Module 5 Flashcards
Heroin: Treatment
- Methadone (most common treatment for pregnant women)
- Buprenorphine (Linked to better treatment adherence w/ fewer side effects and overdoses
- Naltrexone (Opioid antagonist, non-addictive may improve compliance is an issue)
- Behavioral therapy mixed w/ pharmacology. (MAT)
Pathophysiology of Diabetes
- Endocrine disorder of carbohydrate metabolism
-Results from inadequate production or utilization of insulin - Breakdown of fats and proteins for energy
- Cellular and extracellular dehydration
Four Cardinal Signs and Symptoms of Diabetes
Polyuria
Polydipsia
Weight Loss
Polyphagia
Polyuria
From increased vascular volume due to hyperosmolarity of blood from hyperglycemia kidneys function to excrete large volume of urine
Polydipsia
Caused by the underlying dehydration created by polyuria and cellular dehydration
Weight Loss
Occurs as a result of the breakdown of fats and muscle; of which ketones and fatty acids are the end product
Polyphagia
The tissue breakdown causes a state of starvation that compels the individual to eat excessive amounts of food
Classification of Diabetes Mellitus
Type 1: Absolute insulin deficiency (10% of population)
Type 2: Insulin resistance (90% of population)
Gestational Diabetes Mellitus: Any glucose intolerance noticed in pregnancy
Influence of Pregnancy on Diabetes
-Physiologic changes of pregnancy alter insulin requirements
- Decreased in first trimester
- Increased in second and third trimester
-Hormones -> insulin antagonist
Influence of Pregnancy on Diabetes
-Physiologic changes of pregnancy alter insulin requirements
- Decreased in first trimester
- Increased in second and third trimester
-Hormones -> insulin antagonist
- HPL
- Somatotropin
- Accelerates progress of vascular disease
-More difficult to control pregnancy
Maternal Risk for Diabetes
-Hydramnios
-Preeclampsia - eclampsia
- Hyperglycemia and Ketoacidosis
- C-Section
-Increased susceptibility to infections
-Worsening retinopathy
Hydramnios
Too much amniotic fluid around the fetus
Preeclampsia
High blood pressure during pregnancy ( after 20 weeks gestation with systemic features)
-Signs and Symptoms
- Proteinuria (high protein in urine)
- Rising BP
- Edema
-Risk Factors:
- Hx of preeclampsia in previous pregnancies
- Family history
- Obesity
- 1st pregnancy
- Very young (<18), Very old (>35… Advance Maternal Age)
Treatment: Magnesium Sulfate 4-7mg/dL (to prevent seizures during & after labor)
HELLP Syndrome
Hemolysis
Elevated Liver enzyme
Low Platelet count (<100,00)
Associated with severe preeclampsia
Symptoms:
- Nausea
- Vomiting
- Malaise
- Epigastric Pain
Sensitized Women
- Small amounts of fetal blood cross placenta
- Rh- mother, Rh+ fetus
- Maternal ism antibodies produced (RHOGAM will not help)
Diagnosis of Preeclampisa
Systolic BP: greater than or equal to140mm Hg
Diastolic BP: greater than or equal to 90mm Hg
* on two occasion at least 4 hours apart after 20 weeks of gestation in a woman w/ previously normal BP
Ectopic Pregnancy
Pregnancy outside the uterine cavity
- 2% of all pregnancies… implantation in Fallopian tubes
Signs and Symptoms:
- Dull abdomen pain
- Spotting
-Delayed menses
Treatment:
- Methotrexate: destroy/ stops cell growth
- Avoids surgery
Molar Pregnancy (Hydatiform Mole)
Benign proliferation of trophoblasts (20% become malignant)
- 1:15000 pregnancies
- Increased incidence in:
- Women w/ low protein intake
- Asian women
- > 35 years old
- Prior miscarriage
Signs and Symptoms:
- N&V
- Vaginal Bleeding
-Abnormally high hCG levels
- Hypertension
- No fetus, only cysts
Management:
- Monitor for malignancy
-D&C
- No pregnancy for 1 year
-Emotional support
Bleeding Disorders in Pregnancy
-Placenta Previa
-Placenta Abruption
-Vasa Previa
Placenta Previa
Implantation in the lower uterine segment, over or near the cervical os
- Etiology is unclear
Risk Factors:
- From scarring: previous previa, prior C/S, abortion, multiparty
- Large placenta, multiple gestation
- Infertility
- > 35 years old
Signs and Symptoms:
-PAINLESS bright red bleeding
-Spontaneous bleeding after sex
- Breech baby
-Relaxed, soft uterus
AVOID VAGINAL EXAMS
- Monitor vital signs and pulse ox
- Monitor pads (weigh them for amount of blood)
- Measure urine output
- IV
Placenta Abruption
Premature separation of a normal implanted placenta (BEFORE birth, typically after 20 weeks)
- Bleeding may be external or concealed
- Severity depends on degree of separation
- Partial Abruption (concealed hemorrhage)
- Partial Abruption… marginal (apparent hemorrhage)
- Complete Abruption (bleeding concealed but apparent)
Risk Factors:
-Maternal Hypertension (MOST COMMON)… >140/90
- Seizures
- Blunt trauma to abdomen
-Smoking/ cocaine usage
- Previous abruption history
Signs and Symptoms:
- Dark red vaginal bleeding
- Sharp abdominal pain
- Contractions
AVOID vaginal exams and sex
-Prepare mom for birth if active bleeding
- Assess urinary output
-IV Fluids and blood replacement
-Weigh pads to assess blood loss
Polyhydramnios vs Oligohydramnios
Poly: Excessive amniotic fluids ~ >200mL
-Associated w/ fetal GI anomalies and maternal diabetes
- Treatment: watch and no nothing unless short of breath and in pain.. then do amniocentesis
Oli: Scanty amniotic fluid ~ <50mL
- Etiology unknown
- Risks: fetal adhesions and fetal malformations
- Treatment: amnioinfusion
