Chapter 20: Selected Health Conditions And Vulnerable Populations Flashcards
Diabetes type 2
Insulin resistance or deficiency from obesity, sedentary,
Adults over 30 but now in kids
90%
Type 1 diabetes
Absolute insulin deficiency due to autoimmune, before 30, 10%
Gestational diabetes mellitus
Glucose intolerance with onset during pregnancy. Complications include macrosomia, hypoglycemia, birth trauma, preeclampsi, c-section.
Pregnancy causesincrease peripheral resistance to insulin and an compensatory increase in insulin secretion. Placental hormones can cause insulin resistance at a level that tends to parallel the growth of the fetus-placenta. hPL (human placental lactogen) and somatotropin ( growth hormone). Normally the pancreas responds and maintains glucose levels. Peaks in last trimester when fetus needs lots of nutrients.
Impaired fasting glucose
Hyperglycemia at lower level than qualifies for diabetes. 100-125 fasting
Blood 140-199 after 2 hours glucose tolerance test
No symptoms of diabetes
Newborns LGA
Normal fasting levels
fasting<140
Teaching guidelines for diabetes in the pregnant woman
Keep appointments.
Perform glucose checks before each meal and at bedtime. Call provider with any levels outside the range.
Perform daily fetal kick counts.
Drink 8 to 10 glasses of water each day.
Wear proper footwear.
Exercise.
Breast-feed to lower your blood glucose
If on insulin give at the correct time every day, eat breakfast within 30 minutes, plan meals and snacks.
Avoid simple sugars.
Know signs and symptoms of hypoglycemia and treatment. These include sweating, tremors, cold, clammy, headache, hungry, blurred vision, disorientation, irritability. Trtmt: 8 oz milk and 2 crackers or glucose tablets
Carry glucose basters such as Lifesavers to treat hypoglycemia. Know signs and symptoms of hyperglycemia and treatment. These include dry mouth, frequent urination, thirsty, rapid breathing, tired, flushed, hot skin, headache, drowsiness. Treatment: call doc
Wear bracelet
Wash hands
Report illness or dehydration
Diabetic management
Screen urine for protein, key tones, leukocyte, evaluate kidney function, eye examinations, HBA1C. Monitor fetus with ultrasound to monitor growth, activity, amniotic fluid volume, and validate age
Macrosomia
A newborn with excessive birthweight over 4000 g or 8 pounds 13 oz or greater than 90% for gestational age. There is an increased risk for shoulder dystocia, traumatic birth injury, asphyxia. They may have hypoglycemia, hypomagnesium, polycythemia, electrolyte disturbance.
Uncontrolled blood sugars can cause complications. It can result from hyperinsulinemia stimulated by fetal hyperglycemia
Oral hypoglycemic medications for women
Insulin does not cross the placenta. Insulin is based on the women’s weight
Glyburide (diabeta) and Metformin do not cross placenta so will not cause fetal hypoglycemia. Outcomes similiar to insulin. Need nutritional counseling. Saftey of oral is still being studied.
Glycosylated hemoglocin HbA1c
Measurement of the average glucose levels during the last 100 to 120 days is crucial to achieve the best pregnancy outcome.
Less than 7% indicate good control.
Greater than 8% indicates poor control.
Defects can occur by the eighth week of gestation, preconceptual counseling is critical. Common malformations include renal, cardiac, skeletal, and CNS.
HIV therapy
The purpose is to decrease the viral load as much as possible for the HIV-positive patient with drug therapy. Antiretrovirals given bid from 14 weeks gestation until birth, IV during labor, and oral syrup for newborn first 6 weeks of life.
Antiretrovirals treatment to prevent mother to child transmission. Do not encourage breast-feeding. HIV women are at risk for preterm delivery, premature rupture of membranes, Hemorrhage, postpartum infection, poor wound healing, UTIs.
The newborn is at risk for prematurity, IUGR, low birth weight, and infection.
C-section is performed before the onset of labor and ROM. Decision should be based on womans viral load, duration of ROM, and progress of labor.
Cocaine, alcohol, marijuana,
study torch sheet
Cocaine
Vasoconstriction, gestational hypertension, abruptio placenta, abortion, snow baby syndrome, CNS defect, IUGR
Marijuana
Anemia, inadequate weight gain, amotivational syndrome, hyperactive startle reflex, newborn tremors, prematurity, IUGR
Alcohol
Spontaneous abortion, in adequate weight gain, IUGR, fetal alcohol spectrum disorder, the leading cause of intellectual disability
FASD: Attention deficit, inability to see consequences, inability to learn from previous experiences, poor memory and reasoning, thin upper lip, small head circumference, small eyes, low nasal bridge, short palpebral fishers, short nose, flat face, receding jaw, epicanthal folds. brain, craniofacial, heart defects, neurotoxicity, immune dysfuntion.
Risk: Age, socioeconomic status, ethnicity, poor nutrition, late prenatal care, depression, family disorganization
Cardiac decomposition
Decomposition refers to the heart inability to maintain adequate circulation. Tissue perfusion in the mother and fetus is impaired. The pregnant woman is most vulnerable from 28 to 32 weeks of gestation and in the first 48 hours postpartum.
Assess for shortness of breath on exertion, dyspnea, cyanosis, sweating, jugular vein engorgement, rapid respirations, abnormal heartbeat, heart racing or palpitations, chest pain with effort or emotion, fainting, increased fatigue, a moist frequent cough. It is vital to assess this because a moms hemodynamic status determines the health of the fetus.
Chronic hypertension
Woman has high blood pressure before pregnancy or before 20 weeks of gestation, or when it persists longer than 12 weeks after birth. The patient should be seen every two weeks until 28 weeks. After that, weekly until birth. After 24 she needs to document fetal movement.
DASH diet: adequate potassium, mg, calcium. Limit sodium to 2.4 g.
Exercise, quit smoking, avoid alcohol, rest in left recumbent position.
Meds for Asthma during pregnancy
The goal is to prevent hypoxic episodes to preserve continuous fetal oxygenation. Medications include inhaled corticosteroids which are the preferred for the management of all levels during pregnancy. Budesonide (inhaled corticosteroid), albuterol (short acting beta2 agonist, salmeterol (long acting beta2 agonist).
Contraindicated with asthma are Cytotec and hemabate which are used for cervical ripening and pp hemorrhage. They can cause bronchospasm.
Oral corticosteroids are not recommended.
Iron in pregnancy
Foods high in iron: meats, green leafy, legumes, dried fruits, whole grains, peanut butter, fortified cereal, bean dip. Consume with foods high in vitamin C. It can cause constipation so increase exercise, fiber, and fluids.
Iron deficiency anemia is usually related to any dietary intake.
Consequences include preterm delivery, perinatal mortality, postpartum depression, low birth weight, and poor mental and psychomotor performance. Iron supplementation starts at a dose of 30 mg per day beginning at the first prenatal visit.
Group B strep
All pregnant women are screened during 35 to 37 weeks of gestation and treated. Penicillin G is the treatment of choice. Given IV 4 hours before birth.
It can cause newborn pneumonia, meningitis, and sepsis.
