module 6 Flashcards
diabetes
the most common endocrine disorder associated with pregnancy. if an individual is diagnosed with diabetes mellitus their pregnancy is considered high risk. The Key is strict control of glucose
-caused by defects in insulin secretion, insulin action, or both
preexisting conditions
cardiovascular disorders, respiratory, gastrointestinal, integumentary, and CNS disorders, substance abuse
pre-gestational diabetes
patient had diabetes proor to pregnancy
gestational diabetes mellitus
impaired tolerance to glucose with rist onset or recognition during pregnancy. usually determined at 24-28 weeks
risks to newborns with poor glucose control
- congential abnormalities
- spontaneous abortion
- macrosomia: birth trauma and dystocia
- death
- respiratory distress syndrome because of c-sectipon
- intrauterine fetal demise
- hypoglycemia post birth
contributing factors to gestational diabetes
obesity, maternal age greater than 25, previous delivery of lart infant/stillborn
two step method for diagnosis of gestational diabetes
step 1: 1 hr 50g oral glucose screen. a positive is >130-140 mg/dL
step 2: 3 hr 100g oral glucose tolerance test.
scale. myst have exceeded 2 or more blood glucose values
effects of GD on mother
- hypertension
- ketoacidosis
- preterm labor due to preterm ROM
- UTIs from glucose in urine
- dystocia
assessment and nursing diagnsois for gestational diabetes
- interview
- physical exam: assess chronic complications
- labs: renal function, UA and culture, HgA1c: <6.5%
- education on frequent medical and self monitoring
antepartum care
- diet and exercise
- insulin therapy/ self monitoring of glucose
- urine tests
- fetal survailence: fetal kick count, degree of macrosomia, nonstress test
Type 1 DM care vs. GDM care
type 1: inuslin therapy is the most important than diet and exercise and finally fetal suvailence
GD
intrapartum care for GDM
monitor for complications, may requrie c-section. glucose should stag btw 80 and 110
after brith care GDM
insulin requirements decrease substatntially, encourage breast feeding (can also help infant with hypoglycemia), contraception: IUD
- reassess patient at 6-12 wks PP
- this person is at increased risk for type 2 DM later on
iron deficiency anemia
comon un 75-95% of pregnant women. it increases the risk for preterm delivery, perinatal mortality, and poor motor function of the infant.
nursing assessment of anemia
history and physical, PICA? nutrtional intake,
- look for SOB, pallor, dizziness, fatigue
- H and H <11g/dL and <35% is considered anemia
nursing management for anemia
education of good diet, taking vitamins and iron supplements with a source of vitamin C. can cause constipation so also increase fiber.
-things high in iron: meats green leafy veg, leumes, dried fruits, whole grains
PUPS
pruritic urticarial papulases and plaques of prgnancy
may be given cortizone
intrahepatic cholestasis
usually in the 3rd trimester it is an elevated serum bile acid and elevated LFTs, could cause jaundice and is itchy
fetal complications asphyxia events, meconium staining, stillbert, preterm birht
risk factors for pregnancy-related hypertension
- primigravida, > 35 yrs
- anemia
- chronic hypertension
- obesity
- diabetes
- chronic renal disease
- twins +
- family members had it
what is the cutoff for diagosis of preeclampsia
140/90
>300 mg of protein in the urine
-on 2 occasions 4-6 h apart
complications of HTN
- abruptico placentae
- DIC
- IUGR
- preeclampsia and eclampsia
- stroke
- HELLP
- placcental insuff and preterm delivery
- death
chronic hypertension
BP > 140/90 mm Hg before pregnancy or before 20 weeks of gestation
gestational hypertension
elevated BP identified after 20 weeks of gestation without proteinuria
BP returns to normal by 6 wks pp
preeclmpsia
gestationa lypertension plus proteinuria
mild or severe
