Pregnancy induced HTN and diabetes

Question 1

PID:

Answer 1

potentially severe and fatal elevation of BP that occurs during pregnancy

Question 2

How is GDM diagnosed?

Answer 2

• screening between 24-28wks gestation
• FBG
• GTT
• HgA1c

Question 3

4 things to monitor for

Answer 3

• Self-monitoring blood glucose:
o Glycemic control is essential
o If receiving insulin – nocturnal hypoglycemia is an increased risk
• Presence of ketones in blood/urine:
o Monitors dietary intake ins adequate
o Ketones can cause acidosis – fetal anoxia
• Nutrition therapy – dietician:
o Proper weight gain, nutrition, meal planning
o Adequate protein and calcium intake
• Physical activity:
o Typically encouraged
o May have special OB restrictions for bedrest

Question 4

why are ketones bad?

Answer 4

can cause fetal anoxia

Question 5

complications for baby if mom has hyperglycemia?

Answer 5

• Has adverse effects on the fetus throughout pregnancy:
o At conception and during first trimester it increases the risk of multiple fetal malformations.
Later in pregnancy, it increases the risk of macrosomia and metabolic complications at birth

Question 6

Macrosomia:

Answer 6

1. Mother’s blood brings extra glucose to the fetus
2. Fetus makes more insulin to handle extra glucose
3. Extra glucose gets stored as fat and fetus becomes larger than normal

Question 7

At what point would you intiate pharmaco interventions?

Answer 7

if not reaching glycemic targets within 2wks of glucose test with nutrition alone:
o Initiate insulin therapy:
o Do not give PO because it can cross the placenta barrier
♣ Humalog: Short acting, sliding scale
♣ Insulin pump (1unit/hr)
♣ Insulin infusion with labor
♣ Continuously monitor for hyper/hypoglycemia
o Assess fetal growth via ultrasound

Question 8

What might cause edema in the ankles/hands/feet?

Answer 8

The edema is caused by the fluid shift from her capillaries to interstitial cells due to the loss of proteins in the blood. Fluid moves to the area with greater concentration of solutes. Osmotic interstitial pressure pulls fluid into interstitial space

Question 9

rationale for hct:

Answer 9

Hydration status of mother.

Question 10

rationale for platelet:

Answer 10

GDM Decreases liver function and decreased number of platelets, which can cause clotting complications.

Question 11

rationale for urinanalysis:

Answer 11

Proteins and ongoing monitoring of ketones and glucose

Question 12

rationale for lipid profile:

Answer 12

Risk of cardiovascular disease along with PIH.

Question 13

rationale for IVI:

Answer 13

To treat PIH in a crisis situation (in case she develops eclampsia and has a seizure, magnesium sulfate can be administered to treat).