NU143 Unit 2 Case Study Analysis Example

A Glucose Screen of 152 at Twenty-Six Weeks: A Case Study Analysis Interpreting a Second-Trimester Prenatal Visit for a Composite 34-Year-Old in Her Second Pregnancy, From the Screening Result to the Next Test and Teaching

[Student Name]

Purdue University Global

NU143: Maternal Infant Nursing

Unit 2 Case Study Analysis

[Instructor Name]

[Date]

The patient is composite; values are bracketed where illustrative, and thresholds vary by practice, so the provider's protocol governs.

The Visit

[Mrs. L.], a composite 34-year-old office manager, is gravida 2, para 1. Her first baby weighed [4,050] g at birth. She is now [26] weeks. Body mass index before pregnancy [31]. Today: blood pressure [118/72], weight gain [7.5] kg so far, fundal height [26] cm, fetal heart rate [145], urine negative for protein, reports good fetal movement. Her one-hour glucose challenge, a 50-gram glucose drink with a blood draw an hour later, without fasting, came back at [152] mg/dL. Her practice uses a cutoff of [140].

Interpreting Each Finding

Blood pressure normal and no protein in the urine: no sign of a hypertensive disorder today, though these are checked at every visit because preeclampsia usually appears after 20 weeks (American College of Obstetricians and Gynecologists, 2020). Fundal height matches gestational age in centimeters within about two: growth appears appropriate. Fetal heart rate within the normal range, and active movement: reassuring. Weight gain: within the range usually advised for her pre-pregnancy weight at this stage.

The glucose challenge result is the finding that needs action. Pregnancy hormones from the placenta increase insulin resistance as pregnancy advances, which is why screening is done at 24 to 28 weeks, when that effect becomes significant. She also has risk factors for gestational diabetes: age over 30, a body mass index over 30 and a previous large baby (Perry et al., 2022).

Why the Screen Is Not a Diagnosis

The one-hour test is designed to be sensitive, so it catches most women with gestational diabetes but also flags many without it. A result above the cutoff means she needs a diagnostic test, not that she has the condition. Many practices use a two-step approach: the one-hour screen, then a three-hour test after fasting with a 100-gram drink, diagnosing gestational diabetes when two or more values are above set thresholds. Others use a single two-hour test with a 75-gram drink (American Diabetes Association Professional Practice Committee, 2024).

Telling her she has diabetes today would be wrong; telling her the screen means she needs one more test is accurate and less frightening.

The Next Step

Her three-hour test is scheduled within the week. She is told to eat her usual diet for three days beforehand, without cutting carbohydrates, since restricting them can distort the result, and to fast overnight before the test. Blood will be drawn fasting and at one, two and three hours after the drink, and she should stay seated and not eat, smoke or exercise during the test.

Why It Matters

If gestational diabetes is confirmed, untreated high glucose can lead to a large baby, birth injury, a cesarean birth, newborn low blood sugar and higher blood pressure in pregnancy. Treatment with diet, activity and, if needed, medication reduces those risks. Women who have had gestational diabetes also have a higher lifetime risk of type 2 diabetes, so testing after birth is part of care. For Mrs. L., a positive result would also mean closer monitoring of her baby's growth, since her first baby was already large, and a referral to a diabetes educator to plan meals she can keep up with a toddler at home.

Teaching at This Visit

She learns what the screen means and does not mean, how to prepare for the three-hour test, and the signs that would prompt a call before her next visit: headaches, vision changes, swelling of the face or hands, decreased fetal movement or bleeding. She asks whether she did something wrong; the nurse explains that the hormones of pregnancy cause the change, and that her history makes screening especially useful.

What the Nurse Watches For Until the Test

Between today's visit and the diagnostic test, nothing urgent is expected, but the nurse checks that she understands two practical points. First, she should not start a strict low-carbohydrate diet on her own before the test, both because it can produce a falsely normal result and because her baby still needs steady nutrition. Second, if the test is delayed by more than a week or two, she should call, since diagnosis and treatment are most useful when they begin early in the third trimester. The nurse also notes her previous large baby on the chart so that growth is watched closely at the next visits regardless of the test result, and confirms she has a way to get to the laboratory for a three-hour appointment, since transport and work schedules are a common reason the test is missed.

Nursing Priorities

Accurate explanation of the result to reduce anxiety; ensuring the diagnostic test is done promptly; continued routine prenatal surveillance, including blood pressure and fetal movement.

References

American College of Obstetricians and Gynecologists. (2020). Gestational hypertension and preeclampsia (Practice Bulletin No. 222). Obstetrics & Gynecology, 135(6), e237-e260. https://doi.org/10.1097/AOG.0000000000003891

American Diabetes Association Professional Practice Committee. (2024). 15. Management of diabetes in pregnancy: Standards of care in diabetes 2024. Diabetes Care, 47(Suppl. 1), S282-S294. https://doi.org/10.2337/dc24-S015

Perry, S. E., Hockenberry, M. J., Cashion, K., Alden, K. R., Olshansky, E., & Lowdermilk, D. L. (2022). Maternal child nursing care (7th ed.). Elsevier.