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63 Cards in this Set
- Front
- Back
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Diabetes in pregnancy
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disorder in which body does not produce insulin or does not respond to insulin
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When does gestation diabetes occur in pregnancy? What percentage of women does it occur in?
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-occurs during 2-3rd trimester
-occurs in 23% of women |
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How do women develop diabetes during pregnancy?
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2nd trimester insulin resistance due to Human placental lactogen (hPL)
-increases breakdown of insulin due to placental insulinase |
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How is insulin sensitivity affected in the 1st trimester
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-increased estrogen
-increased progesterone -results in decreased glucose levels in mom |
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Over all effects of insulin resistance in mom
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-increased plasma glucose levels
-increased insulin requirements |
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diabetogenic
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-normal effect of pregnancy in a woman....increased insulin and glucose level requirements
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Effects of pregnancy on mom with diabetes
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-difficult labor
-increased risk pregnancy induced hypertension -polyhydramnios->2000ml of amniotic fluid -postpartum hemorrhage (because uterus is so streatched from a big baby in connot contract) -UTI -Ketoacidosis |
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Macrosomia
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-large body....baby
-insulin does not cross placenta -increases in baby's insulin production -can act as growth hormone |
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Hypoglycemia in newborns, why is it common
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-when umbilical cord is cut the glucose the baby has been getting stops
-baby con't to secrete insulin -results in hypoglycemia |
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IUGR
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-intrauterine growth retardation
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Who is at high risk for gestational diabetes
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-over the age of 30
-family hx of type 2 -obesity >200 lbs -3 polys, wt loss, blurred vision -previous birth of >4000gm (8-9 lbs) -unexplained mortality or anomalies -hx of spontaneous abortions/stillborns -hydramnios |
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Detection of diabetes
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-urine testing-may spill glucose if BS>130
-50 gm/hour glucose tolerance test (GTT) screening -screen pregnant women at high risk for...done at 24-28 weeks -if BS >140mg/dl in one hour-do a 3 hr GTT -3 hour or 100gm GTT, + if two values are above norm, repeat in one mo. if only 1 value elevated |
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Normal values for fasting, 1 hr, 2 hr, 3 hr
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-fasting 105
-1 hr 190 -2 hr 165 -3 hr 145 |
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Goals for gestational diabetes mothers
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-maintain normal weight gain 22-30 lbs
-prevent hyper/hypoglycemia |
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Office visits for someone with GDM
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-1st and 2nd trimester every 1-2 wks
-3rd trimester (after 32 wks) 1-2 x week |
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At each dr appointment the mom is assessed for
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-hypo/hyperglycemia
-glycosuria -HTN -vaginal infection/itching -UTI -retinopathy |
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Fetus is assessed for what at each Dr appointment?
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-macrosomia (big body)
-hydramnios (fetal polyuria) -poor FHT |
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Tests to determine fetal condition
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-ultrasound
-daily fetal movement count (DFMC) -alpha fetal protein (AFP)-neural tube defect -biophysical profile -contraction stress test -amniocentesis |
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Diet during pregnancy
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-2000-22000 cal/day in 3 meals and 3/4 snacks
-40-50% CHO-increased fiber -20-25% protein -avoid convenience foods -eat small frequent meals |
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Blood Glucose monitoring
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If on insulin:
-accuchecks ac, hs, 2 hrs after meals Not on insulin: -may do weekly or at office |
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Normal glucose levels for fasting, 2 hr, during sleep
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-Fasting-<105
-2 hrs postprandial-<120 -during sleep 70mg/dl |
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What to teach Mom about GDM
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-S/S of hypo/hyperglycemia
-<60 eat |
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When monioring a patient with GDM during labor what should you do?
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-monitor glucose q 1-2 hrs and maintain at 100mg/dl or less
-continous fetal mother monitoring |
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Monitoring BS during postpartum
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-insulin requirements decrease
-98% revert to normoglycemia -do GTT in 6-12 wks as follow up |
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Gestational hypertensive disorders
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-chronic hypertension
-preeclampsia/eclampsia -gestational hypertension |
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High risk factors for gestational hypertension
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-chronic renal disease
-chronic hypertension -family hx -primigravidas -twins -mom <19 and >40 -diabetes -Rh incompatibility -obesity -hydatidiform mole |
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Chronic hypertension
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-BP >140/90 before 20 wks gestation
-after 20 weeks = preeclampsia |
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Mild Preeclampsia
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-BP >140/90 (x2) at least 4-6 hours apart
-weight gain (+2 lbs/wk in 2nd tri or +1 lb/wk in 3rd tri or sudden gain of 4 lb/wk at any time -dependent edem-eyes, face, fingers -proteinuria- 2+ or 3+ dipstick -urine output> 30cc/hr |
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Nursing care for someone with mild preeclampsia
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-patient at home
-bedrest with BR privileges; side-lying position, -monitor-weight, urine, bp, fetal movement -regular diet |
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Severe preeclampsia
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-BP >160/110 (x2) 4-6 hrs apart
-wt gain -proteinuria > 4+ dipstick -urine output < 30cc/hr -generalized edema may include pul. edema -Cerebral HA or blurred vision -liver involvement -thrombocytoenia with low platelet count -cardiac involvement -hyperreflexia > 3+ -Development of HELLP syndrome -Fetus growth severely stunted |
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HELLP syndrome
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H-hemolysis
E-elevated liver enzymes L-low platelets -this can produce bleeding in mom's ears, eyes, nose |
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Care of patient with severe preeclampsia/HELLP syndrome
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-hospitalized until baby is delivered
-bedrest on side -bed near nurse's station -quiet, calm environment -siderails up, padded -frequent assessments (VS, weight, edema, reflexes, HA, epigastric pain) -foley (strict I&O) -urine for protein -fetal well-being -labs (liver, platelets) |
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Medical management of severe preeclampsia
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-Prevent seizurew with Magnesium sulfate
-control hypertension |
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Magnesium sulfate
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-decreases neuromuscular irritability
-decreases CNS irritability (anticonvulsant effect) -promotes maternal vasodilation, better tissue perfusion |
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S/S of magnesium toxicity
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-loss of knee jerk reflex
-respirations <12 -urine output <30ml/hr -cardiac or respiratory arrest -toxic serum levels > 9.6 mg/dl -signs of fetal distress (tach or brady) |
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Antidote for magnesium sulfate
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-calcium Gluconate
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Meds offen given to control hypertension
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-hydralazine
-labetolol HCL symptoms usually resolve within 48 hrs |
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Eclampsia
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-onset of seizure with person with PIH
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Eclampsia assessment findings:
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-HTN preceds seizure followed by hypotension and collapse
-coma -labor may begin -treat with Mag |
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HELLP syndrome treatment
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-give platelets
-deliver infant ASAP -will return to normal after delivery |
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Gestational hypertension
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-Identified in the latter half of pregnancy
-BP > 140/90 -develops during pregnancy -no proteinuria -no edema -returns to normal by 10th day postpartum |
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Hydatidiform Mole
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-proliferation and degeneration of trophoblasts (outer layer of the blastocyst)
-cells fill with fluid -resembles bunch of grapes due to the fluid filled vesicles -mole-makes large uterus -1/2000 pregnancies -higher in Asians |
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Hydatidiform mole is most commonly seen in
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-women after ovulation on Clomid
-early teens or perimenopausal -lower socioeconomic groups -risk of 2nd mole 4-5x higher than the first |
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S/S of hydatidiform mole
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-bleeding during 1st trimester, dark brown/prune juice
-unusual uterine growth -no fetal parts can be palpated -No FHT -snowstorm pattern on ultrasound -abnormal labs (high hCG) -PIH |
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Medical management of hydatidiform mole
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-many moles abort spontaneously
-suction curettage to evcuate mole -one year following serum HCG levels and pelvic exam -3-20% progress to choriocarcinoma -pregnancy should be avoided for 1 year |
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Hyperemesis Gravidarum
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-extreme N/V during first half of pregnancy that is associated with dehydration, weight loss, electrolyte imbalance.
-relatively rare -worse than morning sickness -usually lasts beyond week 12 -increased hCG |
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Pathology of hyperemesis gravidarum
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-dehydration
-fluid/electrolyte imbalances -hypokalemia -akalosis due to loss of HCL -protein deficiency -starvation w/ muscle wasting |
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Fetus is a t risk for what with hyperemesis gravidarum?
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-abnormal development
-intrauterine growth retardation (IUGR) -death |
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diagnosis for hyperemesis gravidarum
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-hx of intractable vomiting in the first half of pregnancy
-dehydration -ketonuria -weight loss of 5% of preprgnancy weight -other s/s of dehydration |
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Medical therapy of hyperemesis gravidarum
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-control vomiting
-correct dehydration -restore electrolyte balance -maintain nutrition -usually NPO 24-48 hrs -IV's 3000 or more 1st 24 hrs -urine output 1000ml in 24 hrs -antimetics -antihistamines -if no vomiting for 24 hrs start w/ clear liquid -referral for home care -if vomiting recurs start on TPN |
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UTI's
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-frequent site: dilated, flaccid, and displaced ureters
-may cause premature labor if severe |
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Assessment findings of a UTI
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-frequency and urgency of urination
-suprapubic pain -flank pain -hematuria -pyuria -fever and chills |
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Nursing interventions R/T UTI
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-encourage high fluid intake
-provide warm baths to relieve discomfort and promote perineal hygiene -admin and monitor intake of prescribed meds -monitor for signs of premature labor from severe or untreated infections |
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How does alcohol affect nutritional status
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-displaces other nutritional food intake
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A fetus affected by alcohol can show signs of?
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-intrauterine growth retardation (IUGR)
-CNS dysfunction -Craniofacial abnormalities (fetal alcohol syndrome) |
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Cocaine can cause what S/S
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-vasoconstriction, elevated BP, tachycardia
-seizures -spontaneous abortion, fetal malformation, neural tube defects |
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Newborns born with cociane addictions have S/S
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-irritabilty
-hypertonicity, -poor feeding patterns -increased risk of SIDS |
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Newborns born with an opiate addiction have these S/S
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-high pitched cry
-restlessness -poor feedings -withdrawal w/i 24-72 hrs after delivery |
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Nursing care for those babies born to an addiction
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-quiet environment
-wrap infant and hold sungly -observe for seizures -admin anticonvulsants/sedatives as ordered -difficult to quiet |
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Developmental tasks associated with teen pregnancy
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-body image
-secual identity -values -independence from parents -decision making skills -an adult identity |
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STD's in teens
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-gonorrhea and syphillis in 15-19 y/o highest incidence
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Family reactions to adolescent pregnancy
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-shock
-anger -shame -guilt and sorrow |
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The pregnant adolescent's infant is at higher risk for?
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-LBW
-infant mortality -abortion -poor compliance with meds |
