[Exam 1] Chapter 20 - Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Flashcards
Diabetes Mellitus: What is this?
Characterized by a relative lack of insulin or absence of the hormone that is necessary for glucose metabolism
Diabetes Mellitus: What is Type 1 Diabetes??
Insulin resistance or deficiency (autoimmune process). Usually before age of 30.
Diabetes Mellitus: What is Type 2 Diabetes?
Insulin resistance or deficiency (related to obesity, sedentary lifestyle).
Diabetes Mellitus: What is Impaired Fasting Glucose and Impaired Glucose Tolerance
Characterized by hyperglycemia at a lower level that what qualifies for diabetes (fasting blood glucose between 100 and 125, and blood glucose between 140 and 199 after 2 hour test.)
Diabetes Mellitus: What is Gestational Diabetes Mellitus?
Glucose intolerance with its onset during pregnancy usually around the 24th week or first detected in pregnancy
Diabetes Mellitus: During pregnancy, diabetes is classified into what two groups?
Pregestational diabetes which includes women with type 1 or type 2 diabetes
Gestational diabetes, which develops during pregnancy
Diabetes Mellitus: Gestational diabetes is associated with what complications?
Neonatal complications such as macrosomia, hypoglycemia, and birth trauma
Maternal comps such as preeclampsia and casarean birth
Diabetes Mellitus Patho: Understanding the patho of gestational diabetes involves what two components?
Those are the existence of pancreatic beta-cell dysfunction prior to pregnancy and unmasking of this problem by development of insulin resistance during pregnancy
Diabetes Mellitus Patho: Normal pregnancy is characterized by what to insulin?
Increasing peripheral resistance to insulin and a compensatory increase in insulin secretion
Diabetes Mellitus Patho: What happens in direct correlation with growth of placental tissue?
More placental hormones are secreted such as Human Placental Lactogen (hPL) and Growth Hormone (Somatotropin). Insulin increases to overcome this.
Diabetes Mellitus Screening: What is recommended for women to take screening wise?
Risk analysis of all pregnant women at their first prenatal visit and additional screening of all high-risk pregnant women again at 24-28 weeks.
Diabetes Mellitus Screening: Which pregnant women do not need to be screened at their first prenatal visit?
No history glucose intolerance
Less than 25 years
Normal body weight
No family history
Diabetes Mellitus Screening: What elevations can indicate diabetes?
Elevated glycosylated hemoglobin.
and Combining HbA1c and Plasma glucose
Diabetes Mellitus Screening: Typically, screening is based on what?
75g 1-hour glucose challenge test between weeks 24-28. Level above 140 is abnormal.
Diabetes Mellitus Screening: What are the normal testing values for fasting, 1,2,3 hour.
Fasting = <92
1 Hour = < 180
2 Hour = <153
3 Hour = < 140
Diabetes Mellitus and Care for Woman with Pregestational Diabetes: What is generaly the foundation of exercise for someone with GDM?
Diet -> Sometimes Insulin Exercise -> Fetal Surveillance
Diabetes Mellitus and Care for Woman with Pregestational Diabetes: Goals of precocnception care is what?
Integrate the woman into management of diabetes
Achieve the lowest glycosylated hemoglobin A1C
Ensure effective contraception
Identify and evaluate long-term diabetic complications
Diabetes Mellitus and Care for Woman with Pregestational Diabetes: What is Glycosylated Hemoglobin (HbA1C) and what are the good ranges?
Measurement of the average glucose levels during the past 100 to 120 days. <7% indicates good control. >8% indicates poor control and warrants intervention
Diabetes Mellitus and Care for Woman with Pregestational Diabetes: Most common malformations associated with diabetes occur in what systems?
Renal, cardiac, skeletal, and CNS
Diabetes Mellitus and Care for Woman with Gestational Diabetes: ADA recommends maintaining a fasting glucose in what range?
Below 92 fasting
1 hour below 180
2 hour below 153
Diabetes Mellitus and Care for Woman with Gestational Diabetes: Tight control has been advocated with a reduction of ?
Macrosomia
Diabetes Mellitus and Care for Woman with Gestational Diabetes: Nutritional management focuses on?
Maintaining balanced glucose levels and providing enough energy and nutrients for pregnant woman, while avoiding ketosis and minimizing risk of hypoglycemia
Diabetes Mellitus and Care for Woman with Gestational Diabetes: What content of carbohydrates is recommended?
40%
Pharmacologic Therapy for Woman with Gestational Diabetes: How often is insulin given?
Two doses given daily with 2/3 of total insul in morning to cover energy needs of the active day
Pharmacologic Therapy for Woman with Gestational Diabetes - Oral Meds: What has been promising?
Glyburide and Metformin because they do not cross the placenta
Pharmacologic Therapy for Woman with Gestational Diabetes - Oral Meds: ACOG recommends use of diet or insul or oral diabetic meds to achieve 1-hour postprandial blood glucose level of
130 mg/dL
Pharmacologic Therapy for Woman with Gestational Diabetes - Oral Meds: What does exercise do for body?
Helps maintian glucose control by increasing the uptake of glucose into the cells and decreasing central obesity, hypertension, and dyslipidemia, which will ultimately decrease womans insulin requirements
Pharmacologic Therapy for Woman with Gestational Diabetes - Oral Meds: Maternal benefits of exercise include
improved cardiovascular function, limited pregnancy weight gain, decreased musculoskeletal discomfort, and reduced incidence of muscle cramps
Pharmacologic Therapy for Woman with Gestational Diabetes - Oral Meds: Fetal beenfits of exercise include
decreased fat mass, improved stress tolerance, and advanced neurobehavioral maturation
Pharmacologic Therapy for Woman with Gestational Diabetes - Insulin: Reduced in first trimester why?
To prevent hypoglycemia resulting from increased insulin sensitivity as well as from N/V.
Pharmacologic Therapy for Woman with Gestational Diabetes - Insulin: Which insulins are used?
Lispro (Humalog) and Aspart (NovoLog) because they do not cross the placenta, reduce postprandial hyperglycemia and episodes of hypoglycemia between meals
Pharmacologic Therapy for Woman with Gestational Diabetes - Insulin: Target glucose range for fastign and 1 hour?
60-90 mg/Dl and 1 hour = 120 mg/dL
Care During and After for Woman with Gestational Diabetes: What is given for laboring women?
IV Saline or Lactated Ringer’s given and glucose monitored every 1-2 hours. Kept below 110 throughout labor.
Health History and Physical Exam for Diabetes: What should you ask women about this?
ABout duration of disease, management of glucose levels, dietary adjustments, prescence of vascular complications and current vascular status.
Health History and Physical Exam for Diabetes: During antepartum visits, assess clients knowledge about what?
Her disease, including S&S of hypoglycemia, hyperglycemia, and diabetic ketoacidosis, insulin administration techniques and impact of pregnancy.
Health History and Physical Exam for Diabetes: What is the clinical triad of diabetes?
ppolydipsia, polyphagia, and polyuria
Health History and Physical Exam for Diabetes: Factors that place them at high risk include what?
Previous infant with congential anomaly
History of diabetes
35 or older
Multiple pregnancy
Previous infant weighing more than 9 lb
Lab and Diagnostic Testing for Diabetes: Maternal Surveillance may include what?
Urine check for protein and for nitrates and leukocyte esterase
Urine check for ketones
Kidney function eval every trimester
Eye Exam
Lab and Diagnostic Testing for Diabetes: Alpha-fetoprotein levels may be obtained to detect what
congenital anomalies such as open neural tube or ventral wall defects
Lab and Diagnostic Testing for Diabetes: Biophysical profile helps with what?
Monitor fetal well-being and uteroplacental profusion
Lab and Diagnostic Testing for Diabetes: Encourage mother to perform glucose checks how often?
4x day. 3 before meals and one at bedtime
Lab and Diagnostic Testing for Diabetes: What food source percentages should calories come from?
40% of calories from good-quality compelx carbs
35% from protein sources
25% from unsaturated fats
Promoting Optimal Glucose Control for Diabetes: For women in labor, how to you treat profound hypoglycemia?
Keep syringe with 50% dextrose solution
Promoting Optimal Glucose Control for Diabetes: If women birthing via C-Section, what should you monitor?
Monitor womans blood glucose levels hourly and administer short-acting insulin or glucose based on the blood glucose levels as ordered
Promoting Optimal Glucose Control for Diabetes: AFter birth, how often do you monitor glucose levels?
Every 2-4 hours for first 48 hours.
Promoting Optimal Glucose Control for Diabetes: What does breast-feeding do for glucose?
Helps to normalize blood glucose levels
Iron-Deficiency Anemia: What is Anemia?
Reduction in red blood cell volume, measured by hematocrit (Hct) or a decrease in the concentration of hemoglobin (Hgb) in the peripheral blood. Results in reduced capacity of blood to carry oxygen
Iron-Deficiency Anemia: Increased risk during pregnancy due to what?
Increased maternal iron needs and demands fom the growing feetus, increased erythrocyte mass, and in the third trimester, expanded maternal blood volume
Iron-Deficiency Anemia: Clinical consequences of iron-deficiency anemia includes what
preterm delivery, perinatal mortality, and postpartum depression
Iron-Deficiency Anemia: fetal annd neonatal consequences of this includes
low birth weight and poor mental and psychomotor performance
Iron-Deficiency Anemia: With significant maternal iron depletion, fetus will attempt to store iron at expense of
the mother
Iron-Deficiency Anemia: Clinical symptoms of this include what
fatigue, diminished quality of life, impaired cognitive function, increased RF thromboembolic events, ehadache, restless legs syndrome and pica
Iron-Deficiency Anemia Therapeutic Management: What is recommended?
Routine iron supplementation for all pregnant women starting at low dose 30 mg/day beginning at first visi t
Iron-Deficiency Anemia Nursing Assessment: What substances interfere with iron absorption?
Tea, coffee, chocolate, and high-fiber foodss
Iron-Deficiency Anemia Nursing Assessment: What questions should you ask women?
If she has fatigue, weakness, malaise, anorexia, or increased susceptibility to infection
Iron-Deficiency Anemia Nursing Assessment: What do lab tests reveal for Hgb , Hct, Iron, and serum ferritin?
Hgb < 11
Hct < 35%
Serum Iron < 30
Serum Ferritin < 100 mg
Iron-Deficiency Anemia Nursing Management: Why is iron needed in body?
Transport of O2 and CO2 throughout body, aid in production of RBC and helps with immune response
Iron-Deficiency Anemia Nursing Management: Should take iron supplement with what?
Vitamin C containing fluids, rather than milk
Iron-Deficiency Anemia Nursing Management: What foods high in iron?
dried fruits, whole grains, green leafy vegetables, meats, peanut butter, and iron-fortified cereals
Cytomegalovirus: Transmitted how?
Via body fluids only.
Cytomegalovirus: What is this?
Most common congenital and perinatal viral infection in world.
Cytomegalovirus: Leading cause of what loss?
Hearing loss and intellectual disability in US
Cytomegalovirus: CMV infection during pregnancy results in?
Abortion, stillbirth, low birth weight, IUGR, microcephaly, deafness, blindness, intellectual disability, jaundice, or congential/neonatal infection
Cytomegalovirus: What time periods can a mother-to-child transmission occur?
In utero, during birth, and after birth . PErmantely disability only occurs with utero infection
Cytomegalovirus: Symptoms of CMV in fetus and newborn include what
hepatomegaly, thrombocytopenia, IUGR, Juandice, hearing loss, choriorenitis, and intellectual disability
Cytomegalovirus: Tx for this?
There is no vaccine out there. No therapy to prevent or treat infections
Cytomegalovirus: What can you tell mother to help prevent this?
Stress importance of good hand hygiene and use of sound hygiene practices can reduce transmission of virus
Rubella: Spread how?
By droplets or through direct contact with a contaminated object. Risk of spreading to fetus increases with earlier exposure to virus
Rubella: What symptoms can newborn have?
Congential cataracts, glaucoma, cardiac defects, microcephaly, as well as hearing and intellectual disabilities
Rubella: What should be reviewed in women at every prenatal care meeting?
Person and family hx, physical exam, laboratory screening, reproductive plan , nutrition, supplements, weight, exercise, vaccinations
Rubella: How much folic acid should be recomended?
400 mcg per day
Rubella: Vaccination news?
Get vaccination is there no evidence of immunity to these viruses
Rubella: Best education to give women?
To be vaccinated and have adequate immunity against rubella.
Rubella: What percentage rubella antibody titer proves evidence of immunity?
1:8
Rubella: When should women become vaccinated?
During immediate postpartum period so they will be immune before becoming pregnant again
Herpes Simplex Virus: What does this cause to appear on body?
genital herpes and genital infections. Mostly HSV-1.
Herpes Simplex Virus: What is HSV?
Has two subtypes. 1 and 2.
Herpes Simplex Virus: HSV1 associated with what?
Oral lesions (fever blisters). Mostly causing genital herpes now.
Herpes Simplex Virus: HSV2 occurs where
Occurs in genital region
Herpes Simplex Virus: How does infection occur?
By direct contact of the skin or mucous membranes with an active lesions through such activites like kissing, sex, or routine skin-to-skin contact
