Module 6 Maternal HTN and Diabetes Flashcards
what age do women have highest rates of pregnancy related HTN?
women greater than 40 years with their first pregnancy
what are the maternal complications from significant HTN?
- maternal death
- acute renal failure
- pulmonary edema
- HELLP syndrome (hemolysis, elevated liver enzymes and low platelets)
- cerebral edema with seizures
what are the usual causes of maternal deaths r/t severe HTN?
- complications of hepatic rupture
- placental abruption
- eclampsia
definition of hypertensive disorder of pregnancy (HDP)
- 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
what are the 3 categories of hypertensive disorders?
- pre-existing (chronic) HTN
- gestational
- other
what category of HTN can pre-eclampsia occur?
either in pre-existing HTN or gestational
what are the three types of “other” hypertensions?
- transient HTN
- white-coat HTN
- masked HTN
what is existing HTN?
present before pregnancy or appears prior to 20 weeks of gestation
what is gestational HTN?
development of HTN at or after 20 weeks
what are two subgroups for pre-existing and gestational HTN?
co-morbid conditions and evidence of pre-eclampsia
what is pre-existing HTN?
Defined as HTN present before the pregnancy or diagnosed before 20 weeks of gestation
T or F: most women with pre-existing HTN experience complicated pregnancies
F! Most experience UNcomplicated pregnancies
what is there an increase in risk for with pre-existing HTN?
risk of poor fetal growth and fetal stillbirth
what is pre-existing HTN with superimposed pre-eclampsia?
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
whats the link between HTN and development of pre-eclampsia?
- 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
what is pre-eclampsia
Pre-eclampsia is a hypertensive disorder most commonly defined by new onset proteinuria and potentially other end organ dysfunction
what are two key components to diagnosis of pre-eclampsia
HTN and new/worsening proteinuria
what are maternal symptoms that indicate severe pre-eclampsia (6)
Seizures, blindness, stroke, severe liver dysFx, pulmonary edema and myocardial dysfunction
what is NON severe PE
combo of HTN (below 160/110) AND proteinuria with one or more adverse conditions
what is severe PE
having BP greater than 160/110 AND presence of proteinuria with the presence of one or more severe complications
severe complications of PE (just know atleast 5)
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
what is eclampsia
major maternal risk where high blood pressure results in seizures
what is nursing care with someone who has eclampsia
- 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
is strict bed rest recommended?
NO!
prolonged bedrest is known to inc risk of??
thrombophlebitis
what is one important goal of care for women with pre-eclampsia?
prevent or control convulsions (eclamptic seizures)
what is the medication of choice for severe-preeclampsia or HELLP syndrome?
magnesium sulphate
what do nurses need to watch for with magnesium?
watch for S+S of magnesium toxicity because its a CNS depressant
adverse affects of magnesium sulphate?
Lethargy, feeling of heat or warmth, headache, or nausea
early signs of magnesium toxicity include?
Vomiting, respiratory distress, hypotension, flushing, muscle weakness, dec, reflexes, slurred speech
what is eclampsia usually preceded by?
headache, severe epigastric pain, hyperreflexia
can convulsions appear without warning?
yes, they can appear without warning in a seemingly stable women with minimal BP elevations
what S+S precede the convulsions?
inc HTN and tonic contractions of all bodily muscles
what S+S follow convulsions?
hypotension and coma
what is immediate goal of care during a convulsion?
ensure a pt airway!
define gestational diabetes mellitus (GDM)
elevated levels that are first recognized during pregnancy
what are women at risk for if they are diagnosed with GDM early in pregnancy and may be obese?
inc risk of developing sustained glucose intolerance and type 2 diabetes
the mother having GDM places fetus at risk for?
hypoglycemia, IUGR (intrauterine growth restriction) and intrauterine fetal death
when does GDM usually develop
after 20 weeks of pregnancy
when should pregnant women be screen for presence of GDM
24-28 weeks of gestation
when does GDM typically disappear?
when pregnancy is over
what is aim of therapy for women with GDM
meticulous BG control
fasting BGL should be between?
3.8-5.2 (pre-prandial)
BGL 1hour after meal should be?
5.5-7.7
BGL 2 hours post prandial should be?
5.0-6.6
how often are BGL checked during labour and birth?
atleast every hour to maintain levels less than 8
T or F women with GDM return to normal glucose levels after child birth
T
is GDM likely to recur in future pregnancies?
yes! and are at inc. risk of developing glucose intolerance or type 2D later in life
who does pre-gestational diabetes refer to?
applies to women who had T2 or T2 diabetes prior to becoming pregnant
define GDM
classification for women who have carbohydrate intolerance that is discovered during pregnancy
how long after birth should women be assessed for presence of underlying disease?
6 weeks to 6 months after pregnancy ends
what are pregnant women with diabetes prone to?
Type 1 and 2 diabetes are prone to hypoglycemia (low blood glucose) during the first trimester
what are Fetal risks for women with pregestational diabetes?
perinatal mortality, congenital malformations, and morbidities in the neonatal period
how early can insulin resistance begin?
14-16 weeks
what factors contribute to maternal risks and complications for those with DM?
Women with poor glycemic control, longer duration of DM, and presence of complications typically have less optimum pregnancy outcomes
what are some maternal risks and complications that can arise?
congenital malformations, hypertension, preterm delivery, large infants, caesarean birth, and neonatal abnormalities
how should renal function be monitored during pregnancy
should occur using the protein-to-creatinine ratio (PCR) and GFR
what frequently develops during the third trimester for those with diabetes
hydramnios
most common complication with hydramnios are?
placental abruption, uterine dysfunction, and postpartum hemorrhage
what symptoms can lead to diabetic ketoacidosis?
nausea, vomiting, and fever
what can DKA lead to in pregnancy?
intrauterine fetal death and may stimulate preterm labour
when is the risk of hypoglycemia increased?
in pregnancy. if someone had a lot of hypoglycemic episodes before pregnancy, they are more prone to them during gestation
what are the fetal and neonatal risks and complications?
- Hyperglycemia
- ketoacidosis
- congenital abnormalities -infections
- maternal obesity
what is most likely the cause of death for fetal death in the third trimester?
fetal acidosis
what weeks gestation does the fetal pancreas start secreting insulin?
10-14 weeks gestation
how does the fetus respond to maternal hyperglycemia?
by secreting large amount of insulin (hyperinsulinism)
what leads to an increased fetal size (also known as macrosomia)?
insulin acts as a growth hormone, causing the fetus to produce excess stores of glycogen, protein, and adipose tissue which leads to inc. size
what is euglycemia?
condition of having normal concentration of glucose in blood
what is the most important goal with antepartum care?
maintaining euglycemia
how is euglycemia achieved?
combination of insulin, exercise, BG determinations
what is the goal of the nurse in regards to antepartum care?
goal is to educate the changes that pregnancy will have on the mother’s diabetes
what should dietary management be based on?
based on BG and not urine glucose
what are their dietary goals for pregnant mothers with diabetes?
have weight gain constant with a normal pregnancy, prevent ketoacidosis, and achieve euglycemia through consistency in carb intake
when is the best time for pregnant mothers with diabetes to exercise during the day?
after meals
when should BG levels be measured for pregnant diabetics in regards to exercising?
before, during and after exercising
are pregnant women more likely to develop hypo or hyperglycemia? why?
more likely to develop hypo because the goal is to maintain BG in a narrow, low-normal range (3.8-5.2)
what BG level is considered too high for pregnant women?
6.7
will 6.7 show signs of hypergylcemia in pregnant women?
NO!
are all type 1 and type 2’s on insulin during pregnancy?
yes
if a type 2 is on oral hyperglycemics, what must they do?
MUST switch to insulin
in terms of insulin, what happens when the placenta is removed once baby is born?
insulin needs decrease
T or F all type 2 diabetics do not require insulin first couple days after birth (or at all)
F
MOST type 2’s dont require insulin after
why do you NEVER give oral hyperglycemics with pregnant women?
because it crosses the placenta**
ex. if on metformin, you take them off and give insulin instead
what is a risk for diabetic pregnant mother and what do nurses recommend them to do?
risk of going hypoglycemic so they encourage moms to check BG at night and in middle of night
complications for diabetic pregnant women?
• Retinopathy
• HTN (pre-eclampsia)
• Chronic kidney disease (CKD)
-Cardiovascular disease (CVD)
PIH symptoms
- 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
is swelling of feet and ankles normal in PIH?
it is normal unless its pitting edema
