A client with poorly controlled diabetes mellitus gives birth to a newborn at term gestation. When caring for the 2-hour-old newborn, which clinical finding requires the nurse to intervene?

Question

A client with poorly controlled diabetes mellitus gives birth to a newborn at term gestation.  When caring for the 2-hour-old newborn, which clinical finding requires the nurse to intervene?

Quizplus · Accepted Answer

Newborns whose mothers have diabetes mellitus are at increased risk for complications after birth, most commonly hypoglycemia but also hypocalcemia, hyperbilirubinemia, and respiratory distress syndrome. During intrauterine life, exposure to elevated maternal glucose levels causes the fetus to produce high levels of insulin. After birth, the newborn loses the maternal supply of glucose but continues to produce high levels of insulin, as during intrauterine life, increasing the risk of hypoglycemia (ie, blood glucose <40-45 mg/dL [2.2-2.5 mmol/L]). Symptoms of hypoglycemia, usually noted in the first several hours after birth, include jitteriness, irritability, hypotonia, apnea, lethargy, and temperature instability. Immediate intervention is required to prevent neurologic damage (Option C). (Option A) Cyanosis of the hands and feet (acrocyanosis) is a benign, transient finding during the transition to extrauterine life. (Option B) The newborn's heart rate should be assessed by auscultation of the apical pulse for a full minute. A normal heart rate for a newborn is 110-160/min but may increase to 180/min during crying or may decrease to 100/min during sleep. (Option D) The newborn's respiratory pattern should be assessed for one full minute. Normal newborn respirations are 30-60/min and decrease to an average of 40/min after the transition period. Educational objective: Newborns whose mothers have diabetes mellitus are at increased risk for hypoglycemia, especially in the first several hours after birth. A common symptom of newborn hypoglycemia is jitteriness. Newborn hypoglycemia requires immediate intervention to prevent neurologic damage.

A Client with Poorly Controlled Diabetes Mellitus Gives Birth to a Newborn