Ch 29, Endocrine and Metabolic disorders Flashcards
During the (__) and (__) trimesters, pregnancy exerts what effect on the maternal metabolic status?
During the (2nd) and (3rd) trimesters, pregnancy exerts a diabetogenic effect on maternal metabolic status
What does “Diabetogenic” mean?
Diabetogenic means “causing diabetes”
Major hormonal changes in the pregnant mother lead to a decreased tolerance to (________), increased (________) resistance, decreased hepatic (________) stores, and increased hepatic production of (________)
Major hormonal changes in the pregnant mother lead to a decreased tolerance to (glucose), increased (insulin) resistance, decreased hepatic (glycogen) stores, and increased hepatic production of (glucose)
Diabetes Mellitus refers to a group of metabolic diseases characterized by (_____)glycemia, resulting from defects in (_________) secretion, (_________) action, or both
Diabetes Mellitus refers to a group of metabolic diseases characterized by (hyper)glycemia, resulting from defects in (insulin) secretion, (insulin) action, or both
Insulin is produced by the (_____) cells in the (_____ __ _________) in the (__________)
Insulin is produced by the (beta) cells in the (islets of Langerhans) in the (pancreas)
Insulin regulates (_____ _______) levels by enabling glucose to enter (_______) and (______) cells, where it is used for energy
Insulin regulates (blood glucose) levels by enabling glucose to enter (adipose) and (muscle) cells, where it is used for energy
When insulin is insufficient or ineffective in promoting glucose uptake, glucose accumulates where?
Causing what?
Glucose accumulates in the bloodstream, causing Hyperglycemia
Type 1 DM accounts for what percentage of DM cases?
5-10% of all cases
Type-1 DM are caused primarily by the destruction of pancreatic (_____ ____) cells, and that are prone to (____________)
Type-1 DM are caused primarily by the destruction of pancreatic (islet beta) cells, and that are prone to (ketoacidosis)
People with type-1 DM are typically of (___) age, have (______) onset of illness, and have an absolute (_______ __________)
People with type-1 DM are typically of (young) age, have (abrupt) onset of illness, and have an absolute (insulin deficiency)
Type 2 DM account for what percentage of DM cases?
90-95%
Type 2 DM patients typically have insulin (__________) and usually relative insulin (__________)
Type 2 DM patients typically have insulin (resistance) and usually relative insulin (deficiency)
Gestational DM is defined as a (_______________) intolerance that develops during pregnancy and requires that (_____________) intolerance be identified by the (__) or (__) trimester.
Gestational DM is defined as a (carbohydrate) intolerance that develops during pregnancy and requires that (carbohydrate) intolerance be identified by the (2nd) or (3rd) trimester.
Pregestational DM occurs in what percentage of pregnancies.
10%
Almost ALL women with pregestational diabetes are insulin (__________) during pregnancy, and type (_) diabetes is more common
Almost ALL women with pregestational diabetes are insulin (dependent) during pregnancy, and type (_) diabetes is more common
Macrosomia, found in pregnant diabetic mothers, has been defined as a birth weight more than (_____ to ______) grams.
Macrosomia, found in pregnant diabetic mothers, has been defined as a birth weight more than (4000 to 4500) grams.
Infants born to women with diabetes tend to have a disproportionate increase in (________), (_____), and (_____) size
Infants born to women with diabetes tend to have a disproportionate increase in (shoulder), (trunk), and (chest) size
Children with Macrosomia cause increased risk for getting their shoulders stuck during birth, a situation known as what?
Shoulder dystocia
Due to the incidence of Macrosomia in DM, diabetic mothers face an increased risk for what type of birth?
Cesarian birth; C/section
Macrosomia occurs due to increased maternal (_______) levels. The fetal pancreas secretes (_________) between (__ and __) weeks in response to the mothers (______ _________) levels. That secreted insulin from the baby acts as a type of (__) for the baby, causing Macrosomia.
Macrosomia occurs due to increased maternal (glucose) levels. The fetal pancreas secretes (insulin) between (10 and 14) weeks in response to the mothers (blood glucose) levels. That secreted insulin from the baby acts as a type of (GH) for the baby, causing Macrosomia.
(____)hydramnios frequently develops in the (__) trimester in diabetic mothers.
(____)hydramnios is characterized by what fluid levels?
(Poly)hydramnios frequently develops in the (3rd) trimester in diabetic mothers.
Polyhydramnios is amniotic fluid in excess of 2L, or, an amniotic fluid index of more than 23cm
Why are infections more common in pregnant women WITH diabetes than pregnant women without diabetes?
Because infections love the increased blood sugar levels.
Infections in diabetic women cause increased (_________) resistance and may result in (_____________)
Infections in diabetic women cause increased (insulin) resistance and may result in (ketoacidosis)
Ketoacidosis is an accumulation of (________) in the (_____) resulting from (_____)glycemia and leading to metabolic (________)
Ketoacidosis is an accumulation of (ketones) in the (blood) resulting from (hyper)glycemia and leading to metabolic (acidosis)
DKA may occur with blood glucose levels barely exceeding what mg/dl?
200mg/dl
Despite the improvements in the care of pregnant women with diabetes, the perinatal mortality rate is (__) times higher in diabetic women than non-diabetic women, and (____) remains a great concern
Despite the improvements in the care of pregnant women with diabetes, the perinatal mortality rate is (3X) times higher in diabetic women than non-diabetic women, and (IUFD) remains a great concern
IUFD: Intra Uterine Fetal Demise
Congenital defects are a huge risk for diabetic pregnancies, especially the congenital abnormalities of the (____________) and (________) systems.
Congenital defects are a huge risk for diabetic pregnancies, especially the congenital abnormalities of the (cardiovascular) and (CNS) systems.
Hypoglycemia at birth is also a huge risk for diabetic mothers. What is hypoglycemia at birth?
Babies exposed to increased glucose levels in the womb secrete high insulin amounts. Upon birth, when their umbilical cord s cut, their glucose levels will drop very low
Baseline renal function in a diabetic pregnancy is assessed with what?
What two levels are being assessed in this test?
A 24-hour urine collection test
Levels being tested are:
-Protein excretion
-Creatinine clearance
What blood level may be measured in a diabetic mother to assess average recent glycemic control?
A1C levels
(Glycosylated Hemoglobin A1C)
What does an A1C test provide the nursing staff with a diabetic pregnancy patient?
A1C test provides a “diabetic report card”, meaning an evaluation of past glycemic control
During the (__) and (__) trimesters of pregnancy, routine prenatal care of a diabetic pregnancy are scheduled every (__ to __) weeks
During the (1st) and (2nd) trimesters of pregnancy, routine prenatal care of a diabetic pregnancy are scheduled every (1 to 2) weeks
TO achieve and maintain euglycemia (good glucose) it is important to know proper glucose levels. List the appropriate levels for each time of day:
Before breakfast:
Before lunch or dinner:
Postmeal (1hr):
Postmeal (2hr):
2 a.m. to 6 a.m.:
Before meals: 60-95mg/dl
Before lunch or dinner:60-105mg/dl
Postmeal (1hr): <140mg/dl
Postmeal (2hr): <120mg/dl
2 a.m. to 6 a.m.: >60mg/dl
A large bedtime snack of at least (__)g of (___________) with some protein or (____) is recommended to prevent (_____)glycemia and starvation (_________) during the night
A large bedtime snack of at least (25)g of (carbohydrates) with some protein or (fats) is recommended to prevent (hypo)glycemia and starvation (ketosis) during the night
The ideal diet for diabetic pregnancy is (__ to __)% carbs, (__)% protein, and (__)% fats.
The ideal diet for diabetic pregnancy is (33 to 40)% carbs, (20)% protein, and (40)% fats.
What is the encouraged activity time per day for a diabetic pregnancy?
30-60 minutes
When exercising, when should women record their blood glucose levels?
Before and after exercising
If a womans blood glucose is less than 100mg/dl, she should consume (__ to __) grams of (__________) to prevent (____)glycemia
If a womans blood glucose is less than 100mg/dl, she should consume (15 to 30) grams of (carbohydrates) to prevent (hypo)glycemia
Women should avoid exercise if they have the presence of urine (________) or a blood glucose greater than (____)mg/dl
Women should avoid exercise if they have the presence of urine (ketones) or a blood glucose greater than (200)mg/dl
In Insulin therapy, during the (__) trimester, from weeks (__ to __) of gestation, the insulin does should be reduced by (__ to __)% to avoid hypoglycemia
In Insulin therapy, during the (1st) trimester, from weeks (6 to 10) of gestation, the insulin does should be reduced by (10 to 25)% to avoid hypoglycemia
In insulin therapy, during the 2nd and 3rd trimesters, because of insulin resistance, the dose must be (_________) (__________) to maintain targeted glucose levels
In insulin therapy, during the 2nd and 3rd trimesters, because of insulin resistance, the dose must be (increased) (significantly) to maintain targeted glucose levels
Insulin requirements typically peak at how many weeks gestation?
36 weeks
Procedure for mixing NPH (Intermediate-Acting) and Rapid-Acting Insulin: (skipping checking expiration date)
1.) Gently (______) the insulin vial
2.) Draw into the syringe the amount of
(___) equal to the (____) dose
3.) Inject (___) equal to the (___) dose into
the (___) vial. Remove the syringe from
vial.
4.) Inject air equal to the rapid acting insulin dose into the vial, leave the syringe in the vial.
5.) (_______) the rapid acting vial and withdraw the dose
6.) Without adding more (___) to the (___) vial, withdraw the NPH dose
1.) Gently (invert) the insulin vial
2.) Draw into the syringe the amount of
(air) equal to the (total) dose
3.) Inject (air) equal to the (NPH) dose
into the (NPH) vial. Remove the syringe from vial.
4.) Inject air equal to the rapid acting insulin dose into the vial, leave the syringe in the vial.
5.) (invert) the rapid acting vial and withdraw the dose
6.) Without adding more (air) to the (NPH) vial, withdraw the NPH dose
For Fetal Surveillance to assure fetal well-being, after the ultrasound during your 1st trimester, follow-up ultrasounds are typically scheduled as often as every (_ to _) weeks to monitor fetal growth and abnormalities.
For Fetal Surveillance to assure fetal well-being, after the ultrasound during your 1st trimester, follow-up ultrasounds are typically scheduled as often as every (4 to 6) weeks to monitor fetal growth and abnormalities.
Women with pregestational diabetes are at a higher risk to have a fetus with congenital (_______) anomalies, so a fetal (________________) many be performed between (__ and __) weeks of gestation
Women with pregestational diabetes are at a higher risk to have a fetus with congenital (cardiac) anomalies, so a fetal (echocardiography) many be performed between (20 and 22) weeks of gestation
The preferred method to evaluate fetal well-being is what test?
When is this test usually performed and how often?
NST; Non-Stress Test
Performed at 32 weeks’ gestation and performed at least twice a week
During the Intrapartum stage, women with pregestational diabetes must be monitored for complications of (____________), hypo(__________) and hyper(___________)
During the Intrapartum stage, women with pregestational diabetes must be monitored for complications of (dehydration), hypo(glycemia) and hyper(glycemia)
In a pregestational diabetes pregnancy, once active labor begins, or the glucose level falls below 70mg/dl, an IV infusion containing (__)% dextrose should be piggybacked into the main IV line
In pregestational diabetes, during active labor, blood glucose levels should be checked how often?
Hourly
During active labor in a pregestational diabetes patient:
How should Insulin be infused?
What type of insulin should be infused?
What should the mothers blood glucose be maintained at?
Short-acting insulin should be infused by continuous infusion, piggybacked into the main IV line and titrated
Maintain glucose levels less than 110mg/dl
During the first 24 hours postpartum, insulin requirements (_______) substantially, because the main source of insulin resistance, the (________) hormones, are (__________)
During the first 24 hours postpartum, insulin requirements (decrease) substantially, because the main source of insulin resistance, the (placental) hormones, are (reduced)
Women with preexisting diabetes usually require only (___) to (___) of their most recent pregnancy insulin dose on the first postpartum day
Women with preexisting diabetes usually require only (1/3) to (1/2) of their most recent pregnancy insulin dose on the first postpartum day
What causes hemorrhaging to be a risk in diabetic postpartum complications?
The mothers uterus was overdistended, like in polyhydramnios, or macrosomia
or overstimulated from oxytocin
Are women with diabetes encouraged to breastfeed?
Yes, but apparently bottle is more common (according to Reid)
Women with GDM (Gestational diabetes Mellitus) have (________) risks than women with pregestational DM. However, the risks GDM have are still significant. Specify the risk percentages of each:
-Preeclampsia:
-Cesarean birth:
-Type 2 DM later in life:
Women with GDM (Gestational diabetes Mellitus) have (fewer) risks than women with pregestational DM.
-Preeclampsia: 9.8% if well controlled, 18% if not controlled
-Cesarean birth: 17-25%
-Type 2 DM later in life: 70%
Fetal risks as a result of maternal hyperglycemia are:
-Risk for neonatal (_______________)
-Risk for fetal Hyper(_________)
-Risk for neonatal (hypoglycemia)
-Risk for fetal hyper(insulinemia)
When are most women screened for GDM?
24-28 weeks
For blood glucose screening during prenatal care to test for GDM, ACOG recommends the 2-step screening method. What is the 2-step screening method?
-Mother drinks a 50g oral glucose load (OGTT: Oral Glucose Tolerance Test)
-1 hour later, her plasma glucose is measured
-A glucose value of 130-140mg/dl is considered positive
-After a positive result, a second 3-hour test is done with 100g of oral glucose taken on another day
During the 2nd step of the 2-step screening method for GDM, a patient is positive for GDM if two or more values are met or exceeded after ingesting the 100g oral glucose. List those values for each category:
Fasting:
1-hour
2-hour
3-hour
Fasting: 95mg/dl or 105mg/dl
1-hour: 180mg/dl or 190mg/dl
2-hour: 155mg/dl or 165mg/dl
3-hour: 140mg/dl or 145mg/dl
The standard diabetic diet for a pregnant patient involves intaking what amount of kcalories/day?
2000-2500 kcal/day
What is a typical schedule for
self-monitoring glucose daily?
Monitor/Record glucose when:
-Fasting
-1 or 2 hours after each meal
Pharmacological therapy is begun when despite nutritional/exercise therapy:
-Fasting plasma levels are persistently greater than:
-1-hour post-meal levels are persistently greater than:
-2-hour post-meal levels are persistently greater than:
-Fasting plasma levels are persistently greater than: 95mg/dl
-1-hour post-meal levels are persistently greater than: 140mg/dl
-2-hour post-meal levels are persistently greater than: 120mg/dl
What is the recommended pharmacological treatment drug for GDM?
Insulin
Aside from Insulin, what are 2 drugs used for blood glucose control in GDM?
-Metformin
-Glyburide
Metformin works by decreasing (_______) (_______) production and increasing peripheral (___________) to insulin
Metformin works by decreasing (hepatic) (glucose) production and increasing peripheral (resistance) to insulin
For women with GDM who have well-controlled blood glucose levels, (__________) fetal testing isn’t regularly performed unless there are signs of (_____________), a history of prior (________), or signs of macrosomia.
For women with GDM who have well-controlled blood glucose levels, (antepartum) fetal testing isn’t regularly performed unless there are signs of (hypertension), a history of prior (stillbirth), or signs of macrosomia.
If a woman with GDM has signs of hypertension, macrosomia, or a hx of prior stillbirth, at how many weeks gestation would NST be given?
What should they be monitored for?
32-weeks’ gestation
Monitored for polyhydramnios (a consequence of fetal hyperglycemia)
During the birthing process (intrapartum) blood glucose levels are monitored every (_ to _) hours to maintain blood glucose levels between (__ and ___) mg/dl
During the birthing process (intrapartum) blood glucose levels are monitored every (1 to 2) hours to maintain blood glucose levels between (80 and 110) mg/dl
Even though most women with GDM return to normal glucose levels after birth, up to (___) will have DM or impaired glucose metabolism during postpartum screening
Even though most women with GDM return to normal glucose levels after birth, up to (1/3) will have DM or impaired glucose metabolism during postpartum screening
Women with GDM have a chance as high as (___)% of developing type 2 DM within (__ to __) years
Women with GDM have a chance as high as (70)% of developing type 2 DM within (10 to 20) years
(______) and (________) complicate 50% to (__)% of all pregnancies and typically begin at 4 to (___) weeks gestation. Luckily, they are usually confined to (___) weeks gestation
(Nausea) and (vomiting) complicate 50% to (80)% of all pregnancies and typically begin at 4 to (10) weeks gestation. Luckily, they are usually confined to (20) weeks gestation
When vomiting during pregnancy becomes excessive enough to cause (______) loss, (___________) imbalance, nutritional deficiencies, and (_____)urea, the disorder is termed what?
When vomiting during pregnancy becomes excessive enough to cause (weight) loss, (electrolyte) imbalance, nutritional deficiencies, and (Keton)urea, the disorder is termed Hyperemesis Gravidarum
(___________) gravidarum occurs in 0.3% to (__)% of pregnancies and usually begins in the (__) trimester. (__)% of women unfortunately experience this throughout the pregnancy
(Hyperemesis) gravidarum occurs in 0.3% to (3)% of pregnancies and usually begins in the (1st) trimester. (10)% of women unfortunately experience this throughout the pregnancy
Several maternal characteristics are associated with developing hyperemesis gravidarum:
-(_______) Maternal Age
-(____)parity
-BMI of (______________)
-Low (_________________)
Several maternal characteristics are associated with developing hyperemesis gravidarum:
-(Young) Maternal Age
-(Nulli)parity
-BMI of (less than <18.5 or greater than >25)
-Low (socioeconomic status)
Women with asthma, migraines, hyperthyroid disorders, and psychological illness all have an increased risk of developing what pregnancy issue?
Hyperemesis Gravidarum
What are the 2 trademark signs for Hyperemesis Gravidarum (besides hyperemesis)
-Significant weight loss
-Dehydration
What are signs of dehydration in a woman with Hyperemesis Gravidarum?
-Dry mucous membranes
-Decreased blood pressure
-Increased pulse rate
-Poor skin turgor
Whenever a pregnant woman has nausea and vomiting, the most important initial lab test to screen for is a determination of what?
Ketonuria
Medications can be used if Nausea and Vomiting are out of control. What is the mainline drug of choice used for tx of N/V in pregnancy?
Diclegis
What is the drug Diclegis used for, and what is it a combination of?
Diclegis is used for N/V treatment in pregnant woman
Diclegis is a combination of pyridoxine (Vitamin B6) and doxylamine (Unisom)
What are the other 3 brand name drugs for the tx of N/V in pregnancy?
-Benadryl
-Zofran
-Reglan
Avoiding an empty stomach helps fight Hyperemesis Gravidarum. How frequently should you eat?
What should you separate and how often should you alternate?
Eat every 2-3 hours
Separate liquids from solids and alternate every 2-3 hours
The thyroid undergoes physiological changes during pregnancy, including an increase in (____) and an increase in T3 and T4 production levels of (___)%.
The thyroid undergoes physiological changes during pregnancy, including an increase in (size) and an increase in T3 and T4 production levels of (50)%.
Why is diagnosis hyperthyroidism in pregnancy difficult?
Because many of the signs and symptoms of hyperthyroidism (nausea, anxiety, fatigue, increased heart rate) are all common pregnancy experiences
Hyperthyroidism in pregnancy is rare, with a rate between 0.4% and (__)% of births. In most cases, Hyperthyroidism in pregnancy is caused by (______) disease
Hyperthyroidism in pregnancy is rare, with a rate between 0.4% and (1.7)% of births. In most cases, Hyperthyroidism in pregnancy is caused by (graves) disease
S/S of Hyperthyroidism are:
-(_____) intolerance
-(________)sis
-Fatigue
-Anxiety
-(_________) Lability
-(_____)cardia
-(Heat) intolerance
-(Diaphore)sis
-Fatigue
-Anxiety
-(Emotional) Lability
-(Tachy)cardia
What are 3 signs to differentiate Hyperthyroidism from Pregnancy?
-Weight loss
-Goiter
-Pulse rate greater than 100 beats/min
The two primary drugs used to treat Hyperthyroidism in pregnancy are?
-PTU (propylthiouracil)
-MMI (methimazole)
Hypothyroidism complicates between 0.2% and (__)% or pregnancies, so its even more rare than hyperthyroidism. Hypothyroidism is also associated with (____________) and risk of miscarriage.
Hypothyroidism complicates between 0.2% and (1.2)% or pregnancies, so it’s even more rare than hyperthyroidism. Hypothyroidism is also associated with (infertility) and risk of miscarriage.
Characteristic symptoms of hypothyroidism are:
-Weight (_____)
-Lethargy
-(_________) in exercise (__________)
-(_____) intolerance
-Weight (gain)
-Lethargy
-(Decrease) in exercise (tolerance)
-(Cold) intolerance
What is used to treat Hypothyroidism?
Thyroid hormone supplements like Synthroid (Levothyroxine)
What is the goal of drug therapy for Hypothyroidism?
To maintain the TSH level at the lower end of the normal range for pregnant women
Phenylalanine Hydroxylase (PAH) Deficiency is a sign of cognitive impairment. It is an inborn error of (__________) that is caused by an (___________) recessive trait that creates what?
Phenylalanine Hydroxylase (PAH) Deficiency is a sign of cognitive impairment. It is an inborn error of (metabolism) that is caused by an (autosomal) recessive trait that creates insufficient activity in PAH, an enzyme
An inadequate amount of or abnormal activity of the PAH enzyme impairs the body’s ability to do what?
Metabolize the amino acid Phenylalanine that is found in all protein foods
What toxic effect occurs in the body due to PAH deficiency?
The body cannot metabolize Phenylalanine found in protein, which causes a toxic buildup of PHA in the bloodstream, which interferes with brain development
Experts recommend that maternal PHA levels be less than (__)mg/dl for at least (__) months before conception, and range between (__) and (__) mg/dl throughout pregnancy
Experts recommend that maternal PHA levels be less than (6)mg/dl for at least (3) months before conception, and range between (2) and (6) mg/dl throughout pregnancy
If breastfeeding safe for women with PHA deficiency?
Yes, as long as the baby DOESN’T ALSO have the deficiency
