UNIT 2 HIGH RISK DIABETES CHAPTER 11 Flashcards
OGTT TEST What week gestation is it done?
Screening at 24 to 28 Weeks of Gestation
The first step is a screen consisting of a 50-g oral glucose load followed by a plasma glucose measurement 1 hour later. The woman need not be fasting when the screen is done. A glucose value of 130 to 140 mg/dL, or higher, is considered a positive screen. An initial positive screening result is fol- lowed by step 2, a 3-hour (100-g) oral glucose tolerance test (OGTT) on another day.
An initial positive screening result is fol- lowed by step 2, a 3-hour (100-g) oral glucose tolerance test (OGTT) on another day. ACOG recommends use of the two-step screening procedure because there is no evidence that the one-step method leads to clinically significant improvement in maternal or newborn outcomes. However, use of the one-step method does significantly increase health care costs because more women will be diagnosed with GDM and thus will require more visits, tests, and procedures than pregnant women who do not have this disease
Positive for GDM Two or more values are met or exceeded:
Fasting 95 mg/dL OR 105 mg/dL
1-h 180 mg/dL OR 190 mg/dL
2-h 155 mg/dL OR 165 mg/dL
3-h 140 mg/dL OR 145 mg/dL
Risk factors of gestational diabetes
Obesity
* Family history
* Age >35 years
* Comorbidities
* Previous infant >9lbs. at birth
Pre-conception counseling for Gestational diabetes
Pre-conception counseling
* Comorbidities-HTN, vascular
disease, retinopathy, nephropathy
* Early pregnancy loss/preterm labor
* Macrosomia/cesarean delivery
* Polyhydramnios
* Hyperglycemia-Hypoglycemia-
Ketoacidosis
* More common/serious infections
* Postpartum hemorrhage
affects of Gestational diabetes
- Sudden & unexplained stillbirth
- Congenital malformations
- Cardiovascular system
- Central nervous system
- Skeletal system
- Macrosomia
- Prematurity
- Respiratory distres
What trimester is blood sugar the highest?
1st
2nd
or
3rd
3rd
A. 1st trimester: reduced
B. Second trimester: begin to increase
C. Third trimester: may increase 2-4 x more, most level past 36 weeks
D. Birth: decrease
E. Breastfeeding: up to 25% lower insulin requirements,
F. Weaning breastfeeding infant: return to pre-pregnancy levels.
Antepartum care of gestational diabetes
Antepartum care
* Diet & exercise primary control
* If ineffective insulin control
* Oral hypoglycemic crosses
placenta (glyburide,
metformin)
* Monitoring blood glucose levels
* Fetal surveillance
* Increased risk of type 2 diabetes
After labor would the mothers blood sugar be at risk for hyperglycemia or hypoglycemia?
hypoglycemia
Intrapartum
* Monitor patient closely
* Respond to complications
* May require a cesarean birth
Postpartum care
* Insulin requirements decrease
substantially
* Monitor mother & neonate for
hypoglycemia
* Encourage breastfeeding
* Contraception
- The most likely result of uncontrolled blood sugar to fetal development for the mother with gestational diabetes is:
A. increased pressure on the placenta decreasing nutrients
B.increased fetal size termed macrosomia
C. increased risk of significant fetal anomalies
D. increased risk of postdates delivery
B.increased fetal size termed macrosomia
How much folic acid does the nurse tell female patients is recommended for women of childbearing age?
A. 10mcg
B. 3mcg
C. 3mg
D. 0.4mg
D. 0.4mg
A patient with a history of mild hypertension presents to the prenatal clinic at 12 weeks gestation. Aware of increased risks for this patient which of the following warning signs would the nurse stress for this patient?
A. Leaking of clear fluid from the vagina.
B. Decreased fetal movements after quickening has occurred.
C. Blurry or impaired vision with unusual headache
D. Presence of six or more contractions in an hour.
C. Blurry or impaired vision with unusual headache
A nurse applies external monitors to a woman in active labor. The fetal heart tones (FHT) are noted to be 135-150 bpm with spoon-shaped drops in FHT to 118 that mirror contractions. The nurse correctly identifies this FHT pattern as possible:
A. head compression.
B. cord compression.
C. reassuring tracing.
D. placental insufficiency.
A. head compression.
A woman in early labor has spontaneous rupture of membranes; a large amount of clear fluid is noted from the vagina. The fetal heart tones (FHT) drop to 90-110 with marked variability. The nurse performs a vaginal exam to note a pulsing loop of umbilical cord in the cervix. What is the first action of the nurse?
A. Keep the fetal head up from the cervical opening to protect the fetal cord
B. Place internal fetal heart tone monitors, start oxygen by mask.
C. Place woman in knee-chest position to allow cord slide back into the uterus
D. Call for assistance, prepare patient for emergency cesarean section.
A. Keep the fetal head up from the cervical opening to protect the fetal cord
