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Maternal Newborn-MJ > T4-Advanced Organizer Part 1 > Flashcards

T4-Advanced Organizer Part 1 Flashcards

1
Q

How does high risk mom do kick count at home?

A

Count fetal movement 2-3x day for 30 min-1 hr

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2
Q

How does low risk mom do kick count?

A

Count fetal movement 1-2x day for 30 min-1 hr

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3
Q

How many movements should be felt in each time frame when doing kick counts?

A

5-6

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4
Q

What is fetal alarm signal?

A

No fetal movement in 12 hours

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5
Q

What kind of pregos will begin monitoring early for kick counts and when does it start?

A

Moms will poor glucose control; 28 weeks

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6
Q

What if mom is at hospital, how is she doing kick counts?

A

She is hooked up to EFM and will push a button every time she feels a kick..The button should match the timing of an acceleration on the monitor

  • acceleration= kicks (sign of fetal well being)
  • this is done especially if mom is hypoglycemic
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7
Q

What is reactive NST?

A

Normal FHR baseline with fetal movement (accelerations(

2 15x15 accelerations in 20 min period

If before 32 weeks, then 2 10x10 accelerations in 20 min period

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8
Q

What is nonreactive NST?

A

Test that does NOT demonstrate at least 2 qualifying accelerations within a 20 min period

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9
Q

What does nonreactive NST require?

A

BPP

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10
Q

What is vibroacoustic stimulation and when is it used?

A

Sound and vibration to elicit a fetal response; used during NST to try and elicit a response (baby may be sleeping or something)

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11
Q

What is White’s classification of GDM based on?

A

Age at diagnosis, duration of illness, and presence of vascular disease

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12
Q

Whites classification: What is gestational?

A

A1, A2

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13
Q

Whites classifcation: What is pre gestational?

A

B, C

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14
Q

Whites classification:

What is vascular complications?

A

D, F, R, T

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15
Q

Whites Classification

What classifications result in good outcome?

A

A-C

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16
Q

Pre-existing diabetes. First trimester: Insulin production is ____ because increased peripheral use of insulin. This causes ____ blood glucose aka ____.

A

Insulin production- increased

causes decreased blood glucose (hypoglycemia)

*NV may also reduce glucose–> higher need for insulin

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17
Q

What is an insulin antagonist? What trimester is it secreted in?

A

Human placental lactogen; 1st

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18
Q

When can fetus create its own insulin?

A

10 weeks gestation

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19
Q

By the end of the pregnancy, insulin requirements _____

A

Increase

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20
Q

After the placenta comes out, there is an abrupt drop in ____ and return to prepregnant state. What does this mean?

A

Drop in hormones; insulin needs IMMEDIATELY decrease

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21
Q

If you are breastfeeding, how are the insulin needs?

A

Insulin needs go down for breastfeeding mom right after birth and eventually even back out to match prepreg levels

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22
Q

What trimester is likely to have hypoglycemia?

A

1st

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23
Q

What trimester is likely to have hyperglycemia?

A

2nd and 3rd–this can turn into ketoacidosis

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24
Q

Less or more insulin needed after delivery?

A

Less (drop of placental hormones)

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25
Q

T/F: Oral hypoglycemics are DOC during pregnancy

A

FALSE–rarely used

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26
Q

How are insulin injections given?

A

2/3 daily insulin given in morning at breakfast (combo of intermediate [NPH] or long-acting and a short acting [regular])

1/3 given at night (combo of long acting and short acting)

27
Q

What are s/s of hypoglycemia?

A
  • Blurred vision
  • Diaphoresis
  • Headache
  • Hunger
  • Nervous
  • Shaking/irritable
28
Q

What are s/s of hyperglycemia?

A
  • Ketones in urine
  • Kusmaul respirations
  • Fruity breath
  • Skin dry and flushed
  • Thirst with frequent urination
29
Q

Do you have to fast for 1 hr glucose tolerance test?

A

No

30
Q

Who gets 1 hr glucose test and when?

A

ALL clients at 24-28 weeks

31
Q

Describe 1 hr glucose tolerance test and the levels that tell if its good or too high.

A

Pt given 50 g oral glucose solution and blood drawn in 1 hr. If level is less than 140, they are good. If level is greater than 140, then they need follow up with 3 hr test

32
Q

What are patient instructions prior to 3 hr glucose test?

A
  • Eat as many carbs as you want!!

- NPO starting midnight night before test (fasting!!)

33
Q

Describe 3 hr test.

A

You get fasting glucose level. They take 100 g of glucola and you get 1 hour after, 2 hour after, and 3 hour after levels

34
Q

What levels mean you failed 3 hour test?

A

2 or more values that equal or exceed the following:

  • Fasting less than 95
  • 1 hr less than 180
  • 2 hr less than 155
  • 3 hr less than 140
35
Q

What are normal BG fasting levels?

A

65-95

36
Q

What are normal BG levels 1 after a meal?

A

130-140

37
Q

What are normal BG levels 2 hours post meal?

A

Less than 120

38
Q

What are normal BG levels 3 hour post meal?

A

100

39
Q

What test is more definitive: GTT or OGTT?

A

OGTT

40
Q

What does euglycemia mean?

A

Normal glucose

41
Q

What does A1c show?

A

What blood sugar has been like over last 3 months

42
Q

What is the good thing about A1c?

A

A patient can’t “fake” their levels like they can manipulate with a 1 hr or 3 hr test

43
Q

What is good A1c control?

A

2.5-5.9%

44
Q

What is fair A1c control?

A

6-8%

45
Q

What is poor A1c control?

A

Greater than 8%

46
Q

What instructions would the nurse give the diabetic for an exercise program? (3)

A

15-30 min of walking 4-6x/wk (go on walks with your stroller to get ready for baby)

Eat a snack before exercising (protein or complex carb) like PB or cheese and crackers

Check glucose before, during, and after exercise

47
Q

Diet management for diabetic:

How many calories do non-obese need? obese?

A

Non-obese: 35 cal/kg/IBW/d

Obese: 25cal/kg/IDW/d

48
Q

All pregnant women need _____ meals and ___, regardless of size

A

3 meals and snacks

49
Q

Diet management for diabetic

What % protein, good fat, and carbs is needed?

A

20% protein

25% good fat

55% carbs

50
Q

What is important for diabetic and nighttime?

A

They need a night snack of protein bc glucose drops at night!!

51
Q

Why are problems more common in type 1 diabetic?

A

Due to lack of insulin entirely

52
Q

Type 1 diabetic..we try and wait to deliver until mom is at ___ weeks. Why would she deliver before that?

A

38.5-40 weeks

she would deliver before if mom had poor metabolic control, worsening HTN disorder, or for a macrocosmic or IUGR baby

53
Q

Type 1 diabetic interventions: What kind of insulin is infused via IVPB? What is the glucose level goal? How often do we check glucose?

A

Regular insulin–it can be titrated along with fluids

Goal: Less than 140

Check glucose HOURLY

54
Q

Type 1 interventions: Once the pt starts pushing, how often is glucose checked?>

A

More frequently bc pushing uses more energy (aka more glucose)

55
Q

Type 1 interventions

Why would there be failure to progress in the labor?

A
  • Shoulder dystocia

- Cephalopelvic disproportion (head too big)

56
Q

Why is infant of a diabetic mom at risk for HYPOglycemia shortly after birth?

A

There has been constant exposure to high circulating levels of glucose. After delivery hyperplasia of fetal pancreas occurs resulting in hyperinsulinemia. Clamping of cord causes blood glucose levels to decrease rapidly in presence of hyperinsulinism.

57
Q

What kind of infant is most commonly affected by hypoglycemia?

A

Macrosomic

58
Q

What is normal glucose in a baby less than 1 day old?

A

40-60

59
Q

What is normal glucose in a baby more than 1 day old?

A

50-90

60
Q

What is hypoglycemia in a baby?

A

Less than 45

61
Q

What is the nurse action for a baby who may be hypoglycemia?

A

Immediately get blood glucose from heel stick within first 2 hours of life

62
Q

What can be done to help elevate BG in baby who is hypoglycemic?

A

Breastfeed or formula (brain damage can occur if baby is depleted of glucose!)

63
Q

What are s/s of baby with hypoglycemia?

A
  • Jittery
  • HIGH pitched cry
  • Tremors
  • Hypotonia
  • Unstable temp–BIGGEST ISSUE
64
Q

Why would infant of a diabetic mom be small instead of large?

A

IUGR can occur r/t maternal vascular involvement (D, F, G, R in Whites)

Maternal Newborn-MJ (29 decks)

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