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Ch. 13

Preexisting Conditions for Preg at Risk

What is considered a key to optimal pregnancy outcome? strict maternal glucose control before conception and thru preg
what is DM hyperglycemia resulting in deficient insulin secretion/action/both
Where is insulin produced B-cells in islets of Langerhans of pancreas
what does insulin do reg blood glucose lvls by allowing glucose to enter adipose/muscle cells. It's used for energy. Stimulates protein synthesis. Stores free fatty acids
what is meant by hyperglycemia causes hyperosmolarity of the blood? intracellular fluid moves into vascular system, resulting in cellular dehydration and expanded blood volume,
polyuria and glycosuria and polydipsia are all effects of what the kidneys trying to excrete lg vol of urine to reg excess blood volume and excrete unused glucose. Excess thirst ensues
how does the body compensate for not converting glucose into energy, since it's trapped in blood? Body burn proteins(muscle) and fats. End products: ketones and fatty acids forming ketoacidosis and acetonuria. Wt loss leads to polyphagia(excessive amts of food)
Which organ systems are affected most by DM? What complicatings ensue? eyes, nerves, kidneys, heart atheroscloerosis, retinopathy, nephropathy, neuropathy
What are 4 groups of Diabetes Type 1:absolute insulin deficient 2:insulin resistance (obese/HTN/genetics) Diabetes caused by inf/drugs Gestational diabetes mellitus(GDM)/White
When does fetus start secreting insulin by 10th week. Glucose passes placenta, insulin does not, so glucose lvls proportional to mom's.
which hormones increase B cells to produce insulin? estrogen/progesterone
What happens to insulin dependent women during 1st trimester? prone to hypoglycemia b/c insulin need decr bc of incr prod by pancreas/decr food intake bc N/V, glucose xfer to fetus
What happens during 2nd trimester w/ women with DM insulin resistance bc of all hormones, insulin antagonists. This acts as glucose sparing mechanism so fetus gets enuf glucose.
Third trimester insulin does what requirement incr til 36 wk
Day of delivery does what to insulin/glucose maternal insulin req drop. Breast feeding maintains lower insulin req(25%)
what are glucose levels for preconception for women w/ DM before meals: 80-110 2 hours after meals: <155
When assessing risks for pregnant women with DM, what will the nurse look for? 1 blood glucose control- poor/good 2 time since dx of DM 3 presence of vascular disease
Poor glucose control leads to macrosomia, which is excessive growth, wt>4000-4500g (50%) more shoulder dystocia and C-sections
Which hypertensive disorders are common in pregestational diabetes? What other complications to women are common? preeclampsia/eclampsia. ...Preterm labor/birth, hydramnios, PROM, postpartum hemorrhage, infections
Which vaginal infections is most common in pregnant women with diabetes monilial vaginitis, UTIs,
Which tocolytic drug can contribute to DKA turbutaline (Brethine)
what is euglycemia normal blood glucose lvl: 60-120 for preg woman w/ diabetes
what r some fetus complications related to diabetes still births, congenital anomalies, CNS defects, cardiac, caudal regression
A test for glycosylated Hgb provides what? measure of glycemic control over time, 8-12 wks. Measure Hgb A and want lvl of 5-6% = glucose 90-120.
what is included in physical exam for pregestational diabetes electrocardiogram to get baseline, retinopathy eval, BP to asses risk for preeclampsia, wt gain, fundal ht(abnormal incr)
what are routine lab tests for pregestational diabetes glycosylated hgb, 24hr urine(protein and creatine), urinalysis/culture(UTI), urine(ketones), thyroid
what lifestyle changes must woman make to ensure euglycemia go to bed, get up, excercise, take insulin same time ea day, wear id bracelet, daily bath for good perineal/foot care,
what r s/s of hypoglycemia nervousness, HA, shaking, irritability, personality change, hunger, blurred vision, sweaty skin, tingling of mouth. Not below 60
what should hypoglycemic eat if glucose below 60 1/2c unsweetened fruit juice, 1/2c reg soda, 5-6 Lifesavers, 1T honey, 1c milk, 2-3 glucose tabs. Notify MD if rest 15, eat, rest 15 min and still <60
what is ideal caloric amt for 1st tri? 2nd/3rd? 1st: 2200 cal 2nd/3rd: 2500
what is good option to prevent hypoglycemia and starvation ketosis during night? 25g carb snack w/ some protein
what is ratio of carbs/fats/proteins to meet metabolic needs of fetus/woman 40-50% carbs, 250g min, complex 20% protein 30-40% fats Wt gain = 12kg during preg (26.4lbs)
What kind of insulin is Lispro (Humalog) rapid-acting w/in 25min, peaks at 30min - 1 1/2 hr. Lasts 4-5hrs. Convenient.
what kind of insulin is Humulin/Novolog biosynthetic human insulin, less antibody formations. For new onset
A ratio of what 2:1 long to short acting 2/3 b4 breakfast 1/3 b4 dinner
what are steps to adm insulin insert air to long, air to shot, withdraw short, withdraw long
Table for insulin adm during preg lispro(rapid): onset(15m), Peak(2-3h), Dur(3-4h) Reg(short): 30m, 3-4h, 6-8h Int: 2-4h, 4-12h, 12-24h Long: 3-4h, 14-24h, 24-36h
what are acceptable fasting levels during preg 60-90 hypo <60 hyper >200
During intrapartum, pregestational women usually get what solution? IV lactated Ringers or 5% Dextrose, glucose taken q hr to stay at 70-90 to prevent hyperglycemia in mom and hypo in neonate
With c-section, when should it be scheduled with pregestational preg early morn to facilitate glycemic control.
Does insulin incr or decr in postpartum and why decr bc insulin resistance came from placenta, and levels need to reach 200 b4 insulin is given
what are possible postpartum complications preeclampsia, eclampsia, hemorrhage, infection(endometritis)
breast feeding diabetic mothers are more risk for mastitis and yeast inf
what is important teaching for family planning to diabetic woman reliable birth control, barrier methods being best
What % of GDM will have DM 50% in 5-10yrs of those dx early and obese, >30, fam hx of type 2, hx of infants wt >9lb, hydramnios, unexplained stillbirth/miscarriage/infant w/ anomalies
when is dx of GDM usually made? Second 1/2 of preg, dev after wk 20
GDM places neonate at what risks hypo-glycemia/calcemia, hyperbilirubemia, thrombocytopenia, polycythemia, respiratory distress syndrome
who r low risk for GDM normal wt, <25, no fam hx, not ethnic
When should high risk women be screened for GDM first prenatal vist and 24-28 wks
what are target blood glucose lvls in preg? Target for GDM? 60-120 GDM: Fasting: less than 105 1hr after meals: <155 2hr after meals: <130 Intrapartum: <110
s/s of hyperthyroidism fatigue, heat intolerance, wawrm skin, diaphoresis, tachy, wide PP, unplanned wt loss, loose nails(onycholysis), pulse>100 and not decr wtih Valsava
what are complications of untreated hyperthyroidism during preg LBW, IUGR, stillbirth, preeclampsia, placental abruption, CHF, inf
Tx for hyperthyroidism PTU(propylthiouracil) drug, cross placenta and can induce fetal hypothyroidism/goiter SE: agranulocytosis: fever, malaise, gingivitis, sore throat, thyroid storm(fever,tachy,vomiting,hypotension,stupor,CHF) adn tx: IV fluids/O2/PTU
Most hypothyroidism in preg is rare bc this condition can cause what? sterility tx: synthroid (L-thyroxine) and don't take with iron
what is phenylketonuria deficiency in phenylalanine hydrolase and impairs abilit to metabolize amino acid phenylalanine in protein foods. Leads to retardation cause builds in brain. Newborns tested after birth. Tx: strict diet low phenyl foods
what are major cardiac changes in preg that would affect cardiac diseased pt incr intravascular vol, decr systemic vascular resistance, bc heart disease is #1 nonobstetric maternal killer
what conditions put women at higher mortality during preg in cardiac disease aortic coarctation, myocardial infarction, Marfan syndrome wtih aortic involvement, pulmonary HTN
During birth, what is nsg mgmt goal for woman with cardiac disease HR<110, prevent hypotension and maternal tachy, open glottis pushing
what is peripartum cardiomyopathy PPCM: CHF dev in last mo of preg or w/in 5mos post Af Am, twin pregs, preeclampsia Tx: diuretics, anticoagulants, digoxin. (ACE inhibitors only post bc terattogenic)
Rheumatic Heart Disease(RHD) leads to damaged what? heart valves(mitral), chorda tendineae. This mitral valve stenosis obstructs flow from atrium to ventricles
RHD can lead to what in preg? ventricular failure, pulmonary edema, death Tx: limit activity, Na, diuretics, beta blockers, bed rest
what is mitral valve prolapse(MVP) common, valve prolapses into lft atrium allowing backflow of blood. Hear: Midsystolic click/late systolic murmur tx: asymptomatic, none
what is Eisenmenger's Syndrome right to left or bidirectional shunting at mitral/ventricular lvl and has high mortality rate in preg
what are Atrial/Ventricular Septal defects? ASD: abnormal opening in atria left to right shunting. With incr plasma vol, may have rt-sided heart failure
what is Tetralogy of Fallot? abnormals caused by maldev of truncus arteriosus and lead to right to left shunt. Tx: good prognosis, but untx can lead to infant death
what is Marfan Syndrome? genetic disorder of weakness in connective tissue, result is joint deformities, ocular lens dislocation, weak aortic wall/root
How long should wait to get preg after transplant>? 1yr to avoid rejection episodes
when is stress greatest on preg woman with heart disease 28-32 weeks as hemodynamic changes reach max
when is best time for cardiac surgery? 2nd trimester
If defibrillation is needed for preg woman where should the paddles be placed? one rib interspace higher than normal bc displaced uterus
What are things to remember in CPR on preg woman Not supine(lateral), if not breathing, give 2 slow breaths Rescue breathing w/o chest compressions: 10-12 breaths/min If no pulse: chest compressions 100/min at depth of 1 1/2 - 2in. Recheck pulse after 4 cycles. C-section if no pulse after 5 min.
Nomral H/H values in anemia preg woman? Hct: <32% Hgb: <11 Restless Leg Syndrome common with anemia
Ferritin lvls of 10-15 confirm dx of what? iron deficiency anemia
Folic acid deficiency causes? neural tube defects, cleft lip, cleft palate. During preg, normal intake = 400mcg/day
Sickle cell anemia presents with fever and pain where? abd and extremeties
Cooley anemia is what insufficient globin to fill RBCs, leading RBC death and to bone deficiencies bc of marrow expansion. hereditary, mediterranean
what is most common pulmonary disease in preg asthma and peaks bn 29-36wks
what is goal of therapy for asthma prevent hypoxic episodes 1. relieve bronchospasms(dilators) 2 limit irritant stimuli 3. devr pulmonary response to allergen exposure(dustmites,pollen, dander) 4. limit inflammatory response in airway(antiinflam agents) Drug: Meperidine
cystic fibrosis women have higher incidence of GDM, preterm births, IUGR, neonate deaths
what is cholelithiasis? cholecystitis? choleithiasis: gallstones in gallbladder, more in preg. cholecystitis: inflammation of gallbladder diet: reduce fats to 40-50g/day, limit protein to 10-20%, more carbs, avoid fried foods
Accutane should be avoided in preg bc? high teratogenicity
what is most common causes of pruritis in preg polymorphic eruption of preg/pruritic urticarial papules adn plaques of preg(PUPPP)
what is most common neurological disorder with preg epilepsy
anticonvulsants can counteract what with preg contraceptives can be ineffective, teratogencity, infants can have hemorrhagic disorder bc vit K def.
what is MS demyelinzation of spinal cord and CNS and can be viral disorder. Age 20-40 most common onset
what is most common autoimmune disorder in women of childbearing age systemic lupus erythematosus (SLE)- multisystem inflammatory disease that affects skin, joints, kidneys, lungs, CNS, liver, other organs. Af Am s/s: pericarditis(initial s/s), fatigue, fever, skin rashes, wt loss, arthralgias
preg women with lupus should worry about infection, family planning bc should wait til remission to get preg again
what is myasthenia gravis(MG)? autoimmune muscle end-plate disorder affects motor fx. Muscle weakness in eyes/face/tongue/neck/limbs/resp muscles
what is absolutely contraindicated during labor of women with MG? Mg sulfate bc interferes wtih neuromuscular transmission Tx: acetylcholinesterase inhibitors, immunosuppresive meds, corticosteroid therapy,
what might be used during delivery of women with MG forceps/vacuum assist bc of muscle weakness
what factors incr risk of perinatal HIV transmission prev hx of child w/ HIV, preterm birth, decr mom CD4 count, high mom viral load, firstborn twin, chorioamniontis, intrapartum blood exposure, no AZT tx during ante and intra of preg
HIV positive should be vaccinated against hepB, pneumococcal, influenza, avoid varicella TB test and pap test performed
during birth, what should be done to avoid fetus contact wtih blood or secretions of mom wtih HIV C-section, leave membranes in tact, avoid fetal scalp electrode/forceps/vacuum/episiotomy, bath infant asap,
Smoking during preg can cause? bleeding, miscarriage, stillbirth, prematurity, placenta previa, placental abruption, LBW, SIDS
Women addicted to heroine are allowed what methadone maintenance along wtih behavioral counseling
Created by: palmerag