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