Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NURS 405 > Chapter 26: Concurrent Disorders During Pregnancy > Flashcards

Chapter 26: Concurrent Disorders During Pregnancy Flashcards

1
Q

First diagnosis during pregnancy

A

Gestational diabetes**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Women with any risk factors should be screened for

A

Type 2 or GDM at FIRST prenatal visit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

During the second half of pregnancy, what hormones can create resistance to insulin in maternal cells?

A

Progesterone
Estrogen
Human Placental Lactogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

The increase resistance in maternal cells to insulin allows

A

An abundant supply of glucose to be available for fetus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Increased resistance to insulin in maternal cells may have a

A

Diabetogenic effect -> mom will have episodes of Hyperglycemia and insufficient insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

White Classification: A-1

A

Diet controlled

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

White Classification: A-2

A

Diet and insulin controlled

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Risk factors for gestational diabetes

A

o Overweight (BMI 25> to 25.9) or obesity (>30 or morbidly obese >40)
o Maternal age older than 25 years
o Previous birth outcome assoc. w/ GDM (neonatal macrosomia, maternal HTN, infant w/ unexplained congenital abnormalies, previous fetal death).
o Gestational diabetes in previous pregnancy
o History of abnormal glucose tolerance
o History of DM in a close (1st degree) relative
o Member of high-risk ethnic group (African American, Hispani or latino, American indian, Asian American, pacific islander)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Screening for gestational diabetes

A
  • Everyone gets it during first visit.

- Either by identification of history/risk factors consistent for type 2 DM or GDM or by blood glucose testing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What tests are used for screening of gestational diabetes?

A
  • Basic glucose challenge screening test (GCT)

- Oral glucose tolerance test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What women get the basic glucose challenge screening test?

A

Low risk women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Basic Glucose Challenge Screening Test is administered when?

A

Between 24-28 weeks of gestation, both in low/high risk antepartum patients.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What women get oral glucose tolerance test?

A
  • May be used as initial test if woman is high risk for GDM.

- Mainly used for diagnosis following abnormal GCT levels.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Basic Glucose Challenge Screening Test Procedure

A

o Fasting NOT necessary for GCT, not required to follow pretest dietary instructions
o Ingests 50 g of oral glucose solution **
o Blood sample taken 1 hour later**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Basic Glucose Challenge Screening Test: 140 mg/dL or greater

A

3 hour oral glucose tolerance test**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Basic Glucose Challenge Screening Test: 130-135 mg/dL

A

Identify more women at risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Oral Glucose Tolerance Test

A

Gold standard for diagnosis. More complex.**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Oral Glucose Tolerance Test Procedure

A

o Must be fasting from midnight to the day of the test.
o After fasting plasma glucose is determined, woman ingests 100 g of oral glucose solution
o Plasma glucose levels determine at 1, 2, and 3 hours. **

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

GDM is diagnosis if fasting blood glucose level is abnormal or if two or more of following values occur on the OGTT

A
  • Fasting, greater than 95 mg/dL
  • 1 hour, greater than 180 mg/dL
  • 2 hours, greater than 155 mg/dL
  • 3 hours, greater than 140 mg/dL

2 or more that are abdnormal = diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When is the placenta completed?

A

Placenta not completed until 12 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

GDM risk factors are similar to those existing in preexisting diabetes, except that GDM is

A
  • NOT associated with increased risk for maternal ketoacidosis or spontaneous abortion.
  • Usually not associated with increase in major congenital malformations.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Maternal Hyperglycemia during 3rd trimester increases the risk for

A

Neonatal morbidity and mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Gestational Diabetes Mellitus: Maternal Risks

A

o Preeclampsia
o UTIs
o Hydramnios (fetal diuresis cause)
o Labor dystocia
o C/S
o Uterine atony w/ hemorrhage after birth
o Birth injury to maternal tissues (hematoma, lacerations)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Gestational Diabetes Mellitus: Fetal Neonatal Risks

A
  • Fetal Growth: Marcosomia**
  • Decreased placental perfusion
  • SGA or IUGR
  • Oligohydramnios
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What causes macrosomia in the fetus with a mother who has gestational diabetes mellitus?

A
  • Fetus produces insulin by 10th week of gestation, maternal insulin does not cross.
  • Overproduction of insulin which acts as a growth hormone when glucose is ↑.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Gestational Diabetes: Neonatal Risk Factors

A
  • Hypoglycemia**
  • Hypocalcemia
  • Hyperbilirubinemia
  • Respiratory distress syndrome**
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What causes hypoglycemia in the newborn with a mother with gestational diabetes?

A
  • Fetal insulin production accelerated during pregnancy to metabolize excessive glucose received from mother.
  • When maternal glucose supply is abruptly withdrawn at birth, level of neonatal insulin exceeds available glucose, hypoglycemia develops rapidly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What causes hypocalcemia in newborns with mothers with gestational diabetes?

A
  • During last half of pregnancy, large amounts of calcium are transported across placenta from mother to fetus.
  • At birth, this is stopped, leading to dramatic decrease in total/ionized calcium.
  • <7 mg/dL , first 3 days of life.**
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What causes hyperbilirubinemia in the newborn with a mother with gestational diabetes?

A
  • Fetus experiencing recurrent hypoxia compensate by producing additional erythrocytes (polycythemia) to carry oxygen supplied by mother.
  • After birth, excess erythrocytes are broken down, releases large amt of bilirubin into neonate’s circulation.
  • Poor glycemic control further reduces infant’s ability to metabolize/excrete excess bilirubin.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What causes respiratory distress syndrome in the newborn with a mother with gestational diabetes?

A

Fetal hyperinsulinemia retards cortisol production, necessary for surfactant needed to keep newborn’s alveoli open after birth = ↑ risk for resp. distress syndrome.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Primary goal for gestational diabetes mellitus in pregnancy

A

Maintaining normal blood glucose levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Gestational Diabetes Mellitus Teaching

A

o Eliminate simple sugars in diabetic diet ADA.
o Recommend 30 kcal/kg/day and if obese then 25kcal/kg/day
o Limits carbs to 30 g during pregnancy for breakfast = ↑ levels of cortisol and growth hormones that period.
o Calories divided among three meals and at least 3 snacks.
o Do graduate physical exercise program.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Nursing Care for Gestational Diabetes Mellitus in Pregnancy

A
  • Blood glucose levels evaluated
  • Administer insulin, perform regular fetal surveillance.
  • Increase effective communication.
  • Provide opportunities for control.
  • Providing normal pregnancy care.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How are blood glucose levels evaluated?

A

Common method is measuring fasting blood glucose level (no food for previous 4 hours) and postprandial blood glucose level (2 hours after each meal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

When is insulin started for GDM?

A

Insulin started if fasting is 95+ and/or postprandial values 120+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Maternal Testing in mothers with GDM

A

o Baseline renal function w/ 24-hour urine collection for protein excretion and creatinine clearance.
o UTI random urine sample
o Dipstick on urine (detect ketones, protein, glucose)
o Thyroid function tests → preexisting DM
o Glycosylated hemoglobin or hemoglobin A1c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Glycosylated Hemoglobin or hemoglobin A1C

A
  • Accurate measurement during preceding 2-3 months**

- Not affected by recent intake or restriction of food.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Fetal testing in babies with mothers with GDM

A 
o	“Kick counts”
o	Ultrasonography for fetal growth and amniotic fluid volume
o	Biophysical profile
o	Non stress test
o	Contraction stress test
o	Amniocentesis for fetal lung maturity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

When is testing done to identify fetal compromise in babies with mothers with GDM?

A

Testing to identify fetal compromise begins 28 weeks of gestation if woman has poor glycemic control or by 34 weeks of gestation in lower-risk women with GDM.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are the major maternal risks of DM on pregnancy?

A
  1. HTN
  2. Preeclampsia
  3. Ketoacidosis
  4. UTI
  5. Labor dystocia, C/S, uterine atony with hemorrhage after birth
  6. Birth injury to maternal tissues (hematoma, laceration)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are the major fetal and neonatal risks of DM on pregnancy?

A
  1. Congenital Anomalies
  2. Perinatal Death
  3. Macrosomia (>4000g)
  4. IUFGR
  5. Preterm labor, PROM, preterm birth
  6. Birth injury
  7. Hypoglycemia
  8. Polycythemia
  9. Hyperbilirubinemia
  10. Hypocalcemia
  11. Respiratory distress syndrome
42
Q

What increases the risk for UTI in pregnant women with DM?

A

Increased bacterial growth in nutrient rich urine.

43
Q

What increases the risk for uterine atony in pregnant women with DM?

A

Hydramnios secondary to fetal osmotic diuresis d/t hyperglycemia -> uterus to be overstretched.

44
Q

What increases the risk for perinatal death in a fetus/newborn whose mother has DM?

A

Poor placental perfusion because of maternal vascular impairment, primarily in type 1 DM.

45
Q

What increases the risk for macrosomia in a fetus/newborn whose mother has DM?

A

Fetal hyperglycemia stimulates production of insulin to metabolize carbs, excess nutrients transported to fetus.

46
Q

Anemia

A

Decline in circulating RBC mass reduces capacity to carry oxygen to the vital organs of the mother or the fetus.

47
Q

A woman is considered anemic if

A

Hemoglobin is <10.5 or 11 g/dL**

48
Q

Signs and symptoms of anemia include

A

o Fatigue
o Pale skin
o PICA → sign of anemia, not eating food = problems with weight (loss)
o IN FETUS: If Hgb 6→ reduced variability, late decels (uteroplacental insufficiency), will NOT tolerate labor. Chronic lack of oxygenation.

49
Q

Implications of anemia on infant

A

Significant maternal anemia is associated with preterm birth and low birth weight.

50
Q

Common Types of Anemia include

A
  1. Iron Deficiency

2. Folic Acid Deficiency

51
Q

Iron Requirement

A

1000 mg

52
Q

Sources of iron include

A
  • Meat
  • Fish
  • Chicken
  • Liver
  • Green leafy vegetables
53
Q

Signs and symptoms of Iron Deficiency Anemia in mother

A

o Pallor, fatigue, lethargy, headache
o Inflammation of lips and tongue**
o PICA
o Labs show RBCs that are microcytic and hypochromic
o Plasma iron and serum ferritin levels are low, total iron binding capacity is higher than normal.

54
Q

What women are more likely to be anemic during pregnancy?

A

Women who have multifetal pregnancies or bleeding complications are more likely to be anemic during pregnancy.

55
Q

Affect of iron deficiency anemia on fetus

A
  • Will receive adequate stores at a cost to their mother.
  • If severe, fetus may have reduced RBC volume, Hgb, and iron stores.
    -Profound maternal anemia = reduced fetal oxygen supply
56
Q

Folic Acid

A

-Functions as a coenzyme in synthesis of deoxyribonucleic acid (DNA), essential for cell duplication and fetal and placental growth.
Essential nutrient for RBCs.

57
Q

Folic Acid Deficiency

A
  • Large immature erythrocytes (megaloblasts)

- Often present with iron deficiency anemia

58
Q

Signs and symptoms in mother with folic acid deficiency anemia

A

-Reduction in rate of DNA synthesis and mitotic activity of individual cells, resulting in presence of megaloblasts.

59
Q

What are nonfood factors that contribute to folic acid deficiency?

A
  • Hemolytic anemia’s
  • Increased RBC turnover anemia
  • Multifetal gestation
  • Anticonvulsants
  • Malabsorptions
60
Q

Effect of folic acid deficiency anemia on baby

A
  • Increased risk for spontaneous abortion
  • Abruptio placentae
  • Fetal anomalies
  • Possible neural tube defect**
61
Q

Iron Deficiency Anemia: Treatment

A

• Ferrous sulfate 325 mg 1-3x per day is commonly prescribed.

62
Q

Iron Deficiency Anemia: Treatment Instructions

A
  • Women experience less GI discomfort if iron supplementation is take w/ meals, although absorption is less.
  • Take with 500 mg Vitamin C which may enhance absorption.
  • Take stool softener!!!!!!!!!
63
Q

What should women avoid during iron deficiency anemia treatment?

A

Avoid milk, cheese, calcium products and caffeine

64
Q

How long is iron deficiency anemia treatment continued for?

A

Therapy continued for about 6 months after anemia has been corrected.

65
Q

Folic Acid Deficiency Anemia: Treatment

A
  • Recommend to take 400 mcg (0.4 mg) of folic acid daily and increase to 600 when pregnant.
  • 4 mg of folic acid for 1 month BEFORE and DURING 1st trimester of pregnancy.
66
Q

Why should you increase folic acid in diet?

A
  • RDA for it doubles during pregnancy, must take supplements

* Diabetics more prone to neural tube defects. ↑ folic acid to prevent this.

67
Q

What foods are high in folic acid?

A

Fortified greens: black beans lentils, peanuts, fresh dark green leafy vegetables.

68
Q

During treatment, the nurse should monitor what in the fetus?

A

BPP and NST

69
Q

GBS infection

A

15-40% colonized of pregnant women**

-Leading cause of life-threatening perinatal infection in US.

70
Q

GBS infection occurs when

A

Gram + bacterium colonizes in the rectum, vagina, cervix, urethra** of pregnant woman as well as in non-pregnant woman.

71
Q

GBS Infection: Presentation

A

Presents as asymptomatic, symptomatic maternal infections can occur

  • UTI w/ GBS
  • Chorioamnionitis
  • Metritis
  • Most women respond quickly to antimicrobial therapy.
72
Q

GBS Infection: Fetal-newborn complications

A
  • Sepsis, pneumonia and meningitis are primary infections in early onset GBS disease (Respiratory, low temperature, mottled blue)
  • Permanent neurological consequences likely in infants who survive meninges infections.
73
Q

When does early onset newborn GBS disease occur?

A

First week after birth, 48 hours

74
Q

What is the treatment for GBS infection?

A
  1. PCN is the first line agent for antibiotic treatment of infected women during birth.**
  2. Cephazolin is alternate for patient with non-life threatening PCN allergy.
  3. Clinamycin is used for woman with high risk for anaphylaxis **
75
Q

Optimal identification of GBS carrier status is obtained by

A

Vaginal and rectal culture between 35-37 weeks of gestation.

76
Q

What are factors that can indicate GBS-positive at delivery?

A
  1. Woman who have had previous infant w/ GBS or a GBS in their urine in any trimester.
  2. Delivery at or before 37 weeks
  3. Has ruptured membranes >18 hours
  4. Has a temperature of 100.4 F (38 C) or higher
77
Q

If a patient is positive for GBS, tell the patient

A

That she will be treated with IV antibiotics during labor.

78
Q

Herpes II (HSV)

A
  • Genital herpes one of the most common STD in the HSV group.
  • Most infections of genital herpes is type 2.
79
Q

Herpes II (HSV) Characteristics

A

o Occurs as a direct contact of the skin or mucous membranes with an active lesion.
o Lesions form at site of contact and begin as a group of painful papules that progress rapidly to become vesicles, shallow ulcers, pustules, and crusts.
o Infected person sheds virus until lesions are healed.

80
Q

Is breast feeding okay in women with herpes II?

A

OK if no lesions are on breasts

81
Q

Herpes II (HSV) virus migrates along

A
  • Sensory nerves to reside in sensory ganglion, disease enters latent phase**
  • Reactive later as recurrent infection.
82
Q

Maternal symptoms of herpes II

A

-Many will have no signs and symptoms and shed virus unknowingly.

83
Q

Treatment for Herpes II

A
  • Antiviral chemotherapy (Acyclovir) is prescribe to reduce symptoms and shorten duration of lesions.
  • Given during LATE pregnancy to a woman w/ recurrent outbreak to reduce possibility of her having active lesions at time of birth.
84
Q

Ventrical Transmission of Herpes II

A

From mother to infant. Occurs either:
1. After rupture of membranes -> virus ascends from active lesions**
OR
2. During birth, when the fetus comes in contact w/ infectious genital secretions or when fetal skin is punctured such as w/ FSE.**

85
Q

Fetal effect of herpes II

A
  • Complications are rare.

- If primary infection occurs during pregnancy, rates of spontaneous abortions, IUGR and preterm labor increases.

86
Q

Neonatal effect of herpes II

A
  • Skin lesions or systemic (disseminated) and appear within the first week, disease progresses rapidly.
  • 50% risk of death
87
Q

Is vaginal birth allowed if mother has herpes II?

A
  • Allowed if there are no genital lesions at time of labor.
  • If there are genital lesions, C/S is done.
  • Same goes for FSE.
  • Risk for sepsis**
88
Q

What should you observe in the fetus with a mother that has herpes II?

A

Signs of infections: temperature instability, lethargy, poor sucking, jaundice, seizures, herpetic lesions.

89
Q

Treatment for neonates infected with herpes II

A

Acytoclovir is also prescribed for neonatal infection

90
Q

HIV - Perinatal exposure

A

Infected person with virus that fails the immune system and develops opportunistic infections or malignancies that ultimately are fatal.

91
Q

Time from infection of HIV to development of AIDS is approximately how long?

A

Approximately 11 years with current antiretroviral therapy.

92
Q

What can confirm the diagnosis of AIDS?

A

-CD4 T lymphocyte total count of <200 cells/mm

93
Q

What infant tests are done to diagnose HIV?

A

PCR for viral DNA and viral culture in addition to standard antibody tests.

94
Q

Infant HIV tests can

A

Remain positive for up to 18 months after birth because of passive maternal antibodies.

95
Q

What are maternal symptoms of HIV?

A

1) Flulike symptoms may develop and last a few weeks. Antibodies to HIV (seroconversion) generally appear within few months. HIV +
2 ) Middle or asymptomatic period of minor or no clinical problems follows. Low level viral replication and CD4 cell loss. HIV +
3) Transitional period of symptomatic disease follows (AIDS regardless of CD4 count)
4 ) a late or crisis period of symptomatic disease follows, which consist of opportunistic infections lasting months or years. (AIDS)

96
Q

Treatment for HIV during pregnancy

A
  • Zidovudine is the primary drug.

- It is the most effective to reduce vertical transmission from mother to infant. **

97
Q

Things to consider during treatment of HIV

A
  • If mother has had any antiretroviral therapy during pregnancy, including ZDV, and when it began
  • If mother had any prenatal care and when she started
  • Fetal gestation age
  • If membranes have ruptured, how long they have been ruptured.
98
Q

In mothers with HIV, it is recommended that

A

They have a c/s at 38 weeks prior to labor.**

99
Q

Perinatal Transmission of HIV

A

Infant infection can occur during pregnancy, during L&D, or after birth if infant is breastfed**

100
Q

Fetal/neonatal effects of HIV

A

o Infected newborn is typically asymptomatic at birth, but S&S may become obvious during first year of life.
o Enlargement of liver and spleen
o Lymphadenopathy
o Failure to thrive
o Persistent thrush
o Extensive seborrheic dermatitis (Cradle cap)**
o Often have bacterial infections: meningitis, pneumonia, osteomyelitis, septic arthritis, septicema

NURS 405 (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions