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XIO > maternity week 3 > Flashcards

maternity week 3 Flashcards

1
Q

CLASSIFICATION OF DIABETES

A

*DIABETES MELLITUS: Type I
*DIABETES MELLITUS: Type II
*DM: Other specific types: (i.e. drug induced) *GESTATIONAL DIABETES (GDM): only during pregnancy

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2
Q

GESTATIONAL DIABETES

A
  • CLASS A‐1—2 abnormal values on OGTT, fasting blood glucose normal, diet controlled
  • CLASS A‐2—requires medication to control, not known to have DM prior to pregnancy
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3
Q

PREGESTATIONAL DIABETES

A
  • CLASS B—onset > age 20 (duration < 10 y)
  • CLASS C—onset 10‐19y +/or duration 10‐19 y * CLASS D—onset < 10 y +/or duration > 20 y
  • CLASS F—diabetic nephropathy
  • CLASS R—retinitis proliferans
  • CLASS T—renal transplant
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4
Q

DIABETOGENIC EFFECT OF PREGNANCY

A
  • Metabolism directed towards supplying adequate nutrition to the fetus
  • Increased resistance to insulin
  • Compensatory increased production of insulin by
    the pancreas
  • Post Partum: Return to pre‐pregnant metabolism
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5
Q

1st Trimester

A
  • estrogen /progesterone stimulate beta cells to increase insulin production
  • Promotes increased use of glucose and decreased blood glucose
  • Increase in glycogen stores and decrease in glucose production
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6
Q

WOMEN WITH INSULIN DEPENDENT DIABETES ARE PRONE TO

A

HYPOGLYCEMIA 1ST TRIMESTER

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7
Q

2nd and 3rd Trimesters

A

Increased insulin resistance and increased hepatic production of glucose

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8
Q
A

*Polyhydramnios (hydramnios) *Pre‐eclampsia
*Ketoacidosis
*C/S
*Instrument delivery (vac, forcep) *Shoulder dystocia
*SAB
*Infections

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9
Q

INFLUENCE OF DIABETES ON THE
FETUS

A

*Anomalies *Macrosomia *Fetal demise *Birth trauma *Neonatal
* Hypoglycemia
* RDS
* Polycythemia
* Hyperbilirubinemia
*Miscarriage/SAB

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10
Q

INFLUENCE OF DIABETES ON FETAL/NEONATAL OUTCOME

A

Anomalies
* NTD
* Anencephaly or
microcephaly * Heart defects
Macrosomia

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11
Q

Diabetes NURSING CARE

A

For Type I or II, women should have pre‐conceptual care to stabilize their DM before becoming pregnant.
*HgbA1c <6%
*Blood glucose between 60‐120 mg/dl 10 postprandial
*BP < 130/80
*BMI < 27
*Assessment of thyroid function, nephropathy, and retinopathy
*Teaching on healthy lifestyle, low glycemic foods and folic acid

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12
Q

Diabetes NURSING CARE

A

Screening 24‐28 weeks.
Those at high risk for GDM will be screened in the first semester then again @ 24 – 28 weeks

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13
Q

Diabetes NURSING CARE

A
  • Thorough OB history
    Diabetes NURSING CARE
    • Lab tests: HgA1c
  • Retinopathy,
    neuropathy
  • Diet
  • BMI
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14
Q

Diabetes‐NURSING CARE Risk Assessment

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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15
Q

Diabetes‐NURSING CARE Risk Assessment

A
  • Previous infant with congenital anomaly
  • History of GDM or polyhydramnios in a previous
    pregnancy
  • Previous LGA infant
  • Previous unexplained fetal demise or neonatal
    death
  • Maternal obesity (body mass index [BMI] over
    30)
  • Hypertension before pregnancy or in early pregnancy
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16
Q

ACOG ‘2 step’ approach

A

ACOG ‘2 step’ approach (24 – 28 week 1 hour venous glucose measurement following 50g oral glucose solution), followed by a 100g 3 hour oral glucose tolerance test (OGTT) if positive

17
Q

diagnosis of GDM is based on

A

2 abnormal values on the 3 hour OGTT

18
Q

Screening

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

19
Q

Target Blood Glucose in PG

A

pg 11

20
Q

NUTRITION

A

Counseling by registered dietician/nutritional team if available

21
Q

NUTRITION

A
  • Follow prescribed diet plan
  • Eat well‐balanced diet
  • Divide daily food intake among 3 meals, 2 ‐3 snacks
  • Eat a substantial bedtime snack to prevent severe drop in BG
    level during night
  • Take daily vitamins and iron as prescribed
  • Avoid refined sugar foods
  • Eat consistently each day; don’t skip meals or snacks
  • High dietary fiber foods
  • Avoid alcohol and nicotine, lhimttpi:t//cwawfwf.echinooesemyplate.gov/images/MyPlate
  • Avoid nonnutritive sweeteners as able
22
Q

NUTRITION ‐ Glycemic Index

A

Used to measure the effect of foods on blood sugar level
Low: 55 or less Medium: 56–69 High: 70 or above

23
Q

NUTRITION ‐ Glycemic Index

A
  • Foods high in refined carbs and sugar are digested more quickly and have a higher GI.
    *Other things that effect GI are: acidity, cooking time, how processed a food is , how ripe something is.
24
Q

NUTRITION ‐ Glycemic Load

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
25
Q

page 12

A

XIO (372 decks)

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