Maternal NCM 109 Flashcards
Every day, approximately __________ die from preventable causes related to pregnancy and childbirth.
830 women
___% of all maternal deaths occur in developing countries.
99%
True or False
Maternal mortality is lower in women living in rural areas and among poorer communities.
False (Higher)
True or False
Young adolescents face a higher risk of complications and death as a result of pregnancy than other women.
True
True or False
Skilled care before, during and after childbirth can save the lives of women and newborn babies.
True
Between ____ and ____, maternal mortality worldwide dropped by about ____.
1990 and 2015, 44%
Between 2016 and 2030, as part of the Sustainable Development Goals, the target is to reduce the global maternal mortality ratio to less than __ per ________ live births.
70 per 100 000 live births.
True or False
Small disparities between countries, but also within countries, and between women with high and low income and those women living in rural versus urban areas.
False (Large)
measures the risk of dying from causes related to pregnancy, 1childbirth, and puerperium
MATERNAL MORTALITY RATE
What is the Maternal mortality ratio?
(Number of maternal deaths / Number of live births) X 1000
MMR= ? (what date)
1.1/1000 LB (FEB, 2008)
CAUSES of Maternal Mortality Rate (5)
● Hemorrhage
● Sepsis
● Obstructed Labor/ Labor Dystocia=due to representation of the fetus (shoulder presentation), due to locked twins or pelvic twins
● Hypertension
● Complication of unsafe abortion
measures the risk of dying during the first year of life.
Infant Mortality Rate
It is a good index of its general health because it measures the quality of pregnancy care, overall nutrition, and sanitation, as well as infant health and available care.
Infant Mortality Rate
What is the Infant Mortality Ratio?
the number of deaths in the first year of life divided by the number of live births, multiplied by 1000
IMR=?
13.2/1000LB
CAUSES of Infant Mortality Rate? (9)
● Bacterial Sepsis of newborn
● Respiratory distress of newborn
● Pneumonia
● Disorders related to short gestation to low birth weight
● Congenital Pneumonia
● Congenital Malformation
● Neonatal Aspiration syndrome
● Intrauterine hypoxia and birth asphyxia
● diarrhea and gastroenteritis of presumed infectious origin
measure pregnancy wastage
FETAL DEATH RATE
What is the Fetal Death Ratio?
total fetal death/total live birth X 1000
FDR=? (what date)
5.2/1000 LB feb, 2008
study of the way such disorders occur
Genetics
detailed family history
Genetic Assessment
How many family generations in Genetic Assessment?
Family history (3 generations)
Physical examination of both parents and any affected children
Genetic Assessment
series of laboratory assays of blood, amniotic fluid and maternal and fetal cells.
Genetic Assessment
Disorders that can be passed from one generation to the next because they result from some disorder in the gene of chromosome structure.
Genetic Disorder
study of chromosomes by light microscopy
Cytogenesis
GENETIC COUNSELING AND TESTING PURPOSES: (4)
● Provide concrete, accurate information about the process of inheritance and inherited disorders
● Reassure people who are concerned their child may inherit a particular disorder and the disorder may not occur
● Allow people who are affected by inherited disorders to make informed choices about future reproduction
● Allow people to begin preparation for a child with special needs.
concurrent disorder, pregnancy-related complication, or external factor jeopardizes the health of the woman, fetus or both.
High-risk pregnancy
Assessment that may categorize a pregnancy is at risk: (7)
OBSTETRICAL RECORD
MEDICAL HISTORY
CURRENT OBSTETRIC STATUS
PSYCHOSOCIAL FACTORS
DEMOGRAPHIC FACTORS
LIFERSTYLE
PHYSICAL ASSESSMENT
OBSTETRICAL RECORD of a HIGH RISK PRENATAL CLIENT (6)
● History Infertility
● Premature cervical dilation
● uterine cervical anomaly
● previous experience
● 2 or more abortion
● previous macrosomic infant
MEDICAL HISTORY of a HIGH RISK PRENATAL CLIENT (6)
● cardiac pulmonary disease
● metabolic diseases
● renal disease
● GI disorder
● Seizure disorders
● emotionally disable
CURRENT OBSTETRIC STATUS of a HIGH RISK PRENATAL CLIENT (6)
● inadequate prenatal care
● polyhydramnios
● placenta previa
● abnormal presentation
● RH sensitization
● preterm labor
PSYCHOSOCIAL FACTORS of a HIGH RISK PRENATAL CLIENT (6)
● inadequate finance
● lack of support system
● poor nutrition
● lack of acceptance of pregnancy
● father of baby uninvolved
● minority status
DEMOGRAPHIC FACTORS of a HIGH RISK PRENATAL CLIENT (2) pls memorize the ages and years
● Maternal age under 16 or over 35
● education; under 11 years
LIFERSTYLE of a HIGH RISK PRENATAL CLIENT (9)
● cigarette
● drug abuse
● pollution
● no seatbelts
● alcohol intake
● heavy lifting
● unusual stress
● long period of standing
● presence of smoke
PHYSICAL ASSESSMENT of a HIGH RISK PRENATAL CLIENT (8)
HAIR
EYES
MOUTH
NECK
SKIN
EXTREMITIES
FINGERS & TOENAILS
WEIGHT
HAIR
GOOD NUTRITION ?
shiny, strong with good body,
HAIR
BAD NUTRITION ?
lifeless, dull (possible protein deficit)
EYES
GOOD NUTRITION?
good eyesight, particularly at night, conjunctiva moist & pink
EYES
BAD NUTRITION?
difficulty with night vision (vit. A deficit), pale and dry conjunctiva (iron and fluid deficit)
MOUTH
GOOD NUTRITION?
no cavities, no gingivitis, no cracks/fissures, mucous membrane moist and pink, tongue is moist and non-tender
MOUTH
BAD NUTRITION?
there are fissures on the corners of the mouth (vit. A deficit), pale mucous membrane ( iron deficit)
NECK
GOOD NUTRITION?
normal contour of thyroid gland
NECK
BAD NUTRITION?
thyroid gland enlargement
SKIN
GOOD NUTRITION?
smooth, normal turgor
SKIN
BAD NUTRITION?
rough texture, poor turgor
EXTREMITIES
GOOD NUTRITION?
BAD NUTRITION:
normal muscle mass
EXTREMITIES
BAD NUTRITION?
poor muscle tone
FINGERS & TOENAILS
GOOD NUTRITION?
smooth, pink, normal contour
FINGERS & TOENAILS
BAD NUTRITION?
pale. breaks easily
WEIGHT
GOOD NUTRITION?
normal weight
DIAGNOSTIC TEST IN HIGH-RISK PREGNANCY/PRENATAL
DETERMINATION OF FETAL STATUS
● process of identifying apparently healthy people who may be at increased risk of a disease or condition.
SCREENING
DIAGNOSTIC TEST IN HIGH-RISK PREGNANCY/PRENATAL
DETERMINATION OF FETAL STATUS
● test is to establish the presence (or absence) of disease as a basis for treatment decisions in symptomatic or screen positive individuals (confirmatory test)
DIAGNOSTIC TEST
DIAGNOSTIC TESTS FOR HIGH-RISK PREGNANCY (2)
INVASIVE
NON-INVASIVE
DIAGNOSTIC TESTS FOR HIGH-RISK PREGNANCY
NON-INVASIVE TESTS? (4)
● Fetal ultrasound or ultrasonic testing
● Cardiotocography
● Non stress test (NST)
● Contraction stress test (CST)
A non-invasive diagnosis procedure utilizing high-frequency sound waves to detect intrabody structures.
Ultrasonography/ Fetal Ultrasound/Ultrasonic Testing
Purposes of Ultrasonography/ Fetal Ultrasound/Ultrasonic Testing (4)
- In early pregnancy; to confirm pregnancy
- To detect the fetus’
- Detects placental location (placenta previa) or placental abnormality (H-mole)
- An important aid in high-risk procedures like amniocentesis
Ultrasonography/ Fetal Ultrasound/Ultrasonic Testing
To detect the fetus’ (6)
● Viability, growth
● Number (multiple pregnancy
● Position, presentation
● Abnormalities (structural)
● Fetal Heart Tone (FHT)
● Age of gestation; most accurate at 12-24 weeks; biparietal diameter of 9.5 cm= mature fetus
Preparation of Ultrasonography/ Fetal Ultrasound/Ultrasonic Testing? (4 steps)
- Advice mother:
- Instruct NOT TO VOID
- Transmission gel is spread over maternal abdomen
- Psychological support is given to the mother/father (couple)
What to do when “Advice mother” in preparation of Ultrasonography
Drink one quart of water 2 hours before the procedure
What to do when “Instruct NOT TO VOID” in preparation of Ultrasonography
In amniocentesis with ultrasound to offer visualization= mother should to prevent injuring the distended bladder with needle insertion
What to do when “Psychological support is given to the mother/father (couple)” in preparation of Ultrasonography
● Explain the reason for the procedure, benefits, and the preparation
● Explain that there is no known risk with infrequent sound waves
● Encourage verbalization of fears and concerns. Explain further that:
In Ultrasonography, are all these statements correct?
➔ Confinement is needed
➔ No need for dye and there is noX-ray irradiation
➔ Procedure takes a short time (about 30 minutes) to accomplish
2 and 3 statements are correct. Statement 1 is incorrect
Confinement is NOT needed
is a technical means of recording (-graphy) the fetal heartbeat (-cardio) and the uterine contractions (-toco) during pregnancy, typically in the third trimester.
CARDIOTOCOGRAPHY (CTC)
The machine used to perform the monitoring is called a cardiography, more commonly known as an electronic fetal monitor (EFM).
CARDIOTOCOGRAPHY (CTC)
Interpretation of a CTG tracing requires both qualitative and quantitative description of: (3)
- Uterine activity (contractions)
- baseline fetal heart rate (FHR)
- Baseline FHR variability
CTC
A ______ test result indicates that your baby’s heart rate increases by the expected amount after each of his movements
reactive
CTC
If your baby’s heart rate does not increase after his movements, the test will be __________
non reactive
CTC
A _______ result does npt necessarily indicate a problem.
non reactive
True or False
If the result is still ‘reactive’, your doctor might ask you to come back for another test after an hour.
False (Non Reactive)
a. Observation of FHT related to fetal movement
b. A test of fetal well-being
c. Usually done after week 26 of pregnancy
NON-STRESS TEST (NST)
NON-STRESS TEST (NST) is done after week __ of pregnancy?
week 26
Preparation of NON-STRESS TEST (NST)
a. Position: semi-fowler’s or left lateral position slightly turned to the left
b. BP is checked first
c. Explain:
● procedure takes 30 to 60 minutes to finish
● mother needs to activate “mark button” with each fetal movement
● does jot need hospitalization-ambulatory basis
d. Requires external electronic monitoring in FHT with ultrasound to trace fetal activity and or uterine activity
Interpretation of NST?
NORMAL?
Reactive
Interpretation of NST
(Normal) Increased FHT (accelerating) greater than 15 bpm above baseline?
lasting 15 seconds or more in a 10 to 20-minute period with fetal movement.
Interpretation of NST
Abnormal?
NON-REACTIVE
● No FHR acceleration with fetal movement
Implication of Results of NST
Abnormal results?
mother needs another test, maybe biophysical profile
Purpose
a. Observation of response of the fetus to induced uterine contractions
b. A test of feto-placental well-being
OXYTOCIN CHALLENGE TEST (OCT)/ CONTRACTION STRESS TEST (CST)
Preparation of OCT/CST (4)
a. Semi-fowler’s or left lateral position
b. BP is checked priorly and q15 minutes during the test
c. Explain:
d. Requires external electronic FHT monitoring with ultrasound transducer and tocodynamometer to detect uterine activity
Preparation of OCT/CST
“Explain” ★ Procedure takes __ to ___ hours to finish
1 to 3
Preparation of OCT/CST
“Explain” Mother receives oxytocin of increasing dosage “__________” to the mainline and aimed to cause 3 uterine contractions in 10 minutes.
piggybacked
Preparation of OCT/CST
“Explain” May be done on __________ basis
outpatient
Interpretation of OCT/CST
A. Normal:
Negative
NO late decelerations of FHR which each of 3 contractions during a 10-minute interval
Interpretation of OCT/CST
B. Abnormal:
Positive
WITH late deceleration of FHR with 3 contractions in 10 minutes
Implication of Results of OCT/CST
a. Normal:
● Pregnancy continues;
● normal result of OCT may require weekly tests
Implication of Results of OCT/CST
a. Abnormal:
● may indicate a need to terminate pregnancy
INVASIVE DIAGNOSTIC TESTS (7)
● Chorionic Villus Sampling
● Amniocentesis
● Embryoscopy
● Fetoscopy
● Cordocentesis/ Percutaneous Umbilical Cord Blood Sampling
● Biophysical Profile (BPP)
are small structures in the placenta that act like blood vessels
CHORIONIC VILLUS SAMPLING (Chronic Villi)
These structures contain cells from the developing fetus
CHORIONIC VILLUS
A test that removes a sample of these cells through a needle is called
chorionic sampling (CVS)
In CVS
The sample can be taken through the ___________ or the ______________
Cervix (transcervical) or the abdominal wall (transabdominal)
is a form of prenatal diagnosis to determine chromosomal or genetic disorders in the fetus.
CHORIONIC VILLUS SAMPLING
CVS usually takes place at __-__ weeks’ gestation earlier than amniocentesis or percutaneous umbilical cord blood sampling.
10-12 weeks’
CVS
It is the preferred technique before _ weeks.
BEFORE 15 WEEKS
Preparation CVS (3)
● You might need to have a full bladder for chorionic villus sampling, so drink plenty of fluids before your appointment
● Sign a consent form before the procedure begins
● Consider asking someone to accompany you to the appointment for emotional support or to drive you home afterward
is a test that can be done during pregnancy to look for birth defects and genetic problems in the developing baby.
AMNIOCENTESIS
removes a small amount of fluid from sac around the baby in the womb(uterus)
AMNIOCENTESIS
It is most often done in a doctor’s office or medical center. You do not need to stay in the hospital
AMNIOCENTESIS
done in the second trimester (4th-6th month) of pregnancy
AMNIOCENTESIS
is most often offered to women who are at increased risk for bearing a child with birth defects
AMNIOCENTESIS
You may choose genetic counseling before the procedure
AMNIOCENTESIS
AMNIOCENTESIS
This include who?? (4)
● will be 35 or older when they give birth
● had a screening test result that shows there may be a birth defect or other problem
● Have had babies with birth defects in other pregnancies
● have a family history of genetic disorder
AMNIOCENTESIS will allow you to:
● Learn about the prenatal tests
● Make an informed decision regarding options for prenatal diagnosis
is a diagnostic test, not a screening test
AMNIOCENTESIS
is 99% accurate for diagnosing Down Syndrome
AMNIOCENTESIS
is usually done between 14 and 20 weeks
AMNIOCENTESIS
can be used to diagnose many different gene and chromosome problems in the baby
AMNIOCENTESIS
Amniocentesis can be used to diagnose many different gene and chromosome problems in the baby, including: (4)
● anencephaly
● rare, metabolic disorders that are passed down through families
● other genetic abnormalities, like trisomy 18
● Down Syndrome
Preparation of Amniocentesis (5)
● bladder should be empty during amniocentesis to minimize the chance of puncture
● sign a consent form before the procedure begins. Consider asking someone to accompany you to the appointment for emotional support
● you would have to be anesthetized
● the needle will start from the abdominal wall and move to the uterus after a local anesthesia is administered
● specific amount of amniotic fluid
withdrawn depends on the number of weeks the pregnancy has progressed
After the procedure of Amniocentesis (3)
● After the amniocentesis, your health care provider will continue using the ultrasound to monitor the baby’s heart rate. You might experience cramping or mild pelvic discomfort after an amniocentesis
● You can resume your normal activity level after the procedure. However, you might consider avoiding strenuous exercise and sexual activity for a day or two.
● Contact your health care provider
Amniocentesis
Contact your health care provider if you have: (5)
a. loss of vaginal fluid or vaginal bleeding
b. severe uterine cramping that lasts more than a few hours
c. fever
d. redness and inflammation where the needle was inserted
e. unusual fetal activity or a lack of fetal movement
Examination of the embryo at 9-10 weeks gestation through the intact membranes
EMBROSCOPY
Done by introducing an endoscope into the exocoelomic space transcervically or transabdominally
EMBROSCOPY
This is likely to remain confined to the management of early pregnancy in selected families affected by external fetal abnormalities.
EMBROSCOPY
The procedure-related risk of fetal loss is around a percent.
EMBROSCOPY
examination of the fetus after 11 weeks gestation
FETOSCOPY
performed transabdominally in the amniotic fluid
FETOSCOPY
The technique has evolved with the miniaturization of the optical device by using fibre-optics technology
FETOSCOPY
This procedure is likely to find new applications with the development of ultrasound examination at 10-14 weeks gestation in order to either confirm, or rule out suspected external fetal abnormalities.
FETOSCOPY
In FETOSCOPY, This procedure is likely to find new applications with the development of ultrasound examination at ___-___ weeks gestation in order to either confirm, or rule out suspected external fetal abnormalities.
10-14 weeks
In FETOSCOPY, The technique has evolved with the miniaturization of the optical device by using ___________ technology
fibre-optics technology
is a diagnostic test that examines blood from the fetus to detect fetal abnormalities
PERCUTANEOUS UMBILICAL CORD BLOOD SAMPLING/ CORDOCENTESIS
An advanced imaging ultrasound determines the location where the umbilical cord inserts into the placenta. The ultrasound guides a thin needle through the abdomen and uterine walls to the umbilical cord.
PERCUTANEOUS UMBILICAL CORD BLOOD SAMPLING/ CORDOCENTESIS
The needle is inserted into the umbilical cord to retrieve a small sample of fetal blood
PERCUTANEOUS UMBILICAL CORD BLOOD SAMPLING/ CORDOCENTESIS
The procedure is similar to amniocentesis except the objective is to retrieve blood from the fetus versus amniotic fluid
PERCUTANEOUS UMBILICAL CORD BLOOD SAMPLING/ CORDOCENTESIS
The needle is inserted into the umbilical cord to retrieve a small sample of fetal blood
PERCUTANEOUS UMBILICAL CORD BLOOD SAMPLING/ CORDOCENTESIS
is usually done when diagnostic information can not be obtained through amniocentesis, CVS, ultrasound or the result of these tests were inconclusive
PERCUTANEOUS UMBILICAL CORD BLOOD SAMPLING/ CORDOCENTESIS
PERCUTANEOUS UMBILICAL CORD BLOOD SAMPLING/ CORDOCENTESIS
The sample is sent to the laboratory for analysis, and results are usually available within __hours.
72 hours
Cordocentesis is performed after __ weeks into pregnancy
17 weeks
True or False
Cordocentesis detects chromosomal abnormalities (i.e. DOWN SYNDROME) and blood disorders (i.e. feta hemolytic disease)
True
Cordocentesis may be performed to help diagnose any of the following concerns:
a. malformation of the fetus
b. fetal infection ( i.e. toxoplasmosis or rubella)
c. fetal platelet count in the mother
d. fetal anemia
e. isoimmunization
BIOPHYSICAL PROFILE (BPP)
A scoring combining ultrasound assessment of: (5)
a. fetal breathing
b. fetal movement
c. fetal tone
d. reactivity of the heart rate
e. amniotic fluid volume BPP could have used to predict fetal well-being in high risk pregnancy
BPP Scores
8-10?
8-10: Normal, low risk for chronic asphyxia
BPP Scores
4-6?
4-6: Suspected chronic asphyxia
BPP Scores
0-2?
0-2: Strong suspicion of chronic asphyxia
MEDICAL CONDITIONS AFFECTING PREGNANCY OUTCOMES (3)
- Cardiovascular Disorders (Rheumatic Heart Disease)
- Diabetes Mellitus
- Substance Abuse
● are disease affecting the heart
CARDIOVASCULAR DISORDERS
● involve some type of impaired cardiac function of all pregnancies
CARDIOVASCULAR DISORDERS
● complicates approximately only 1% of all pregnancy
CARDIOVASCULAR DISORDERS
● responsible for the 5% of maternal death during pregnancy
CARDIOVASCULAR DISORDERS
Cardiovascular Disorders commonly cause difficulty during pregnancy.
______________ (characterized by damage to or a defect in one of the four heart valves: the mitral, aortic, tricuspid or pulmonary)
VALVULAR DAMAGE
_____ and _____valves control the flow of blood between the atria and the ventricles (the upper and lower chambers of the heart)
● mitral and tricuspid valves
________ valve controls the flow of blood from the heart to the lungs
Pulmonary valve
______ valve governs blood flow between the heart and the aorta, and thereby the blood vessels to the rest of the body.
Aortic valve
_______ and ______ valves are the ones most frequently affected by the valvular heart disease
Mitral and aortic valves
A complication of Rheumatic Fever in which the heart valves have been permanently damaged.
RHEUMATIC HEART DISEASE
may not exhibit noticeable symptoms, it is often undiagnosed until reaching certain period of time that aggravates the manifestations such as pregnancy
RHEUMATIC HEART DISEASE
an inflammatory disease that may develop after an infection with a group.
RHEUMATIC HEART DISEASE
What bacteria is found in RHEUMATIC HEART DISEASE?
A Streptococcus bacteria ( such as strep throat or scarlet fever)
The disease can affect the heart, joints, skin and brain.
RHEUMATIC HEART DISEASE
COMPLICATIONS OF RHF DURING PREGNANCY (3 process)
During pregnancy there is an increase in blood volume
⇩
Increases pressure on heart valves
⇩
Leading to increased maternal and fetal risks
COMPLICATIONS OF RHF DURING PREGNANCY (3)
● Death of mother and baby
● Increased risk of preterm delivery (may affect baby & mother’s health)
● In some cases, serious complications are associated with a greater risk of heart failure before, during, and after delivery.
DIAGNOSTIC TEST of RHF (5)
- Electrocardiogram (ECG)
- Echocardiography
- Chest Radiography (CXR)
- Ultrasound
- Late deceleration on fetal monitors
RHF
reveals cardiac changes in the mother
Electrocardiogram (ECG)
RHF
a test that uses sound waves to create a moving picture of the heart
Echocardiography
RHF
reveals cardiomegaly (enlarged heart)/ hepatomegaly.
Chest Radiography (CXR)
RHF
shows fetal growth restrictions
Ultrasound
RHF
is possible if the mother’s cardiac decompression causes placental incompetency.
Late deceleration on fetal monitors
TREATMENT OF RHD (10)
● Hospital admission to treat heart failure
● Antibiotics (Penicillin) for infection of the heart valves
● Blood-thinning meds to prevent stroke
● Heart valve surgery to repair or replace damaged heart valves
● Close medical supervision w/ more frequent prenatal visits and adjustments in pregnancy drug therapy
● REST.
● Limited sodium and increased protein and iron intake.
● Prophylactic antibiotics as indicated
● Serial ultrasounds, non stress test, and biophysical profile to evaluate fetal status.
● Prophylactic antibiotic during labor for women with mitral valve prolapse to protect the valve
KEY PATIENT OUTCOMES of RHD (6)
● Maintain adequate cardiac output and placental perfusion
● Maintain hemodynamic stability
● Perform activities of daily living within limitation of disease
● Maintain adequate fluid balance
● Maintain adequate ventilation
● Give birth to a viable neonate
NURSING INTERVENTION of RHD (4)
● Assess maternal vital signs and cardiopulmonary status closely for changes
● Monitor fetal heart rate for changes
● Reinforce the need for more frequent prenatal visits, and assist with arranging follow up visits
● Alert the pt. to danger signs & symptoms that should be reported immediately
is a group of metabolic disorders characterized by elevated levels of blood glucose (hyperglycemia) resulting from defects in insulin production and secretion, decreased cellular response to insulin or both.
DIABETES MELLITUS
True or False
Is DIABETES MELLITUS characterized by elevated levels of blood glucose (hypoglycemia)?
False (hyperglycemia)
THREE TYPES OF DIABETES MELLITUS (DM)
Type 1 (formerly Insulin Dependent Diabetes Mellitus IDDM)
Type 2 (formerly NON-INSULIN) Dependent Diabetes Mellitus (NDDM)
Gestational Diabetes Mellitus
● accounts 5% to 10% of diabetic patient
Type 1 (formerly Insulin Dependent Diabetes Mellitus IDDM)
● Beta cells of the pancreas that normally produce insulin are destroyed by an autoimmune process
Type 1 (formerly Insulin Dependent Diabetes Mellitus IDDM)
● Insulin injections are needed to control the blood pressure glucose level
Type 1 (formerly Insulin Dependent Diabetes Mellitus IDDM)
● Has a sudden onset usually before the age of 30 years
Type 1 (formerly Insulin Dependent Diabetes Mellitus IDDM)
● about 90% to 95% of diabetics have this type of diabetes
Type 2 (formerly NON-INSULIN) Dependent Diabetes Mellitus (NDDM)
● occurs most frequently in patient older than 30 years of age and obese
Type 2 (formerly NON-INSULIN) Dependent Diabetes Mellitus (NDDM)
● results from a decreased sensitivity to insulin (insulin resistance) or from a decrease amount of insulin production
Type 2 (formerly NON-INSULIN) Dependent Diabetes Mellitus (NDDM)
● can be first treated with diet and exercise, then oral hypoglycemic agents as needed
Type 2 (formerly NON-INSULIN) Dependent Diabetes Mellitus (NDDM)
● is characterized by any degree of glucose intolerance with onset during pregnancy (2nd or 3rd Trimester), in clients not previously diagnosed as diabetic.
Gestational Diabetes Mellitus
● occurs when the pancreas cannot respond to the demand for more insulin
Gestational Diabetes Mellitus
● Pregnant women should be screened for glucose levels at the 26th week of gestation
Gestational Diabetes Mellitus
● A 3 hour glucose tolerance test will be performed to confirm diabetes mellitus
Gestational Diabetes Mellitus
● Oral hypoglycemic agents are never used during pregnancy
Gestational Diabetes Mellitus
● Frequently can be treated by diet alone, however, insulin may be needed for some clients.
Gestational Diabetes Mellitus
● Most gestational diabetes convert to normal after delivery, however, these individuals have an increased risk for developing diabetes mellitus in their lifetime.
Gestational Diabetes Mellitus
PREDISPOSING FACTORS of Diabetes Mellitus (11)
● women 35 years of age or older
● younger than 25 years of age
● obese
● with family in diabetes in 1st degree relatives
● members of a certain ethnic racial groups
● Americans, native americans, americans-african, americans or pacific islanders.
● delivering large neonate (usually 10lbs or 4kgs)
● Hx od unexplained fetal or perinatal loss
● Hx of polycystic ovary syndrome
● Hx of congenital anomalies in previous pregnancy
● Increases the risk for hypertensive disorders in pregnancy
ASSESSMENT FINDINGS OR CLINICAL MANIFESTATIONS of Diabetes Mellitus (18)
● Polyuria
● Polydipsia
● Polyphagia
● Fatigue and weakness
● Sudden vision changes
● Tingling or numbness in the hands or feet
● Dry skin
● Dizziness
● Confusion (hypoglycemic)
● Congenital anomalies
● macrosomic or large babies (>10 lbs)
● increase risk of PIH
● poor fetal heart tone and rate (from poor tissue perfusion)
● glycosuria
● ketonuria
● hydramnios
● possibility of increased infection (monilial and yeast infection)
● fetal death
DIABETES MELLITUS IN PREGNANCY: (4)
- DM is more difficult to control during pregnancy
- Premature delivery is more frequent
- The newborn infant of a diabetic mother is subject to hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, and congenital anomalies
- Stillborn and neonatal mortality rates are higher
DIAGNOSTIC TESTS for DIABETES MELLITUS (4)
- Fasting Blood Sugar (FBS) or FASTING PLASMA GLUCOSE/ NON FASTING PLASMA GLUCOSE (RBS)
- Oral Glucose Challenge Test (50-g)
- Glycosylated Hemoglobin Measurement
- Ophthalmic examination
- Urine Culture
DIAGNOSTIC TESTS for DIABETES MELLITUS
● fasting plasma glucose of 136 mg/dl or more or a NON fasting plasma glucose of 200 mg/dl or more meets the threshold for the diaphysis of DIABETES.
Fasting Blood Sugar (FBS) or FASTING PLASMA GLUCOSE/ NON FASTING PLASMA GLUCOSE (RBS)
DIAGNOSTIC TESTS for DIABETES MELLITUS
● After 60 mins or 1 hr, ingestion of the 50-g glucose load, a venous blood sample is taken for glucose determination.
● If the result is 140 mg/dl or more the woman is scheduled for a 100-g 3-hour fasting. Glucose Tolerance Test. If 2 out of the 4 blood samples are abnormal or the fasting blood values is above 95-mg/dl then, a diagnosis of DIABETES is made.
Oral Glucose Challenge Test (50-g)
DIAGNOSTIC TESTS for DIABETES MELLITUS
● use to detect the degree of hyperglycemia present or the amount of glucose attached to hemoglobin
● This is advantageous because it reflects the average blood glucose level over the past 4 to 6 weeks ( the time the RBC were picking up the glucose) not just the
level on the day of resting.
Glycosylated Hemoglobin Measurement
DIAGNOSTIC TESTS for DIABETES MELLITUS
● should be done once per trimester
Ophthalmic examination
DIAGNOSTIC TESTS for DIABETES MELLITUS
● should be done each trimester to detect asymptomatic UTI
Urine Culture
Normal blood glucose level is ???
80-129 mg/dl
Normal level of HbA is ???
3.0% - 6.9% of the total hemoglobin
IMPLEMENTATION of DIABETES MELLITUS Patients (17)
● Screen clients between the 24th and 28th weeks of pregnancy
● Prenatal visits bimonthly for 6 months and weekly thereafter
● The goal of therapy is to maintain the blood glucose in a narrow low range of 65 - 130 mg/dl
● Monitor for signs of hypoglycemia ; episodes of mild or moderate hypoglycemia can be treated with oral intake of 10 - 15 g of simple carbohydrates
● Observe for signs of hyperglycemia
● Assess insulin needs
● Monitor and maintain blood glucose levels according to gestational week
● Monitor for glycosuria and ketonuria
● Monitor weight
● Insulin administration if diet cannot control blood glucose levels
● Assess for signs of pre eclampsia, which includes HPN, proteinuria, and edema
● Check for increase temperature and signs of infections
● Instruct the client to report burning and pain on urination or vaginal or itching
● Assess fetal status and monitor for signs of premature labor
● Assess for signs of polyhydramnios
● Increase caloric intake to 2200 - 2500 daily or as prescribed, with adequate insulin therapy so that glucose will move into the cells
● Calories in diet consist of 50% to 60% carbohydrates, 12% to 20% protein, 20% to 30% fat.
IMPLEMENTATION of DIABETES MELLITUS Patients
Screen clients between the __th and __th weeks of pregnancy
24th and 28th
IMPLEMENTATION of DIABETES MELLITUS Patients
The goal of therapy is to maintain the blood glucose in a narrow low range of __ - ___ mg/dl
65 - 130 mg/dl
IMPLEMENTATION of DIABETES MELLITUS Patients
Monitor for signs of hypoglycemia ; episodes of mild or moderate hypoglycemia can be treated with oral intake of __- __ g of simple carbohydrates
10 - 15 g
IMPLEMENTATION of DIABETES MELLITUS Patients
Increase caloric intake to ____- ____daily or as prescribed, with adequate insulin therapy so that glucose will move into the cells
2200 - 2500
IMPLEMENTATION of DIABETES MELLITUS Patients
Calories in diet consist of __% to __% carbohydrates, __% to __% protein, __% to __% fat.
50% to 60% carbohydrates, 12% to 20% protein, 20% to 30% fat respectively.
