2 diabetes, Pku, Iron Deficiency Flashcards
Type 1 vs type 2
Gestational vs pregestational
Type 1: absolute insulin deficency
Type 2: realtive insulin deficiency, resistance
Gestational: didnt have it prior to pregnancy
Pregestational diabetes: has type 1or2 DM prior to pregnancy
Diabetes 1st half of pregnancy
(Pregestation)
N/V
Decreased need for insulin
Placenta not fully developed (hPL not present)
Diabetes 2nd half of pregnancy
(Pregestational)
Placenta full developed (hPL leads to increased cell resistance to insulin)
-lead to maternal hyperglycemia and hyperinsulinemia
Allow glucose and aminoacids to be available for fetus
Will need more insulin to control hyperglycemia
Mangement of pregestational DM
-increases what
-tx
-1st vs 2/3rd trimester
Increases risk for miscarriage and anomalies
Balance of diet, exercise, monitoring
More freq prenatal visits
1st: less insulin needed/risk of hypoglycemia
2nd/3rd: more insulin needed due to metabolic changes
-risk of hyperglycemia
Pregestational and gestational diabetes mellitus maternal risks
Hypo/hyperglycemia
Ketoacidosis
Pre-eclampsia (vascular changes caused by diabetes)
Pre and gestational diabeyes fetal risk
Polyhydramnios (too much sugar)
IUFD (intrauterine fetal demise(death)
Macrosomia (>4000g) big baby
Congential malformations (pregestational only)
Hypoglycemia after birth (need glucose in 1st of life)
Respiratory distress syndrome
RF of GDM
Obesity
FH of DM
Prior Hx of GDM
HTN (high cholesterol)
Nursing assessment
Findings s/s of diabetes
3 p’s (polydipsia, polyuria, polyphagia)
Infections (UTIs, yeast, infections)
Polyhydramnios (increased fundal height)
Nursing assessment
Screening
Screening can begin sooner if risk exist
Urine screening at every prenatal visit
Glucose tolerance test
GDM care management
How to do a gtt
When is it done
1: chug drinks
2: lab drawn
Done 24-28wks
1hr GTT 130-140 if higher do a 3hr GTT
Nursing care & management of diabetes
Monitor what two things
Monitor fasting and postprandial glucose (after you eat)
-FBS or before meals 60-90 mg/dl
-2hrs <120 (after you eat)
Diabetes management in pregnancy
Insulin
Oral
Monitor (2)
Insulin: injections or pump
Oral hypoglycemia
Monitor blood sugar: administer insulin as needed
Monitor fetal status:
For pregestational not gestational bc its not diagnosed yet:
-screening for anomalies with first anatomical ultrasound around 20 wks
-daily kick counts
-by wk 32: weekly/biweekly US,NST, BPP
Intrapartum care management
Induce when
Htn is what
How to assess lung maturity and when
Blood glucose checked when and goal
Look for signs of what
Induction at 39-40 wks:
HTN, non-reassuring fetal status
Lung maturity: check by amniocentesis if <38wks
Blood sugar checked on admission and as needed during labor typically q1-2hrs with a goal of 90-110
(Look for mother sign of hypoglycemia in gestational diabetes since mom used more glucose in labor)
Postpartum care management
Gestational vs pregestational
Gestational
Return to normal glucose after birth
Recur in future pregnancies
More likely to develop diabetes later in life
pregestational
-Once baby is gone insulin need goes down so make sure to lower it or theyll be at risk of hypoglycemia
-monitor blood sugars regularly
PKU (phenylketonuria) in preg
Absence of enzyme that allows phenylalanine to be metabolized
Toxic levels = cognitive impairment in fetus
Controlled by low protein diet (low in phenylalanine)
