Chapter 29

Question 1

Pregnancy with Diabetes Mellitus

Answer 1

Considered high risk

Key to an optimal outcome is strict glycemic control

Question 2

Effects of Diabetes Mellitus

Answer 2

Fetal growth acceleration, rise in placental hormone levels, insulin resistance

At birth, maintenance of normal maternal glucose levels is essential to reduce neonatal hypoglycemia

Question 3

Metabolic Changes Associated with Pregnancy

Answer 3

GLUCOSE CROSSES THE PLACENTA, INSULIN DOES NOT

INSULIN NEEDS INCREASE DURING THE FIRST TRIMESTER

ABOUT 10% OF PREGNANCIES HAVE PREEXISTING DM

Question 4

Neonatal Effects of Diabetes Mellitus

Answer 4

Hypoglycemia
Hypocalcemia
Hyperbilirubinemia
Respiratory distress syndrome

Question 5

Postpartum Care of Pregestational Diabetes Mellitus

Answer 5

FIRST 24 HOURS, INSULIN REQUIREMENTS DROP SUBSTANTIALLY

Risk of hemorrhage due to uterine distention

Question 6

Risk Factors for Gestational Diabetes Mellitus

Answer 6

Overweight
Maternal age older than 25
Previous birth outcome often associated with GDM
GDM in previous pregnancy
History of abnormal glucose tolerance
Family history of diabetes
Member of a high-risk ethnic group

Question 7

GDM Antepartum Care

Answer 7

Diet, exercise, self-monitoring of blood glucose, pharmacologic therapy, fetal surveillance

Question 8

GDM Intrapartum Care

Answer 8

Blood glucose monitored hourly in labor

Infusion of regular insulin

Question 9

GDM Postpartum Care

Answer 9

Will return to normal glucose levels after birth

Likely to recur in future pregnancies

Question 10

Hyperemesis Gravidarum

Answer 10

EXCESSIVE, PROLONGED VOMITING ACCOMPANIED BY WEIGHT LOSS, ELECTROLYTE IMBALANCE, NUTRITIONAL DEFICIENCIES, AND KETONURIA

Question 11

Initial Care for Hyperemesis Gravidarum

Answer 11

IV therapy for correction of fluid and electrolyte imbalances

Medications

Enteral or parenteral nutrition as a last resort

Question 12

Therapeutic Management of Hyperemesis Gravidarum

Answer 12

Promethazine (Phenergan)

Diphenhydramine (Benadryl)

Histamine-receptor antagonists

Gastric acid inhibitors

Metoclopramide (Reglan)

Ondansetron (Zofran)

Question 13

Hyperthyroidism in Pregnancy

Answer 13

Rare in pregnancy, usually caused by Graves’ disease

Heat intolerance, diaphoresis, fatigue, anxiety, emotional lability, tachycardia, weight loss, goiter, high pulse rate

Drug therapy is primary treatment

Question 14

Hypothyroidism in Pregnancy

Answer 14

Severe hypothyroidism is often associated with infertility and increased risk of miscarriage

Weight gain, lethargy, decrease in exercise capacity, cold intolerance

LEVOTHYROXINE is medication regimen