3.2 - Management of hypoglycaemia Flashcards

1
Q

EXAM

Identify risk a factors for the mother and fetus related to poor glycaemic control during pregnancy

A

polyhydramnios

  • preeclampsia
  • C/S
  • PPH
  • perinatal death
  • macrosomia (shoulder dystocia, perineal trauma)
  • birth trauma
  • neonatal hypoglycaemia, hypocalcaemia, magnesaemia
  • respiratory distress syndrome
  • hyperbilirubinaemia
  • neonatal polycythaemia

-baby starts producing it’s own insulin due to the increase glucose in the fetal circulation. when born excess glucose not available however baby still have insulin in their system

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2
Q

EXAM

Explain the role of the midwife in caring for the infant with hypoglycamia

A
  • routine bgl’s post birth
  • administer glucogel if required
  • Formula and EBM top ups
  • regular feeding plan
  • maintain temp
  • recognise deterioration
  • aim for bgl over 2.6
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3
Q

exam

Demonstrate an understanding of procedural pain and it’s management in the neonate

A
  • breast feeding at the time
  • glucose
  • S2S
    *
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4
Q

EXAM

Reflect upon safety factors in relation to administration of medications to the vulnerable neonate

A
  • 6 rights’s
  • double checking of drug/dose/patient
  • check to bedside
  • quiet area if possible
    *
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5
Q

Risk Factors

A
  • Decreased Hepatic glucose production/stores
  • Increase rate of glucose utilisation
  • Abnormalities of endocrine regulation
  • Inherited disorders
  • Other factors
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6
Q

Decreased hepatic glucose production/stores (inadequate substrate supply)

A
  • Reduced glycogen stores
  • reduced fat stores ie - Prem infant
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7
Q

Increased rate of glucose utilisation

A
  • cold stress
    • rapidly depletes brown fat stores
    • exhaustion of glycogen stores
  • Asphyxia
    • O2 supplies is limited so the infant relies on anaerobic metabolism for energy production
    • RDS prom ^WOB increases on the metabolic demand
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8
Q

Abnormalities of endocrine regulation

A
  • hyperinsulinaemia (excess insulin)
  • IDM (most cause of common cause of endocrine distrubance
  • Congenital hyperinsulinaemia
  • Beckwick-wiedemann syndrome
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9
Q

Inherited disorder

A

Syndromes:

  • Growth hormone or cortisol deficiency
  • Cogneital hypothyriodism
  • Congenital adrenal hyperplasia
  • trisomy 21

Metabolic disorders

  • checked on the NST
  • disorders associated with deficiencies of specific enzymes
  • glycogen store disease
  • Fructose 1 6 diphosphatase
    • hepatic deficiency which impacts gluconeogenesis
  • galactosemia
  • Maple syrup urine disease
    • It means the body cannot process certain amino acids (the “building blocks” of protein), causing a harmful build-up of substances in the blood and urine.
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10
Q

Other factors

A
  • infant with sepsis
  • Defectos of glucose transports
    • GLUT 1 and GLUT 2 deficiency
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11
Q

thermoregulation

A
  • S2S
  • Kangaroo care
  • dry wraps
  • hats
  • temp
  • large surface area
  • lack of subcutaneous fat
  • limited metabolic reserves
  • decreased ability to shiver
  • become cold quickly
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12
Q

Glycaemic control

A
  • glucose
  • breastfeeding
  • enteral feeding
  • intravenous dextrose
  • blood glucose levels
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13
Q

oxygen and respiratory status

A
  • acrocyanosis & peripheral cyanosis is a normal finding in neonates
  • more cyanosis means decrease O2 saturations
  • management
    • nasal cannulas
    • CPAP
    • Ventilation
  • physical assessment
  • oximetry
  • arterial blood gases
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14
Q

mentimeter

A
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15
Q

Neonatal blood glucose levels should be maintained in the scn

A

at or above 2.6mmol

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16
Q

Infants who are hypoglycaemic

A

can be asymptomatic

subtle

17
Q

A high pitched cry in the hypoglycaemic infant indicates

A

CNS excitation

cerebal irritation from lack of glucose

18
Q

Glycolysis

A

the breakdown of glucose into co2+ Ho2 and ATP

19
Q

Premature infants are at risk of hypoglycaemia due to

A

delayed feeding establishment

decreased glycogen stores and brown fat

increased likelihood of perinatal asphyxia and respiratory compromise

20
Q

What complication may arise from unresolved hypoglycaemia

A

seizures

21
Q

sucrose is thought to aid pain management for neonates by

A

stimulating b endorphins and dopamine and acetylcholine release

22
Q

PIPER stands for

A

paediatric infant perinatal emergency retrieval