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