Unit 8: Glucose Regulation and Maladaptive Behavior Flashcards

1
Q

What is hyperglycemia values?

A

> 140

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2
Q

What are hypoglycemic values?

A

<70

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3
Q

What is the main energy source for the fetus?

A

glucose

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4
Q

What are the metabolic changes associated with glucose and the first trimester?

A

Insulin production increases
Tissue glycogen stores increase
Hepatic glucose production decreases

These three things lead to decreased fasting glucose levels

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5
Q

What are the metabolic changes associated with glucose and the 2nd/3rd trimester?

A

Mother becomes more insulin resistant due to increase need of glucose for the fetus (18-36 weeks)

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6
Q

What is key to optimal outcomes when dealing with diabetes?

A

Strict maternal glucose control

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7
Q

What maternal risks and complications come from having pregestational diabetes?

A

Hydramnios
Increased risk for hemorrhage
Hypo or hyperglycemia
Ketoacidosis (>200)
Preterm birth
Preeclampsia
Macrosomia (increase fetus weight)
Increase miscarriage
Increase risk of infection

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8
Q

What are fetal and neonatal risks with pregestational diabetes?

A

Increased mortality risk
Congenital malformations (3x high occurrence)
Respiratory distress syndrome
Prematurity
Intrauterine Fetal Demise
Hypoglycemia
Jaundice

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9
Q

Antepartum interventions to manage pregestational diabetes

A

Review self-monitoring, diet, and exercise
Lab tests (UA, A1c, baseline renal function)
Prenatal visits 1-2 weeks then a couple times a week during 3rd trimester
Insulin therapy

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10
Q

Intrapartum interventions to manage pregestational diabetes

A

Monitor closely and get glucose levels every hour
Insulin infusion (regular insulin) on separate line

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10
Q

Postpartum interventions to manage pregestational diabetes

A

Encourage breastfeeding - reduces need for insulin
Watch insulin levels (should return to normal after placenta is delivered)

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11
Q

What are the insulin needs during pregnancy?

A

Need insulin more often because of the amount of glucose the fetus needs

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12
Q

What is gestational diabetes?

A

Carbohydrate intolerance that is identified during 2nd or 3rd trimester

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13
Q

What are risk factors for gestational diabetes?

A

Family hx
Obesity
HTN
Glycosuria
25yrs or older
Previous stillbirth or malformed/macrosomic fetus

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14
Q

What is the screening for gestational diabetes mellitus?

A

1 hr: 50g oral glucose followed by a plasma glucose measurement 1hr later
3 hr: overnight fast and at least 3 days of unrestricted diet; avoid caffeine and smoking

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15
Q

What are antepartum interventions to manage gestational diabetes?

A

Education and support - make sure they know it isn’t their fault they have this
Diet and exercise
Pharmacologic therapy
Self-monitoring - strict control needed
Fetal surveillance

16
Q

What are intrapartum interventions to manage gestational diabetes?

A

Target range 80-110 mg/dL
Rapid-acting insulin
May not need IV insulin (may not be hourly checks)
Avoid dextrose solutions
Anticipate macrosomia, CPD

17
Q

What are postpartum interventions to manage gestational diabetes?

A

Return to normal glucose levels after birth
Reassess 4-12 weeks postpartum
Lifestyle modifications decrease risk for developing type 2

18
Q

What are the maternal and fetal effects of drug abuse?

A

Miscarriage
Altered nutrition to fetus
Structural abnormalities in fetus
Decreased access to/compliance with health care increases fetal risk
Increased exposure to violence
Increased risk for mental health

19
Q

What are the screening procedures for prenatal substance exposure?

A

Screened on their first visit
Asked about OTC, prescriptions, caffeine, alcohol, nicotine, and illicit drug use
Screen for mental health and partner violence

20
Q

What is the assessment done for prenatal substance exposure?

A

Obtain a medical history
Complete labs and physical examination

21
Q

What interventions can be done for prenatal substance abuse?

A

Education
Breastfeeding exposure
Group programs
Outpatient monitoring