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mod 3 Flashcards

1
Q

What is Diabetes Mellitus?

A

Endocrine disorder in which the pancreas cannot produce adequate insulin to regulate glucose levels

Includes both Type 1 and Type 2 diabetes.

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2
Q

What is Gestational Diabetes Mellitus?

A

Any degree of glucose intolerance or abnormal glucose metabolism with the onset occurring during pregnancy.

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3
Q

When is insulin released?

A

When the sugar level of the blood is high, insulin is released to regulate blood glucose levels.

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4
Q

What is the usual concern in Diabetes Mellitus?

A

Hyperglycemia.

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5
Q

What is the goal of treatment for diabetes during pregnancy?

A

Controlling balance between insulin and blood glucose to prevent hyper/hypoglycemia.

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6
Q

Why does Gestational Diabetes Mellitus (GDM) happen?

A

Resistance to insulin caused by the effect of maternal hormones on beta cells of the pancreas.

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7
Q

Can a non-diabetic pre-pregnancy develop Gestational Diabetes Mellitus?

A

Yes, less than 5% (2–3%) of non-diabetic patients develop GDM during pregnancy.

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8
Q

What are the major maternal risks associated with Gestational Diabetes Mellitus?

A
  • Hypertension and/or preeclampsia
  • UTI
  • Ketoacidosis
  • Labor dystocia or obstructed delivery
  • Postpartum hemorrhage
  • Hematoma and lacerations.
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9
Q

What fetal risks are associated with Gestational Diabetes Mellitus?

A
  • Congenital anomalies
  • Perinatal death
  • Macrosomia
  • Intrauterine growth retardation (IUGR)
  • Birth injury
  • Hypoglycemia
  • Polycythemia
  • Hyperbilirubinemia
  • Hypocalcemia.
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10
Q

What is Type 1 Diabetes Mellitus characterized by?

A

Destruction of the beta cells in the pancreas that usually leads to absolute insulin deficiency.

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11
Q

How is Type 2 Diabetes Mellitus managed?

A

Dependent on oral hypoglycemic agents and synthetic insulin together with diet and exercise.

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12
Q

What is impaired glucose homeostasis?

A

A state between ‘normal’ and ‘diabetes’ where the body is no longer using or secreting insulin properly.

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13
Q

What are the signs of maternal hypoglycemia?

A
  • Shaking/tremors
  • Sweating
  • Pallor
  • Disorientation
  • Hunger
  • Blurred vision.
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14
Q

What are the signs of maternal hyperglycemia?

A
  • Fatigue
  • Flushed skin
  • Dry mouth
  • Frequent urination
  • Rapid, deep respirations
  • Drowsiness
  • Depressed reflexes.
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15
Q

What is the normal serum glucose level?

A

80–120 mg/dL.

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16
Q

What is the diagnostic value for pre-diabetic fasting blood glucose?

A

101–125 mg/dL.

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17
Q

What is the procedure for diagnosing diabetes?

A

A blood sample is taken to check glucose levels; fasting for 8 to 12 hours is required.

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18
Q

What does glycosuria indicate?

A

The kidneys begin to excrete quantities of glucose in the urine to lower serum glucose levels.

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19
Q

What causes polyuria in diabetes?

A

Increased urination due to osmotic action of glucose in the urine.

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20
Q

What is the effect of maternal vascular impairment on the fetus?

A

Poor placental perfusion leading to perinatal death.

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21
Q

What is the risk of having a macrosomic fetus?

A

Stimulates production of insulin, leading to potential complications during delivery.

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22
Q

What are the nursing responsibilities for blood glucose monitoring?

A
  • Wash hands before puncturing
  • Use sides of fingers for puncture
  • Wipe away the first drop of blood.
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23
Q

Fill in the blank: The presence of glucose in urine is referred to as _______.

A

glycosuria.

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24
Q

True or False: Gestational diabetes can signal an increased risk for type 2 diabetes later in life.

A

True.

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25
Q

What technique should be used to decrease sensation of pain during injections?

A

Use sides of fingers instead of ends

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26
Q

What should be done with the first drop of blood during a blood test?

A

Wipe away the first drop

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27
Q

What is the purpose of the Oral Glucose Challenge Test?

A

To check for risk of GDM

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28
Q

At what gestational weeks is the Oral Glucose Challenge Test typically performed?

A

24–38 weeks AOG

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29
Q

What fasting serum glucose level confirms a diagnosis of diabetes?

A

126 mg/dL or above

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30
Q

What non-fasting serum glucose level indicates diabetes?

A

200 mg/dL or above

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31
Q

What is the glucose load ingested during the Oral Glucose Challenge Test?

A

50-g glucose load

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32
Q

What serum glucose level after 1 hour indicates the need for a 100-g, 3-hour fasting glucose tolerance test?

A

> 140 mg/dL

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33
Q

What fasting glucose level indicates GDM if 2/4 abnormal blood samples are found?

A

> 95 mg/dL

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34
Q

What does Glycosylated Hemoglobin (HbA1C) measure?

A

The average glucose level over the past 4–6 weeks

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35
Q

What is the upper normal level of HbA1C?

A

6% of total hemoglobin

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36
Q

What happens to glucose attached to hemoglobin as blood sugar increases?

A

It increases

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37
Q

When was insulin produced synthetically?

A

1921

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38
Q

What is the gold standard for management of diabetes?

A

Insulin administration

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39
Q

What type of insulin is combined with short-acting insulin for diabetes management?

A

Intermediate type

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40
Q

What occurs in early pregnancy that affects insulin levels?

A

Lower synthetic insulin

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41
Q

What hormones stimulate normal insulin production during early pregnancy?

A

Estrogen and progesterone

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42
Q

In late pregnancy, why is there a higher need for synthetic insulin?

A

Increased glucose used by woman and fetus

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43
Q

What is the recommended starting insulin dose distribution?

A

2/3 in the morning, 1/3 in the evening

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44
Q

What should be avoided in pregnancy regarding oral hypoglycemic agents?

A

They can cross the placenta and are teratogenic

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45
Q

What is the correct order for drawing insulin?

A

Inject air to intermediate insulin first, then to regular insulin

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46
Q

What should be done with insulin before administration to avoid pain?

A

Warm at room temperature

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47
Q

How should insulin be injected to minimize leakage?

A

Inject slowly (2-4 seconds)

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48
Q

What should patients with hypoglycemia consume?

A

A glass of milk and crackers

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49
Q

What is the recommended action for hyperglycemia?

A

Assess urine for ketones and inform healthcare provider

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50
Q

How often should blood glucose be monitored?

A

At least 4 times a day

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51
Q

What is the normal creatinine clearance value?

A

0.7-1 mg/dL

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52
Q

What does the Lecithin-Sphingomyelin (L:S) ratio determine?

A

Fetal lung maturity

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53
Q

What is the expected L:S ratio for a mature fetus?

A

1:2

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54
Q

What is the preferred method of delivery for patients with GDM?

A

Vaginal birth

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55
Q

What is the risk associated with cesarean birth in GDM patients?

A

Higher risks including exacerbated hyperglycemia

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56
Q

What happens to maternal glucose levels after delivery?

A

They usually return to normal

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57
Q

What is the risk for women who had diabetes pre-pregnancy?

A

50-60% risk for developing Type 2 DM later in life

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58
Q

What dietary control should be maintained during pregnancy?

A

Adequate glucose intake to prevent hypoglycemia

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59
Q

What is the recommended weight gain during pregnancy for women with GDM?

A

25-30 lbs

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60
Q

What is a potential nursing diagnosis related to GDM?

A

Risk for ineffective tissue perfusion

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61
Q

What should be monitored closely in cases of hydramnios?

A

Uterine contraction and risk for hemorrhage

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62
Q

What is the recommended weight gain during pregnancy to limit fetus size?

A

25-30 lbs

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63
Q

What is the minimum caloric intake recommended for pregnant women?

A

1800 calories

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64
Q

What macronutrient distribution is recommended in a 1800–2400 calorie diet?

A
  • 20% protein (CHON)
  • 40-50% carbohydrates (CHO)
  • 30% fats
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65
Q

What should pregnant women do to prevent hypoglycemia during the night?

A

Encourage protein and complex carbohydrates at night

66
Q

True or False: Pregnant women are most vulnerable to hypoglycemia at night.

67
Q

What types of foods are recommended for pregnant women to maintain stable glucose levels?

A
  • Rice
  • Breads
  • Oats
  • Spaghetti
  • Cassava
  • Potatoes
  • Egg
  • Whole grain toast
  • Hummus
  • Whole grain crackers
68
Q

What are the benefits of exercise during pregnancy?

A
  • Lowers blood sugar
  • Helps with weight control
  • Improves glucose metabolism
  • Provides cardiopulmonary benefits
69
Q

What should be done if uterine contractions occur during exercise?

A

Stop walking, hydrate, and rest in a side-lying position

70
Q

What is the percentage of pregnant women who use illegal drugs?

71
Q

List some fetal effects of cocaine use during pregnancy.

A
  • Hyperarousal state
  • Increased STIs
  • Spontaneous abortion
  • Abruptio placenta
  • Pre-eclampsia
  • Premature labor
72
Q

True or False: Marijuana use during pregnancy can lead to reduced milk production.

73
Q

What are the effects of tobacco use during pregnancy?

A
  • Low maternal perfusion
  • Abruptio placenta
  • Preterm labor
  • Increased risk of SIDS
74
Q

What are the risks associated with alcohol use during pregnancy?

A
  • Spontaneous abortion
  • Fetal alcohol spectrum disorder (FASD)
  • Intrauterine growth restriction (IUGR)
75
Q

Fill in the blank: HIV is transmitted from _______.

A

[person-to-person]

76
Q

What is the significance of the CD4 count in HIV patients?

A

A CD4 count below 500 cells/mm3 indicates risk for opportunistic infections

77
Q

What is the role of antiretroviral therapy (ART) in HIV-positive pregnant women?

A

Decreases viral load and reduces transmission risk to the infant

78
Q

What are early symptoms of HIV in pregnant women?

A
  • Fatigue
  • Anemia
  • Diarrhea
  • Progressive weight loss
79
Q

What substance abuse treatment groups are available for pregnant women?

A
  • Alcoholics Anonymous (AA)
  • Cocaine Anonymous (CA)
  • Heroin Anonymous (HA)
  • Marijuana Anonymous (MA)
  • Nicotine Anonymous (NicA)
  • Narcotics Anonymous (NA)
  • Pills Anonymous (PA)
80
Q

What are common withdrawal symptoms from substance abuse?

A
  • Nausea and vomiting
  • Diarrhea
  • Abdominal pain
  • HPN (Hypotension)
  • Shivering
81
Q

What is the most serious STI affecting pregnant women and their infants?

82
Q

What is the effect of caffeine on pregnant women?

A

Stimulates CNS and cardiac function, crosses the placental barrier

83
Q

What should be monitored during labor for women with a history of substance abuse?

A

Electronic fetal monitoring, contractions, and fetal heart tones (FHT)

84
Q

What is the risk of maternal-fetal transmission of HIV if untreated?

85
Q

True or False: HIV is curable.

86
Q

What CD4 count is usually associated with a higher chance for opportunistic infections?

A

<200 cells/mm3

A CD4 count lower than 200 cells/mm3 indicates a higher risk for opportunistic infections.

87
Q

What is a key preventive measure against opportunistic infections?

A

Maintain a higher CD4 count

A higher CD4 count helps in reducing the chances of opportunistic infections.

88
Q

What are risk factors for opportunistic infections?

A
  • Multiple sexual partners
  • Bisexual partners
  • IV drug use with shared needles
  • Blood transfusion
  • Vertical transmission

These factors increase the exposure to HIV and other infections.

89
Q

True or False: HIV can be transmitted through saliva.

A

False

The presence of the virus in saliva is extremely low, making transmission via saliva unlikely.

90
Q

What are some maternal complications associated with HIV?

A
  • Intrapartum and postpartum hemorrhage
  • Poor wound healing
  • GU infections
  • Fever
  • Swollen lymph nodes
  • Recurrent respiratory tract infections
  • Oral candidiasis
  • Preterm births
  • Small for gestational age
  • Failure to thrive
  • Enlarged spleen and liver

These complications arise due to the effects of HIV on the immune system.

91
Q

What is the normal range for CD4 cell count?

A

> 500 T4 cells/mm3

Maintaining a CD4 count above this level is crucial for immune health.

92
Q

What does the Polymerase Chain Reaction (PCR) test check for in HIV diagnosis?

A

Level of antigens in the blood

PCR tests are important for detecting the presence of HIV antigens.

93
Q

What is the most commonly used screening test for HIV?

A

Enzyme-Linked Immunosorbent Assay (ELISA)

A positive ELISA test requires a confirmatory test, such as the Western blot.

94
Q

What is the purpose of administering Zidovudine (AZT)?

A

Prevents progressive deterioration of the immune system

Zidovudine is administered to reduce the risk of opportunistic infections.

95
Q

What are the potential adverse effects of Zidovudine?

A
  • Nausea
  • Loss of appetite
  • Paresthesia
  • Headache
  • Fever
  • Agranulocytopenia
  • Thrombocytopenia

These side effects necessitate careful monitoring during treatment.

96
Q

What is the role of Rh immune globulin (RhIG) in pregnancy?

A

Prevents the mother from forming natural antibodies against Rh-positive blood

RhIG is administered to Rh-negative women to prevent Rh sensitization.

97
Q

What happens during Rh sensitization?

A

The mother forms antibodies against Rh-positive blood

This immune response can lead to hemolytic disease of the newborn in subsequent pregnancies.

98
Q

What fetal effects can result from hemolysis due to Rh sensitization?

A
  • Enlarged liver and spleen
  • Vascular hypertonicity
  • Congestive heart failure
  • Hydrops fetalis
  • Anemia
  • Hyperbilirubinemia

These conditions arise from the destruction of fetal red blood cells.

99
Q

What does the Doppler velocity of fetal middle cerebral artery indicate?

A

Predicts fetal anemia or destruction of fetal RBCs

Monitoring this velocity helps assess the risk of hemolytic disease.

100
Q

What is the significance of a high ratio in anti-D antibody titer?

A

Indicates Rh sensitization

A ratio of 1:16 or above necessitates monitoring and potential interventions.

101
Q

Fill in the blank: HIV can be transmitted through _______.

A

Body secretions

This includes semen, vaginal fluids, and breastmilk.

102
Q

What is the goal of medical management for HIV?

A

Maintain the CD4 cell count at greater than 500 cells/mm3

This goal is critical for sustaining the immune system.

103
Q

What procedure is used to determine the blood type of the baby?

A

PUBS

PUBS stands for Percutaneous Umbilical Blood Sampling.

104
Q

What is the purpose of injecting RBCs directly into a vessel in the fetal cord?

A

Restore fetal RBCs

105
Q

When should RBCs be given to the fetus?

A

When hematocrit levels are less than 30% intravascularly/intraperitoneally

106
Q

How much washed red cells are typically used in fetal transfusion?

A

75–150 mL

107
Q

What is a potential complication of the procedure involving RBC injection?

A

Lacerations in cord blood vessel

108
Q

What is the most common type of anemia during pregnancy?

A

Iron-deficiency anemia

109
Q

What is pseudoanemia?

A

A condition where blood volume expands during pregnancy slightly ahead of the red cell count

110
Q

What is the normal hemoglobin level for the 1st trimester of pregnancy?

111
Q

What dietary factors contribute to iron-deficiency anemia in pregnancy?

A

Low iron diet, heavy menstrual periods, unhealthy weight-reducing programs

112
Q

What is a characteristic of iron-deficiency anemia?

A

Microcytic and hypochromic anemia

113
Q

What are common symptoms of iron-deficiency anemia?

A

Pallor, fatigue, lethargy, headache, tachycardia

114
Q

What is pica?

A

Persistent craving and compulsive eating of non-food substances

115
Q

What dietary recommendations are made for iron-deficiency anemia?

A

Eat a diet high in iron and vitamins, such as organ meats, shellfish, spinach, legumes

116
Q

What is the recommended daily dosage of folic acid for pregnant women?

A

400 mcg daily; 800 mcg for those currently pregnant

117
Q

What are the maternal complications of folic acid-deficiency anemia?

A

Spontaneous abortion, abruptio placenta, neural tube defects

118
Q

What is pregnancy-induced hypertension (PIH)?

A

Condition with vasospasm during pregnancy leading to hypertension

119
Q

What are the clinical manifestations of PIH?

A

Hypertension, proteinuria, and edema

120
Q

What is the cure for pregnancy-induced hypertension?

A

After birth of the infant

121
Q

What is the significance of elevated diastolic blood pressure in preeclampsia?

A

Indicates the degree of peripheral arterial spasm present

122
Q

What is mild preeclampsia characterized by?

A

BP of 140/90 mmHg with proteinuria 1+ or 2+

123
Q

What is a common dietary advice for iron supplementation?

A

Take iron supplements with orange juice or a vitamin C supplement

124
Q

What is the effect of vasospasm in PIH on fetal health?

A

Reduced fetal nutrient and oxygen supply

125
Q

What are the risk factors for developing pregnancy-induced hypertension?

A

Women of color, multiple pregnancies, primiparas younger than 20 or older than 40

126
Q

True or False: The body requires more blood volume during pregnancy, leading to increased risk of anemia.

127
Q

Fill in the blank: The highest need for iron during pregnancy is in the _______.

A

third trimester

128
Q

What defines REECLAMPSIA?

A

Abnormal assessment results taken on two occasions, at least 6 hours apart at bed rest.

129
Q

What is the blood pressure threshold for diagnosing high blood pressure in REECLAMPSIA?

A

BP of 160/110 mmHg or above.

130
Q

What constitutes proteinuria in the context of REECLAMPSIA?

A

3+ or 4+ proteinuria, or 5g/24h urine collection.

131
Q

What is the significance of extreme edema in REECLAMPSIA?

A

It indicates severe depletion of albumin in the blood.

132
Q

What are the characteristics of pitting edema?

A

Edematous tissue can be indented; scored as follows:
* 1+: slight indentation
* 2+: moderate indentation
* 3+: deep indentation
* 4+: remains after removal of finger.

133
Q

What indicates non-pitting edema?

A

Edematous tissue cannot be indented with finger pressure; caused by excess lymphatic fluid.

134
Q

What are common additional signs and symptoms of REECLAMPSIA?

A
  • Reduced urine output/oliguria (400–600 mL per 24 hours)
  • Severe epigastric pain, nausea, and vomiting
  • Shortness of breath, coughing, and dyspnea from pulmonary edema
  • Visual disturbances
  • Severe headache, hyperreflexia, and ankle clonus.
135
Q

What is the laboratory value for platelet count in REECLAMPSIA?

A

Platelet count <100,000.

136
Q

What is ECLAMPSIA?

A

Most severe stage of PIH with a high maternal mortality rate of 20%.

137
Q

What are the phases of a tonic-clonic seizure in ECLAMPSIA?

A

Tonic Phase (20 seconds) and Clonic Phase (up to 1 minute).

138
Q

What is the role of antihypertensive drugs in managing REECLAMPSIA?

A

Promotes vasodilation.

139
Q

What is the therapeutic range for magnesium sulfate?

A

5–8 mg/dL.

140
Q

What are signs of magnesium sulfate toxicity?

A
  • Blood pressure decreased
  • Urine output decreased (oliguria)
  • Respiratory depressions <12
  • Patellar reflex absent.
141
Q

What is the antidote for magnesium toxicity?

A

Calcium gluconate.

142
Q

What nursing diagnosis is associated with REECLAMPSIA?

A

Ineffective tissue perfusion related to vasoconstriction of blood vessels.

143
Q

What are nursing interventions for mild PIH?

A
  • Promote bed rest at home
  • Lateral recumbent position
  • Good nutrition
  • Monitor antiplatelet therapy.
144
Q

What is the significance of a premonition or aura in ECLAMPSIA?

A

It indicates that a seizure is about to occur.

145
Q

How should a patient be positioned during a seizure?

A

Turn the woman on her side to prevent aspiration.

146
Q

What is the recommended management for postpartum hypertension?

A

Monitor blood pressure.

147
Q

Fill in the blank: Severe epigastric pain, nausea, and vomiting may indicate ______.

A

abdominal edema and ischemia to pancreas and liver.

148
Q

True or False: A cesarean section is preferred over a normal spontaneous delivery in cases of proteinuria, edema, and hypertension.

149
Q

When does ENTION typically occur after delivery?

A

10–14 days after delivery

150
Q

When does ENTION usually occur in relation to birth?

A

In the first 48 hours after birth

151
Q

What should be monitored in a patient with ENTION?

152
Q

Which of the following is a sign of DM?
A) Weight gain
B) Metabolic alkalosis
C) Hypoglycemia
D) Polydipsia

A

D) Polydipsia

153
Q

Which test is more accurate for diagnosing DM?

154
Q

What is the most useful health teaching regarding insulin for a pregnant client with DM?

A

Rotate injection sites

155
Q

Caloric needs of a pregnant client with DM should mainly consist of:

A

Carbohydrates

156
Q

Which age group is at risk of substance abuse during pregnancy?

A

Young adults with abusive parents

157
Q

What is the confirmatory test in the diagnosis of HIV?

A

Western blot test

158
Q

When should RhIG be administered to protect the succeeding pregnancy?

A

In the first 72 hours after delivery

159
Q

Which health teaching will benefit a pregnant client taking iron supplements?

A

Take the iron tablets with orange juice

160
Q

The following are triad symptoms of PIH except:

A

Proteinuria

161
Q

What is the drug of choice in PIH?

A

Magnesium sulfate

162
Q

What is an appropriate intervention when a pregnant client with PIH experiences seizures?

A

Turn the head to the side

maternal (1 decks)

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