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OB/Peds > Exam 3 Diabetes > Flashcards

Exam 3 Diabetes Flashcards

1
Q

Which women in White’s classification generally have positive pregnancy outcomes as long as their BG levels are controlled?

A

Classes A-C

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2
Q

Class A1

A

Woman has 2 or more abnormal values with normal fasting BS. BG levels are diet controlled

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3
Q

Class A2

A

Woman has not been known to have diabetes before pregnancy but requires medication for BG control

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4
Q

Class B

A

Onset of dz occurs after age 20 and duration of illness is less than 10 years

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5
Q

Class C

A

Onset of dz occurs between 10-19 or duration is 10-19 years

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6
Q

Class D

A

Onset of dz occurs at less than 10 years of age or duration of illness greater than 20 years

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7
Q

Class F

A

Pt developed diabetic nephropathy

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8
Q

Class R

A

Pt developed retinitis proliferans

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9
Q

Class T

A

Pt has had a renal transplant

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10
Q

Risk factors for GDM

A

Family hx, stillbirth, malformed or macrocosmic fetus, obesity, HTN, glycosuria, older than 25

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11
Q

When is GDM usually diagnoses?

A

2nd half of pregnancy

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12
Q

Who should be screened for GDM?

A

All preg women not known to have pre gestational DM

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13
Q

What are the 2 different screening methods for GDM?

A
  1. Oral glucose tolerance test

2. 3 hour OGTT

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14
Q

Management of GDM is based on what?

A

BG not urine glucose

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15
Q

GDM diets are individualized to what?

A

Increased fetal requirements, pre-pregnancy weight, dietary habits, overall health, ethnic background, lifestyle, stage of pregnancy, nutrition

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16
Q

Dietary goal with GDM

A

Provide weight gain consistent with normal preg, prevent ketoacidosis, and minimize wide fluctuations of blood glucose levels

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17
Q

First trimester calories for GDM

A

2200

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18
Q

Second and third trimester calories for GDM

A

2500

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19
Q

Standard diabetic diet for GDM

A

3 meals and 1-3 snacks, on time, never skip

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20
Q

Four hours without food intake increases the risk of what?

A

Hypoglycemia

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21
Q

Bedtime snack to prevent hypoglycemia and ketosis

A

25 grams of carbs with some protein and fat

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22
Q

Ideal diet breakdown for GDM

A

55% carbs
20% protein
25% fat (less than 10% saturated)

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23
Q

Good food groups for GDM

A

Complex carbs, high in fiber and starch and protein to help regulate the BG level by a more sustained glucose release

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24
Q

Recommended exercise for GDM

A

Aerobic with resistance training for at least 30 min most days of the week, non-weight bearing activities such as arm exercises or recumbent bicycle

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25
Q

When is the best time to exercise

A

After meals when glucose level is rising

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26
Q

Insulin needs during 1st trimester

A

Decreases

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27
Q

Insulin needs during 2nd and 3rd trimesters

A

Increases

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28
Q

Insulin needs during labor

A

Vary

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29
Q

What is the most commonly prescribed oral agent for GDM?

A

Glyburide

30
Q

How safe is glyburide during pregnancy?

A

Minimal amounts cross the placenta

31
Q

When are antepartum women instructed to monitor their BS?

A

Rising in the morning, after breakfast, before and after lunch, after dinner, bedtime

32
Q

When are BG levels monitored intrapartumly?

A

Hourly

33
Q

When do most women with GDM return to normal BG levels?

A

After childbirth

34
Q

What is the risk for GDM in the woman’s next pregnancy?

A

35-75%

35
Q

What is the woman’s risk for developing type 2 DM in the next 20 years?

A

35-60%

36
Q

What is associated with an increased risk of miscarriage concerning GDM?

A

Poor glycemic control around the time of conception and in the early weeks of pregnancy

37
Q

Poor glycemic control in women without vascular dz increases the risk of what?

A

Fetal macrosomia

38
Q

Macrosomia

A

A birth weight more than 400-4500 grams or greater

39
Q

Characteristics of babies born to women with GDM

A

Disproportionate increase in shoulders, trunk, and chest size. May cause shoulder dystocia. Increased risk for cesarean birth

40
Q

Polyhydramnios concerning GDM

A

Frequently develops during the 3rd trimester, unknown cause

41
Q

What is the most important cause of perinatal loss in a diabetic pregnancy?

A

Congenital malformation

42
Q

What is the incidence of congenital malformations related to?

A

The severity and duration of the diabetes

43
Q

Common birth injuries associated with diabetic pregnancies

A

Brachial plexus palsy, facial nerve injury, humerus or clavicle fracture, cephalhematoma

44
Q

What are infants at risk for at birth?

A

Hypoglycemia, hyperbilirubinemia, respiratory distress

45
Q

What are the major causes of cardiac dz in preg women?

A

Cardiomyopathy and congenital heart dz

46
Q

Class I heart dz

A

Asymptomatic without limitation of physical activity

47
Q

Class II heart dz

A

Symptomatic with slight limitation of activity

48
Q

Class III heart dz

A

Symptomatic with marked limitation of activity

49
Q

Class IV heart dz

A

Symptomatic with inability to carry on any physical activity without discomfort

50
Q

Maternal cardiac dz risk group 1

A
  • Mortality rate less than 1%
  • Corrected tetralogy of fallot
  • Pulmonic/tricuspid dz
  • Mitral stenosis
  • Patent Ductus Arteriosis
  • Ventricular septal defect
  • Atrial septal defect
51
Q

Maternal cardiac dz risk group 2

A
  • Mortality rate 5-15%
  • Artificial valves
  • Mitral stenosis (classes 3-4)
  • Atrial fibrillation
  • Uncorrected tetralogy of fallot
  • Aortic coarctation (uncomplicated)
  • Aortic stenosis
  • Previous MI
  • Marfan syndrome w/ normal aorta
52
Q

Maternal cardiac dz risk group 3

A
  • Mortality rate 25-50%
  • Aortic coarctation (complicated)
  • Endocarditis
  • Marfan syndrome w/ aortic involvement
  • Eisenmenger syndrome
  • Pulmonary HTN
53
Q

S/S of cardiac decompensation are taught when?

A

At the first prenatal visit and reviewed at each subsequent visit

54
Q

The heart dz pregnant women should increase her intake of what?

A

Fluids and fiber, may be given a stool softener

55
Q

Subjective S/S of cardiac decompensation

A

Increased fatigue, dyspnea, smothering feeling, frequent cough, palpitations, generalized edema

56
Q

Objective S/S of cardiac decompensation

A

Irregular, weak, rapid pulse, progressive generalized edema, crackles at base of lungs after 2 inspirations and exhalations that do not clear after coughing, Orthopnea, rapid respirations greater than or equal to 25 breaths per min, moist frequent cough, cyanosis of lips and nail beds

57
Q

How is cardiac function supported intrapartumly?

A

By keeping head and shoulders elevated and body parts resting on pillows

58
Q

What kind of labor is preferred for women with cardiac dz?

A

Spontaneous or induced labor followed by vaginal birth

59
Q

Which position usually facilitates positive hemodynamics during labor?

A

Side lying

60
Q

What kind of oxygen is important during labor with cardiac dz?

A

Mask

61
Q

Why are C-Sections not recommended for heart dz?

A

Risk of dramatic fluid shifts, sustained hemodynamic changes, increased blood loss

62
Q

What is given immediately after birth to prevent hemorrhage?

A

Oxytocin

63
Q

What should not be used in heart dz pts after delivery?

A

Methergine, it causes HTN

64
Q

What is the most hemodynamically difficult period for heart dz pts after birth?

A

The first 24-48 hours

65
Q

Activity after labor for heart dz pts

A

Progressive ambulation is permitted as tolerated

66
Q

hat is the most common medical disorder of pregnancy affecting 20-60% of women?

A

Anemia

67
Q

Normal hematocrit range in nonpreg woman

A

37-47%

68
Q

Normal hematocrit values for preg women with adequate iron

A

33%

69
Q

Anemia in pregnancy is defined as what?

A

Hemoglobin less than 11% in the 1st and 3rd trimesters and less than 10.5% in the 2nd trimester

70
Q

What is considered severe anemia?

A

A hemoglobin level less than 6-8%

71
Q

Primary chronic dz of brain reward and motivation

A

Substance abuse

72
Q

Current standard of care during pregnancy for women addicted otto opioids

A

Methadone maintenance

OB/Peds (11 decks)

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