Concurrent Disorders Flashcards
women with hyperthryoidism usually suffer what for the first 4-8 weeks of pregnancy
severe N/V
how is hyperthyroidism treated in pregnancy
PTU
how long does it take for PTU to reach its max effectiveness for the tx of hyperthyroidism
6-8 weeks
women with hypothyroidism have a high risk of what?
infertility
rupture
how is hypothyroidism treated in preg
synthroid
what lab level is monitored with hypothyroidism?
TSH
what nursing education needs to be stressed to women who are preg w/ hypothyroidism?
timeliness of med admin
strict adherence to meds
what is maternal phenylketonuria?
a high accumulation of phenylalanine in the moms blood, and a deficiency of phenylalanine hydrolase (enzyme)
what can maternal PKU cause?
mental retardation, birth defects, and heart disease in babies
what is the key prevention for PKU?
ID of women in their reproductive years and babies when they are first born
if a woman has PKU, can they breastfeed?
no
if a baby has PKU, can they breastfeed
yes
name cardiovasc changes that occur during preg
incr intravasc vol
decr systemic vasc resistance
CO changes during labor and birth
intravasc vol changes that occur just after birth
how is CV disease classified?
class I-class IV
class I CV disease
asympt @ normal actvity level
class II CV disease
sympt w/ ordinary activity
class III disease
sympt w/ decr ordinary activity
class IV disease
sympt @ rest
when is CV disease classification evaluated in a preg?
3 months and again @ 7 or 8
women with CV diseases have a higher risk of what?
miscarriages preterm birth and labor intrauterine growth restriction congenital heart lesions incr in babies decr CO to the baby
T/F- more and more heart transplant recipients are successfully completing pregnancies
True
if a woman is a heart transplant pt, what must they be assessed for before conception?
- qual of ventricular fx
- potential rejection of transplant
what delivery method is preferred for heart transplant moms?
vaginal
what delivery method is more common among heart transplant recip moms
C sec
how long should conception be post-poned for after heart transplant?
at least 1 yr
infants of heart transplant mothers may exhibit what during the 1st week of life?
immunosuppressive effects
if a mother is a heart transplant, they cannot breastfeed if they are taking which med?
cyclosporine
what may happen during a vaginal delivery of a heart transplant recipient?
- moms heart may have too much load
- mom becomes very tired
- HCP’s may have to use forceps or vaccuum to assist mom in labor
how does CPR in a pregnant woman differ from CPR in a reg pt?
- defib paddles must be placed one rib interspace higher than usual
what should be monitored during and after cardiac arrest of mom?
fetus
what are ther objectives for mothers who have asthma?
- relieve bronchospasm
- limit irritant stimuli
- decr pulm response to allergen exposure
- limit inflammatory response in airways
what should be at the bedside or nearby of a mom with asthma regardless of when their last attack was?
inhaler
if an infant or mother has CF, they will be ______ of the CF gene?
carriers
what is an important characterization of CF?
exocrine glands produce and release excessive viscous secretions
how does CF complicate a pregnancy?
- chronic hypoxia
- frequent pulm infections
- resp and digestive system problems
what GI disorders may affect mom during preg?
- cholelithiasis (gallstones)
- cholecystitis (inflamm of the gallbladder)
- IBD
what birth defects are related to epileptic meds?
cleft lip/palate
neural tube defects
what is a big concern/issue with epileptic moms?
failure to take medication
why do epileptic moms fail to adhere to their RX regime during preg?
- message that meds are harmful to the fetus
- risks to infants exxaggerated
what is the concern if mom seizes while pregnant?
- reduction of blood flow and O2 to the baby
what can be done for moms with MS?
- bed rest and steroids during exacerbations/ progression of the disease
what is Lupus Erythematosus?
autoimmune antibody production that affects skin, joints, kidneys, lungs, CNS, and other body organs
what is the concern for Lupus patients during preg?
immunosuppressive meds not reccommended during preg
what is the objective for care of Lupus patients?
reducing the risk of infections
what is super important for HIV + moms before conception (if possible)
preconception counseling
when is a mom tested for HIV in her preg?
@ 8 weeks
does pregnancy accelerate HIV/AIDS?
no
how can HIV transmission to baby be reduced?
-if mom stays on meds throughout preg
what groups are at an incr risk for HIV during preg?
-minority races and ethnicities
what do HIV moms have an incr risk for?
- concurrent infecs
- std’s
- sti’s
- PID
what factors affect how an HIV infected mother is treated?
- patient
- rship status
- their behaviors
- willingness to adhere to mgmt
what HIV med must preg take?
Highly Active Antiretroviral Therapy (HAART)
what else should HIV mothers be tested for?
- sti’s
- hepatitis
how should opportunistic infecs be treated in HIV mothers
meds specific to that infec
what is the absolute objective of care for HIV pregnancy?
decreasing the neonates exposure to mom blood and secretions
what medical precautions are taken during care of HIV preg?
standard precautions
what risks are assoc with smoking moms?
- bleeding complications
- miscarriage/stillbirth
- prematurity
- placenta previa
- placental abruption
- low birth weight
- SIDS
what barriers stop sub abuse moms from getting prenatal tx
- fear of losing custody of other kids or baby
- criminal prosecution
- sub abuse tx programs do not address issues affecting preg women
- long waiting lists and lack of health insurance
what is a realistic goal for treating sub abuse mom?
-decr sub abuse
when are women more likely to make lifestyle changes
during a pregnancy
T/F- there no meth tx for pregnant women
false- there is meth tx
when are sub abuse moms difficult to care for?
intrapartum
PP
are DM moms considered high risk?
yes
what is the best approach to tx for DM moms?
multidisciplinary
what is the key to optimum outcome for DM?
glucose control prior to and throughout preg
what is the primary fuel used by the fetus?
glucose
def Gest DM
any degree of glucose intol with onset or recognition during preg
what is the rship bx hormones and insulin during preg?
placental hormones work in opposition to insulin
important tx interventions of DM before preg?
- importance of adhering to a plan
- use of a dietary log
- glucose control before preg
what are serious risks/complications assoc w/ GDM?
ketoacidosis
hypoglycemia
ketoacidosis is assoc w/
hyperglycemia
when is a GDM mom at highest risk for hypoglycemia and why?
- early in the pregnancy
- hepatic production is diminished
- insulin/meds may need to be tweaked
- N/V
- decreased food intake by mom
- glucose transfer to embryo
insulin needs during the first trimester and why
- insulin needs reduced
- incr insulin production by the pancreas
- incr peripheral sens to insulin
insulin needs during 2nd trimester
- insulin needs incr
- placental hormones, cortisol, and insulinase act as insulin antagonists—> decr effectiveness of insulin
insulin needs during 3rd trimester
-gradually incr until approx 36 weeks
insulin needs on day of delivery
- insulin needs drop drastically to pre-preg levels
insulin needs of breastfeeding mothers
low insulin requirements
insulin needs of non-breastfeeding mother
insulin needs of pre-preg level within 7-10 days
insulin needs of mom who is weaning breastfeeding
insulin needs return to pre-preg levels
def macrosomia
big baby at birth
what is a macrosomic baby at risk for?
hypoglycemia
babies of diabetic mothers are at incr risk for
-sudden/unexplained still birth
- congenital problems
CNS
Cardiac defects
skeletal defects
diabetic mothers are at incr risk for what and what types?
-infections
UTI’s
yeast
what birth complication are GDM patients at risk for
-shoulder dystocia
what is the minimum glucose level of infants
40
T/F- there is extensive diabetic tx needed PP for a GDM mom
fasle- no diabetic tx needed
