. Insulin Injections and Insulin Pumps A. Types of Delivery Devices B. Candidates for an Insulin Pump C. Potential Complications with Insulin Pumps VII. Managing DKA during Pregnancy VIII. Postpartum Period A. Risks for Developing Type II Diabetes B. Risks to Baby C. Breastfeeding D. Prevention and/or Delay of Type II Diabetes IX. Resources Written: Post-Test Evaluation

10 Evaluation Title of Education Activity: Excellence in Care: Diabetes and Pregnancy Location: DVD Video Format time Date: Participants check out and complete on own Purpose of this Activity: The purpose of this activity is to enrich the participant s contribution to quality healthcare and the pursuit of professional career goals by providing current and updated information on gestational diabetes and how nurses can assist clients in the management of the disease throughout the gestational period. Directions/Instructions: Please complete this evaluation questionnaire. Your anonymous responses will be used to revise this activity and to plan future educational activities. Circle the number that best fits your evaluation of this activity. 1 = Not at all 2 = Somewhat 3 = Almost completely 4 = Completely 1. Rate your achievement of these objectives: 1. Define Gestational Diabetes Mellitus (GDM) Identify risk factors for GDM Discuss the classifications of Diabetes during pregnancy Describe recommendations for treatment of GDM including medical nutrition therapy Explain the types of devices available for insulin delivery Discuss how to manage diabetic ketoacidosis (DKA) Identify postpartum prevention of Type 2 diabetes Explore resources available for current information related to diabetes and GDM Rate the effectiveness of the teaching/learning resources?

11 Diabetes and Pregnancy Eval. Pg Please evaluate the guest speaker- Laura Abbey RN, BSN, MA, CDE a. Knowledge and currency of topic b. Ability to make points clear c. Ability to apply content to practice Please evaluate the moderator- Alyssa Monacelli RN, BSN a. Guides the discussion b. Asks pertinent questions c. Fosters clarification of presented information Were the objectives relevant to the overall purpose? (see above) 6. How long (in minutes) did it take you to complete the entire activity (including taking the pre-test, watching the video, taking the post-test, and completing this evaluation tool)? Minutes 7. List two (2) ways you will integrate what you learned in this activity into your practice and/or employment environment. 8. The following were disclosed prior to the beginning of this activity either in writing or verbally? a. Requirements for successful completion Yes No b. Conflicts of Interest Yes No c. Commercial Support Yes No d. Non-endorsement of Products Yes No e. Off-label Use Yes No 9. Did you, as a participant, notice any bias that was not previously disclosed in this presentation? Yes No If Yes, please describe who was biased and how.

12 Diabetes and Pregnancy Eval. Pg Comments: If you answered (1) to any of the above, please comment. 11. Please list any suggestions or topics for future programming.

13 Printed Name: Date: Address (where you would like to receive your certificate of completion): City: State: Zip code: Birth Year: Birth Month: Instructions: Complete this post-test after watching the video. Choose the best answer by circling the letter corresponding to your choice. Submit your post-test, completed evaluation, completed registration, and payment to: Austin Community College Health Professions Institute Attn: Online Nursing Videos 5930 Middle Fiskville Rd. Austin, TX Fax: Instructions: Choose the best answer Post-Test: Diabetes and Pregnancy 1. Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance first recognized during pregnancy. According to the video, the onset is usually identified during what gestational period? a weeks b weeks c weeks d weeks 2. Risks factors for GDM are similar to risk factors for Type II diabetes and include: a. Ethnicity, History of still birth b. BMI >25, History of GDM c. Family History, History of Polycystic Ovarian Syndrome d. All of the above are risk factors

14 Post-Test Diabetes and Pregnancy Con t 3. High risk candidates for GDM include women having: a. one (1) risk factor b. no identified risk factors other than being pregnancy c. two (2) or more risk factors d. None of the above 4. According to the video, the literature suggests that pre-existing diabetic women who are on long-acting insulin (Lantis) should be placed on regular insulin during pregnancy. a. True b. False 5. There are two (2) types of GDM. Type A2 maintenance requires: a. Insulin administration or other medications; diet modification and meal planning b. Diet modification only c. Physical activity only d. Diet modification and physical activity only 6. Complications associated with poorly controlled GDM include: a. hypertension b. pre-eclampsia c. increased risk for developing type 2 diabetes d. all of the above 7. Complications for the baby of uncontrolled GDM include: a. Low birth weight; hyperglycemia; RDS b. Low birth weight; hypoglycemia; RDS c. Macrosomia; hypoglycemia; hyperbilirubinemia d. Macrosomia; hyperglycemia; hypobilirubinemia 8. Hypoglycemia unawareness, which occurs in diabetics, is defined as: a. Loss of the ability to recognize hyperglycemia symptoms b. Loss of the ability to recognize hypoglycemic symptoms c. Increased unawareness of hyperglycemic episodes d. Increased awareness of hypoglycemic episodes

15 Post-Test Diabetes and Pregnancy Con t 9. American Diabetic Association (ADA) recommends the following prior to becoming pregnant for individuals with diabetes: a. No additional recommendations are made for individuals with pre-existing diabetes prior to pregnancy b. Evaluation for complication associated with exiting diabetes c. Family, planning, Normal blood glucose levels without hypoglycemia, prenatal care d. Both b and c 10. One major disadvantage associated with administration of oral hypoglycemic agents during pregnancy is that most of these agents have not been approved by the FDA for GDM. a. True b. False 11. When is a glucose challenge test is performed to screen pregnant women for GDM? a weeks b week c weeks d. Never 12. Medical nutrition therapy for women with GDM includes all of the following except: a. Appropriate weight gain; Normoglycemia b. A Carbohydrate controlled meal plan c. Avoiding foods high in saturated fat d. limit water intake and incorporate high glycemic index foods 13. Protocol for managing DKA (diabetic ketoacidosis) during pregnancy includes all of the following: a. Correcting volume depletion; continuous fetal monitoring b. Insulin infusion; blood glucose monitoring c. Correcting electrolyte imbalances; treat precipitating factors d. All of the above are part of a DKA protocol for pregnant women

16 Post-Test Diabetes and Pregnancy Con t 14. Women with GDM are at increased risk of developing diabetes one (1) to two (2) years following delivery. a. True b. False 15. Benefits for breast feeding in women with GDM following delivery include all of the following except: a. Breast feeding is thought to help the pancreas improve function following delivery b. Assist mother in burning calories and promoting weight loss c. Promote lower cholesterol levels in mom and baby d. May lower the baby s risk for diabetes Resources Assignment: Use your computer to locate two (2) additional professional websites where nurses can go to obtain current information about Gestational Diabetes Mellitus (GDM). You may not submit the resources provided in the student packet/handout for this independent study (American Diabetes Association and American Dietetic Association). Website: Retrieval Date: Brief Description of Information Provided: Website: Retrieval Date: Brief Description of Information Provided: