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high risk OB > diabetes in pregnancy > Flashcards

diabetes in pregnancy Flashcards

1
Q

complications with fetus in pregnancy (diabetic)

A

-fetal death (pre-gest DM)
-birth defects (pre-gest DM)
-IUGR (pre-gest DM)
-macrosomia
-birth trauma
-NN hypoglycemia
-NN polycythemia/hyperbilirubinemia
-NN resp distress
-childhood obesity
-development metabolic diseases in lifetime (obesity, HTN, CVD, T2DM)

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2
Q

polycythemia

A

too many red blood cells

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3
Q

complications for mom in pregnancy (diabetic)

A

-hypoglycemia (early pregnancy)
-DKA
-retinopathy (pre-gest DM)
-nephropathy (pre-gest DM)
-vasculopathy (pre-gest DM)
-HTN disorders
-polyhydramnios/hydramnios
-infection
-preterm labor/birth
-PPH (bc of big baby)
-trauma

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4
Q

type DM:
-absolute insulin deficiency
-immune

A

T1DM

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5
Q

type DM:
-defective insulin secretion and insulin resistance
-due to lifestyle

A

T2DM

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6
Q

diabetes diagnosed in 2nd or 3rd tri that was not clearly overt diabetes prior to gestation

A

gestational

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7
Q

how does early pregnancy effect insulin production

A

-increased insulin production
-increased tissue sensitivity to insulin
(storing up insulin for later growth)
*easier to be hypoglycemic

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8
Q

how does later pregnancy effect insulin production

A

-increase insulin antagonistic hormones
-decreased tissue sensitivity
*easier to be hyperglycemic

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9
Q

factors that trigger DKA in pregnancy

A

-fasting hyperglycemia
-infection
-stress
-emesis
-dehydration
-gastroparesis
-meds (sympathomimetics, steroids)

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10
Q

what are tocolytics for
what kind of med is it

A

break up contractions
ex: terbutaline (sympathomimetic)

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11
Q

how can sympathomimetics and steroids trigger DKA

A

increase glucose levels

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12
Q

how do vascular complications with diabetes affect the fetus

A

impaired blood flow to placenta

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13
Q

recommended A1C for preconception care

A

<6.0-6.5

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14
Q

screening for gestational diabetes for women with and without risk factors for T2DM

A

-with risk factors: at preconception or 1st prenatal visit
-without risk factors: 24-28 weeks screening

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15
Q

*diagram for 2 step gestational diabetes screening

A
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16
Q

step 1 of 2 step GDM screening

A

1 hour (50 g) oral glucose screen
-if neg (<130): routine prenatal care
-if pos (>130): 2nd step

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17
Q

step 2 of 2 step GDM screening

A

normal diet and exercise for 3 days before test
NPO for 12 hours before test
3 hour (100 g) OGTT
-neg: routine care
-pos: if 2 or more values are exceeded
(fasting: 95+, 1 hour: 180+, 2 hour: 155+, 3 hour: 140+)

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18
Q

blood glucose range recommended during pregnancy

A

60-140

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19
Q

what big HTN disorder does any type of diabetes increase the risk for

A

pre-eclampsia

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20
Q

1st tri care for woman with PGDM

A

-early sonogram (confirm due date, assess for anomalies)
-monitor for S+S complications
-lots of pt education

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21
Q

what kind of diabetes is shown through 1st tri

A

only pregestational DM

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22
Q

what is considered hypoglycemia during pregnancy

A

<70

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23
Q

example of 15 grams carbs

A

4 oz juice/soda

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24
Q

Tx for blood sugar of 60-70

A

15 g carbs

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25
Q

Tx for blood sugar of 40-60

A

30 g carbs (1/2 liquid, 1/2 solid)

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26
Q

2nd tri care for PGDM/GDM (screenings)

A

-MSAFP @16-18 weeks (looking for NTD)
-fetal ECG @18-22 weeks, 34 weeks
-ultrasound q4-6weeks (growth, anomalies, hydramnios, possible doppler blood flow)

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27
Q

sick day management guidelines

A

-continue insulin as ordered
-check urine ketones q4-6h
-check BS q1-2h
-consume liquid or soft foods
-sip 15-30 g carbs/hr during periods vomiting

-notify HCP if liquids not tolerated
-notify HCP S+S of ketoacidosis
-notify HCP if BS >200
-notify HCP if urine ketones >moderate

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28
Q

S+S ketoacidosis to report to HCP

A

-abdominal pain
-N/V
-polyuria/polydipsia
-fruity breath
-tachypnea
-altered mental status
-leg cramps

29
Q

meal plan recommendations for PGDM and GDM moms

A

-based on prepregnancy BMI and nutritional status
-40% carbs, 20% protein, 40% fat
-3 meals + 3 snacks
-large bedtime snack to avoid hypoglycemia

30
Q

why do you have to be careful for mom with PGDM/GDM with vascular disease doing exercise

A

shunts blood flow away from baby

31
Q

exercise recommendations for PGDM/GDM moms

A

-best time exercise is 10-20 min after meal
-don’t exercise if pos urine ketones, BS >200
-walking/aerobic 30 mins/day

32
Q

how many times do pregestational diabetic moms have to monitor capillary BS

A

5-8 times/day
-fasting, 1-2 hour pp, bedtime, 2-3 am

33
Q

how many times do gestational diabetic moms have to monitor capillary BS

A

atleast 4 times/day
-fasting, 1-2 hour pp

34
Q

when during pregnancy do you need:
-less insulin
-more insulin

A

less: 13-20 weeks EGA
more: 20 weeks-birth

35
Q

risk with continuous subq insulin infusion (CSII)

A

pump failure resulting in DKA

36
Q

preferred med for managing diabetes in pregnancy

A

insulin

37
Q

oral antidiabetic med options during pregnancy (2)

A

-metformin (drug of choice)
-glyburide

38
Q

3rd tri care for PGDM/GDM moms

A

-delivery an option if needed
-kick counts
-NST/BPP/AFI: 28-32 weeks, 1-2x/week
-ultrasound for growth (small/large)
-monitor for vascular complications (esp T1DM)

39
Q

when is it ok to await spontaneous labor or induce at 40 weeks

A

-well controlled diabetes
-no comorbidities
-reassuring fetal testing
*no going past term

40
Q

when should there be an early birth (36-38 weeks or earlier)

A

-vasculopathy
-nephropathy
-poor glucose control
-prior fetal loss
-prior macrosomia
-fetal compromise

41
Q

when should there be a C/S

A

-baby estimated weight >4500 g (9-10 lbs)
-OB indications

42
Q

L&D considerations for diabetic moms (IVs, BP, baby)

A

-mainline IV NS
-IVPB D5 (when labor begins or BS<70)
-IVPB reg insulin in NS
-check BS q1-4h
-maintain BS between 70-110
-IV bolus prn (NS only, give slowly)
-continuous EFM
-monitor for failure to descend/progress
-anticipate shoulder dystocia
-anticipate need for neonatal resuscitation

43
Q

postpartum care considerations for diabetic moms

A

-dramatic drop for insulin needs first 24 hours
-risk hemorrhage (uterine distention from LGA, hard to palpate fundus if obese)
-risk for infection
-delayed lactogenesis
-DC IV insulin

44
Q

benefits breastfeeding for diabetic moms

A

-better BS control
-reduces risk infant for developing DM

45
Q

when should the 2 step glucose test be repeated after birth

A

-4-12 weeks PP (or after breastfeeding stopped)
-1 year PP
-q3-5years
-prior to another pregnancy

46
Q

nursing care for DKA

A

-fluids
-insulin
-electrolyte replacement (esp K)
-O2
-EFM (also tells you mom’s perfusion status)
-uterine activity (dehydration can cause Cxs)

47
Q

IDM

A

infant of diabetic mother

48
Q

effects of hypo/hyperglycemia in fetus during later pregnancy

A

-fetal hyperinsulinemia
-excessive growth (esp shoulders and body)
-inhibited release of surfactant
-hypoxia (increased RBC production to compensate, leads to NN polycythemia)

49
Q

effects of hypo/hyperglycemia in fetus during early pregnancy

A

-spontaneous abortion
-congenital malformations (cardiac, CNS, GU, skeletal)

50
Q

cues of shoulder dystocia during labor and delivery

A

-slowing of progress of labor
-more than 60 secs from head to body being born
-external rotation doesn’t occur
-when head emerges, it retracts against perineum (turtle sign)
-palpation of overlapping suture lines and edema of baby’s head during vaginal exam

51
Q

proactive plan for shoulder dystocia (prepare for all diabetic moms)

A

-big room size
-position for birth (squatting)
-anesthesia (epidural)
-episiotomy
-empty bladder

52
Q

Tx for shoulder dystocia

A

-call for help
-mcroberts maneuver (knees to ears)
-suprapubic pressure

if those don’t work:
-woods maneuver (“screw maneuver”, hands on baby’s scapula and clavicle, rotating shoulders toward fetal chest)

if that doesn’t work:
-gaskin maneuver (all 4s)/running start position

53
Q

maternal risks with shoulder dystocia

A

-PPH
-extended episiotomy
-rectal injuries

54
Q

neonatal risks with shoulder dystocia

A

-asphyxia
-brachial plexus injury
-fracture of humerus/clavicle

55
Q

white’s classification of diabetes:
A1
-onset
-fasting BS
-2 hr pp BS
-Tx

A

onset: gestational
fasting BS: <105
2 hr pp BS: <120
Tx: diet and exercise

56
Q

white’s classification of diabetes:
A2
-onset
-fasting BS
-2 hr pp BS
-Tx

A

onset: gestational
fasting BS: >105
2 hr pp BS: >120
Tx: insulin

57
Q

white’s classification of diabetes:
B
-onset
-duration
-vascular disease
-Tx

A

onset: 20+ yo
duration: <10 yrs
vascular disease: none
Tx: insulin

58
Q

white’s classification of diabetes:
C
-onset
-duration
-vascular disease
-Tx

A

onset: 10-19 yo
duration: 10-19 yrs
vascular disease: none
Tx: insulin

59
Q

white’s classification of diabetes:
D
-onset
-duration
-vascular disease
-Tx

A

onset: <10 yo
duration: >20 (?)
vascular disease: benign retinopathy
Tx: insulin

60
Q

white’s classification of diabetes:
F
-onset
-duration
-vascular disease
-Tx

A

onset: any
duration: any
vascular disease: nephropathy
Tx: insulin

61
Q

white’s classification of diabetes:
R
-onset
-duration
-vascular disease
-Tx

A

onset: any
duration: any
vascular disease: proliferative retinopathy
Tx: insulin

62
Q

white’s classification of diabetes:
H
-onset
-duration
-vascular disease
-Tx

A

onset: any
duration: any
vascular disease: heart
Tx: insulin

63
Q

risk factors for type 2 diabetes which would indicate the need to screen the pregnant woman at her first prenatal visit

A

-morbid obesity
-family history
-gestational diabetes in previous pregnancy

64
Q

how should woman prepare for 3 hr OOGT

A

atleast 3 days unrestricted diet and normal physical activity
no smoking or caffeine for 12 hrs before

65
Q

positive results for GDM from 3 hr OOGT

A

fasting: 95
1 hr pp: 180
2 hr pp: 155
3 hr pp: 140

66
Q

target BS levels for pregnant woman with diabetes
-fasting
-before meal
-1 hr pp
-2 hr pp
-2 am -6 am

A

-fasting: 60-95
-before meal: 60-105
-1 hr pp: <140
-2 hr pp: <120
-2 am-6 am: >60

67
Q

recommendation for follow up testing of a woman who had gestational diabetes following the birth of the baby

A

-4-12 wks postpartum (or after breastfeeding stops)
-1 year after birth
-every 3-5 years
-before another pregnancy

68
Q

Tx for BS of 60-70 in pregnant woman

A

15 g carbs (4 oz juice/soda)

69
Q

Tx for BS of 40-60 in pregnant woman

A

30 g carbs (1/2 solid, 1/2 liquid)
*adding protein reduces risk rebound hypoglycemia

high risk OB (14 decks)

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