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NRSG 206: OB > [Exam 1] Chapter 20 - Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations > Flashcards

[Exam 1] Chapter 20 - Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Flashcards

1
Q

Diabetes Mellitus: What is this?

A

Characterized by a relative lack of insulin or absence of the hormone that is necessary for glucose metabolism

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2
Q

Diabetes Mellitus: What is Type 1 Diabetes??

A

Insulin resistance or deficiency (autoimmune process). Usually before age of 30.

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3
Q

Diabetes Mellitus: What is Type 2 Diabetes?

A

Insulin resistance or deficiency (related to obesity, sedentary lifestyle).

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4
Q

Diabetes Mellitus: What is Impaired Fasting Glucose and Impaired Glucose Tolerance

A

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.)

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5
Q

Diabetes Mellitus: What is Gestational Diabetes Mellitus?

A

Glucose intolerance with its onset during pregnancy usually around the 24th week or first detected in pregnancy

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6
Q

Diabetes Mellitus: During pregnancy, diabetes is classified into what two groups?

A

Pregestational diabetes which includes women with type 1 or type 2 diabetes

Gestational diabetes, which develops during pregnancy

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7
Q

Diabetes Mellitus: Gestational diabetes is associated with what complications?

A

Neonatal complications such as macrosomia, hypoglycemia, and birth trauma

Maternal comps such as preeclampsia and casarean birth

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8
Q

Diabetes Mellitus Patho: Understanding the patho of gestational diabetes involves what two components?

A

Those are the existence of pancreatic beta-cell dysfunction prior to pregnancy and unmasking of this problem by development of insulin resistance during pregnancy

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9
Q

Diabetes Mellitus Patho: Normal pregnancy is characterized by what to insulin?

A

Increasing peripheral resistance to insulin and a compensatory increase in insulin secretion

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10
Q

Diabetes Mellitus Patho: What happens in direct correlation with growth of placental tissue?

A

More placental hormones are secreted such as Human Placental Lactogen (hPL) and Growth Hormone (Somatotropin). Insulin increases to overcome this.

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11
Q

Diabetes Mellitus Screening: What is recommended for women to take screening wise?

A

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.

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12
Q

Diabetes Mellitus Screening: Which pregnant women do not need to be screened at their first prenatal visit?

A

No history glucose intolerance

Less than 25 years

Normal body weight

No family history

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13
Q

Diabetes Mellitus Screening: What elevations can indicate diabetes?

A

Elevated glycosylated hemoglobin.

and Combining HbA1c and Plasma glucose

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14
Q

Diabetes Mellitus Screening: Typically, screening is based on what?

A

75g 1-hour glucose challenge test between weeks 24-28. Level above 140 is abnormal.

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15
Q

Diabetes Mellitus Screening: What are the normal testing values for fasting, 1,2,3 hour.

A

Fasting = <92
1 Hour = < 180
2 Hour = <153
3 Hour = < 140

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16
Q

Diabetes Mellitus and Care for Woman with Pregestational Diabetes: What is generaly the foundation of exercise for someone with GDM?

A

Diet -> Sometimes Insulin Exercise -> Fetal Surveillance

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17
Q

Diabetes Mellitus and Care for Woman with Pregestational Diabetes: Goals of precocnception care is what?

A

Integrate the woman into management of diabetes

Achieve the lowest glycosylated hemoglobin A1C

Ensure effective contraception

Identify and evaluate long-term diabetic complications

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18
Q

Diabetes Mellitus and Care for Woman with Pregestational Diabetes: What is Glycosylated Hemoglobin (HbA1C) and what are the good ranges?

A

Measurement of the average glucose levels during the past 100 to 120 days. <7% indicates good control. >8% indicates poor control and warrants intervention

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19
Q

Diabetes Mellitus and Care for Woman with Pregestational Diabetes: Most common malformations associated with diabetes occur in what systems?

A

Renal, cardiac, skeletal, and CNS

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20
Q

Diabetes Mellitus and Care for Woman with Gestational Diabetes: ADA recommends maintaining a fasting glucose in what range?

A

Below 92 fasting
1 hour below 180
2 hour below 153

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21
Q

Diabetes Mellitus and Care for Woman with Gestational Diabetes: Tight control has been advocated with a reduction of ?

A

Macrosomia

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22
Q

Diabetes Mellitus and Care for Woman with Gestational Diabetes: Nutritional management focuses on?

A

Maintaining balanced glucose levels and providing enough energy and nutrients for pregnant woman, while avoiding ketosis and minimizing risk of hypoglycemia

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23
Q

Diabetes Mellitus and Care for Woman with Gestational Diabetes: What content of carbohydrates is recommended?

A

40%

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24
Q

Pharmacologic Therapy for Woman with Gestational Diabetes: How often is insulin given?

A

Two doses given daily with 2/3 of total insul in morning to cover energy needs of the active day

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25
Q

Pharmacologic Therapy for Woman with Gestational Diabetes - Oral Meds: What has been promising?

A

Glyburide and Metformin because they do not cross the placenta

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26
Q

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

A

130 mg/dL

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27
Q

Pharmacologic Therapy for Woman with Gestational Diabetes - Oral Meds: What does exercise do for body?

A

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

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28
Q

Pharmacologic Therapy for Woman with Gestational Diabetes - Oral Meds: Maternal benefits of exercise include

A

improved cardiovascular function, limited pregnancy weight gain, decreased musculoskeletal discomfort, and reduced incidence of muscle cramps

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29
Q

Pharmacologic Therapy for Woman with Gestational Diabetes - Oral Meds: Fetal beenfits of exercise include

A

decreased fat mass, improved stress tolerance, and advanced neurobehavioral maturation

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30
Q

Pharmacologic Therapy for Woman with Gestational Diabetes - Insulin: Reduced in first trimester why?

A

To prevent hypoglycemia resulting from increased insulin sensitivity as well as from N/V.

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31
Q

Pharmacologic Therapy for Woman with Gestational Diabetes - Insulin: Which insulins are used?

A

Lispro (Humalog) and Aspart (NovoLog) because they do not cross the placenta, reduce postprandial hyperglycemia and episodes of hypoglycemia between meals

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32
Q

Pharmacologic Therapy for Woman with Gestational Diabetes - Insulin: Target glucose range for fastign and 1 hour?

A

60-90 mg/Dl and 1 hour = 120 mg/dL

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33
Q

Care During and After for Woman with Gestational Diabetes: What is given for laboring women?

A

IV Saline or Lactated Ringer’s given and glucose monitored every 1-2 hours. Kept below 110 throughout labor.

34
Q

Health History and Physical Exam for Diabetes: What should you ask women about this?

A

ABout duration of disease, management of glucose levels, dietary adjustments, prescence of vascular complications and current vascular status.

35
Q

Health History and Physical Exam for Diabetes: During antepartum visits, assess clients knowledge about what?

A

Her disease, including S&S of hypoglycemia, hyperglycemia, and diabetic ketoacidosis, insulin administration techniques and impact of pregnancy.

36
Q

Health History and Physical Exam for Diabetes: What is the clinical triad of diabetes?

A

ppolydipsia, polyphagia, and polyuria

37
Q

Health History and Physical Exam for Diabetes: Factors that place them at high risk include what?

A

Previous infant with congential anomaly

History of diabetes

35 or older

Multiple pregnancy

Previous infant weighing more than 9 lb

38
Q

Lab and Diagnostic Testing for Diabetes: Maternal Surveillance may include what?

A

Urine check for protein and for nitrates and leukocyte esterase

Urine check for ketones

Kidney function eval every trimester

Eye Exam

39
Q

Lab and Diagnostic Testing for Diabetes: Alpha-fetoprotein levels may be obtained to detect what

A

congenital anomalies such as open neural tube or ventral wall defects

40
Q

Lab and Diagnostic Testing for Diabetes: Biophysical profile helps with what?

A

Monitor fetal well-being and uteroplacental profusion

41
Q

Lab and Diagnostic Testing for Diabetes: Encourage mother to perform glucose checks how often?

A

4x day. 3 before meals and one at bedtime

42
Q

Lab and Diagnostic Testing for Diabetes: What food source percentages should calories come from?

A

40% of calories from good-quality compelx carbs

35% from protein sources

25% from unsaturated fats

43
Q

Promoting Optimal Glucose Control for Diabetes: For women in labor, how to you treat profound hypoglycemia?

A

Keep syringe with 50% dextrose solution

44
Q

Promoting Optimal Glucose Control for Diabetes: If women birthing via C-Section, what should you monitor?

A

Monitor womans blood glucose levels hourly and administer short-acting insulin or glucose based on the blood glucose levels as ordered

45
Q

Promoting Optimal Glucose Control for Diabetes: AFter birth, how often do you monitor glucose levels?

A

Every 2-4 hours for first 48 hours.

46
Q

Promoting Optimal Glucose Control for Diabetes: What does breast-feeding do for glucose?

A

Helps to normalize blood glucose levels

47
Q

Iron-Deficiency Anemia: What is Anemia?

A

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

48
Q

Iron-Deficiency Anemia: Increased risk during pregnancy due to what?

A

Increased maternal iron needs and demands fom the growing feetus, increased erythrocyte mass, and in the third trimester, expanded maternal blood volume

49
Q

Iron-Deficiency Anemia: Clinical consequences of iron-deficiency anemia includes what

A

preterm delivery, perinatal mortality, and postpartum depression

50
Q

Iron-Deficiency Anemia: fetal annd neonatal consequences of this includes

A

low birth weight and poor mental and psychomotor performance

51
Q

Iron-Deficiency Anemia: With significant maternal iron depletion, fetus will attempt to store iron at expense of

A

the mother

52
Q

Iron-Deficiency Anemia: Clinical symptoms of this include what

A

fatigue, diminished quality of life, impaired cognitive function, increased RF thromboembolic events, ehadache, restless legs syndrome and pica

53
Q

Iron-Deficiency Anemia Therapeutic Management: What is recommended?

A

Routine iron supplementation for all pregnant women starting at low dose 30 mg/day beginning at first visi t

54
Q

Iron-Deficiency Anemia Nursing Assessment: What substances interfere with iron absorption?

A

Tea, coffee, chocolate, and high-fiber foodss

55
Q

Iron-Deficiency Anemia Nursing Assessment: What questions should you ask women?

A

If she has fatigue, weakness, malaise, anorexia, or increased susceptibility to infection

56
Q

Iron-Deficiency Anemia Nursing Assessment: What do lab tests reveal for Hgb , Hct, Iron, and serum ferritin?

A

Hgb < 11

Hct < 35%

Serum Iron < 30

Serum Ferritin < 100 mg

57
Q

Iron-Deficiency Anemia Nursing Management: Why is iron needed in body?

A

Transport of O2 and CO2 throughout body, aid in production of RBC and helps with immune response

58
Q

Iron-Deficiency Anemia Nursing Management: Should take iron supplement with what?

A

Vitamin C containing fluids, rather than milk

59
Q

Iron-Deficiency Anemia Nursing Management: What foods high in iron?

A

dried fruits, whole grains, green leafy vegetables, meats, peanut butter, and iron-fortified cereals

60
Q

Cytomegalovirus: Transmitted how?

A

Via body fluids only.

61
Q

Cytomegalovirus: What is this?

A

Most common congenital and perinatal viral infection in world.

62
Q

Cytomegalovirus: Leading cause of what loss?

A

Hearing loss and intellectual disability in US

63
Q

Cytomegalovirus: CMV infection during pregnancy results in?

A

Abortion, stillbirth, low birth weight, IUGR, microcephaly, deafness, blindness, intellectual disability, jaundice, or congential/neonatal infection

64
Q

Cytomegalovirus: What time periods can a mother-to-child transmission occur?

A

In utero, during birth, and after birth . PErmantely disability only occurs with utero infection

65
Q

Cytomegalovirus: Symptoms of CMV in fetus and newborn include what

A

hepatomegaly, thrombocytopenia, IUGR, Juandice, hearing loss, choriorenitis, and intellectual disability

66
Q

Cytomegalovirus: Tx for this?

A

There is no vaccine out there. No therapy to prevent or treat infections

67
Q

Cytomegalovirus: What can you tell mother to help prevent this?

A

Stress importance of good hand hygiene and use of sound hygiene practices can reduce transmission of virus

68
Q

Rubella: Spread how?

A

By droplets or through direct contact with a contaminated object. Risk of spreading to fetus increases with earlier exposure to virus

69
Q

Rubella: What symptoms can newborn have?

A

Congential cataracts, glaucoma, cardiac defects, microcephaly, as well as hearing and intellectual disabilities

70
Q

Rubella: What should be reviewed in women at every prenatal care meeting?

A

Person and family hx, physical exam, laboratory screening, reproductive plan , nutrition, supplements, weight, exercise, vaccinations

71
Q

Rubella: How much folic acid should be recomended?

A

400 mcg per day

72
Q

Rubella: Vaccination news?

A

Get vaccination is there no evidence of immunity to these viruses

73
Q

Rubella: Best education to give women?

A

To be vaccinated and have adequate immunity against rubella.

74
Q

Rubella: What percentage rubella antibody titer proves evidence of immunity?

A

1:8

75
Q

Rubella: When should women become vaccinated?

A

During immediate postpartum period so they will be immune before becoming pregnant again

76
Q

Herpes Simplex Virus: What does this cause to appear on body?

A

genital herpes and genital infections. Mostly HSV-1.

77
Q

Herpes Simplex Virus: What is HSV?

A

Has two subtypes. 1 and 2.

78
Q

Herpes Simplex Virus: HSV1 associated with what?

A

Oral lesions (fever blisters). Mostly causing genital herpes now.

79
Q

Herpes Simplex Virus: HSV2 occurs where

A

Occurs in genital region

80
Q

Herpes Simplex Virus: How does infection occur?

A

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

NRSG 206: OB (42 decks)

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