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N232 > Module 6 Maternal HTN and Diabetes > Flashcards

Module 6 Maternal HTN and Diabetes Flashcards

1
Q

what age do women have highest rates of pregnancy related HTN?

A

women greater than 40 years with their first pregnancy

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2
Q

what are the maternal complications from significant HTN?

A
  • maternal death
  • acute renal failure
  • pulmonary edema
  • HELLP syndrome (hemolysis, elevated liver enzymes and low platelets)
  • cerebral edema with seizures
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3
Q

what are the usual causes of maternal deaths r/t severe HTN?

A
  • complications of hepatic rupture
  • placental abruption
  • eclampsia
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4
Q

definition of hypertensive disorder of pregnancy (HDP)

A
  • HTN greater than 140/90 taken at two separate measurements atleast 15 min apart
  • Severe HTN is greater than 160/110 taken at two separate measurements atleast 15 min apart
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5
Q

what are the 3 categories of hypertensive disorders?

A
  1. pre-existing (chronic) HTN
  2. gestational
  3. other
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6
Q

what category of HTN can pre-eclampsia occur?

A

either in pre-existing HTN or gestational

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7
Q

what are the three types of “other” hypertensions?

A
  1. transient HTN
  2. white-coat HTN
  3. masked HTN
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8
Q

what is existing HTN?

A

present before pregnancy or appears prior to 20 weeks of gestation

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9
Q

what is gestational HTN?

A

development of HTN at or after 20 weeks

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10
Q

what are two subgroups for pre-existing and gestational HTN?

A

co-morbid conditions and evidence of pre-eclampsia

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11
Q

what is pre-existing HTN?

A

Defined as HTN present before the pregnancy or diagnosed before 20 weeks of gestation

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12
Q

T or F: most women with pre-existing HTN experience complicated pregnancies

A

F! Most experience UNcomplicated pregnancies

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13
Q

what is there an increase in risk for with pre-existing HTN?

A

risk of poor fetal growth and fetal stillbirth

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14
Q

what is pre-existing HTN with superimposed pre-eclampsia?

A

defined in the presence of the following findings:

  • HTN before 20 weeks with new or worsening proteinuria
  • Both HTN and proteinuria before 20 weeks
  • Sudden increase in BP in a woman whose HTN was previously well controlled
  • Thrombocytopenia
  • Elevated liver enzymes
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15
Q

whats the link between HTN and development of pre-eclampsia?

A
  • women with pre-eclampsia HTN (PEH) and other comorbidities (renal disease or type 1 diabetes) are at increased risk of developing PE
  • Women who develop HTN prior to 34 weeks are also at increased risk of developing pre-eclampsia
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16
Q

what is pre-eclampsia

A

Pre-eclampsia is a hypertensive disorder most commonly defined by new onset proteinuria and potentially other end organ dysfunction

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17
Q

what are two key components to diagnosis of pre-eclampsia

A

HTN and new/worsening proteinuria

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18
Q

what are maternal symptoms that indicate severe pre-eclampsia (6)

A

Seizures, blindness, stroke, severe liver dysFx, pulmonary edema and myocardial dysfunction

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19
Q

what is NON severe PE

A

combo of HTN (below 160/110) AND proteinuria with one or more adverse conditions

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20
Q

what is severe PE

A

having BP greater than 160/110 AND presence of proteinuria with the presence of one or more severe complications

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21
Q

severe complications of PE (just know atleast 5)

A

Oliguria, cerebral disturbances (alerted LOC, confusion, or headache), eclampsia or stroke, visual disturbances, hepatic damage or rupture, including epigastric pain, thrombocytopenia, hemolytic anemia, pulmonary edema, and fetal growth restriction

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22
Q

what is eclampsia

A

major maternal risk where high blood pressure results in seizures

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23
Q

what is nursing care with someone who has eclampsia

A
  • consistent assessment of BP to establish baseline
  • bedrest in attempt to decrease the progression to severe HTN
  • diets in high protein and low in salt
  • adequate fluid intake helps maintain optimum fluid volume and aids in renal perf
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24
Q

is strict bed rest recommended?

A

NO!

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25
Q

prolonged bedrest is known to inc risk of??

A

thrombophlebitis

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26
Q

what is one important goal of care for women with pre-eclampsia?

A

prevent or control convulsions (eclamptic seizures)

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27
Q

what is the medication of choice for severe-preeclampsia or HELLP syndrome?

A

magnesium sulphate

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28
Q

what do nurses need to watch for with magnesium?

A

watch for S+S of magnesium toxicity because its a CNS depressant

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29
Q

adverse affects of magnesium sulphate?

A

Lethargy, feeling of heat or warmth, headache, or nausea

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30
Q

early signs of magnesium toxicity include?

A

Vomiting, respiratory distress, hypotension, flushing, muscle weakness, dec, reflexes, slurred speech

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31
Q

what is eclampsia usually preceded by?

A

headache, severe epigastric pain, hyperreflexia

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32
Q

can convulsions appear without warning?

A

yes, they can appear without warning in a seemingly stable women with minimal BP elevations

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33
Q

what S+S precede the convulsions?

A

inc HTN and tonic contractions of all bodily muscles

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34
Q

what S+S follow convulsions?

A

hypotension and coma

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35
Q

what is immediate goal of care during a convulsion?

A

ensure a pt airway!

36
Q

define gestational diabetes mellitus (GDM)

A

elevated levels that are first recognized during pregnancy

37
Q

what are women at risk for if they are diagnosed with GDM early in pregnancy and may be obese?

A

inc risk of developing sustained glucose intolerance and type 2 diabetes

38
Q

the mother having GDM places fetus at risk for?

A

hypoglycemia, IUGR (intrauterine growth restriction) and intrauterine fetal death

39
Q

when does GDM usually develop

A

after 20 weeks of pregnancy

40
Q

when should pregnant women be screen for presence of GDM

A

24-28 weeks of gestation

41
Q

when does GDM typically disappear?

A

when pregnancy is over

42
Q

what is aim of therapy for women with GDM

A

meticulous BG control

43
Q

fasting BGL should be between?

A

3.8-5.2 (pre-prandial)

44
Q

BGL 1hour after meal should be?

A

5.5-7.7

45
Q

BGL 2 hours post prandial should be?

A

5.0-6.6

46
Q

how often are BGL checked during labour and birth?

A

atleast every hour to maintain levels less than 8

47
Q

T or F women with GDM return to normal glucose levels after child birth

A

T

48
Q

is GDM likely to recur in future pregnancies?

A

yes! and are at inc. risk of developing glucose intolerance or type 2D later in life

49
Q

who does pre-gestational diabetes refer to?

A

applies to women who had T2 or T2 diabetes prior to becoming pregnant

50
Q

define GDM

A

classification for women who have carbohydrate intolerance that is discovered during pregnancy

51
Q

how long after birth should women be assessed for presence of underlying disease?

A

6 weeks to 6 months after pregnancy ends

52
Q

what are pregnant women with diabetes prone to?

A

Type 1 and 2 diabetes are prone to hypoglycemia (low blood glucose) during the first trimester

53
Q

what are Fetal risks for women with pregestational diabetes?

A

perinatal mortality, congenital malformations, and morbidities in the neonatal period

54
Q

how early can insulin resistance begin?

A

14-16 weeks

55
Q

what factors contribute to maternal risks and complications for those with DM?

A

Women with poor glycemic control, longer duration of DM, and presence of complications typically have less optimum pregnancy outcomes

56
Q

what are some maternal risks and complications that can arise?

A

congenital malformations, hypertension, preterm delivery, large infants, caesarean birth, and neonatal abnormalities

57
Q

how should renal function be monitored during pregnancy

A

should occur using the protein-to-creatinine ratio (PCR) and GFR

58
Q

what frequently develops during the third trimester for those with diabetes

A

hydramnios

59
Q

most common complication with hydramnios are?

A

placental abruption, uterine dysfunction, and postpartum hemorrhage

60
Q

what symptoms can lead to diabetic ketoacidosis?

A

nausea, vomiting, and fever

61
Q

what can DKA lead to in pregnancy?

A

intrauterine fetal death and may stimulate preterm labour

62
Q

when is the risk of hypoglycemia increased?

A

in pregnancy. if someone had a lot of hypoglycemic episodes before pregnancy, they are more prone to them during gestation

63
Q

what are the fetal and neonatal risks and complications?

A
  • Hyperglycemia
  • ketoacidosis
  • congenital abnormalities -infections
  • maternal obesity
64
Q

what is most likely the cause of death for fetal death in the third trimester?

A

fetal acidosis

65
Q

what weeks gestation does the fetal pancreas start secreting insulin?

A

10-14 weeks gestation

66
Q

how does the fetus respond to maternal hyperglycemia?

A

by secreting large amount of insulin (hyperinsulinism)

67
Q

what leads to an increased fetal size (also known as macrosomia)?

A

insulin acts as a growth hormone, causing the fetus to produce excess stores of glycogen, protein, and adipose tissue which leads to inc. size

68
Q

what is euglycemia?

A

condition of having normal concentration of glucose in blood

69
Q

what is the most important goal with antepartum care?

A

maintaining euglycemia

70
Q

how is euglycemia achieved?

A

combination of insulin, exercise, BG determinations

71
Q

what is the goal of the nurse in regards to antepartum care?

A

goal is to educate the changes that pregnancy will have on the mother’s diabetes

72
Q

what should dietary management be based on?

A

based on BG and not urine glucose

73
Q

what are their dietary goals for pregnant mothers with diabetes?

A

have weight gain constant with a normal pregnancy, prevent ketoacidosis, and achieve euglycemia through consistency in carb intake

74
Q

when is the best time for pregnant mothers with diabetes to exercise during the day?

A

after meals

75
Q

when should BG levels be measured for pregnant diabetics in regards to exercising?

A

before, during and after exercising

76
Q

are pregnant women more likely to develop hypo or hyperglycemia? why?

A

more likely to develop hypo because the goal is to maintain BG in a narrow, low-normal range (3.8-5.2)

77
Q

what BG level is considered too high for pregnant women?

A

6.7

78
Q

will 6.7 show signs of hypergylcemia in pregnant women?

A

NO!

79
Q

are all type 1 and type 2’s on insulin during pregnancy?

A

yes

80
Q

if a type 2 is on oral hyperglycemics, what must they do?

A

MUST switch to insulin

81
Q

in terms of insulin, what happens when the placenta is removed once baby is born?

A

insulin needs decrease

82
Q

T or F all type 2 diabetics do not require insulin first couple days after birth (or at all)

A

F

MOST type 2’s dont require insulin after

83
Q

why do you NEVER give oral hyperglycemics with pregnant women?

A

because it crosses the placenta**

ex. if on metformin, you take them off and give insulin instead

84
Q

what is a risk for diabetic pregnant mother and what do nurses recommend them to do?

A

risk of going hypoglycemic so they encourage moms to check BG at night and in middle of night

85
Q

complications for diabetic pregnant women?

A

• Retinopathy
• HTN (pre-eclampsia)
• Chronic kidney disease (CKD)
-Cardiovascular disease (CVD)

86
Q

PIH symptoms

A
  • rapid weight gain
  • swelling of face and fingers
  • flashes of lights or dots before the eyes
  • dimness/blurring of vision
  • severe, continuous headache
  • dec. urine output
  • proteinuria
87
Q

is swelling of feet and ankles normal in PIH?

A

it is normal unless its pitting edema

N232 (9 decks)

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