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54/64 Unit 1 > Infertility And Gestational Diabetes > Flashcards

Infertility And Gestational Diabetes Flashcards

1
Q

Reproductive structures that produce and release female gametes and sex hormones like estrogen and progesterone

A

Ovaries

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2
Q

Tiny, sac-like structures that each hold a single primary oocyte

A

Ovarian follicles

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3
Q

The process of egg production

A

Oogenesis

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4
Q

Hormones involved in the reproductive cycle

A

GnRH (released by hypothalamus), FSH & LH (released by anterior pituitary)

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5
Q

Male gonads responsible for making sperm and the androgen hormone testosterone

A

Testicles

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6
Q

Why are the testicles outside of the body?

A

For proper spermatogenesis (sperm are very sensitive to temperature)

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7
Q

An inability to conceive after one year of regular, unprotected sexual intercourse

A

Primary infertility

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8
Q

Inability to conceive after carrying a child to viability (at least 20 weeks)

A

Secondary infertility

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9
Q

Why is a comprehensive history and physical necessary when assessing for infertility?

A

Because ANY disruption in the process of conception may cause infertility

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10
Q

The nurse should refer for evaluation after _____ of failure to conceive

A

1 year

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11
Q

The nurse should refer for evaluation after _____ of failure to conceive for HIGH RISK patients

A

6 months

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12
Q

Maternal age >___ poses a risk for infertility

A

35

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13
Q

Genetic conditions that may cause a higher risk of infertility

A

Turner or Down Syndrome

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14
Q

Examples of fertility-lowering diseases

A

Endometriosis, Polycystic Ovarian Disease

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15
Q

What are the 6 essential components of female fertility?

A

Favorable cervical mucus, clear passage between cervix and tubes, patent tubes with normal motility, ovulation and release of ova, no obstruction between ovary and tubes, endometrial preparation

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16
Q

Lack of ovulation

A

Anovulation

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17
Q

Syndrome by which no oocytes are retrieved from the mature follicle after ovulation induction in IVF cycles

A

Empty follicle syndrome

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18
Q

Syndrome resulting from trauma to the endometrium in which curettage scar tissue bonds together and decreases the volume of the uterine cavity

A

Asherman’s syndrome

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19
Q

Female CNS/Endocrine factors that can contribute to infertility

A

Excessive weight loss, thyroid dysfunction, stress, inadequate estrogen/progesterone levels

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20
Q

What are the 4 essential components of male fertility?

A

Normal semen analysis, unobstructed genital tract, normal genital tract excretions, ejaculate deposited at the cervix

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21
Q

What is often the FIRST diagnostic test for male infertility because it is least invasive?

A

Semen analysis

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22
Q

How does obesity contribute to male infertility?

A

Inhibits adequate vaginal penetration

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23
Q

Oligospermia is classified as <___ mil/mL

A

20

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24
Q

Infections that affect sperm production and maturation factors

A

Gonorrhea, Chlamydia, Orchitis

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25
Q

Diseases that affect sperm production and maturation factors

A

Mumps infection after puberty

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26
Q

Examples of trauma that affect sperm production and maturation factors

A

Vasectomy, riding mountain bikes

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27
Q

Environmental factors that affect sperm production and maturation

A

Radiation, smoking, alcohol, drug use, malnutrition, stress, constrictive underclothing

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28
Q

Factors that can alter the shape or motility of sperm

A

Infections (prostatitis, chlamydia), polyspermia, asthenospermia

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29
Q

Loss or reduction of sperm motility

A

Asthenospermia

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30
Q

Ejaculation into the bladder

A

Retrograde ejaculation

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31
Q

Initial infertility assessment factors

A

Ovarian function, cervical mucus, sperm adequacy, tubal patency, pelvic organ condition

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32
Q

Female infertility assessment

A

Age (35+), history (medical, surgical, obstetric, gynecologic, sexual), occupation/environment risk, nutrition status, substance use

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33
Q

Male infertility assessment

A

History (medical, surgical, sexual), substance use, occupation/environment risk

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34
Q

Tests/procedures that determine when/if a female is ovulating

A

Basal body temp. Charts, urine ovulation predictor, endometrial biopsy, transvaginal ultrasound

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35
Q

Patient education for measuring basal body temperature

A

Take temp each morning before rising

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36
Q

Basal body temperature BEFORE ovulation

A

Temp drop 0.2 F 24-36 hours before ovulation

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37
Q

Basal body temperature AFTER ovulation

A

Temp rises 0.5-1.0 F 24-72 hours after ovulation due to progesterone released by the corpus luteum

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38
Q

Urine ovulation predictor identifies

A

LH surge prior to ovulation

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39
Q

Procedure that checks the endometrial response to hormonal cycle to ensure proper prep for implantation

A

Endometrial biopsy

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40
Q

What female hormones are analyzed for the diagnosis of infertility?

A

Prolactin, progesterone, estrogen, FSH, LH, thyroid

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41
Q

Female infertility diagnostic procedure that uses radiopaque dye to visualize fallopian tube patency and flushes debris or adhesions

A

Hysterosalpingography (HSG)

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42
Q

Nursing consideration for HSG

A

Assess for iodine/seafood allergy

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43
Q

Radiographic procedure that examines internal structures of the uterus

A

Hysteroscopy

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44
Q

Female infertility diagnostic for patients with endometriosis consisting of gas insufflation to visual internal organs and remove endometrial deposits while the patient is under general anesthesia

A

Laparoscopy

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45
Q

Infertility diagnostic in which patients have sex at a particular time followed by analysis of mucus and sperm interaction

A

Postcoital test

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46
Q

Semen analysis examines

A

Number, morphology, and motility

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47
Q

Semen analysis sample should be obtained after ___ days of abstinence and ___ separate analysis should be done

A

3; 2

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48
Q

Infertility diagnostic that assesses for antisperm antibodies and enzymatic defect (which prevents sperm from penetrating ova)

A

Sperm Penetration Assay (SPA) or Hamster Test

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49
Q

Male infertility diagnostic that visualizes testes transrectally to assess ejaculatory ducts, seminal vesicles, and vas deferens

A

Ultrasonography

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50
Q

Testicular biopsy checks for

A

Endocrine issues, blockage, or non-production

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51
Q

Male infertility diagnostic consisting of an X-ray of veins after administration of dye and assesses blood flow to scrotum

A

Venography

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52
Q

Postcoital mucus examination timing

A

Before ovulation, 8-12 hours after intercourse

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53
Q

Cervical mucus characteristics before ovulation

A

Raw egg white

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54
Q

Cervical mucus characteristics after ovulation

A

Thick, cloudy, pasty

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55
Q

Infertility treatment modalities education

A

Change in lifestyle (drugs, diabetes control), sexual techniques, timing of sexual intercourse

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56
Q

Infertility medications teaching

A

Must be taken on a regular schedule

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57
Q

Medication that induces ovulation by stimulating GnRH, LH, and FSH

A

Clomiphene citrate (Clomid)

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58
Q

Patient education for Clomid

A

Take for 5 consecutive days, starting with lowest dose

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59
Q

Medication that stimulates follicular development and blocks conversion to estrogen, therefore stimulating FSH and GnRH

A

Letrozole (Femara)

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60
Q

Patient education for Femara

A

Take for 5 consecutive days

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61
Q

Clomid and Femara work by

A

Increasing ovulation

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62
Q

Medication that supports ovulation by managing hyperinsulinemia in patients with PCOS

A

Metformin

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63
Q

Too much insulin may prevent

A

Ovulation

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64
Q

Assisted Reproductive Technology that places prepared sperm at cervical OS or in uterus

A

Intrauterine Insemination (IUI)

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65
Q

Therapeutic donor insemination may be useful for

A

Chromosomal concerns

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66
Q

Individual that is inseminated with semen and carries fetus until birth

A

Surrogate mother

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67
Q

Assisted reproductive technology in which eggs are collected and fertilized in laboratory with sperm, then embryo is transferred into uterus

A

In Vitro Fertilization

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68
Q

Assisted reproductive technology involving fertilization in the fallopian tube

A

In vivo fertilization

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69
Q

Two types of In Vivo Fertilization

A

Gamete intrafallopian transfer (GIFT) and Zygote intrafallopian transfer (ZIFT)

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70
Q

ART Laparoscopic procedure in which oocytes are retrieved and immediately combine with sperm, then immediately transferred into fallopian tubes

A

GIFT

71
Q

ART laparoscopic procedure that combines IVF and GIFT in which zygote is transferred to fallopian tube for transport to the uterus

A

ZIFT

72
Q

Infertility complementary and alternative therapies

A

Acupuncture, herbal treatments, chiropractic care

73
Q

Cons of IVF

A

Ethical/moral issues, expensive! (One cycle can range from 12-20K)

74
Q

A group of conditions characterized by a high level of blood glucose (blood sugar)

A

Diabetes

75
Q

Diabetes resulting from destruction of beta cells in the pancreas by the immune system causing reduced insulin production

A

Type I

76
Q

Characteristics of type I diabetes

A

Early and sudden onset, typically occurring before age 20

77
Q

Type I diabetes management

A

Insulin Injections (this type of diabetes is “insulin dependent”)

78
Q

Diabetes in which the pancreas produces enough insulin, but cells become unresponsive/resistant to insulin

A

Type II

79
Q

Type II diabetes risk factors

A

Obesity, inactivity, unhealthy diet

80
Q

Characteristics of Type II diabetes

A

Gradual onset, typical occurring in adulthood after age 30

81
Q

Management for type II diabetes

A

Weight loss, low-carb diet

82
Q

Insulin deficiency caused by insulin resistance due to placental hormones that typically resolves after birth of the baby

A

Gestational diabetes

83
Q

Hormone produced by the beta cells of the pancreas necessary for glucose intake by target cells

A

Insulin

84
Q

Gestational diabetes risk factors

A

Family hx, obesity, previous unexplained stillbirth, prior infant weight >9 lbs, prior fetal anomalies, age >25, any ethnic group

85
Q

As pregnancy progresses, Human Placental Lactogen (HPL) and progesterone cause

A

Decreased gastric motility, reduced insulin receptor sensitivity, and increased insulin resistance

86
Q

As pregnancy progresses, tolerance to glucose __________

A

Decreases

87
Q

As pregnancy progresses, hepatic glucose production _________

A

Increases

88
Q

As pregnancy progresses, insulin secretions _________ to compensate, and insulin production __________ by the 3rd trimester

A

Increase; doubles

89
Q

Why does insulin production and secretion increase during pregnancy?

A

To ensure that glucose is going to the baby for fuel

90
Q

As a result of large amount of circulating glucose diverting to the fetus, the mother will

A

More quickly dip into glucose stores for fuel

91
Q

Behaviors of normal pregnancy

A

Mild fasting hypoglycemia, progressive insulin resistance, hyperinsulinemia, mild postprandial (after eating) hyperglycemia

92
Q

Why does a pregnant women experience mild fasting hypoglycemia?

A

Due to the overproduction/elevation of insulin which will drop blood sugar

93
Q

Significance of mild postprandial hyperglycemia in pregnancy

A

Mild postprandial hyperglycemia increases the amount of time of elevated maternal glucose level and increases the flux of maternal nutrients to the fetus

94
Q

During the first trimester of pregnancy, the need for insulin is _________

A

Decreased

95
Q

During the first trimester of pregnancy, estrogen and progesterone levels _________

A

Increase

96
Q

Function of increased levels of estrogen and progesterone during the first trimester of pregnancy

A

Stimulate increased insulin secretion, enhance peripheral glucose utilization and transport to fetus, decrease fasting blood glucose

97
Q

Hormones that decrease blood glucose during the first trimester of pregnancy

A

Cortisol and HPL

98
Q

Decreased food intake during the first trimester of pregnancy results in increased risk of __________

A

Hypoglycemia

99
Q

During the second and third trimester, insulin need is __________

A

Increased

100
Q

During the second and third trimester, pregnancy hormones antagonize insulin’s effectiveness at cellular level which can result in a(n) _________ release of glucose from storage

A

Increased

101
Q

Placental enzyme that accelerates the breakdown of insulin which results in decreased insulin effectiveness and decreased peripheral uptake of glucose during the second and third trimesters of pregnancy

A

Insulinase

102
Q

Why do insulin requirements often decrease dramatically during labor and delivery?

A

Decreased food intake (decreased need for insulin), increased metabolism and workload for labor (labor is considered a workout which eliminates the need for insulin)

103
Q

Postpartum behaviors

A

Significant decrease in hormones (HPL, progesterone, estrogen), increased insulin sensitivity (after separation of placenta), further decreased insulin requirements with breastfeeding

104
Q

Influence of pregnancy on diabetes and insulin requirements

A

Insulin requirements change throughout pregnancy and may double or quadruple by the end of pregnancy

105
Q

Influence of pregnancy on diabetes: complications

A

Increased risk of HTN, nephropathy, retinopathy, hypoglycemia, ketoacidosis, and progression of vascular disease

106
Q

Maternal risks of diabetes on pregnancy outcome

A

Hydramnios, increased risk for preeclampsia/eclampsia, ketoacidosis, dystopia (fetopelvic disproportion), worsening retinopathy, urinary/vaginal infection (r/t glycosuria)

107
Q

Fetal-neonatal risks of diabetes on pregnancy outcome

A

Congenital anomalies, Intrauterine Growth Restriction (IUGR) with vascular disease present, LGA/macrosomia (>9 lbs), respiratory distress syndrome (RDS), polycythemia/hyperbilirubinemia, hypoglycemia

108
Q

How does maternal diabetes influence RDS in fetus/neonate?

A

High levels of fetal insulin inhibit an enzyme needed for surfactant production

109
Q

How does maternal diabetes influence neonatal polycythemia/hyperbilirubinemia?

A

Due to diminished glycosylated hemoglobin to carry oxygen

110
Q

How does maternal diabetes influence neonatal hypoglycemia?

A

After maternal blood glucose is cut off, high levels of insulin activity deplete glucose levels leaving newborn at risk

111
Q

Maternal antepartum diabetes medical management goals

A

Maintain physiologic equilibrium between insulin availability and glucose utilization; optimal health for both mother and newborn

112
Q

Maternal antepartum diabetes dietary regulation

A

Balanced diet lower in carbs

113
Q

Maternal antepartum glucose monitoring

A

3-4x a day

114
Q

What is recommended for diabetic women who are trying to conceive?

A

Preconception counseling (diabetes should be very well managed prior to pregnancy to prevent complications!!)

115
Q

Maternal antepartum insulin administration

A

Intermediate or short acting, or oral hypoglycemics such as metformin

116
Q

Medication that prevents the development of preeclampsia

A

Aspirin 81 mg PO daily starting second trimester

117
Q

Fetal antepartum medical management at 8-10 weeks

A

Crown-rump length for dating

118
Q

Fetal antepartum medical management at 16-18 weeks

A

Maternal serum alpha fetoprotein

119
Q

Fetal antepartum medical management at 18-20 weeks

A

Anatomy scan

120
Q

Fetal antepartum medical management at 20-22 weeks

A

Fetal echocardiogram

121
Q

Fetal antepartum medical management at 24 weeks

A

US for growth restriction every 4 weeks

122
Q

Fetal antepartum medical management at 32 weeks

A

Twice weekly NSTs (or earlier if complications)

123
Q

What do Non-Stress Tests (NSTs) assess?

A

Fetal oxygenation and well-being

124
Q

Reassuring NST

A

2 accelerations in 20 minutes

125
Q

Fetal antepartum medical management at 37-39 weeks

A

Consider induction if complications

126
Q

Fetal antepartum medical management at 39 weeks

A

Delivery

127
Q

Gestational diabetes HgbA1c levels

A

> /= 6.5%

128
Q

Oral Glucose Tolerance Test (OGTT) screening for gestational diabetes

A

Done between 24-28 wks, 100 g oral glucose load, 1 hour screening, if 1 hour failed (BS</= 130) then proceed to 3 hour

129
Q

If ___ or more values are abnormal following a 3 hour OGTT, then gestational diabetes is diagnosed

A

2

130
Q

Fasting OGTT normal BG results

A

95 mg/dL

131
Q

1 hr OGTT normal BG results

A

180 mg/dL

132
Q

2 hour OGTT normal BG results

A

155 mg/dL

133
Q

3 hour OGTT normal BG results

A

140 mg/dL

134
Q

Goal fasting BG level

A

<95

135
Q

Goal 1 hour postprandial BG level

A

<130-140

136
Q

Goal 2 hour postprandial BG

A

<120

137
Q

Goal BG during active labor

A

<110

138
Q

Normal A1c level

A

4.5-6.0%

139
Q

A1c level ___ 8.5% poses a 3-4% risk congenital anomaly

A

<

140
Q

A1c ___ 8.5% poses a 22.4% risk of congenital anomaly

A

>

141
Q

Maintaining maternal euglycemia intrapartum

A

BG q1-2 hours during active labor, IV insulin

142
Q

Goal of diabetes medical management intrapartum

A

Prevention of neonatal hypoglycemia

143
Q

OGTT should be repeated ___-___ weeks postpartum

A

4-12

144
Q

Recommended contraception postpartum

A

Progesterone only or hormone free

145
Q

Prevention of fetal hypoglycemia

A

Frequent feedings (breastfeeding or formula)

146
Q

What weight classifies a LGA/macrosomic neonate?

A

> 4500 g, characterized by excessive body fat and organomegaly

147
Q

Excessive growth (LGA/macrosomia) is due to

A

High levels of maternal glucose

148
Q

Small for gestational age (SGA) is due to

A

Perfusion issues from diabetes related to vascular disease

149
Q

Increased newborn glucose can cause

A

Hypovolemia (or decreased body water)

150
Q

Newborn hypoglycemia

A

BG < 40 mg/dL

151
Q

S/S of newborn hypoglycemia present within ___-___ hours of delivery

A

1-2

152
Q

Newborn hypoglycemia treatment

A

IV or oral glucose, or feeding

153
Q

S/S of newborn hypoglycemia

A

Poor feeding and/or vomiting, apnea, hypothermia, jitteriness, grunting, irritability, bluish/pale skin color, lethargy, tremors/seizures

154
Q

Decreased maternal serum magnesium levels at term, caused by increased urinary excretion of calcium, causes secondary __________ in the newborn

A

Hypoparathyroidism (low calcium)

155
Q

Newborn hypocalcemia is characterized by

A

Tremors

156
Q

T/F: newborn hypocalcemia rarely requires treatment

A

True

157
Q

Newborn hyperbilirubinemia develops between ___-___ hours post-delivery

A

48-72

158
Q

Causes of newborn hyperbilirubinemia

A

Decreased extracellular volume causing increased Hct and increased breakdown of RBCs, hepatic immaturity impairing bilirubin conjugation, birth trauma/hematoma

159
Q

Causes of birth trauma

A

Macrosomia, shoulder dystocia

160
Q

Shoulder dystocia can result in

A

Broken clavicle and nerve damage

161
Q

Birth trauma increases the risk for

A

Newborn jaundice

162
Q

Newborn polycythemia pathophysiology

A

Fetal hyperglycemia and hyperinsulinemia = increased O2 consumption; glycosylated hemoglobin binds to O2, decreased amount of O2 available to fetus which stimulates production of erythropoietin and RBCs. Increased RBCs increases Hct which increased risk for hyperbilirubinemia

163
Q

RDS occurs particularly in

A

Infants of poorly controlled diabetic mothers

164
Q

RDS pathophysiology

A

Fetal lungs are less mature than expected for gestational age due to insulin antagonizing synthesis of lectin, and decreased phospholipid phosphatidylglycerol levels

165
Q

Protein needed for lung maturation and surfactant production

A

Lectin

166
Q

Lipid needed for surfactant stabilization

A

Phospholipid phosphatidylglycerol

167
Q

RDS nursing consideration

A

Test for lung maturity prior to delivery if before 39 weeks

168
Q

Congenital heart defects related to diabetes

A

Transposition of the great vessels, ventricular septal defect, patent ductus arteriosus

169
Q

Congenital heart defect resulting in a hole in the heart

A

Ventricular septal defect

170
Q

Congenital heart defect resulting in an opening between the 2 major blood vessels leading from the heart

A

Patent ductus arteriosus

171
Q

Congenital birth defects related to diabetes

A

Small left colon syndrome, renal anomalies, neural tube defects, sacral agenesis

172
Q

Congenital birth defect specific to diabetes in which there is partial or complete absence of the sacrum and lower lumbar spine

A

Sacral agenesis

173
Q

Prevention of congenital birth defects related to diabetes

A

TIGHT glycemic control!!

54/64 Unit 1 (9 decks)

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