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Module 6 - LGA/IDM

LGA/IDM

QuestionAnswer
Metabolism The physical and chemical processes by which the body builds and maintains itself through anabolism and catabolism
LGA Newborn Weight > 90%ile All measurements usually > 90%ile
Exception is IDM where usually only_____ is > 90%ile weight
Medical Management Early diagnosis Antenatal testing Often early delivery Early feeding to prevent hypoglycemia Rx individual problems
Type 1 diabetes that is poorly controlled or White’s classes A-C (with healthy vasculature) tends to produce__infant LGA
Type 1 diabetes that is poorly controlled or White’s classes A-C (with healthy vasculature) Macrosomia * Excess adipose tissue * Ruddy color * Thick umbilical cord * Large placenta Risk for obesity in childhood
Severe diabetes or diabetes of long duration (White’s classes D-F with vascular disease) tends to produce____infant SGA
IDM - One of two Clinical Pictures Type 1 diabetes that is poorly controlled or White’s classes A-C (with healthy vasculature)
IDM - One of two Clinical Pictures Severe diabetes or diabetes of long duration (White’s classes D-F with vascular disease)
IDM-Common Complications Hypoglycemia r/t fetal hyperinsulinemia
IDM-Common Complications Hypocalcemia r/t decreased function parathyroid glands
IDM-Common Complications Hyperbilirubinemia r/t polycythemia
IDM-Common Complications Birth trauma r/t macrosomia
IDM-Common Complications Polycythemia r/t hypoxia and compensatory response
IDM-Common Complications RDS r/t delayed surfactant synthesis
IDM-Common Complications Congentital birth defects – cardiac, gi, sacral agenesis
IDM-Medical Management Goal: early detection and tight______ control glucose
Check cord blood glucose @ birth then heelstick _______, then q 4hr until _____of age q 1hr X 4, 24 hrs
Early feedings to maintain normal glucose , which is_________ (45-96 mg/dL)
IV infusions of________if po feedings not tolerated or do not maintain normal levels D-10-W
Assessment Signs of RD * hyperbilirubinemia * birth trauma * congenital anomalies
Nursing Diagnosis Altered Nutrion less than body req r/t increased glucose metabolism secondary to hyperinsulinemia * Impaired gas exchange r/t RD secondary to impaired production of surfactant
Plan/Implementation Early detection/monitoring of BG (glucose tests); Early detection/monitoring of polycythemia (obtaining central hematocrits); Early detection/monitoring of hyperbilirubinemia
Evaluation The IDM's RD and metabolic problems are minimized; parents verbalize and undergo steps of maternal DM
Dr. Priscilla White's classification of diabetes mellitus classifies according to ____________ age of onset, duration, vascular disease, and need for insulin
White’s classes A-C (with healthy vasculature)are________ Type 1 diabetes who tend to produce LGA infant that is poorly controlled
White’s classes D-F with vascular disease are____ Severe diabetes or diabetes of long duration who tend to produce SGA infant
LGA infant of Type I Classes A - C have ________ Macrosomia Excess adipose tissue Ruddy color Thick umbilical cord Large placenta Risk for obesity in childhood
Certain ehnic groups tend to have macrosmic babies_______ Native Amer, Mexican Amer, African Amer, Pacific Islanders
The excess growth of the IDM infant is from exposure to high levels of ______ maternal glucose
The IDM responds to excess maternal glucose with increased_________ production and hyperplasia of the ____________ beta cells insulin, pancreatic
IDM may be _______ as childrwn obese
Altho IDMs are unusually large, they have immature physiological functions and have many of the problems of__________ preterm infants
Thought the maternal glucose supply is lost, the IDM continues to produce high levels of ______, which depletes the infant's ________ within hours sfter birth insulin, blood glucose
S/S of hypoglycemia include____________ tremors, cyanosis, apnea. temperature instability, poor feeding and hypotonia
Tremors are the obvious signs of_______ hypocalcemia
Diabetic women tend to have decreased _________levels secondary to increased urinary calcium excretion, which causes secondary_________ in their infants magnesium, hypoparathyroidism
IDMs have__________ total body water and therefore are not_________ decreased, edematous
Their excess weight is because of increased weight of_____________, _____________ and increased _______ _______ visceral organs, cardiomegaly, body fat
________________, which can occur 48 - 72 h after birth may be caused by decreased extracellular volume, which increases the _______ level Hyperbilirubinemia, hematocrit
Fetal hypoxia stimulates RBC production, known as _____ polycythemia
The nurse should not be lulled into thinking a big baby is a ______ baby mature
The nurse must consider both the _____ ____ and whether the baby is ____ or ____ in planning and providing safe care gestational age, AGA, LGA
Nursing Diagnosis Alteration in Calcium Homeostasis r/t inappropriate thyroid response * Increased Incidence of Congenital Anomalies r/t poor maternal metabolic control
Nursing Diagnosis Ineffective Family Coping: Compromise r/t illness of the baby
Created by: CCBCMDNursing218