Maternal POC part 2 - Michigan



Beneficiary:      

Diabetes (Type 1, 2 and Gestational)

| | | |

|INTERVENTION LEVEL |RISK INFORMATION |INTERVENTIONS |

| | |Using Motivational Interviewing techniques, complete the following interventions: |

| | | |

| | |Refused all interventions |

| | | |

| | |For Low and Moderate risk levels |

|LOW |Diabetes and receiving care. | |

|Date:       | |Ask beneficiary about diabetes management. |

| |Client has: |Date 1st Addressed:       |

| |Type 1 | |

| |Type 2 |Discuss importance of controlling diabetes during pregnancy and/or postpartum. |

| |Current Gestational Diabetes |Date 1st Addressed:       |

| |History of Gestational Diabetes | |

| | |Discuss possible pregnancy complications: |

| | |Date 1st Addressed:       |

| | |Increased blood pressure |

| | |Infant weight gain/large for gestational age |

|MODERATE |Diabetes and not receiving care. |Increased risk of early preterm delivery |

|Date:       | |Increased risk of cesarean section |

| |Client has: | |

| |Type 1 |Discuss possible infant complications: |

| |Type 2 |Date 1st Addressed:       |

| |Current Gestational Diabetes |low blood glucose |

| |History of Gestational Diabetes |low blood calcium |

| | |high bilirubin (jaundice) |

| |In care for diabetes but noncompliant |breathing difficulties |

| | | |

| | |Encourage regular monitoring of blood glucose and follow meal plan recommendations. |

| | |Date 1st Addressed:       |

| | | |

| | | |

| | | |

| | |Advise regarding the importance of making all medical care appointments and following medical care provider |

| | |recommendations. |

| | |Date 1st Addressed:       |

| | | |

| | |Follow up to assure appointments are scheduled and kept. |

| | |Date 1st Addressed:       |

| | | |

| | |Assist with referral to Diabetes Educator. |

| | |Date 1st Addressed:       |

| | | |

| | |Refer to Registered Dietitian. |

| | |Date 1st Addressed:       |

| | | |

| | |Assist client in developing a safety plan in case of uncontrolled blood sugars. |

| | |Date 1st Addressed:       |

| | |Wear ID bracelet to identify that she is diabetic. |

| | |Help identify a support person to administrate necessary medication if unconscious and call 911. |

| | |Contact provider immediately if blood sugar level not within recommended range. |

| | |Aware of own high/low blood sugar symptoms. |

| | | |

| | | |

| | | |

| | |Call 911. |

| |At imminent risk due to life threatening diabetic |Date 1st Addressed:       |

| |complications | |

|EMERGENCY Date:       | |Inform MHP. |

| | |Date 1st Addressed:       |

| | | |

| | |Inform medical provider. |

| | |Date 1st Addressed:       |

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