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XIO > Maternity week 3-1 > Flashcards

Maternity week 3-1 Flashcards

1
Q

Diabetes Defined

A

Disease process marked by impaired production of, or impaired response to, insulin.

Disease process leads to hyperglycemia.

Chronic, untreated disease causes secondary effects in multiple body systems.

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2
Q

pre-gestational diabetes

A

existed before pregnancy

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3
Q

Gestational Diabetes

A

Glucose intolerance/onset in pregnancy
GDMA1= diet-controlled; GDMA2 =medication controlled
Affects up to 10% of pregnancies in U.S.

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4
Q

Diabetes 2/2 Other causes:

A

Diabetes 2/2 Other causes: drug-induced, disease/procedure-induced

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5
Q

Diabetes in Pregnancy

A

Pregestational Diabetes vs. Gestational Diabetes Mellitus (GDM)

GDM dx confers risk of dx. of Type II DM Postpardum (this just means they had it before but didn’t know it. preg did not cause diabetes):

Up to 10% of pregnant people w/ GDM will receive GDM dx postpartum
30-65% of pregnant people w/ GDM will receive GDM dx 10-20 yrs later

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6
Q

GDM Risk Factors

A

Previous pregnancy affected by GDM
Hx of infant >9#
Member of ethnic group with high risk
Obesity
Physical inactivity
PCOS
Hypercholesteremia
1st deg relative w/ diabetes
HTN

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7
Q

Diabetes Risk Assessment:
Nursing Care

A

No history of glucose intolerance
Younger than 25 years old
Normal body weight
No family history (first-degree relative) of diabetes
No history of poor obstetric outcomes
Not from an ethnic/racial group with a high prevalence of diabetes

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8
Q

GDM Sub-types

A

CLASS A-1 (GDMA1 or A1GDM):
2 abnormal values on OGTT
Diet-controlled
Fasting blood glucose normal

CLASS A-2 (GDMA2 or A2GDM):
Medication controlled.
No dx of pre-gestational diabetes

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9
Q

Metabolic Changes
in Pregnancy

A

1st trimester - more sensitive to insulin, in 2nd and 3rd, starts to drop.

“Diabetogenic” Effect of Pregnancy
Metabolism directed towards supplying adequate nutrition to the fetus
Increased resistance to insulin: estrogen, progesterone, human chorionic somatomam-motropin (Hcs), cortisol, human placental lactogen released by placenta
Compensatory increased production of insulin by the pancreas
Post Partum: Return to pre-pregnant metabolism

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10
Q

1st trimester

A

goes up = estrogen /progesterone stimulate beta cells to increase insulin production
Increased insulin sensitivity
Increased glucose metabolism/dec blood glucose
Increase in glycogen stores and decrease in glucose production
Pre-gestational DM= inc risk hypoglycemia

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11
Q

2nd and 3rd Trimesters

A

Increased insulin resistance

Increased hepatic production of glucose

How is extra glucose stored
by fetus?

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12
Q

Gestational Diabetes Screening

A

1st tri screening for high risk clients
Inconsistent practices
Routine screening: 24-28 weeks
GLT
GTT if indicated by abnormal GLT (ACOG: 2 step approach)

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13
Q

Testing:
Glucose Load vs. Glucose Tolerance

A

Oral Glucose Load Test (OGLT or GLT)
*Administer 50g oral glucose (Glucola) p.o.
*Draw1 hour venous blood glucose (bg) *Refer for GTT if bg >139 mg/dL
*Some labs do 75g load/2 hour bg

Oral Glucose Tolerance Test (OGTT or GTT)
*Draw fasting venous blood glucose
*Administer 100 g oral glucose p.o.
*Draw 1 hour, 2 hour, 3 hour bg

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14
Q

Testing:
Glucose Load vs. Glucose Tolerance cont’d

A

GTT normal values
*Fasting bg <95 mg/dL
*One hour bg <180 mg/dL
*Two hour bg <155 mg/dL
*Three hour bg <140 mg/dL

Two elevated bg=GDM dx

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15
Q

Complications of
GDM: Pregnant Person

A

Polyhydramnios (hydramnios): hyperglycemia= inc fetal diuresis
Abnormal blood glucose
Pre-eclampsia/GHTN
Ketoacidosis
C-Section
Instrument assisted delivery (vac, forcep)
Shoulder dystocia
SAB
Infections: UTI, chronic monilial vaginitis

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16
Q

Complications of
GDM: Fetus/Neonate

A

Congenital anomalies: hyperglycemia in 1st tri.:
NDS (neural tube defects, usually from folic acid)
Anencephaly/microcephaly
Cardiac anomolies
Macrosomia
Preterm birth
Fetal asphyxia
IUGR
Perinatal Death
RDS
Polycythemia
Hyperbilirubinemia
Hypoglycemia
Childhood Obesity/Carb Intolerance

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17
Q

Screenings 
Throughout Pregnancy

A

Fundal Height
Blood Tests for genetic screening
Ultrasound for physical anomalies
Echocardiogram for heart anomalies
Lab Tests: U/A and Culture, Serum Glucose, Glycosylated Hgb (A1c), Electrolytes and Renal Function

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18
Q

Perinatal Diabetes
Nursing Care

A

Pre-gestational counseling for clients w/ DM

Complete OB hx

Serum lab tests: HgA1C thyroid function, nephropathy, and retinopathy
Urine screen (POC - point of care = at the bedside)
Teach: dietary modifications, changes in activity, blood glucose monitoring/med administration PRN, home BP monitoring
Refer to dietrician/nutritionist per provider order

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19
Q

Patient Education:
Nutrition

A

Follow prescribed diet plan

Divide daily food intake: 3 meals, 2 -3 snacks

Eat bedtime snack to prevent hypoglycemia NOC

Avoid refined sugar foods

Don’t skip meals or snacks

High dietary fiber foods

Avoid alcohol and nicotine

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20
Q

Patient Education:
Glycemic Index - don’t need to know this

A

Measures effects of food on bg (lower GI=lower BG):

Low:55 or less
Medium:56–69
High:70 or above

Variables that affect GI: cooking time, how processed, how ripe

21
Q

Patient Education:
Nutrition/Glycemic Load - don’t need to know this

A

(Grams of carbohydrate X Glycemic Index)/100 = Glycemic Load

Low GL: 10 or less
Medium GL: 11 to 19
High GL: 20 or higher

More precise than GI=effect on BG + how fast it enters blood stream

22
Q

Patient Education:
Target Blood Glucose in PG

A

Pre-meal or Fasting = 60-99
Post-meal 1 hr = 100 - 129
Post-meal 2 hr < or = 120

23
Q

Hypoglycemic Agents: Insulin

A

Insulin preferred med for GDMA2 (ACOG):
Weight based dosing
Does not cross placenta
Decreased in 1st tri
Divided dosing
Long-acting or intermediate-acting: up to 24 hour effect
+
Short-acting:
Novolog/Humalog,“clear”: 3-6 hour effect

24
Q

Hypoglycemic Agents: 
Oral Meds

A

2nd line
May be easier for clients to manage
Glyburide
Promising data
2.5 mg-20mg QD or BID
Does not cross placenta

Metformin: Less frequently recommended; ***crosses placenta

25
Q

Exercise

A

How much?
30 min moderate-intensity aerobic exercise/5 days week
OR
150 minutes +/week.
Walking 10-15 post-meal lowers BG

Type of exercise should be discussed with HCP.

26
Q

insulin = does it cross the placenta?Cardiac Disease
&
Pregnancy

A

NO

27
Q
A

4% of pregnant people have pre-existing cardiac disease

Congenital or acquired (Ricci, Table 20.3, p 699-700)

Cardiac disease accounts for 10-25% of maternal mortality

Risk Classes I-IV: lowest to highest risk; based on level of functioning

Congenital heart disease=1/2 of all cardiac disease in pregnancy

28
Q

risk class IV - cardiac disease

A

pregnancy not recommended - could lead to death

29
Q

Cardiac Disease and Pregnancy:
Nursing Care

A

Early Diagnosis
Assess current tx: make/implement plan
Nutrition counseling
Activity level: consult MD
Rest
Fetal surveillance
Monitor Weight Gain

30
Q

Cardiac Disease and Pregnancy:
Nursing Care

A

Frequent and thorough assessments
Recognize S&S of cardiac decompensation
During Labor anticipate hemodynamic monitoring, epidural and assess for fluid overload.

31
Q

Cardiac Disease and Pregnancy:
Nursing Assessments

A

Fatigue
Tachycardia
Increased RR
Poor FHT variability from poor tissue perfusion
Decreased amniotic fluid from IUGR
Edema from poor venous return

32
Q

Rh Incompatability

A

Rh factor and Coombs (antibody) determined (1st visit)
Rh +, Rhesus antigen present
Rh -, Rhesus antigen is not present
Rh – exposed to Rh antigen=antibody response

33
Q

if patient has Coombs positive test,

A

we can’t give rhogam bc the antibodies have already formed.

34
Q

iron foods

A

peanut butter raisins***

35
Q

cocaine

A

vasoconstriction, causing hemmorhage and Placental abruption and separation.

36
Q

4 Ps for substance use disorder screening

A

Parents: Did either of your parents ever have a problem
with alcohol or drugs?
Partner: Does your partner have a problem with
alcohol or drugs?
Past: Have you ever had any beer or wine or liquor?
Pregnancy: In the month before you knew you were
pregnant, how many cigarettes did you smoke? In the
month before you knew you were pregnant, how much
beer, wine or liquor did you drink?

37
Q

screening for alcohol/substances should be

A

ongoing

38
Q

GBS - what trimester?

A

3rd

39
Q

TORCH infections of pregnancy

A

Toxoplasmosis
Other (Syphylis)
Rubella
Cytomegalovirus
HSV

40
Q

Reproductive Tract
Infections in Pregnancy

A

Chlamydia * low birth weight
Gonorrhea *IUGR, preterm birth
Group B Strep *Preterm birth, sepsis
Herpes *Congenital infection
HPV *None known
Syphilis *IUGR, stillbirth,
congenital infection, preterm birth

41
Q

Rubeola (Measles)
in Pregnancy

A

SAB, PTL
Maternal encephalitis
Maternal pneumonia
Limited fetal effects (if no pregnancy loss

42
Q

Rubella 
in Pregnancy
(German Measles):
Fetal Effects (Bella’s hearing)

A

Congenital cataracts
Glaucoma
Cardiac defects,
Microcephaly
Hearing and intellectual disabilities.
Hearing impairment is the most common manifestation

43
Q

Cytomegalovirus (CMV) (mega liver)

A

Effects 60% of the population.
Fetus can be infected through placenta, more common with primary infection
Congenital effects > hepatosplenomegaly, jaundice, growth restriction, hearing loss, intellectual disability
Virus transmitted by sexual contact, saliva or urine, infected blood
Good hygiene to help prevent it

44
Q

HIV - on test

A

1 in 9 women unaware HIV+

AIDS: 3rd leading cause of death in U.S. in ages 25-44

Routine screening at 1st PNC visit

Retrovirus: Standard tx is antiretroviral therapy independent of viral load

Perinatal transmission rate 1% if adequately tx’d/35% if not

Greatest risk of vertical transmission during labor/after ROM

45
Q

Vertical transmission

A

Vertical transmission is where viruses can pass between mother and baby in utero

46
Q

greatest risk of Vertical transmission is in the

A

intranatal period (this is during labor) and esp after the rupture of membranes

47
Q

Hepatitis B

A

Universal testing for pregnant people
Hep B immunoglobulin within 12 hours of birth
Bathe NB
Hep B vaccine within 24 hours
Breastfeeding is not contraindicated unless bleeding nipples. any baby born to person with HIV or Hep B will get a bath.

48
Q

Varicella

A

Congenital Varicella Syndrome when contracted early in pregnancy:
Low birth weight,
Skin lesions
SAB
chorioretinitis
Cataracts
Pneumonia
Fetal growth restriction
Delayed milestones
Cutaneous scarring
Limb hypoplasia, microcephaly
Ocular abnormalities
Intellectual disability and early death

49
Q

Varicella

A

Varicella pneumonia (birthing person)

Newborns who contract it: 30% mortality rate

Offer PP vaccine if non-immune

XIO (372 decks)

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