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Maternity > Exam 2: HIV, GDM, HTN > Flashcards

Exam 2: HIV, GDM, HTN Flashcards

1
Q

HIV: acute phase

A

viral production

flu like symptoms for 2-4 weeks after exposure

ability to spread HIV the highest –> CD4 count drops

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2
Q

HIV: latency phase

A

viral rep continues with lymphatics, but slows down

free of symptoms

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3
Q

HIV: persistent generalized lymphadenopathy

A

possibly remaining in this stage for years; AIDS develops within 7 to 10 years

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4
Q

AIDS

A

high viral load and low CD4 count

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5
Q

Perinatal transmission of HIV is called

A

vertical tranmission

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6
Q

How do we treat HIV in pregnancy women

A

Antiretroviral therapy 2x daily from 14 weeks until birth; IV admin during labor

AVOID INSTRUMENTATION SUCH AS EPISIOTOMIES, FETAL SCALP ELECTRODES

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7
Q

How do we treat HIV in newbords

A

liquid antiretroviral (retrovir) for 1-6 weeks of life

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8
Q

T/F a pregnant woman who is HIV positive must undergo a C/S

A

F, only when viral load is high enough

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9
Q

If you get GDM are you at a higher risk for developing DM type 2

A

yes

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10
Q

Type 1 DM

A

autoimmune, insulin deficient

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11
Q

Type 2 DM

A

insulin resistant

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12
Q

Glucose intolerance

A

fasting glu of 100-125

risk of LGA infants

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13
Q

GDM

A

any degree of glu intolerance first detected in pregnancy

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14
Q

Maternal complications of GDM

A

Dystocia or difficult labor

C section

Still born

Increased risk of developing preeclampsia

more frequent UTI

Hydramnios

Chronic vaginitis

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15
Q

Fetal complications from GDM

A

LGA/Macrosomia

hypoglycemia

fetal asphyxia

respiratory distress

jaundice

stillborn

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16
Q

First trimester: _______ in need for insulin

A

decrease

risk of hypoglycemia secondary to morning sickness

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17
Q

First trimester: decreased ______ = decreased need for insulin

A

hPL

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18
Q

2nd and 3rd trimester: insulin requirement _________

A

increases

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19
Q

2nd and 3rd trimester: increase in…

A

glucose use and storage

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20
Q

Insulin need during labor

A

increased energy needs during labor may require increased insulin to balance IV glucose

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21
Q

Insulin in post partum

A

abrupt decrease in insulin required

22
Q

Pregnancy and insulin chart

A

peripheral insulin R –> compensatory increase in insulin secretion –> increase glu demandes in increase hPL –> insulin resistance peaks at 3rd tri –> postprandial hyperglycemia (repeat)

23
Q

Screening for GDM in pregnancy

A

all women under a risk assessment at 1st prenatal visit

high risk women reassessed between 24-28 weeks

24
Q

First visit glucose blood levels

A

Fasting (over 125)
HbA1C (over 7%)
random (over 200)

25
Q

24-28 weeks glucose blood levels

A

Fasting (over 95)
75g OGTT 1hr (over 180)
75g OGTT 2 hr (over 153)

26
Q

GDM can only be diagnosed using what

A

oral glucose tolerance test (at 24-28 weeks)

27
Q

hypoglycemia in a newborn

A

glucose less than 40

28
Q

S/S of hypoglycemia in a newborn

A

apnea

cyanosis and seizures

poor feedings

jitteriness

lethargy

weak cry

hypothermia

29
Q

Care management: maternal monitoring for GDM

A

Physical exam

urine test

eye exam in 1st tri

renal function each tri

HbA1C every 4-6 weeks

30
Q

Fetal monitoring for GDM

A

non-stress test

genetic screening like alpha fetoprotein

amniocentesis

31
Q

Care of women with diabetes during labor

A

IV saline or lactated ringer’s

Monitor blood glucose every 1 to 2 hours

infusion of regular insulin

insulin requirement drops quickly after birth so monitor for hypoglycemia

32
Q

Post partum breastfeeding aids in blood glucose homeostasis

A

transfer of mother’s glucose to breast milk to feed the baby

colostrum helps balance baby’s blood sugar levels

33
Q

Glucose challenge test at ______ weeks post partum

A

6 wks –> if normal it’s screened every 3 years

34
Q

Chronic HTN

A

present before the pregnancy or diagnosed before 20 weeks gestation

BP equal to 140/90 or greater

35
Q

Gestation HTN

A

after 20 weeks gestation but no proteinuria

36
Q

Preeclampsia

A

140/90 or greater after 20 weeks gestation AND protein in urine, epi abdominal pain, neuro complications, liver involvement, elevated Cr

37
Q

eclampsia

A

all the same as pre- but added seizures

38
Q

Chronic HTN is associated with increased incidence of

A

abruptio placentae = hemorrhage

superimposed preeclampsia

increased perinatal mortality

SGA in infant

39
Q

What is the diagnostic criteria for GHTN

A

onset during pregnancy based on two measurements that meet criteria for BP elevation within 1 week period

40
Q

Do S/S disappear after birth for preeclampsia

A

yes

41
Q

Pathophysiology of preeclampsia

A

disruption in placental perfusion and endothelial cell dysfunction

poor perfusion from vasospasm

42
Q

What is disseminated intravascular coagulation

A

blood clot formation in small vessels

43
Q

HEELP

A

Hemolysis

Elevated liver enzymes

Low platelet

Hepatic dysfunction

44
Q

What stimulates lung maturity in fetus

A

dexamethasone or betamethasone

45
Q

What is a normal patellar reflex

A

2+

46
Q

How do we diagnose/test proteinuria

A

dipstick

24 hour collection (gold standard)

47
Q

Drug treatment of HTN in pregnancy

A

“her new lab method”

hydralazine
nifedipine
labetalol
methyldopa

48
Q

Why do we use Mg sulfate

A

prophylactically to prevent seizures

49
Q

Loading dose of Mg sulfate

Maintenance dose

A

4-6 mg over 15 to 30 minutes

dilute in 1000 mL LR, give 2g/hour

50
Q

Therapeutic range of Mg

A

4-7

51
Q

Antidote of Mg toxicity

A

calcium gluconate

Maternity (9 decks)

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