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Maternal Exam 3 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Which one of these crosses the placenta: glucose or insulin?

A

Glucose crosses the placenta.

Insulin does not.

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2
Q

If mom is hyperglycemic, what will baby be categorized as too?

A

Baby will be hyperglycemic

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3
Q

Your diabetic patient who is in her first trimester asks which is she at more risk of: hypoglycemia or hyperglycemia?
Why?

A

Hypoglycemia

This is due to

  1. n/v around 6-12 weeks of PG
  2. Elevated Estrogen and Progesterone which means INSULIN gets used up more by cells
  3. Increased storage of glycogen in liver
  4. Decrease glucneogenesis
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4
Q

What trimesters do diabetogenic effects occur in?

A

2nd & 3rd

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5
Q

What diabetogenic effects happens to hormones in 2nd and 3rd trimester?

A

PG hormones are being released more due to placenta being developed now

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6
Q

What diabetogenic effect happens to glucose in 2nd and 3rd trimester?

A

Decrease tolerance of glucose

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7
Q

What diabetogenic effect happens to insulin in 2nd and 3rd trimester? Why is this happening?

A

An increase in insulin resistance (insulin isn’t transporting the glucose anymore)

The insulin resistance is due to the placental hormones of PG which is also increasing.

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8
Q

Which hormones is it that are being increased due to the placenta being diabetogenic in the 2nd and 3rd trimester?

What is the net effect of these hormones?

A 
HCS (human chorionic sommatropin) 
Estrogen 
Progesterone
Prolactin
Cortisol 
Insulinase - which ruins insulin activity

They elevate glucose in the blood stream

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9
Q

What would you expect the blood glucose levels or net effect be due to placenta hormones?

What does this mean for mom?

A

Elevation of glucose in the blood stream

And so her insulin need is going to rise in order to take care of the more glucose

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10
Q

What happens if mom’s blood glucose goes down in the 2nd and 3rd trimester?

A

If BG goes down, there is an issue in the PG.
The BG in these trimesters should never go down.
(they can only go down in1st)

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11
Q

In normal diabetes - when the body goes long periods of not being able to use their glucose/carbs?
What does this lead to?

A

The human body will turn to fats and proteins

Ketoacidosis > metabolic acidosis
- ketones and fatty acids accumualte

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12
Q

What happens to a diabetics weight if they are in ketoacidosis?

Now will this same thing happen to PG mom too if she is diabetic?

A

They have weight loss

YES

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13
Q

When Melzher says “Hyperglycemia acts as an osmotic diuretic” what does this mean

So if mom is hyperglycemic and you check her hydration status, what will you find?

(Why did you see the more peeing/polyuria though?)

A

She means the hyperglycemia causes increased urine output. And that leads to intracellular and extracellular dehyration of the cell

Her skin might be dry and also mucous membranes

(The osmotic diuresis goes on leads to more blood volume which you have to pee out)

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14
Q

Why does polyphagia occur in diabetes?

A

Extreme hunger occurs bc the cells are starving

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15
Q

Why does polydipsia occur?

A

Extreme thirst occurs bc the cells are dehydrated from the polyuria actually

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16
Q

Why did you see the more polyuria?

When you check mom’s pee, you see a glucose reading of 3+. Is this ok?
What do you know may come after this?

A

Osmotic diuresis causes increased blood volume and you must pee it out

If it is above 1+ that means mom is spilling glucose. And this is abnormal
She can start spilling ketones and go into acetonuria too if she is already beginning to breakdown fat and proteins

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17
Q

You notice mom is having the polyuria, polyphagia, and polydipsia symptoms. When you go to check her BS what are you expecting and why?

A

Hyperglycemia bc it is the high BS that causes the osmotic effects to take place and cause the 3 P’s

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18
Q

Patient asks what the difference is between Gestational Diabetes and regular diabetes. What do you tell her?

A

Gestational Diabetes means they discovered you were a diabetic during your PG. But this doesn’t mean you have no chance of being diabetic before hand.

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19
Q

Your patient might have gestational diabetes. What tests do you anticipate?

A

Blood glucose level.

May do fasting test first at 1 hr and then 2 hr, 3 hr.

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20
Q

Patient diagnosed with Type 1 diabetes doesn’t understand the patho of this. Can you explain?

A

Beta cells in the pancreas are being destroyed & so the organ isn’t making insulin anymore for you to use.
And you need that insulin to carry and use your glucose

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21
Q

Who is more prone to ketoacidosis.

Type 1 or Type 2 diabetics?

A

Type 1 diabetics

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22
Q

In knowing that your patient was diagnosed with Type 2 diabetes, how do you explain it to them?

A

Type 2 develops gradually over time.

It is more of an insulin resistance issue

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23
Q

What are other reasons or types of diabetes out there?

A

From genes, injury, illness, or drugs

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24
Q

Patient with cardiac issues isn’t controlling her diabetes as she should.
What do you educate her on about the possible vascular issues that can happen if she doesn’t get in control?

A

Atherosclerosis
Retinopathy
Nephronpathy
Neuropathy

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25
Q

What are the two main reasons a mom may have Gestational diabetes

A

1) she already had it and just didn’t know it

2) Her hormones of PG /placenta caused it which antagonizes insulin

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26
Q

What is the first suggestion when trying to manage/tx Gestational diabetes?

A

Lifestyle changes such as change diet and work out

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27
Q

Wha is the second option for management/tx

of Gestational diabetes?

A

Oral agents like Metformin & Glyburide

These are easier to use too.

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28
Q

What is the third option for management/tx of gestational diabetes when the other two options didn’t work

A

Mom will go on insulin if the diet/exercise/metformin didn’t work .

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29
Q

Goal BS for pregnancy:

Fasting

A

95 fasting BG

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30
Q

Goal BS for pregnancy:

1 hr after eating

A

140 @1 hr

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31
Q

Goal BS for pregnancy :

2 hr after eating

A

120 @2 hr

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32
Q

Pros of using oral agents to control diabetes?

What do healthcare professional need to make sure of?

A

They’re easier to use

Make sure the patient went and got the prescription. Just bc you told them to go doesn’t mean they did

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33
Q

A mom says to you that since she has gestational diabetes she’ll have it again next pregnancy. What is your response?

A

Tell her it is likely if she isn’t willing to make lifestyle choices to better prepare for PG

So point is she doesn’t have to be gestational diabetic again.

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34
Q

T/F

Gestation diabetes never goes away

A

Very false.
Most of the time it goes away with birth.
If it doesn’t, then you have type 2 onset

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35
Q

At what age do women start to be at higher risk for gestational diabetes?

A

35+ making her an older gravida

36
Q

Weight category that increases chances of gestational diabetes

A

Obesity

BMI 25-30 is overweight

BMI 30+ is obese

37
Q

If your mom has diabetes, does that put you at risk for gestational deibates?

A

Yes actually it does. Family hx of diabetes is a big one

38
Q

Races that are at higher risk of gestational diabetes?

A

Non-caucasian races .

So asians, hispanics, blacks.

39
Q

You had an LGA baby in previous PG. Can this affect your chances of diabetes?

How do some other cultures view having a large baby as?

A

Yes gestational diabetes is more of risk due to the baby being over 9 Ibs bc that means that baby was having hyperglycemia episodes

Not all cultures realize a 9 IB baby is not always healthy either. Some encourage it even

40
Q

What type of congenital anomalies are common in baby’s born w gestational diabetic moms?

A

cardiac; asd, vsd

orthopedic: club foot or others issues w lower extremities

Neuro:
hydrocephaly, anencephaly

41
Q

Cardiac risk factor that goes hand in hand with diabetes?

A

Hypertension is very common

42
Q

A woman with polycystic ovarian syndrome who is also a diabetic becomes pregnant. Using nursing knowledge, why do you think might be the reason

A

She must be taking Metformin since it can increase PG in polycystic conditions

43
Q

A woman says she has pregestational diabetes. What does she mean by this?

A

It means she was diabetic before getting pregnant with Type 1, Type or type 4. Just diabetic

44
Q

What do we recommend for women who are diabetic but want to get pregnant?
And why?

A

We really want those pregnancies to be planned.

It allows them to better control their control before PG

45
Q

Euglycemia

A

BS of 65-130 fasting which is the goal

but they would LOVE 65-90

46
Q

When will they do routine blood sugar screening in PG for low risk? Why then?

A

Low risk @ 24-28 weeks

Do it at this time because this is the period of greatest risk for gestational diabetes: max hormones, bloodlfow, hypertension risk

47
Q

Routine screening of blood glucose in PG procedure

What if it is abnormal first time?
What should they do but not all physicians follow?

How many tests can be done before sort of considered to be gestational diabetic?

A

Nonfasting of 50 mg glucose for 1 hr first time

If abnormal, do the fasting 100 mg and a 3 hr glucose

  • do after 3 days of high carb
  • avoid smoking and caffeine

After 2 its sort of decided

48
Q

Which test screens for glycosylated hemoglobin?

A

Hemoglobin A1C
which measures control over last 2-6 weeks

Means rbc are coated with sugars/glucose & then are unable to even bind with hemoglobin so mom and baby are hypoxemic

49
Q

What is a good hemoglobin A1C score in pregnacy?

A

Less than 6.5%

- lower it is, the better and she is able to oxygenate her and her baby

50
Q

Who is going to have less risk in PG - someone with glycemic issues or someone who can control it?

A

Better if mom can control it bc if she can’t, she’ll have a big baby. And she might not get a vaginal delivery

51
Q

What does Macrosomia mean

What is shoulder dystocia.
If you’re the physician, how do you recognize the shoulder problem?

A

Birth weight more than 4000 grams or more than 9 ibs

Shoulder dystocia is when baby shoulders are too big to fit through pelvis
The baby will act like a turtle and bob its head in and out

52
Q

A mom who doesn’t have good control of her glucose levels is wondering what her labor is gonna look like. What do you say?

A

Baby will be large.

Your labor will be a scheduled c-section or induction. Shoulder dystocia can happen or other complications.

53
Q

What can happen to the clavicle if shoulder dystocia occurs?

What can they try if shoulders don’t fit?

A

Clavicle can be injured

vaccum, forceps, episiotomy

54
Q

Mom is polyhydraminos and is a gestational diabetic/pre gestational diabetic. . Why does this happen?

A

Mom’s blood sugar is making baby pee more. And so the fluid accumulates to more than 1000cc

55
Q

What risks of hypertension are there with diabetes?

A

Pre-eclampsia and eclampsia

56
Q

Which diabetics are more likely to become ketoacidodic again?

If you keep seeing type 1 sugars go up, what will you as the nurse probably see?
What can happen to the baby?

When is it likely these people may se]fetal death?

A

Type 1 (usually in 2nd & 3rd trimester)

keto acidosis symptoms.

Baby can die due to no cellular function, no enzyme function, and low ph

36-39 weeks. baby just dies in utero
- which is why we will do an induction to avoid this problem

57
Q

What type of infections are diabetics really. prone to?

A

yeast infections

They get infections often but yeast is favorite

58
Q

Cardiac progression issues with maternal’s poor control of diabetes

A

retinopathy, nephrpathy, neuropathy

  • and stress of PG doesn’t not help these things .
    you can literally go blind
59
Q

Diabetes increases risk of miscarriage. But what trimester is this usually?

A

The miscarriage will happen in 1st trimester if its from diabetes

60
Q

Now, if the fetus dies in utero when it it most likeluy?

A

36-39 weeks due to the poor glycemic control

61
Q

Mom is an advanced diabetic and mom had an IUGR baby. why?

A

Due to mom’s atherosclerosis, baby lacked oxygen and so they couldn’t grow

(new diabetics = big baby)
(pregestational or advanced diabetics = small baby)

62
Q

Why is prematurity considered a possible outcome if mom is diabetic?

A

We just know there are more complications, and so we might have to go in and save that baby

63
Q

What is the biggest risk of being delivered early (which happens a lot in diabetic patients)?

So if you see a big baby on the vent in Nicu, what does that probably mean

A

RDS or respiratory distress syndrome from lack of surfactant and slower lung development despite age

Baby had a diabetic mom bc their lungs suck

64
Q

You notice the doctor says to not give mom her usual diabetic meds on the day of her delivery. What is the reason for this?

A

After mom delivers, she can become hypoglycemic due to loss of the placenta and its hormones.
And so we are just trying to avoid a dramatic drop and over correction (for 4-6 hours after delivery)

OR IS THIS THE BABY?

65
Q

Baby born to diabetic mom is having polycythemia . Explain why this is happening and how to see if it is normal or not

A

Due to diabetes, baby is dehydrated.
It causes a pseudo rising in the rbcs

To see if it is a pseudo issue, check other labs like BUN, SG, hematocrit. If they too have raised all of a sudden, then you know it is dehydration.

66
Q

Why might baby be in a state of hyperbilirubemia if mom was diabetic ?

A

As liver becomes affected, they can’t metabolize bilirubin.

67
Q

How can you try to educate mom on how to do better with diabetes and PG?

A

If she wants a happy, healthy baby she needs to be compliant and do what’s needed.

68
Q

When educating diabetic mom on her diet, how many meals should she be having?
Amount of calories per meal?

What is the reasoning?

A

Mom should be getting 6 small meals a day. The meals should be equal in portion too.
300-500 calories

Helps the digestion process and stabilizes her glucose

69
Q

You tell diabetic mom she should have a bed time snack. She asks if she can eat popcorn. What do you tell her?

What is the most important meal of the day with diabetic moms?

A

It is best to eat protein instead bc the protein will help you make it through the night due to slowing digestion

Well the snack and the breakfast are very important just in general

70
Q

Night time snack that can also help with morning n/v?

A

Protein!

71
Q

What is the point of doing urine testing for mom as part of her treatment?

A

We are really looking for her ketones in the urine .

Glucose in the urine is not the focus

72
Q

T/F

Diabetic moms need less fetal surveillance

A

FALSE FALSE FALSE. increased tests all over the place

73
Q

Great exercises suggestions for diabetic mom during PG?

A

Walking or Swimming

- the water one is great actually

74
Q

Safety suggestions for PG mom’s who are diabetic

A

Wear ID bracelet and carry her treatment supplies with her at all times

75
Q

Can insulin pumps be used in PG?

A

Yes & in abdomen too

76
Q

Why are ultrasounds in the first trimester so important?

A

It helps you know the age of the baby and also the earlier you do one, the more accurate it will be

77
Q

What does the Alpha Fetal Protein test do?

A

Tests for neural tube defects

- if its high , not good

78
Q

What do fetal echocardiograms look for?

A

Fetal cardiac anomalies

79
Q

When does mom need to start really paying attention to kick counts?

A

3rd trimester

80
Q

NST

A

Non-stress test is common in 3rd semester

- will do it 2nd if multiples

81
Q

Biophysical profile trimester

A

3rd trimester

82
Q

Amniocentesis trimester

A

3rd trimester

83
Q

Ultrasound AFI

Ultrasound Cord velocity study

A

Amniotic fluid index or volume

Cord velocity or how blood flows through cord
- if the resistance is high, s/d ratio is rising and hypertension probably

84
Q

What type of delivery will a diabetic mom have?

A

Induced or C-section that is scheduled

85
Q

Before delivery of diabetic mom’s baby. You need to assess lung maturity. How do you do this?

A

PG levels (phsophotital glycerol) or l/s ratio

  • want it to be positive after 35 weeks
86
Q

Doctors will hold insulin/diabetes meds on day of delivery for ______.
What will they do isntad?

A

Due to hypoglycemia from placenta delivery

Hourly BS checks
Bolus insulin if needed can be used
- d5lr or lr but sliding scale for sure
sliding scale = rapid acting

Insulin IV stopped once placenta is delivered and give sub q insulin

Maternal Exam 3 (8 decks)

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