Diabetes part 2/ Hyperemsis/ PKU Flashcards
After delivery, the the doctor says mom’s insulin needs will drop. Why is this?
Well once she delivers the placenta, the hormones that inhibited insulin from working are no longer there.
After delivery, how much should you monitor mom’s BG?
If mom still needs to be on insulin after delivery, in what nature will this be?
Do so frequently. Don’t want to forget about it. She’s not out of the woods
She’ll be on insulin sliding scale until it stabilizes
Diabetic mom asks if she can breast feed her baby? What is your response?
If diabetic mom then says she is taking oral agents, does that affect whether she can breast feed or not now?
Of course she can. The breastfeeding can actually help control her BS
If she is taking oral agents like metformin or glysurbide, then no she can’t. It’ll cross over to breast milk
You assess mom’s breast and she reports having mastitis. What is this and why might she have it?
Mastitis is a breast infection. It comes from Nipple breakdown and staph getting in.
After mom gives birth you do bring up mom’s family planning details. She says she wants to use a form of BC. What do you recommend?
Barrier methods are a great option.
Otherwise, she needs to stick to progesterone only products like Depoprovera.
After delivery, when will they re-check FBS?
6 weeks postpartum
Major risks for diabetic mom following delivery?
Hemorrhage, infection, preeclampsia (can even start after delivery)
What is the action of glucagon?
So your patient has been hypoglycemic (low blood sugars) for the past couple days. Should you give them glucagon?
Releases the stored glycogen from the liver
No you shouldn’t.
Glucagon only helps release stored liver but if they’ve been low sugared for a couple days, they won’t even have any glucose stored left.
Give them fresh glucose instead!
- honey under tongue
- if able to swallow, give them oral glucose
What is key about managing diabetic patients?
Educate them on the disease process of diabetes & how to manage their glucose
- if you do this, this makes sure they have all the info they need to be successful
Educate on how to use insulin too
What are easy ways for mom to assess the fetus well being?
Kick counts
Who is more likely to comply: 35 year old having first child or 16 yr old ?
35 year old
- the adolescent ages aren’t as mature and so they don’t
Why is emotional support so important for diabetic PG moms?
They are at risk for complications and this can give someone anxiety.
A mom comes in complaining of severe n/v. What is this condition called?
Hyperemesis Gravidarum
What is Hyperemesis Gravidarum?
Mom having severe N/V in PG
Causes of Hyperemesis Gravidarum?
Very unclear ….
High levels of hCG from chorion villi
High estradiol levels (substrate of level)
Lower levels of prolactin
Displacement of GI tract
Thyroid changes
Genes
Psychological reason due to stress
- not all mom’s want a PG
- diabetes and PG is stressful in itself
Does having multiple gravidas put you at greater risk of hyperemesis?
Actually no - it is the nulliparous or women who have never given birth who tend to be at higher risk for n/v.
Do older women or younger women have more risk for hyperemesis?
Younger, adolescent women
A mom carrying twins comes in and says she is having extreme nausea and vomiting. What is you education?
Mom’s carrying twins or having multiple gestations are are higher risk for hyperemesis (n/v).
A mom with a molar pregnancy comes in saying she is experience a lot of n/v. What is your response?
Molar pregnancy’s or the type of pregnancies that aren’t real, tend to have more hyperemesis.
How can eating disorders affect how you handle pregnancy?
How do you as the nurse handle this?
Mom’s with anorexia in their history may not want to eat bc gaining weight is hard for them and make them feel nervous to the point they accidentally purge.
Explain that she needs to eat for her baby.
Who is more at risk of hyperemesis:
A mom who has never had hyperemesis or one that has?
A mom who has had hyperemesis before.
Who is more at risk of hyperemesis:
Mom with no history of hyperemesis in her family or mom with sisters who’ve had it
Family history is important so mom who has had sisters have it is at more risk of hyperemesis
What will mom’s weight look like if she has hypereemsis?
She will be losing weight
What will mom’s hydration status be with hyperemesis?
Mom will be dehydrated and her skin turgor will be poor
What Labs do yo anticipate if mom is hyperemesis?
CBC Electrolytes are off Liver enzymes elevated Bilirubin elevated Thyroid function
- these changes can be deadly
With hyperemesis, what will moms urine labs and trends be like
Ketonuria and oliguria (less urine output)
What physiological changes are happening to mom with hyperemesis (that sort of line up with lab)?
Muscle wasting
Hepatic and renal damage w/o tx
- Jaundice
Bleeding disorders
Vitals that can occur with hypereemsis?
Hypotension and tachycardia
- think about it, they have less fluid and blood volume
Mom with hyperemesis gravidarum had Metabolic Alkalosis first. Then she had Acidosis later on.
Why is this?
She is throwing up and loses stomach acid (ph of 2).
A patient with hyperemesis gravidarum asks if her condition can be harmful to her or her baby. As the nurse, what do you say?
Be honest and say yes, hyperemesis can have deadly alterations
You have a hyperemesis mom. How do you anticipate her being treated?
Status she might have to go on?
- Antiemetics like zofran, reglan, Phenergan
- Benadryl for rest
- IV vitamins due to not getting enough
- Electrolytes
- Antacids, histamine blockers, and ppi
NPO status
What home remedies can mom use to help with hyperemesis that you suggest?
Coke products
Ginger
Protein at bed time
Nursing assessment duties for Hyperemesis that you know you should do for MOM?
- Assess her emesis
- Administer her meds
- Log intake and output
- Monitor her weight
- Assess mom’s vitals
- Her emotions
- Jaundice or bleeding!!!
Nursing assessments for hyperemesis you do for fetus?
- Assess FHR
Mom with hyperemesis develops yellow tinting in her skin and eyes. Why is this?
Her liver enzymes and bilirubin have increased
What should you provide for mom with hyperemeiss?
- Give a quiet environment
- Emotional support should be given
- could have abusive relationship! this is common
If mom is a frequent flyer for hyperemesis, what might we consider?
Psych issues could be going on
And she may be looking for safety from abuse
What do we make sure mom is doing before she is dismissed from hospital for hyperemesis?
We need to make sure she can eat and drink okay.
If she can’t, she’ll just end up back here.
Hyperthyroidism is a common result of _____.
Graves disease
If mom has hyperthyroidism, what will her pG symptoms be like?
Exaggerated
Heat intolerance Diaphoresis Fatigue Anxiety Irritable Tachycardia!!
PG mom has hyperthyroidism. You know which labs were the diagnosis she had?
Elevated t4 and t3 but more importantly, a decreased TSH.
What are independent symptoms of hyperthyroidism that may occur in PG (shouldn’t be hap?
weight loss
goiter
tachycardia (we should never be this in pg)
Mom asks what are possible risks to her baby since she has hyperthyroidism. Your response?
If left untreated -
spontaneous abortion - sab
preterm labor
baby born with a thyroid disorder too
What activity level orders do you anticipate for a hyperthyroid diagnosed PG mother?
Bedrest and decreased activity
Antithyroid drugs to treat hyperthyroidism in pregnancy include
1st trimester
2nd and 3rd trimester
What side effects happen with all of these antithyroid meds?
When will these meds be stopped?
What will dosage be like?
1st trimester - PTU or propylthiouracil
2nd & 3rd trimester - Methimazole MMI
- you can breast feed with this one
SE: pruritus and skin rash but can be treated with moisturization
Around 32-36 weeks to decrease fetal effects
small most effective dose
Doctor explains that the antithyroid meds for _________ condition may cause what for the newborn?
antithyroid meds treating hyperthyroidism
may cause the newborn to have a suppressed thyroid
- goiter, bradycardia, iugr
Medication you’ll be giving to hyperthyroid mom for tachycardia?
What will happen if the doctor doesn’t treat the tachycardia?
Inderal Propanolol
Mom can have pre-eclampsia and then heart failure
Will they ever give radioactive iodine for PG hyperthyroid mom?
No - it will destroy the fetus’s thyroid
Again use PTU and MMI instead
Surgical option to treat hyperthyroidism in PG if mom isn’t able to take the medications? Trimester this has to be done?
Subtotal Thyroidectomy in the 3rd trimester
Is mom always gonna have hyperthyroidism before pregnancy?
Actually no. The thyroid increases 25% in PG and so when you get PG you can be diagnosed
Mom is taking 45 mg/day of antihyperthyroid meds. . Can she breast feed?
how should doses be taken?
When do you take the antihyperthyroid meds in relation to breastfeeding?
No she can’t. Only breastfeed if it less than 20 mg.
Divided
Take meds AFTER you breast feed.
Wait 3-4 hrs to breast feed.
What labs are monitored once baby is born if mom has hyperthyroidism?
T4 levels for hypothyroidism possibility
What is Hypothyroidism ? Labs?
Opposite of hyperthyroidism.
Labs will show a decrease in t3 & t4. Increase in TSH.
What does hypothyroidism do to you basal metabolic rate?
What other related condition might happen with hypothyroidism
Decreased BMR rates
Goiter
What lack of substance can cause hypothyroidism?
Is it common in the US?
Iodine insufficiency
Uncommon bc we have iodized salt
So what is the most common cause of hypothyroidism in US?
explain
Hashimoto’s thyroiditis
Hashimotos is when the thyroid gland is destroyed by autoantibodies
Mom comes in and complains of not being able to get pregnant. What might be the reason for this?
If so, what will her labs be like
Hashimotos rt hypothyroidism
- it is very common for this to happen
decrease t3 or t4 but more importantly an elevated TSH
Hypothyroidism symptoms?
Decreased fertility Exhausted Overweight Skin is dry and cold Constipated Hair loss Brittle nails
Hormone replacement treatment used for hypothyroidism?
What should the hormone/med not be taken with?
Thyroxine levothyroxine Synthroid
Do not take with iron bc that reduces absorption.
PG Mom want to know the risks if she allows her hypothyroidism to go untreated?
Miscarriage rate of 50% Hypertension Preterm labor Placenta abruptio Stillbirth possibility Goiter for baby Neuro defects of baby Low birth wieght
After delivery, when do newborns get screened for thyroid disorders?
Only after 24 hrs of age and after a feeding
New mom says her hyperthyroid med were reduced after PG. She came in 6 weeks later to get her tsh levels drawn up and they were elevated. What will be done?
She will be told to take a higher dosage again
What is PKU and how did it happen?
Phenyl Ketone Urea
When you can’t convert phenyl to tyrosine due to not having the liver enzyme phenyl. hydrolase.
And so the phenyl just accumulates and interferes with. brain function bc of the toxic build up.
So in knowing how PKU works, what is a direct result?
how is it passed on?
Cognitive impairment of baby
- bc it accumulates in blood and is able to cross the blood brain barrier
autosomal recessive so genetic metabolism error
What will kids with PKU look like?
Light hair, eyes, and skin due the accumulation of phenyl inhibits melanin
How do those with PKU diet?
Low phenyl foods
If you are a mom who has PKU but you want to get PG what should your diet be like?
3 months before getting PG you need to eat low phenl foods especially and then this will continue in PG
What happens if a PKU MOM doesn’t follow her diet in pregnancy to fetus?
Mental retardatin
Microphephaly
Cong. heart defects
Growth retardation
all to the fetus
PKU affected mom wants to know if she can breastfeed her infant. Her baby doesn’t have PKU. Your response?
Yes she can breastfeed as long as the baby isn’t pku affected.
Now if both were PKU affected, that would be a no.
PKU affected mom wants to know how to feed her pku affected baby. How does she do this
She can mix breast milk and phenyl free based milk together if lab ok’s it
Or
she can just use the formula
Education for parents with pku about their grandchildren
If their child isn’t pku affected, they’re still carriers to the autosomal recessive gene which means other family can have it
