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OB Exam 3
OB Chapter 20
| Question | Answer |
|---|---|
| Diabetes in Pregnancy | Type 1 or Pregestional Diabetes vs. Gestational Diabetes |
| endocrine disruption in pregnancy is | natural |
| 1st trimester | increased use of glucose |
| 2nd trimester | increased insulin-resistance |
| why is there an increased insulin resistance in 2nd trimester | increased peripheral resistance to insulin AND compensatory increase in insulin secretion Controlled by placental hormones & other metabolic |
| as baby grows, | glucose demand increases |
| as glucose demand increases, | insulin resistance increases |
| as insulin resistance increases, | there is a compensatory increase in insulin secretion |
| Pre- gestational Diabetes | Type 1 Type 2 (more common) Associated w/ morbidity & mortality |
| Gestational Diabetes | Carb intolerance acquired in pregnancy 10% of all pregnancies Associated w/ neonatal complications at birth & long-term maternal consequences |
| Pregestational Diabetes: risk and complications | Miscarriage Macrosomia HTN / Preeclampsia / PTL Polyhydramnios Infections Ketoacidosis Hypoglycemia Perinatal mortality Congenital malformations Birth injuries C/S |
| Gestational Diabetes risk factors | Ethnicity (Hispanic, Black, Native American) Family hx diabetes Obesity HTN Glycosuria Older age |
| Gestational Diabetes complications | Preeclampsia C/S Type 2 diabetes later in life Birth injuries (macrosomia) |
| peak insulin resistance is | 24-28 wks, increases as gestation moves forward |
| Pregestational antepartum care assessment | PRE – conception counseling for attainment of glycemic control HbA1C < 7% : the GOAL Maternal labwork Fetal testing! |
| Gestational antepartum care assessment | Risk analysis in 1st trimester Glucose tolerance test (2nd trimester): 24-28 weeks pregnancy |
| Pregestational Diabetes: Management | Diet & Exercise: RD appt Pharmacologic Management: Insulin Maternal & Fetal Surveillance: Frequent visits & testing Management during labor & birth: glucose monitoring q1-2 hours and lucose monitoring newborn per protocol after birth |
| Gestational Diabetes: Therapeutic Management | Lifestyle Modifications Glucose monitoring Pharmacologic Management Maternal & Fetal Surveillance Management during labor & birth |
| Lifestyle Modifications for GDM | Diet & Exercise RD appt |
| Glucose monitoring for GDM | Frequent screening |
| Pharmacologic Management for GDM | Insulin Glyburide or Metformin (oral) |
| Maternal & Fetal Surveillance for GDM | NSTs (32 wks) |
| Management during labor & birth for GDM | Glucose monitoring q1-2 hours Glucose monitoring newborn per protocol after birth |
| Diabetes: Nursing Assessment | Identify risk factors Physical examination Surveillance |
| Surveillance of Mom for GDM | Urine check for protein, nitrates, leukocyte esterase, and ketones Kidney function evaluation every trimester Eye examination in the first trimester HgbA1C every 4 to 8 weeks to monitor glucose trends |
| Surveillance of Baby for GDM | ultrasound to provide information about fetal growth, activity, and amniotic fluid volume and to validate gestational age |
| inutero infections | toxoplasma other agents (syphilis) rubella cytomegalovirus HSV |
| intrapartum infections | GBS hep B virus HIV |
| perinatal infections can cause | impaired growth developmental anomalies mortality |
| inutero infections are contracted via | transplacentally or via RoM |
| Cytomegalovirus (CMV) | most common perinatal viral infection in the world Leading cause of hearing loss & intellectual disability in the US |
| Herpes (HSV) | antivirals in pregnancy- Acyclovir spontaneous abortion, birth anomalies, IUGR, or preterm labor neurological impairment & death |
| Toxoplasmosis | Parasitic infection congenital anomalies & fetal death |
| Hepatitis B Virus | all pregnant women should be tested for hepatitis B surface antigen (HBsAg) Newborn will receive Hep B vaccine w/in 12 hrs after birth |
| Varicella Zoster Virus | Establish maternal immunity Associated with severe illness for mother & newborn in herpes family and if person have chicken pox they may have increased immunity |
| Parvovirus B19 | “fifth disease” - will have red cheeks Can lead to severe fetal complications or death Prevention is key bc there is no immunization Can have respiratory complications, transmitted by saliva |
| HIV (Human immunodeficiency virus) | Decisions need to be made about drug therapies, mode of delivery, feeding method of newborn Education and support |
| HIV (Human immunodeficiency virus) | Decisions need to be made about drug therapies, mode of delivery, feeding method of newborn Education and support If lower viral load, they will be ojay |
| Vulnerable Populations | Adolescents, Advanced Maternal Age, Obesity |
| Pregnant Adolescent health risks | increased risk for anemia, preeclampsia, instrumental delivery, preterm birth, low birth weight, fetal growth restriction, postpartum depression, and maternal and infant mortality compared with pregnant people aged 20 and older |
| Pregnant Adolescent social risks | lower socioeconomic status, fewer years of education, and increased risk of intimate partner violence |
| Pregnant Adolescent unique challenges | increased risk of mood and behavioral disorders, cognitive and learning problems, early sexual activity, and early parenthood increased prevalence of alcohol ingestion and cigarette smoking |
| Pregnant Adolescent nursing management pt 1 | Assist adolescent in identifying family and friends who want to be involved and provide support Help adolescent identify the options for this pregnancy, such as abortion, self-parenting, foster care for baby or themself or adoption |
| Pregnant Adolescent nursing management pt 2 | Explore with the adolescent if the pregnancy was planned or unintended Identify barriers to seeking prenatal care Monitor maternal and fetal well-being throughout pregnancy and labor Stress that the patient’s physical well-being is important |
| Vulnerable Populations: Advanced Maternal Age is | greater than 35 years old |
| advanced maternal age is associated with a higher risk of complications in pregnancy like | premature rupture of membrane, retained placenta/placental fragments, severe perineal tear grade 3/4, placental abruption, chorioamnionitis, puerperal fever, maternal intensive care unit admission, and prolonged hospitalization |
| advanced maternal age can cause risks to fetus/NB pt 1 | intrapartum intrauterine fetal death (IUFD), 5-min Apgar score below 7, birth asphyxia, congenital malformations, being LGA, meconium aspiration, jaundice |
| advanced maternal age can cause risks to fetus/NB pt 2 | transient tachypnea of the newborn, brachial plexus injury, mechanical ventilation, seizures, hypoglycemia, sepsis, encephalopathy, and intracranial hemorrhage |
| nursing management of advanced maternal age | Daily intake of low-dose aspirin (81 mg/day) for the prevention of preeclampsia A first-trimester detailed fetal anatomic ultrasound An additional ultrasound for growth assessment one time in the third trimester |
| obesity mother complications | miscarriage, gestational diabetes or HTN, preeclampsia, PTB, delivery complications, VTE, C/S delivery, PPH |
| obesity mother management | lower body weight & inflammation prior to pregnancy diet, exercise, & behavior modification |
| obesity mother nursing considerations | nonjudgemental care support interventions aimed at reducing weight prior to pregnancy - EBP care |
| substance misuse mothers | Substance misuse is prevalent and underdiagnosed Increases risk of maternal complications & poor birth outcomes |
| substances that can be misused | alcohol cannabis opioids/heroin psychotherapeutic drugs nicotine |
| alcohol affect | Spontaneous abortion, inadequate weight gain, IUGR, FASD (the leading cause of intellectual disability) |
| cannabis affect | Vasoconstriction and mild diuresis in pregnant person; fetal stimulation, but teratogenic effects not documented via research |
| nicotine affect | Vasoconstriction, reduced uteroplacental blood flow, decreased birth weight, spontaneous abortion, prematurity, placental abruption, fetal demise |
| opioids/heroin affect | Maternal and fetal withdrawal, placental abruption, preterm labor, premature rupture of membranes, perinatal asphyxia, newborn sepsis and death, intellectual impairment, malnutrition |
| psychotherapeutic drugs affect | Central nervous system depression, newborn withdrawal, maternal seizures in labor, neonatal abstinence syndrome, delayed lung maturity |
| fetal alcohol syndrome | low nasal bridge short palpebral fissures short nose flat midface receding jaw thin upper lip minor ear abnormalities epicanthal folds |
| Vulnerable Populations: Substance Misuse – Nursing Assessment | Routine screening & education Questionnaires to reduce stigma Urine tox screen – varied usefulness |
| Vulnerable Populations: Substance Misuse – Nursing Management | Key to success is being NONJUDGEMENTAL! Interventions need to be tailored to individual needs Positive drug screen may warrant referral to state agency depending on laws |
Created by:
leh195