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Maternal-Newborn (Josh) > T4 - Endocrine Metabolic Disorders (Josh) > Flashcards

T4 - Endocrine Metabolic Disorders (Josh) Flashcards

1
Q

– – is caused by lack of insulin or lack of insulin effect.

A

Diabetes Mellitus

***Key to optimal pregnancy outcome is strict glucose control

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2
Q

— — is an absolute insulin insufficiency and requires administration of exogenous insulin.

— — is insulin resistence with varying degrees of insulin deficiency.

A

Type 1 DM

Type 2 DM

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3
Q

Risk factors for Gestational Diabetes Mellitus (GDM)

A

obesity

aging

sedentary lifestyle

HTN

prior GDM

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4
Q

Gestational DM:

Class — can be controlled via diet.

Class — requires meds.

A

A1

A2

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5
Q

Gestational DM:

Woman has two or more abnormal values with normal fasting blood sugar.

A

Class A1

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6
Q

Gestational DM:

Woman was not known to have diabetes before pregnancy, but requires medication for blood glucose control.

A

Class A2

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7
Q

Pregestational DM:

Onset of disease occurs after age 20 and duration of illness is

A

Class B

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8
Q

Pregestational DM:

Onset of disease occurs b/t 10-19 years old or duration of 10-19 years or both.

A

Class C

***NOTE: Class A-C generally have GOOD PREG outcomes

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9
Q

Pregestational DM:

Onset of disease occurs at 20 years or both.

A

Class D

***Note: Class D-T will have vascular complications

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10
Q

Pregestational DM:

Client has developed diabetic nephropathy.

A

Class F

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11
Q

Pregestational DM:

Client has developed Retinitis Proliferans

A

Class R

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12
Q

Pregestational DM:

Client has had a Renal Transplant

A

Class T

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13
Q

During the first trimester, pregnancy — insulin production.

A

increases

***can cause hypoglycemia

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14
Q

What conditions lead to hypoglycemia in pregnancy?

A

Fetus takes lots of mom’s glucose

N/V can drop blood glucose

Human Placental Lactogen (HPL) is secreted
**an insulin antagonist

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15
Q

By the 2nd and 3rd trimesters, insulin requirements —

A

increase

***as much as 4 x’s the usual amount

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16
Q

With expulsion of placenta, what happens to body’s insulin needs?

A

abrupt drop of hormones and return to prepregnant state –> insulin needs DECREASE

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17
Q

When are insulin needs greatest during pregnancy?

A

wks 36-40

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18
Q

Maternal Risks w/ DM

A

Worsening of pre-existing disease (vascular or renal probs)

Hypoglycema first half of preg

Hyperglycemia (Ketoacidosis) in 2nd and 3rd trimesters

Polyhydramnios

Pre-eclampsia

Dystocia

***all these probs are more common with Type 1 DM

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19
Q

When does fetus start producing own insulin?

A

baby pancreas produces own insulin by 10 WEEKS gestation

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20
Q

Diabetes affects on fetus

A

Macrosomia

LGA

IUGR r/t maternal vascular probs

Delayed Lung Maturity

Hypoglycemia after birth

Neural Tube and Skeletal Defects

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21
Q

Screening and Testing to Rule Out Gestational DM

A

50 gram Oral Glucose Tolerance Test

3 Hr Oral Glucose Tolerance Test (OGTT)

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22
Q

Oral Glucose Tolerance Test:

How to perform 50 Gram OGTT

A

No fasting

Routine for all clients at 24-28 wks

50 g of oral glucose cola drink and blood drawn one hour later

Glucose > 130-140 mg/dL is positive and will follow up with 3 Hr Test

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23
Q

Oral Glucose Tolerance Test:

How to perform 3 Hr OGTT

A

Load up on CHO

Fast after midnight

100 g glucola –> blood drawn at fasting, 1, 2, and 3 hrs

Positive if 2 OR MORE VALUES equal or exceed

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24
Q

What values are we looking for with 3 Hr OGTT?

BOOK

A

Fasting = 60-99
1 hr = 100-129
2 hr =

25
Q

What values are we looking for w/ 3 Hr OGTT?

her PPT slides

A

Fasting =

26
Q

If 1 hr (50 g) OGTT is 140?

A

140 = do a 3 hr exam to further evaluate GDM

27
Q

What is an acceptable fasting blood sugar level?

A

60-90 mg/dL

28
Q

3 Hr OGTT:

Two elevations greater — than indicates diabetes.

A

140 mg/dL

29
Q

What is a good number for Blood Glucose?

A

Fasting = 60-90
1 hr = 130-140
2 hr =

30
Q

Hgb A1C:

Levels — indicate good blood sugar control.

Levels — indicates fair control

Levels — indicate poor control.

A

Good = 2.5 - 5.9%

Fair = 6-8%

Poor = > 8%

31
Q

What is Euglycemia?

A

Glucose of 65-95 before meal

Glucose of 130-140 one hr after meal

32
Q

Calories:

Non-obese pregnant client needs —

Obese client needs —

A

35 cal/kg/day

25 cal/kg/day

33
Q

Diet for DM:

How many meals per day?

A

3 x’s day w/ 2-3 snacks

34
Q

Diet for DM:

How many carbs?

Protein?

Fat?

A

carbs = no more than 55%

protein = 20%

fat = 25%

35
Q

Diet for DM:

What type of snack is important to prevent drop in Blood Sugar during night?

A

night snack high in protein

36
Q

Insulin Therapy:

— of daily insulin dose is given at breakfast.

A

2/3

**combo of intermediate or long-acting and short-acting

37
Q

Insulin Therapy:

— of daily insulin is given in evening.

A

1/3

** combo of long and short-acting

38
Q

— are seldom used during pregnancy.

A

Oral DM meds

39
Q

S/S of Hypoglycemia

A

Nervousness

HA

Shaking/Irritability

Hunger

Blurred Vision

Diaphoresis

40
Q

Treatment for Hypoglycemia:

What can we do if glucose is

A

drink 15 mg simple carbs

  • **whole milk
  • **hard candy

Rest 15 mins and recheck

If > 60, eat a meal w/ protein to stabilize glucose level

41
Q

What is hyperglycemia?

A

> 130 mg/dL

42
Q

S/S of Hyperglycemia

A

Skin dry and flushed

Thirsty w/ frequent urination

Kussmaul respiration w/ fruity odor

43
Q

Fetal Surveillance for DM:

A

MSAFP at 15-20 wks gestation

US for anomalies

Fetal ECG at 20-22 wks

BPP

NST 1-2 times weekly from 34 wks

Daily kick counts from 28 wks

44
Q

Management of Diabetes during Labor and Birth

A

Regular Insulin via IV piggyback

Hourly glucose checks

***maintain

45
Q

Why are glucose checks done more frequently during Second Stage of Labor?

A

Voluntary pushing requires more energy

46
Q

Why is maintaining integrity of nipples an areola important w/ DM patients?

A

they are more prone to infection than a normal client

47
Q

Contraceptives for DM Client

A

Oral contraceptives contraversal r/t effect on carb metabolism and risk of thrombus

Instead, use:

  • Barrier Method
  • IUD
48
Q

Risk Factors for Gestational DM

A

Family history of DM

Native Americans

Maternal Obesity

Previous LGA baby

Previous unexplained stillbirth

49
Q

S/S of Hypoglycemia in Neonate

A

Jittery

Tremors

Hypotonia

Unstable Temp

50
Q

How much weight loss can Hyperemesis cause?

A

at least 5% or prepregnancy weight

51
Q

When does Hyperemesis ususally begin?

A

at 4 wks and lasts up to 20 wks

52
Q

Possible causes of Hyperemesis

A

Increasing Estrogen levels

Increasing Progesterone levels

Increasing hCG levels

Hyperthyroidism

Esophageal Reflux

53
Q

Can psycho-social factors like ambivalence cause hyperemesis?

A

Yes

54
Q

With hyperemesis, how do we want them to eat?

A

every 2-3 hrs

sometimes w/out liquids

bland to begin with

55
Q

What are the Fetal Risks associated w/ Hyperemesis?

A

IUGR

Anomalies

Death from hypoxia or maternal ketoacidosis

56
Q

What are signs of starvation that can alert us to hyperemesis?

A

Muscle wasting

Jaundice

Bleeding Gums (Vit. Deficiency)

57
Q

Mgmt of Hyperemesis

A

IV Fluids

NPO until dehydration resolved and for 48hrs after vomiting has stopped

I’s and O’s (including emesis)

Daily Weights

Small, frequent meals once 48 hrs w/ no vomiting

58
Q

Maternal PKU:

What levels of Phenylalanine do we want?

A

2-6 mg/dL

Maternal-Newborn (Josh) (29 decks)

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