NCM 109 Flashcards
Is an endocrine disorder in which the pancreas cannot
produce adequate insulin to regulate body glucose levels
DIABETES MELLITUS
A state characterized by the destruction
of the beta cells in the pancreas that
usually leads to absolute insulin
deficiency.
Type 1
A state that usually arises because of
insulin resistance combined with a
relative deficiency in the production of
insulin
Type 2
A condition of abnormal glucose
metabolism that arises during pregnancy.
Possible signal of an increased risk for
type 2 diabetes later in life.
GESTATIONAL
DIABETES
A state between “normal” and “diabetes”
in which the body is no longer using
and/or secreting insulin properly.
IMPAIRED
GLUCOSE
HOMEOSTASIS
a state
when fasting plasma glucose is
at least 110 but under 126 mg/dl
Impaired fasting glucose:
a
state when results of the oral
glucose tolerance test are at
least 140 but under 200 mg/dl in
the 1-hour sample
Impaired glucose tolerance:
high glucose concentration causes extra fluid to shift
and enlarge the amount of amniotic fluid.
Hydramnios
may create birth problems at the end of the
pregnancy because of CPD.
macrosomic infant
Obesity
Age over 25 years
History of large babies (10 lb or more)
History of unexplained fetal or perinatal loss
History of congenital anomalies in previous pregnancies
History of polycystic ovary syndrome
Family history of diabetes (one close relative or two distant
ones)
Member of a population with a high risk for diabetes (Native
American, Hispanic, Asian)
RISK FACTORS FOR DEVELOPING GESTATIONAL
DIABETES:
o Greater than or equal to 126 mg/dl or a nonfasting
plasma glucose greater than or equal to 200 mg/dl
meets the threshold for the diagnosis of diabetes and
does not need confirmation.
NPO for 8 hrs. before the test
FASTING PLASMA GLUCOSE (FBS)
o Between 24 and 28 weeks’ gestation to determine if
they are at risk for gestational diabetes.
50-G GLUCOSE CHALLENGE TEST
o The woman drinks an oral 100-g glucose solution;
o A venous blood sample is then taken for glucose
determination at 1, 2, and 3 hours later.
o If two of the four blood samples collected for this test
are abnormal or the fasting value is above 95 mg/dl,
a diagnosis of diabetes is made
ORAL GLUCOSE TOLERANCE TEST (OGTT)
is an automatic pump with thin tubing,
which is placed subcutaneously, most often on the woman’s
abdomen.
insulin pump
Normal level of serum creatinine for pregnant women:
0.4 –
0.8 mg/dl
(i.e., a small amount of
amniotic fluid) may indicate fetal growth
restriction or a fetal renal abnormality
Oligohydramnios
(i.e., an excessive amount of
amniotic fluid) may indicate gastrointestinal
malformation or poorly controlled disease.
Polyhydramnios
is usually performed by week 36 of pregnancy to
assess fetal lung maturity
lecithin/sphingomyelin ratio by amniocentesis
he most hazardous times for a fetus during a diabetesinvolved pregnancy are
o Because of his or her large size.
weeks 36 to 40 of pregnancy.
A form of high blood pressure in pregnancy
A condition in which vasospasm occurs in both small and
large arteries during pregnancy
Also called as TOXEMIA or PREECLAMPSIA
it occurs in about 5 to 7% of all pregnancies
pregnancy Induced Hypertension
or the presence of
antiphospholipid antibodies in maternal blood
antiphospholipid syndrome
o High blood pressure that is present before
pregnancy begins
Chronic Hypertension
BP 140/90 mmHg or
Systolic BP > 30 mmHg; Diastolic 15 mmHg above
pregnancy level
No proteinuria nor edema
BP returns to normal after birth
GESTATIONAL HYPERTENSION
BP 140/90 mmHg
Systolic BP > 30 mmHg; Diastolic 15 mmHg above
pregnancy level
Proteinuria +1 to +2
Weight gain 2 lbs/wk in 2nd trimester; 1 ln/wk in 3rd
trimester
Mild edema in upper extremities or face
MILD PREECLAMPSIA
BP 160/110 mmHg
Proteinuria: 3+ to 4+ on a random sample
Oliguria: 500 ml or less in 24 hrs
Pulmonary involvement: shortness of breath
Hepatic dysfunction
Epigastric pain due t
SEVERE PREECLAMPSIA
o Is most readily palpated over bony surfaces, such as
over the tibia on the anterior leg, the ulnar surface of
the forearm, and the cheekbones, where the
sponginess of fluid-filled tissue can be palpated
against bone.
Extreme edema
If there is swelling or puffiness at these points to a
palpating finger but the swelling cannot be indented
with finger pressure, the edema is described as
nonpitting.
Seizure or coma occurs
Signs and symptoms of preeclampsia
eclampsia
(5-8 mg/100ml)
Muscle relaxant
Prevent seizures
Magnesium sulfate
to reduce hypertension (5-
10 mg/IV)
Lowers BP by peripheral dilatation
Can Cause tachycardia
Hydralazine (Apresoline)
Antidote for MgSO4 intoxication
10 ml of a 10% calcium gluconate must be
Calcium gluconate
Halt seizures
5-10 IV, administer slowly
- Dose may be repeated q 5 to 10 minutes
(up to 30 mg/hr
Diazepam (Valium)
PRELIMINARY SIGNS BEFORE SEIZURE
BP suddenly rises from additional spasm
Temperature rises (39.4-40°C) from increased cerebral
pressure
Blurring of vision or severe headache from increased
cerebral edema
Hyperactive reflexes
Epigastric pain and nausea from vascular congestion of the
liver or pancreas
TONIC-CLONIC SEIZURES
Tonic Seizures:
o Signs and Symptoms:
Back arches
Arms and legs stiffen
Jaw closes abruptly
Respirations stop
Lasts for approx. 20 secs
Clonic Seizures:
o Signs and Symptoms:
Body muscles contract and relax repeatedly
Inhales and exhales irregularly
Incontinence of urine and feces may occur
Lasts up to 1 min
O2 therapy continued
MgSO4 or diazepam (Valium) may be
administered via IV as an emergency measure
o Semi-comatose
o Extremely close observation is necessary because
seizure may cause premature separation of the
placenta and labor may begin
o Painful stimulus of contraction may initiate another
seizure
o Keep woman on side lying position
o Keep NPO
o Continue monitoring FHR and uterine contractions
o Check for vaginal bleeding every 15 mins
Postictal State:
