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Module 6 - LGA/IDM
LGA/IDM
| Question | Answer |
|---|---|
| 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 |
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CCBCMDNursing218
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