Alterations In Antepartum Flashcards
Leading cause of death in US
Cardiovascular Disorder
Increased possibility of mom and/or fetus suffering harm, damage, loss, or death
High-risk pregnancies
A chronic endocrine disorder of carbohydrate metabolism, results from inadequate production OR utilization of insulin/resistance to insulin
Diabetes Mellitus (DM)
What will woman not be able to do if they have Diabetes Mellitus?
Women cannot meet need for essential nutrients for fuel and storage
What is insulin produced by?
Beta cells of islets of Langerhans in pancreas
How does insulin lower glucose levels?
By enabling glucose to move from blood into muscle, liver, and adipose tissue cells
Where is glucose stored?
In liver as glycogen
What does glucagon do?
Stimulates breakdown of stored liver glycogen into glucose –> bloodstream
Also stimulates synthesis of glucose for amino acids
Etiological classifications of DM
Type 1 DM
Type 2 DM
Impaired glucose tolerance/fasting glucose
Gestational DM
Absolute insulin deficiency (due to autoimmune process); usually occurs before age of 30; appox 10% have this type
Type 1
Insulin resistance or deficiency; primarily in adults over 30, but now being seen in children; 90% of diagnosed cases
Type 2
Glucose intolerance with its onset during pregnancy or first detected in pregnancy
Gestational diabetes Mellitus
Classifications of DM in Pregnancy
- Pregestational diabetes (type 1 or 2)
2. Gestational diabetes
What kind of complications could you see with a mother that has Pregestational Diabetes?
Retinopathy, nephropathy, neuropathy, CV disease, HTN
What risks come up with a mother with gestational diabetes
Risk of macrosomia, hypoglycemia, birth trauma, and mom in preeclampsia, C/S
Big babies often get _____ trauma at birth
Shoulder
What is macrosomia
Newborn with excessive birth weight. Fetus > 4,500 grams
What is concern with gestational diabetes?
That it may progress to Type 2 DM
High blood glucose lead to what three things?
Cellular dehydration, glycosuria, extracellular dehydration
What are four classic symptoms of DM
Polyuria, polydipsia, polyphagia, weight loss
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
What in cells is oxidized for energy in some one with DM
Fats and protein
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
How does pregnancy affect Diabetes Mellitus
- Physiologic changes alter insulin requirements
- may increase difficulty with DM control
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
3%
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
