Module 6 Unit A Flashcards
How does the size of the thyroid gland change during pregnancy?
Thyroid size - During pregnancy, the thyroid gland increases in size by 10% in iodine replete countries but by 20% to 40% in areas of iodine deficiency
Normal physiologic changes in thyroid and thyroid hormones during pregnancy
Thyroid gland enlarges up to 30% of its normal size by the third trimester.
How do TSH lab values adjust during pregnancy?
1st Trimester Normal or Decrease
2nd Trimester Normal
3rd Trimester Normal
How do Free T3 lab values adjust during pregnancy?
1st Trimester Normal
2nd Trimester Normal
3rd Trimester Normal
How do free T4 lab values adjust during pregnancy?
1st Trimester Normal
2nd Trimester Normal
3rd Trimester Normal
How do total T3 lab values adjust during pregnancy?
1st Trimester High
2nd Trimester High
3rd Trimester High
How do total T4 lab values adjust during pregnancy?
1st Trimester High
2nd Trimester High
3rd Trimester High
What are the clinical signs and symptoms of hypothyroidism?
Nonspecific clinical findings that may be indistinguishable from common s/s of pregnancy - fatigue, constipation, cold intolerance, muscle cramps, and weight gain.
Other findings include edema, dry skin, hair loss, and a prolonged relaxation phase of DTRs
Goiter may or may not be present in cases of hypothyroidism and is more likely to occur in women who have Hashimoto thyroiditis (also known as Hashimoto disease) or who live in areas of endemic iodine deficiency.
Hashimoto thyroiditis is the most common cause of hypothyroidism in pregnancy
What are the risks of uncontrolled hypothyroidism on the birthing person?
Adverse perinatal outcomes such as spontaneous abortion preeclampsia preterm birth abruptio placentae and fetal death
What are the risks of uncontrolled hypothyroidism on the fetus and newborn?
increased risk of low birth weight and impaired neuropsychological development
Rare for maternal thyroid inhibitory antibodies to cross the placenta and cause fetal hypothyroidism
What lab tests should the nurse midwife order to diagnose hypothyroidism?
TSH and free T4
How should the nurse midwife manage a patient with hypothyroidism?
Adequate maternal iodine intake is needed for the maternal and fetal synthesis of T4 .
Women of reproductive age should assess their diets and dietary supplements to confirm that they are meeting the recommended daily dietary intake of 150 micrograms of iodine.
Pregnant women with overt hypothyroidism - treat with adequate thyroid hormone replacement to minimize the risk of adverse outcomes.
American Thyroid Association and the American Association of Clinical Endocrinologists recommend T4 replacement therapy, beginning with
Levothyroxine in dosages of 1–2 micrograms/kg daily or approximately 100 micrograms daily
What are the clinical signs and symptoms of hyperthyroidism question the hyperthyroidism?
Nervousness, tremors, tachycardia, frequent stools, excessive sweating, heat intolerance, weight loss, goiter, insomnia, palpitations, and hypertension.
Distinctive s/s of Graves - ophthalmopathy (lid lag and lid retraction) and dermopathy (localized or pretibial myxedema)
What are the risks of uncontrolled hyperthyroidism on the birthing person?
Inadequately treated maternal thyrotoxicosis is associated with a greater risk of severe preeclampsia and maternal heart failure than treated, controlled maternal thyrotoxicosis
What are the risks of uncontrolled hyperthyroidism on the fetus and newborn?
Inadequately treated hyperthyroidism is associated with an increase in medically indicated preterm deliveries, low birth weight, and possibly fetal loss
Abruption, hydrops, stillbirth, fetal tachycardia, goiter, transient hyper or hypothyroid
Most cases of maternal hyperthyroidism- neonate is euthyroid.
Risks associated w/Graves disease-related either to disease itself or thioamide treatment of the disease
What lab tests should the nurse midwife order to diagnose hyperthyroidism?
TSH and free T4
How should the nurse midwife manage a patient with hyperthyroidism?
Refer
Overt hyperthyroidism - thioamide to minimize the risk of adverse outcomes.
Either propylthiouracil or methimazole, both thioamides, can be used to treat pregnant women with overt hyperthyroidism - new studies show may not be safe
Refer
What is hyperemesis gravidarum?
Excessive NVP, no standard definition exists.
What are the diagnostic criteria for hyperemesis gravidarum?
Persistent vomiting present before 9 weeks
Dehydration and/or ketonuria
Weight loss + 5% of initial body weight
Electrolyte imbalance (hypokalemia)
How should the nurse midwife assess for hyperemesis gravidarum?
PUQE index - score 13+ = severe NVP/HG
Hx - diet, meds, eating disorders
Elimination - stool, blood in vomit - consider peptic ulcer or esophagitis w/repeated vomiting
Fever or chills
Exposure to viral infection or contaminated food
Abd pain, hx of eating disorders
PEx - weight {compare to previous weights}, VS, skin turgor, mucous membranes, condition of tongue, abd palpation for organomegaly, tenderness or distension, bowel sounds, uterine size
Lab tests -
CBC, UA, BUN, CMP/electrolytes
LFT - to r/o hepatitis, pancreatitis and cholestasis
TSH and T4 - to r/o thyroid disease
US - confirm pregnancy and r/o multiples or hydatidiform mole
What effect does hyperemesis gravidarum have on the birthing person?
Adverse psychological -concerns about economics, employment, depression, anxiety, fear about future pregnancies
Transient biochemical hyperthyroid state- doesn’t need tx, resolves spontaneously ~18-20 weeks GA
What effect does hyperemesis gravidarum have on the fetus and newborn?
If maternal weight gain normalizes not associated w/ adverse outcomes.
If low weight gain - increases r/f PTL & LBW
How should the nurse midwife manage a person with hyperemesis gravidarum?
Consult, and usually collaborative
Need to break cycle
IV fluids - NEVER dextrose r/t r/f Wernicke’s encephalopathy from thiamine deficiency
Usually NS
Consider adding K+, thiamine or MV daily to prevent Wernicke’s {so basically a banana bag}
IV or IM antiemetics, reglan (metoclopramide) or zofran initially
If still can’t tolerate PO fluids and PO antiemetics reconsult MD
MD may need to order corticosteroids and either parenteral or NG feeding
