1) Baby P.J. is the newborn of a patient with gestational diabetes. When will you first check P. J.'s capillary blood sugar? a) Immediately after birth b) Only if P.J. is symptomatic c) Within the first few hours after birth (preferably after the first feed) per protocol d) Upon transfer to postpartum care 2) P.J.'s initial capillary BG is 46 mg/dL at 90 minutes old after an initial feed that lasted about 20 minutes. He was awake/alert during the feed with a latch score of 8/10 due to full staff assist. P.J. is now sleeping while skin-to-skin with his mother. What is the appropriate next step for hypoglycemia management? a) Administer glucose gel, as he is hypoglycemic  b) Check a blood sugar prior to the next scheduled feeding in 2-3 hours c) Draw a serum blood glucose level d) Wake P.J. up because he needs to eat more 3) After P.J. and his family transfer to postpartum care, you provide instruction for the parents to call you before the next feed so that you can check P.J.'s blood sugar. Prior to the next feed, you obtain a capillary BG of 48 mg/dL. P.J. is well-appearing, demonstrating feeding cues like rooting and lip smacking. What is the appropriate next step for hypoglycemia management?  a) Provide lactation support   b) Check a blood glucose level prior to the next feed in about 3 hours  c) Monitor for signs and symptoms of hypoglycemia d) All of the above 4) P.J.'s parents call you about 3 hours later, saying that he is not waking up for the next feed. Upon assessment, P.J. is responsive to stimulation, but appears lethargic with decreased muscle tone. His vital signs are WNL. You check a capillary blood glucose and it is 22 mg/dL. What is (are) the next appropriate step(s) in hypoglycemia management (select all that apply)?  a) Notify the provider  b) Administer glucose gel or IV glucose c) Supplement with expressed milk, donor milk or formula d) Monitor blood glucose after treatment per protocol e) Continue stimulating P.J. until he wakes up to eat 5) What is the purpose of administering glucose gel or IV glucose to a baby that is hypoglycemic? a) To sustain glucose levels between feeds b) To correct hypoglycemia by quickly increasing plasma levels of glucose  6) What is the purpose of supplementing glucose gel or IV glucose with expressed milk, donor milk or formula in neonatal hypoglycemia management? a) To sustain glucose levels between feeds b) To correct hypoglycemia by quickly increasing plasma levels of glucose  7) After glucose gel administration and supplementing per protocol, P.J.'s next blood sugar is 48 mg/dL. What is the next appropriate step in hypoglycemia management?  a) Provide lactation support b) Check a blood glucose level prior to the next feed in about 3 hours c) Monitor for signs and symptoms of hypoglycemia d) All of the above

Glucose Homeostasis in the Newborn

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