T4 - Advance Organizer (Josh) Flashcards
How many times per day does a mom need to do a kick count?
High Risk = 2-3 x’s day
Low Risk = 1-2 x’s day
How many times per day does a mom need to do a kick count?
High Risk = 2-3 x’s day
Low Risk = 1-2 x’s day
How many fetal movements should mom feel in a one hour kick count?
5-6
No fetal movements within – is serious and requires a visit to doctor.
12 hrs
Why would diabetic mom need less insulin during first trimester?
Baby taking up some blood sugar
N/V can cause sugar loss
Human Placental Lactogen (HPL) is secreted (it’s an insulin antagonist)
What happens to insulin requirements in 2nd and 3rd Trimesters?
increases by as much as 4 x’s normal need
What weeks of gestation are insulin needs the highest?
36-40 wks
Which A1c levels show good control?
fair control?
poor control?
Good = 2.5-5.9%
Fair = 6-8%
Poor = > 8%
What is normal HCT in pregnancy?
Hgb?
HCT = 33
Hgb = 11
— increases Iron absorption.
— decreases iron absorption.
Vit C
Milk, Tea, and Coffee
How much Folic Acid should mom receive during pregnancy?
400 mg/day
What is a Reactive NST?
2 Accels (15x15) in 20 min period
***if less than 32 wks, 10x10
During labor, what glucose level do we want to maintain for mom?
During labor, monitor glucose —-.
hourly
***more in second stage b/c voluntary pushing requires more energy
— helps stabilize blood sugar postpartum.
Breastfeeding
Why do we need to maintain the integrity of diabetic mom’s nipples if she’s breastfeeding?
diabetics are more prone to infection so any cracks can lead to mastitis
What happens to insulin needs upon expulsion of placenta?
fall dramatically
What levels are we looking for in the 1 hr (50g) OGTT?
How many fetal movements should mom feel in a one hour kick count?
5-6
No fetal movements within – is serious and requires a visit to doctor.
12 hrs
Why would diabetic mom need less insulin during first trimester?
Baby taking up some blood sugar
N/V can cause sugar loss
Human Placental Lactogen (HPL) is secreted (it’s an insulin antagonist)
What happens to insulin requirements in 2nd and 3rd Trimesters?
increases by as much as 4 x’s normal need
What weeks of gestation are insulin needs the highest?
36-40 wks
Which A1c levels show good control?
fair control?
poor control?
Good = 2.5-5.9%
Fair = 6-8%
Poor = > 8%
What is normal HCT in pregnancy?
Hgb?
HCT = 33
Hgb = 11
What numbers constitute a positive 3 hr OGTT?
> 140 or > 145
***avoid caffeine and smoking for 12 hrs before test
How much Folic Acid should mom receive during pregnancy?
400 mg/day
What is a Reactive NST?
2 Accels (15x15) in 20 min period
***if less than 32 wks, 10x10
During labor, what glucose level do we want to maintain for mom?
During labor, monitor glucose —-.
hourly
***more in second stage b/c voluntary pushing requires more energy
Why is infant of diabetic mom at risk for hypoglycemia shortly after birth?
Baby has been dealing with mom’s high glucose levels in utero
When placental supply is cut off, the baby has all this excess insulin and a much lower supply of glucose
***remember, baby pancreas produces insulin at 10 wks gestation
Why do we need to maintain the integrity of diabetic mom’s nipples if she’s breastfeeding?
diabetics are more prone to infection so any cracks can lead to mastitis
What happens to insulin needs upon expulsion of placenta?
fall dramatically
What levels are we looking for in the 1 hr (50g) OGTT?
If 1 Hr OGTT is positive, what do we do?
Do a three hour test
When is the 3 hr (100 G) OGTT positive for diabetes?
when two or more values are met
3 Hr (100 g) OGTT Values:
Fasting =
1 hr =
2 hr =
3 hr =
Fasting = > 95
1 hr = > 180
2 hr = > 155
3 hr = > 140
What are the targeted glucose levels during pregnancy in relation to meals?
Fasting = 60-99
1 hr post meal = 100-129
2 hr post meal =
2/3 of daily insulin is given at – and 1/3 is given at –
breakfast
evening
When would we do a C/S for HSV2 client?
if active lesions are present in the birth canal
Which type of diabetic meds are seldom used during pregnancy?
oral meds
Instructions regarding exercise for diabetic pregnant client?
Monitor Closely
15-30 mins walking for 4-6 times/wk
Snack of protein or complex carb BEFORE exercise
Monitor glucose before, during, and after exercise
What numbers constitute a positive 3 hr OGTT?
> 140 or > 145
***avoid caffeine and smoking for 12 hrs before test
What test is given to newborn of HIV mom?
ELISA test which looks for presence of HIV antibodies
What does MSAFP look for?
Alpha Fetoprotein, which is produced in FETAL gestational tract and liver
increasing levels are detectable in maternal serum b/t 14-34 wks
What are elevated levels of Alpha Fetoprotien indicative of?
Neural Tube defects
Abdominal Wall defects
Cocaine can lead to ——
placental abruption
Why is infant of diabetic mom at risk for hypoglycemia shortly after birth?
Baby has been dealing with mom’s high glucose levels in utero
When placental supply is cut off, the baby has all this excess insulin and a much lower supply of glucose
***remember, baby pancreas produces insulin at 10 wks gesttaion
What serum glucose level are we looking for in newborn?
40-60
How do we treat hypoglycemia in newborn?
early and often breastmilk
formula
D5W
***NGT if can’t suck well
When is the greatest risk for a mom who has cardiac insufficiency?
28-32 wks b/c fluid volume peaks
S/S of Cardiac Decompensation
Fatigue
Dyspnea, Cough (feels smothered)
Weak, thready pulse
Tachycardia (> 100)
Bradycardia (> 25)
Orthopnea
Crackles at base of lungs
Cyanosis
What should we remember for a cardiac client during 2nd stage of labor?
no pushing or bearing down
What will the FHR strip look like for a cardiac patient mom?
late decels due to poor placental perfusion
Where can a client contract Toxoplasmosis?
Raw Meat
Cat Litter
What does RPR test for?
Syphillis
**could lead to spontaneous abortion or PTL
When would we do a C/S for HSV2 client?
if active lesions are present in the birth canal
When should HIV mom get medications?
Zidovudine after 14 wks gestation orally
IV during labor
When should infant get ZDV if mom had HIV?
~ 6 months (weeks???)
Delivery plan for HIV mom
No pitocin to avoid lacerations
no scalp electrodes
no episiotomy
no breastfeeding
What test is given to newborn of HIV mom?
ELISA test which looks for presence of HIV antibodies
When are pregnant women screened for Hep B?
all are screened early on
at risk screened in 3rd trimester
What is treatment for newborn r/t Hep B mom?
given immune globuline at birth to prevent skin surface contamination
repeated at 1 and 6 months
Cocaine can lead to ——
placental abruption
What if mom is less than 32 weeks and has complications from HELLP?
give corticosteroids to help with fetal lung development
What if mom is > 34 wks and has complications from HELLP?
go ahead and deliver
Question 27
Question 27
