T4-Advanced Organizer Part 1 Flashcards
How does high risk mom do kick count at home?
Count fetal movement 2-3x day for 30 min-1 hr
How does low risk mom do kick count?
Count fetal movement 1-2x day for 30 min-1 hr
How many movements should be felt in each time frame when doing kick counts?
5-6
What is fetal alarm signal?
No fetal movement in 12 hours
What kind of pregos will begin monitoring early for kick counts and when does it start?
Moms will poor glucose control; 28 weeks
What if mom is at hospital, how is she doing kick counts?
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
What is reactive NST?
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
What is nonreactive NST?
Test that does NOT demonstrate at least 2 qualifying accelerations within a 20 min period
What does nonreactive NST require?
BPP
What is vibroacoustic stimulation and when is it used?
Sound and vibration to elicit a fetal response; used during NST to try and elicit a response (baby may be sleeping or something)
What is White’s classification of GDM based on?
Age at diagnosis, duration of illness, and presence of vascular disease
Whites classification: What is gestational?
A1, A2
Whites classifcation: What is pre gestational?
B, C
Whites classification:
What is vascular complications?
D, F, R, T
Whites Classification
What classifications result in good outcome?
A-C
Pre-existing diabetes. First trimester: Insulin production is ____ because increased peripheral use of insulin. This causes ____ blood glucose aka ____.
Insulin production- increased
causes decreased blood glucose (hypoglycemia)
*NV may also reduce glucose–> higher need for insulin
What is an insulin antagonist? What trimester is it secreted in?
Human placental lactogen; 1st
When can fetus create its own insulin?
10 weeks gestation
By the end of the pregnancy, insulin requirements _____
Increase
After the placenta comes out, there is an abrupt drop in ____ and return to prepregnant state. What does this mean?
Drop in hormones; insulin needs IMMEDIATELY decrease
If you are breastfeeding, how are the insulin needs?
Insulin needs go down for breastfeeding mom right after birth and eventually even back out to match prepreg levels
What trimester is likely to have hypoglycemia?
1st
What trimester is likely to have hyperglycemia?
2nd and 3rd–this can turn into ketoacidosis
Less or more insulin needed after delivery?
Less (drop of placental hormones)
T/F: Oral hypoglycemics are DOC during pregnancy
FALSE–rarely used
How are insulin injections given?
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)
What are s/s of hypoglycemia?
- Blurred vision
- Diaphoresis
- Headache
- Hunger
- Nervous
- Shaking/irritable
What are s/s of hyperglycemia?
- Ketones in urine
- Kusmaul respirations
- Fruity breath
- Skin dry and flushed
- Thirst with frequent urination
Do you have to fast for 1 hr glucose tolerance test?
No
Who gets 1 hr glucose test and when?
ALL clients at 24-28 weeks
Describe 1 hr glucose tolerance test and the levels that tell if its good or too high.
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
What are patient instructions prior to 3 hr glucose test?
- Eat as many carbs as you want!!
- NPO starting midnight night before test (fasting!!)
Describe 3 hr test.
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
What levels mean you failed 3 hour test?
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
What are normal BG fasting levels?
65-95
What are normal BG levels 1 after a meal?
130-140
What are normal BG levels 2 hours post meal?
Less than 120
What are normal BG levels 3 hour post meal?
100
What test is more definitive: GTT or OGTT?
OGTT
What does euglycemia mean?
Normal glucose
What does A1c show?
What blood sugar has been like over last 3 months
What is the good thing about A1c?
A patient can’t “fake” their levels like they can manipulate with a 1 hr or 3 hr test
What is good A1c control?
2.5-5.9%
What is fair A1c control?
6-8%
What is poor A1c control?
Greater than 8%
What instructions would the nurse give the diabetic for an exercise program? (3)
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
Diet management for diabetic:
How many calories do non-obese need? obese?
Non-obese: 35 cal/kg/IBW/d
Obese: 25cal/kg/IDW/d
All pregnant women need _____ meals and ___, regardless of size
3 meals and snacks
Diet management for diabetic
What % protein, good fat, and carbs is needed?
20% protein
25% good fat
55% carbs
What is important for diabetic and nighttime?
They need a night snack of protein bc glucose drops at night!!
Why are problems more common in type 1 diabetic?
Due to lack of insulin entirely
Type 1 diabetic..we try and wait to deliver until mom is at ___ weeks. Why would she deliver before that?
38.5-40 weeks
she would deliver before if mom had poor metabolic control, worsening HTN disorder, or for a macrocosmic or IUGR baby
Type 1 diabetic interventions: What kind of insulin is infused via IVPB? What is the glucose level goal? How often do we check glucose?
Regular insulin–it can be titrated along with fluids
Goal: Less than 140
Check glucose HOURLY
Type 1 interventions: Once the pt starts pushing, how often is glucose checked?>
More frequently bc pushing uses more energy (aka more glucose)
Type 1 interventions
Why would there be failure to progress in the labor?
- Shoulder dystocia
- Cephalopelvic disproportion (head too big)
Why is infant of a diabetic mom at risk for HYPOglycemia shortly after birth?
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.
What kind of infant is most commonly affected by hypoglycemia?
Macrosomic
What is normal glucose in a baby less than 1 day old?
40-60
What is normal glucose in a baby more than 1 day old?
50-90
What is hypoglycemia in a baby?
Less than 45
What is the nurse action for a baby who may be hypoglycemia?
Immediately get blood glucose from heel stick within first 2 hours of life
What can be done to help elevate BG in baby who is hypoglycemic?
Breastfeed or formula (brain damage can occur if baby is depleted of glucose!)
What are s/s of baby with hypoglycemia?
- Jittery
- HIGH pitched cry
- Tremors
- Hypotonia
- Unstable temp–BIGGEST ISSUE
Why would infant of a diabetic mom be small instead of large?
IUGR can occur r/t maternal vascular involvement (D, F, G, R in Whites)
