Alterations In Antepartum Flashcards by Bailey Pontius

Leading cause of death in US

Cardiovascular Disorder

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Increased possibility of mom and/or fetus suffering harm, damage, loss, or death

High-risk pregnancies

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A chronic endocrine disorder of carbohydrate metabolism, results from inadequate production OR utilization of insulin/resistance to insulin

Diabetes Mellitus (DM)

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What will woman not be able to do if they have Diabetes Mellitus?

Women cannot meet need for essential nutrients for fuel and storage

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What is insulin produced by?

Beta cells of islets of Langerhans in pancreas

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How does insulin lower glucose levels?

By enabling glucose to move from blood into muscle, liver, and adipose tissue cells

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Where is glucose stored?

In liver as glycogen

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What does glucagon do?

Stimulates breakdown of stored liver glycogen into glucose –> bloodstream
Also stimulates synthesis of glucose for amino acids

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Etiological classifications of DM

Type 1 DM
Type 2 DM
Impaired glucose tolerance/fasting glucose
Gestational DM

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Absolute insulin deficiency (due to autoimmune process); usually occurs before age of 30; appox 10% have this type

Type 1

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Insulin resistance or deficiency; primarily in adults over 30, but now being seen in children; 90% of diagnosed cases

Type 2

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Glucose intolerance with its onset during pregnancy or first detected in pregnancy

Gestational diabetes Mellitus

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Classifications of DM in Pregnancy

Pregestational diabetes (type 1 or 2)

2. Gestational diabetes

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What kind of complications could you see with a mother that has Pregestational Diabetes?

Retinopathy, nephropathy, neuropathy, CV disease, HTN

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What risks come up with a mother with gestational diabetes

Risk of macrosomia, hypoglycemia, birth trauma, and mom in preeclampsia, C/S

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Big babies often get _____ trauma at birth

Shoulder

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What is macrosomia

Newborn with excessive birth weight. Fetus > 4,500 grams

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What is concern with gestational diabetes?

That it may progress to Type 2 DM

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High blood glucose lead to what three things?

Cellular dehydration, glycosuria, extracellular dehydration

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What are four classic symptoms of DM

Polyuria, polydipsia, polyphagia, weight loss

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Pathophysiology of DM

Pancreas doesn’t produce sufficient amounts of insulin, poor carbohydrate metabolism, glucose cannot move into cells it remains in bloodstream, body cells become energy depleted, fats and proteins are oxidized for energy, wasting of body’s fat and muscle tissue

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What in cells is oxidized for energy in some one with DM

Fats and protein

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What can happen with wasting of body’s fat and muscle tissue in DM

Ketosis from fat breakdown and negative nitrogen balance with protein breakdown

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How does pregnancy affect Diabetes Mellitus

Physiologic changes alter insulin requirements

- may increase difficulty with DM control

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What hormones affect DM? How?

Rise in progesterone, estrogen, Human Placental Lactogen, and Growth Hormone (somatotropin) *they increase insulin resistance, especially the last 20 weeks

Insulin needs are _______ in the early 1st trimester. Why?

Decreased! hPL low, minimal embryo demands, less food consumed, N/V may occur

When do insulin requirements increase? When do they peak?

Increase late 1st trimesters and peak in last trimester

Why is insulin not sufficient especially in second trimester?

Placenta secretes hPL (antagonist), decidua produces prolactin, Growth Hormone, increased cortisol and glycogen ***so we see increased PVR to insulin and the process that makes insulin available to the fetus

What is Hydramnios?

Excessive fluid

PROM

Premature Rupture of Membrane

What does it mean if we say cord prolapse?

Umbilical cord falls through before baby and could cut off circulation

Complications for mom with DM

Hydramnios, Ketoacidosis, gestational HTN, hypoglycemia, preterm labor after PROM, stillbirth, chronic monilial vaginitis, difficult labor

Complications for fetus with DM

Cord prolapse with hydramnios, congenital abnormalities, macrosomia, birth trauma, preterm labor, fetal asphxia, perinatal death, polycythemia, RDS

What are the 4 categories that can put a women at high risk for pregnancy

Pre-existing medical disorders Social/personal Obstetric/ previous pregnancy CuRrent pregnancy

How many pregnant women have cardiovascular disorders

Although very few women die during pregnancy as result of heart disease what does happen

Experience other complications like HF, arrhythmias, stroke

What kind of offspring does a women with cardiovascular disorders have

Premature, lbw, RDS, IVH, death

Women with cardiovascular disorders ______ (can/cannot) have a successful pregnancy

Can

What conditions need to avoid pregnancies

Tetralogy of fallot Transposition of great vessels Eisenmengers syndrome

Why is pregnancy hard for women with cardiovascular disorders

Normal adaptions that pregnant women make are harder to make for their heart

What kind of adaptations that most pregnant women have to make are hard for women with cardiovascular disorders to make

Increased workload Increased blood volume Increased cardiac output

Class I cardiovascular disorder

Uncompromised | A symptomatic

Class II cardiovascular disorder

Slightly compromised | Some fatigue, palpitation, anginal pain

Symptoms of abortion

Pelvic/abdominal cramping Bleeding Passage of products of conception

What are two meds you would give to a person having an abortion

Rhogam | Anything to produce uterine contractions

How is an ectopic pregnancy formed

Implantation of fertilized ovum outside uterus

Where is the most common site for an ectopic pregnancy

Fallopian tube

There are multiple causes for an ectopic pregnancy one being a drug called diethylstilbestrol (DES) what is this drug used for

Was used for nausea | Women whose mothers were given this drug while pregnant are more susceptible to have an ectopic pregnancy

What are symptoms of and ectopic pregnancy

``` One-sided abdominal pain No menses until 1-2 months Internal and external bleeding Referred right shoulder pain Hcg increases slowly ```

What must you do for a ruptured ectopic pregnancy

Medical emergency& pregnancy loss

Gestational trophoblast disease

Hydatidiform mole- benign neoplasm of chorion

Common sign for hydatidiform mole

Vaginal bleeding Often brownish but sometimes bright red

What are the two types of gestational trophoblastic disease

Complete and partial

Complete gestational trophoblastic disease

Develops from "empty" egg being fertilized with normal sperm

What is the risk with complete gestational trophoblastic disease

Choriocarcinoma

Partial gestational trophoblastic disease

Normal ovum fertilized by 2 sperms or 1 sperm without chromosome 46

Symptoms of gestational trophoblastic disease

Vaginal bleeding Anemia Hydrops vesicles Rapid enlargement of abdomen

What is one thing that elevated hcg's could mean

Choriocarcinoma

Why must you treat choriocarcinima immediately

Could metastasize to lung, lower genital tract, brain, and liver

Class III cardiovascular disorders

Markedly compromised Excessive fatigue, dyspnea, palpitation, anginal pain Comfortable at rest

Class IV cardiovascular disorders

Severely compromised Cannot do physical activities w/o anginal pain Symptomatic at rest

What class of cardiovascular disorders should avoid pregnancy

Class IV

How is a pregnant women with cardiovascular disorder have different doctor visits than normal

More assessments | Every 2 weeks until 36 weeks and then every week until birth

What are factors that could cause strain on a pregnNt women with cardiovascular disorders

Infection Anemia Pyelonephritis Weight gain

What are our goals of nursing care with a pregnant women with a cardiovascular disorder

Early diagnosis | Stabilization of maternal hemodynamic status

What are 4 ways as nurses we can help a pregnant women with cardiovascular disorders.

More frequent visits Educate her to increase understanding Decrease anxiety and stress Talk to support systems

What are some nutritious foods to tell a women with cardiovascular disorders to keep in mind

``` Iron Protein Low sodium Adequate calcium High fiber ```

If you see in a clients chart that she is having testing done soon what should you do

Prepare them for it and warn them and tell them all the good that it will do for the baby and the pregnant mother

Is the nursing care for a pregnant women with cardiovascular disorder over when she delivers

No | Post-partal care is just as important as antepartal

a condition that results in an increased level of circulating red blood cells in the bloodstream

Polycythemia

What could be wrong if your infant is showing symptoms of irritability and occasional tetany?

Hypocalcemia

Immature liver cannot metabolize increased bilirubin resulting from polycythemia

Hybilirubinemia

Care goals DM patient

Minimize risks of disease to achieve healthy mom and newborn, maintain glycemic control, nutritional management, exercise

What is medication of choice in pregnancy and lactation

Insulin

Goal for Pregestational DM fasting glucose

Equal to or less than 126 mg/dL

Goal for gestational DM @ 24-28 weeks fasting glucose

Less than 92 mg/dL

What is good control for Glycosylated hemoglobin HbA1c level?

Less than 7%

Measurement of average glucose levels during past 100-120 days

Glycosylated hemoglobin HbA1c level

What does a high HbA1c level correlate with? Greater than what level?

Correlates with fetal congenital anomalies. Greater than 10% correlates with 20-25% anomalies

What type go insulins don't cross placenta?

Short acting like lispro (Humalog) and aspart (NovoLog). Oral hypoglycemics like metformin and glyburide

What can you use to evaluate fetal status with DM

Alpha fetoprotein, fetal movement, NST, biophysical profile in nonreactive NST, Ultrasound, amniocentesis

What would you do if mother with DM had nonreactive NST?

Biophysical profile

Normal L/S ratio? What would you see with diabetic?

2/1 | Would see higher with diabetic

What would you do to get L/S ratio in DM patient? What do you want it to be ?

Amniocentesis for L/S ratio (2-3.5). Want it to be higher to deliver the baby

How should you store insulin

Cool temperature

What may insulin needs do following delivery

Decrease because fetus no longer there and hormones change

What should you teach postpartum mom about sexual activity

Use barrier methods for BC. Don't want her to get pregnant and don't want her to take BC

Why do insulin needs fall postpartally

Fall in hPL, progesterone, and estrogen levels