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Semester Three - Half Two - Nursing 212 > Module 9 (Exam 3) Diabetes > Flashcards

Module 9 (Exam 3) Diabetes Flashcards

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1
Q

Gestational Diabetes

A

A classification of diabetes with onset or first recognition during pregnancy

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2
Q

Polyhydramnios

A

Greater than normal amounts of amniotic fluid

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3
Q

Carbohydrate Metabolism

A
  1. Insulin
    1. Beta cells of pancreas
    2. Makes glucose available to body cells
  2. Diabetes
    1. Inadequate insulin and/or inability to use insulin for carbohydrate metabolism
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4
Q

Type I Diabetes

A

Insulin deficiency

Exists prior to pregnancy

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5
Q

Type II Diabetes

A

Insulin resistance

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6
Q

Incidence of gestational diabetes

A

Prevalence varies in direct proportion to prevalence of type II diabetes in a given segment of society

7% incidence

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7
Q

GDB Risk Factors

A
  • BMI greater than 25-29 (overweight) or greater than 29 (obese)
  • Chronic HTN
  • Maternal age greater than 25
  • Family history of diabetes
  • History fetal macrosomia
  • Unexplained fetal death in utero
  • Multigestation
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8
Q

Early pregnancy diabetogenesis

A
  • Insulin sensitivity
  • Little alteration in maternal metabolic rate
  • Potential for hypoglycemia
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9
Q

Late pregnancy diabetogenesis

A
  • Insulin resistance
  • Placental hormones block insulin usage
  • Potential for hyperglycemia
  • Placental hormones favor fetal growth
  • Human placental lactogen and progesterone and estrogen
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10
Q

Why do insulin needs decline during the 1st trimester?

A

Insulin sensitivity

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11
Q

Why do insulin needs dramatically increase during the 2nd and 3rd trimesters?

A
  • Insulin resistance peaks
  • Placental blockers hamper insulin usage
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12
Q

Why do insulin needs dramatically decrease postpartum?

A

Placental delivery negates hPL

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13
Q

Screening for GDM

A
  • Glucose Challenge Test
    • Routine screening at 24-28 weeks gestation
    • 50G oral glucose solution
    • 1 hour postprandial blood draw
  • Acceptable level is greater than 140mg/dl
  • Finding of greater than or equal to 140mg/dl calls for a Oral Glucose Tolerance Test
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14
Q

Oral Glucose Tolerance Test

A
  • Fasting blood glucose
  • 100G oral glucose solution
  • Postprandial blood draws every hour X 3

Diagnostic Criteria:

Fasting: greater than 95mg/dl

1 hour: greater than 180 mg/dl

2 hours: greater than 155mg/dl

3 hours: greater than 140mg/dl

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15
Q

What conditions must be met for a diagnosis of GDB?

A

Elevated fasting plasma glucose level

OR

Two or more elevated postprandial plasma glucose levels

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16
Q

Medical Management of GDB

A
  1. Goal: Euglycemia (FBG is less than 95mg/dl)
  2. Glucose monitoring
  3. Dietary monitoring
  4. Exercise
  5. Pharmacologic intervention
    1. Insulin
    2. Oral agents may be acceptable (Glyburide/glucophage)
17
Q

Delivery of a baby whose mother has GDB

A
  1. Amniocentesis to assess lung maturity
    1. LS ratio 2:1 in non-diabetic woman - 3:1 in a diabetic woman
    2. PG must be present
  2. Delivery at 38-39 weeks
    1. R/t decline in placental function
18
Q

Nursing management of GDB

A
  1. Self-care instruction and support
  2. Lifestyle modification
  3. Dietary Management
  4. Approach a caloric restriction with caution
  5. Refer to a registered dietician or nutritionist
  6. Guidelines: carbohydrate counting, exchange system
19
Q

Hyperglycemia symptoms

A
  1. Fatigue, drowsiness
  2. Hot, dry skin
  3. Thirst, dry mouth
  4. Frequent urination
  5. Rapid, deep respiration
  6. Headache
  7. Fruity breath
20
Q

Hypoglycemia

A
  1. Tremors
  2. Diaphoresis
  3. Cold, clammy skin
  4. Hunger
  5. Blurred vision
  6. Disorientation
  7. Irritability
21
Q

Effects on the infant of a diabetic mother

A
  1. Excessive glucose in utero
  2. Stimulates development of RBCs
  3. Polycythemia leads to neonatal hyperbilirubinemia
  4. Stimulates pancreatic growth
  5. Large pancreas results in more insulin
  6. Insulin acts as a growth hormone that leads to fetal macrosomia
  7. Insulin delays surfactant production therefore increasing the potential for respiratory distress syndrome
22
Q

Delivery and PP for the infant of diabetic mother

A
  1. Risk for birth related complications including pre-term birth and macrosomia
  2. Impaired respirartory function r/t delayed surfactant production
  3. Risk for hypoglycemia r/t increase in insulin production
  4. Risk for hyperbilirubinemia r/t polycthemia
23
Q

Pre-exisiting diabetes concerns (type 1)

A
  1. Increased risk for spontaneous abortion and fetal malformations
  2. Preeclampsia
  3. Polyhydramnios
    1. Uterine overdistention, fetal polyuria
24
Q

Criteria for Fasting BG

A

Greater than 95mg/dL

If this criterion is met, GBD is diagnosed

25
Q

Criteria for 1 hour BG

A

Greater than 180mg/dL

this plus one other abnormal value = GBD

26
Q

Criteria for 2 hour BG

A

Greater than 155 mg/dL

this plus one other abnormal value = GBD

27
Q

Criteria for 3 hour BG

A

Greater than 140 mg/dL

this plus one other abnormal value = GBD

28
Q

Criteria for Glucose Challenge Test (GCT)

A

Acceptable level is less than 140 mg/dL

Finding of greater than or equal to 140 mg/dL

Semester Three - Half Two - Nursing 212 (41 decks)

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