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Exam 4 (Spring) > Pregnancy at Risk - Diabetes > Flashcards

Pregnancy at Risk - Diabetes Flashcards

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1
Q

What are the 4 classifications for DM?

A

Type 1
Type 2
Other
Gestational

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2
Q

Who is considered a high risk during pregnancy (r/t diabetes)?

A

Women with Type 1 DM

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3
Q

What is the key to postive pregnancy outcomes for pts. with diabetes?

A

Excellent glycemic control

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4
Q

Diabetes is a chronic multisystem disese r/t what?

A

Abnormal insulin production
Impaired insulin utilization
Or both

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5
Q

What can trigger the onset of gestational diabetes?

A

Extra metabolic demands

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6
Q

Gestational diabetes may develop in pregnant women with risk factors for what?

A

Diabetes 2

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7
Q

What happens to the glucose of a woman with gestational diabetes after she gives birth?

A

It usually returns to normal

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8
Q

Babies born to a mom who had gestational diabetes are usually how many pounds at birth?

A

> 10 lbs

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9
Q

What hormone enables energy use and storage and decreaes blood glucose concentration?

A

Insulin

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10
Q

In pregnancy, ______ can cause insulin resistance

A

Progesterone

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11
Q

Human placental growth hormone modifies what?

A

The metabolic state of the mother during pregnancy to facilitate the energy supply of the fetus

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12
Q

Human placental growth hormone is made by what?

A

The placenta

Duh! (:

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13
Q

When does type 1 DM usually begin?

A

In childhood

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14
Q

Type 1 diabetes has a _____ onset

A

Rapid

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15
Q

What is the cause of type 1 DM?

A

Unknown cause

-There is no pancreatic production of insulin

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16
Q

In type 2 DM, does the pancreas form insulin?

A

Yes; it forms SOME

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17
Q

In what age group does type 2 DM usually occur in?

A

Adults

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18
Q

How can type 2 DM be controlled?

A

By diet and exercise

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19
Q

What are secondary complications of type 2 DM?

A

Blindness
Heart attack
Stroke
Amputation

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20
Q

Maternal complications associated with diabetes

A

Hydramnios rates 10x greater (>PROM)
Infection rates higher (UTI and yeast)
Ketoacidosis can = fetal death

21
Q

Preconception counseling for diabetes

A

Parter should be involved
FInances considered
Contraception issues require attention an dteaching
Type 2 DM pts. and Gestational diabetes can safely take on Glyburide, a sulfonyurea agent, or SQ insulin. Other agents cross placena and may be teratogenic

22
Q

Fetal and neonatal complications r/t gestational diabetes

A
  • Stillbirth >36wks
  • Congenital anomaly 6-10% per pregnancy with cardiac, CNS, and skeletal most common
  • Macrosomia >4000 gm, birh injuries, C/S
  • IUGR r/t maternal vascular disease and increased risk for BDS
  • Neonatal hypoglycemia, F&E imbalances, hyperbilirubinemia, and polycythemia
23
Q

Sulfonylureas stimulate _______ production

A

Insulin

24
Q

Insulin needs during pregnancy

A
  • Lower in 1st trimester d/t increased production by pancreas and increased peripheral insulin sensitivity
  • Increased in the 2nd trimester d/t maternal hormones acting as insulin antagonists
  • Dramatic increases by 3rd trimester
  • Levels off at 36 wks
  • By delivery, maternal needs significantly drop
25
Q

MSAFP

A

Found in both fetal serum and also amniotic fluid

  • Pursue potential medical interventions
  • Begin planning for a child w/ special needs
  • Start adressing anticipated life changes
  • Identify support groups
  • Make a decision about carrying child to term
26
Q

Blood glucose monitoring during pregnancy

A

Key to control

Daily urine ketone checks to pick up on ketoacidosis early on

27
Q

Normal blood glucose during pregnancy

A

60-120 mg/dl

28
Q

Fetal non-stress test

A

Simple, non-invasive test performed in pregnancies >28 wks gestation

29
Q

When is a fetal NST done?

A

If baby not moving like usual
If overdue
If suspect placenta is not functioning adequately
If high risk for any reason

30
Q

What can a fetal NST indicate?

A
  • Baby is not recieving enough O2 because placental or umbilical cord problems
  • Fetal distress
31
Q

HbA1C

A

Blood glucose attatches to a hemoglobin in the RBCs
RBCs live 3 mos
When HGB/RBC is measured, it reflects average BG for prior 2-3 mos

32
Q

What is the normal HbA1C?

A

4-6%

33
Q

What level of HbA1C is diagnostic of diabetes?

A

> 6.5%

34
Q

When might an HbA1C be inaccurate?

A

If pt. is also anemic

35
Q

How often should HbA1C test done?

A

Q 3 months

36
Q

When is a contraction stress test done?

A

At 34 wks

37
Q

Contraction stress test

A

Oxytocin given IV
Monitor HR and contractions
O2 levels may drop, causing HR to drop

38
Q

Biophysical progile (BPP)

A

Measures baby’s HR, muscle tone, movement, breathing, and the amount of amniotic fluid

  • NST
  • Fetal ultrasound
39
Q

Teaching for diabetes during pregnancy?

A

Decrease stressors- need strict daily routine
Diet = 3 meals, 3 snacks, never skip
Acitivty= mild exercise
Insulin = appropriate dose to maximize glucose levels and reduce hypoglycemia
Rest= set sleep schedule; planned rest
BG = Keep between 60-120 depending on meals and time of day

40
Q

Fetal surveillance

A

EDD established
Measure MSAFP between 16-18 wks d/t high rate of neural tube defects
Fetal echo to detect cardiac problems by 22 wk
Beginning at 28 wks, NST weekly
In presence of non-reactive NST, order a CST or BPP

41
Q

Nursing care of pt. with diabetes who is pregnant: History

A 
Age diagnosed
Glycemic control
Diet and activity
Insulin use
Medical and OB Hx
42
Q

Nursing care of pt. with diabetes who is pregnant: Assesment

A 
Knowledge base
Motivation
Support systems
S&S
Weight 
Labs (UA, urine C&S, BG, Hgb, A1c)
43
Q

____% of gestational diabetics develop DM later

A

50%

44
Q

When is gestational diabetes usually diagnosed?

A

in the 2nd and 3rd trimester as maternal intake and pregnancy hormones increase insulin resistance

45
Q

Risk factors for gestational diabetes

A 
Prior deliveries >4500 gm
>25 yrs
Obesity
Family hx of type 2 DM
Polyhydramnios
Unexplained stillbirth
46
Q

Glucose tolerance test

A

BG measured at intervals after the pt/ drinks a concentrated carbohydrate drink
GTT- high risk women initially and 24-28 wks
BS >139 goes to 2 hour GTT

47
Q

Management of GDM

A

Managed like type 1 or 2 wirh focus on glycemic control
Diet and exercise (usually)
Less likely to require c/s

48
Q

If you have GDM, it is typical in future pregnancies with an _____ onset

A

Earlier

Exam 4 (Spring) (12 decks)

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