Ch 29, Endocrine and Metabolic disorders

Question 1

During the (__) and (__) trimesters, pregnancy exerts what effect on the maternal metabolic status?

Answer 1

During the (2nd) and (3rd) trimesters, pregnancy exerts a diabetogenic effect on maternal metabolic status

Question 2

What does “Diabetogenic” mean?

Answer 2

Diabetogenic means “causing diabetes”

Question 3

Major hormonal changes in the pregnant mother lead to a decreased tolerance to (________), increased (________) resistance, decreased hepatic (________) stores, and increased hepatic production of (________)

Answer 3

Major hormonal changes in the pregnant mother lead to a decreased tolerance to (glucose), increased (insulin) resistance, decreased hepatic (glycogen) stores, and increased hepatic production of (glucose)

Question 4

Diabetes Mellitus refers to a group of metabolic diseases characterized by (_____)glycemia, resulting from defects in (_________) secretion, (_________) action, or both

Answer 4

Diabetes Mellitus refers to a group of metabolic diseases characterized by (hyper)glycemia, resulting from defects in (insulin) secretion, (insulin) action, or both

Question 5

Insulin is produced by the (_____) cells in the (_____ __ _________) in the (__________)

Answer 5

Insulin is produced by the (beta) cells in the (islets of Langerhans) in the (pancreas)

Question 6

Insulin regulates (_____ _______) levels by enabling glucose to enter (_______) and (______) cells, where it is used for energy

Answer 6

Insulin regulates (blood glucose) levels by enabling glucose to enter (adipose) and (muscle) cells, where it is used for energy

Question 7

When insulin is insufficient or ineffective in promoting glucose uptake, glucose accumulates where?
Causing what?

Answer 7

Glucose accumulates in the bloodstream, causing Hyperglycemia

Question 8

Type 1 DM accounts for what percentage of DM cases?

Answer 8

5-10% of all cases

Question 9

Type-1 DM are caused primarily by the destruction of pancreatic (_____ ____) cells, and that are prone to (____________)

Answer 9

Type-1 DM are caused primarily by the destruction of pancreatic (islet beta) cells, and that are prone to (ketoacidosis)

Question 10

People with type-1 DM are typically of (___) age, have (______) onset of illness, and have an absolute (_______ __________)

Answer 10

People with type-1 DM are typically of (young) age, have (abrupt) onset of illness, and have an absolute (insulin deficiency)

Question 11

Type 2 DM account for what percentage of DM cases?

Answer 11

90-95%

Question 12

Type 2 DM patients typically have insulin (__________) and usually relative insulin (__________)

Answer 12

Type 2 DM patients typically have insulin (resistance) and usually relative insulin (deficiency)

Question 13

Gestational DM is defined as a (_______________) intolerance that develops during pregnancy and requires that (_____________) intolerance be identified by the (__) or (__) trimester.

Answer 13

Gestational DM is defined as a (carbohydrate) intolerance that develops during pregnancy and requires that (carbohydrate) intolerance be identified by the (2nd) or (3rd) trimester.

Question 14

Pregestational DM occurs in what percentage of pregnancies.

Answer 14

10%

Question 15

Almost ALL women with pregestational diabetes are insulin (__________) during pregnancy, and type (_) diabetes is more common

Answer 15

Almost ALL women with pregestational diabetes are insulin (dependent) during pregnancy, and type (_) diabetes is more common

Question 16

Macrosomia, found in pregnant diabetic mothers, has been defined as a birth weight more than (_____ to ______) grams.

Answer 16

Macrosomia, found in pregnant diabetic mothers, has been defined as a birth weight more than (4000 to 4500) grams.

Question 17

Infants born to women with diabetes tend to have a disproportionate increase in (________), (_____), and (_____) size

Answer 17

Infants born to women with diabetes tend to have a disproportionate increase in (shoulder), (trunk), and (chest) size

Question 18

Children with Macrosomia cause increased risk for getting their shoulders stuck during birth, a situation known as what?

Answer 18

Shoulder dystocia

Question 19

Due to the incidence of Macrosomia in DM, diabetic mothers face an increased risk for what type of birth?

Answer 19

Cesarian birth; C/section

Question 20

Macrosomia occurs due to increased maternal (_______) levels. The fetal pancreas secretes (_________) between (__ and __) weeks in response to the mothers (______ _________) levels. That secreted insulin from the baby acts as a type of (__) for the baby, causing Macrosomia.

Answer 20

Macrosomia occurs due to increased maternal (glucose) levels. The fetal pancreas secretes (insulin) between (10 and 14) weeks in response to the mothers (blood glucose) levels. That secreted insulin from the baby acts as a type of (GH) for the baby, causing Macrosomia.

Question 21

(____)hydramnios frequently develops in the (__) trimester in diabetic mothers.

(____)hydramnios is characterized by what fluid levels?

Answer 21

(Poly)hydramnios frequently develops in the (3rd) trimester in diabetic mothers.

Polyhydramnios is amniotic fluid in excess of 2L, or, an amniotic fluid index of more than 23cm

Question 22

Why are infections more common in pregnant women WITH diabetes than pregnant women without diabetes?

Answer 22

Because infections love the increased blood sugar levels.

Question 23

Infections in diabetic women cause increased (_________) resistance and may result in (_____________)

Answer 23

Infections in diabetic women cause increased (insulin) resistance and may result in (ketoacidosis)

Question 24

Ketoacidosis is an accumulation of (________) in the (_____) resulting from (_____)glycemia and leading to metabolic (________)

Answer 24

Ketoacidosis is an accumulation of (ketones) in the (blood) resulting from (hyper)glycemia and leading to metabolic (acidosis)

Question 25

DKA may occur with blood glucose levels barely exceeding what mg/dl?

Answer 25

200mg/dl

Question 26

Despite the improvements in the care of pregnant women with diabetes, the perinatal mortality rate is (__) times higher in diabetic women than non-diabetic women, and (____) remains a great concern

Answer 26

Despite the improvements in the care of pregnant women with diabetes, the perinatal mortality rate is (3X) times higher in diabetic women than non-diabetic women, and (IUFD) remains a great concern IUFD: Intra Uterine Fetal Demise

Question 27

Congenital defects are a huge risk for diabetic pregnancies, especially the congenital abnormalities of the (____________) and (________) systems.

Answer 27

Congenital defects are a huge risk for diabetic pregnancies, especially the congenital abnormalities of the (cardiovascular) and (CNS) systems.

Question 28

Hypoglycemia at birth is also a huge risk for diabetic mothers. What is hypoglycemia at birth?

Answer 28

Babies exposed to increased glucose levels in the womb secrete high insulin amounts. Upon birth, when their umbilical cord s cut, their glucose levels will drop very low

Question 29

Baseline renal function in a diabetic pregnancy is assessed with what? What two levels are being assessed in this test?

Answer 29

A 24-hour urine collection test Levels being tested are: -Protein excretion -Creatinine clearance

Question 30

What blood level may be measured in a diabetic mother to assess average recent glycemic control?

Answer 30

A1C levels (Glycosylated Hemoglobin A1C)

Question 31

What does an A1C test provide the nursing staff with a diabetic pregnancy patient?

Answer 31

A1C test provides a "diabetic report card", meaning an evaluation of past glycemic control

Question 32

During the (__) and (__) trimesters of pregnancy, routine prenatal care of a diabetic pregnancy are scheduled every (__ to __) weeks

Answer 32

During the (1st) and (2nd) trimesters of pregnancy, routine prenatal care of a diabetic pregnancy are scheduled every (1 to 2) weeks

Question 33

TO achieve and maintain euglycemia (good glucose) it is important to know proper glucose levels. List the appropriate levels for each time of day: Before breakfast: Before lunch or dinner: Postmeal (1hr): Postmeal (2hr): 2 a.m. to 6 a.m.:

Answer 33

Before meals: 60-95mg/dl Before lunch or dinner:60-105mg/dl Postmeal (1hr): <140mg/dl Postmeal (2hr): <120mg/dl 2 a.m. to 6 a.m.: >60mg/dl

Question 34

A large bedtime snack of at least (__)g of (___________) with some protein or (____) is recommended to prevent (_____)glycemia and starvation (_________) during the night

Answer 34

A large bedtime snack of at least (25)g of (carbohydrates) with some protein or (fats) is recommended to prevent (hypo)glycemia and starvation (ketosis) during the night

Question 35

The ideal diet for diabetic pregnancy is (__ to __)% carbs, (__)% protein, and (__)% fats.

Answer 35

The ideal diet for diabetic pregnancy is (33 to 40)% carbs, (20)% protein, and (40)% fats.

Question 36

What is the encouraged activity time per day for a diabetic pregnancy?

Answer 36

30-60 minutes

Question 37

When exercising, when should women record their blood glucose levels?

Answer 37

Before and after exercising

Question 38

If a womans blood glucose is less than 100mg/dl, she should consume (__ to __) grams of (__________) to prevent (____)glycemia

Answer 38

If a womans blood glucose is less than 100mg/dl, she should consume (15 to 30) grams of (carbohydrates) to prevent (hypo)glycemia

Question 39

Women should avoid exercise if they have the presence of urine (________) or a blood glucose greater than (____)mg/dl

Answer 39

Women should avoid exercise if they have the presence of urine (ketones) or a blood glucose greater than (200)mg/dl

Question 40

In Insulin therapy, during the (__) trimester, from weeks (__ to __) of gestation, the insulin does should be reduced by (__ to __)% to avoid hypoglycemia

Answer 40

In Insulin therapy, during the (1st) trimester, from weeks (6 to 10) of gestation, the insulin does should be reduced by (10 to 25)% to avoid hypoglycemia

Question 41

In insulin therapy, during the 2nd and 3rd trimesters, because of insulin resistance, the dose must be (_________) (__________) to maintain targeted glucose levels

Answer 41

In insulin therapy, during the 2nd and 3rd trimesters, because of insulin resistance, the dose must be (increased) (significantly) to maintain targeted glucose levels

Question 42

Insulin requirements typically peak at how many weeks gestation?

Answer 42

36 weeks

Question 43

Procedure for mixing NPH (Intermediate-Acting) and Rapid-Acting Insulin: (skipping checking expiration date) 1.) Gently (______) the insulin vial 2.) Draw into the syringe the amount of (___) equal to the (____) dose 3.) Inject (___) equal to the (___) dose into the (___) vial. Remove the syringe from vial. 4.) Inject air equal to the rapid acting insulin dose into the vial, leave the syringe in the vial. 5.) (_______) the rapid acting vial and withdraw the dose 6.) Without adding more (___) to the (___) vial, withdraw the NPH dose

Answer 43

1.) Gently (invert) the insulin vial 2.) Draw into the syringe the amount of (air) equal to the (total) dose 3.) Inject (air) equal to the (NPH) dose into the (NPH) vial. Remove the syringe from vial. 4.) Inject air equal to the rapid acting insulin dose into the vial, leave the syringe in the vial. 5.) (invert) the rapid acting vial and withdraw the dose 6.) Without adding more (air) to the (NPH) vial, withdraw the NPH dose

Question 44

For Fetal Surveillance to assure fetal well-being, after the ultrasound during your 1st trimester, follow-up ultrasounds are typically scheduled as often as every (_ to _) weeks to monitor fetal growth and abnormalities.

Answer 44

For Fetal Surveillance to assure fetal well-being, after the ultrasound during your 1st trimester, follow-up ultrasounds are typically scheduled as often as every (4 to 6) weeks to monitor fetal growth and abnormalities.

Question 45

Women with pregestational diabetes are at a higher risk to have a fetus with congenital (_______) anomalies, so a fetal (________________) many be performed between (__ and __) weeks of gestation

Answer 45

Women with pregestational diabetes are at a higher risk to have a fetus with congenital (cardiac) anomalies, so a fetal (echocardiography) many be performed between (20 and 22) weeks of gestation

Question 46

The preferred method to evaluate fetal well-being is what test? When is this test usually performed and how often?

Answer 46

NST; Non-Stress Test Performed at 32 weeks' gestation and performed at least twice a week

Question 47

During the Intrapartum stage, women with pregestational diabetes must be monitored for complications of (____________), hypo(__________) and hyper(___________)

Answer 47

During the Intrapartum stage, women with pregestational diabetes must be monitored for complications of (dehydration), hypo(glycemia) and hyper(glycemia)

Question 48

In a pregestational diabetes pregnancy, once active labor begins, or the glucose level falls below 70mg/dl, an IV infusion containing (__)% dextrose should be piggybacked into the main IV line

Question 49

In pregestational diabetes, during active labor, blood glucose levels should be checked how often?

Answer 49

Hourly

Question 50

During active labor in a pregestational diabetes patient: How should Insulin be infused? What type of insulin should be infused? What should the mothers blood glucose be maintained at?

Answer 50

Short-acting insulin should be infused by continuous infusion, piggybacked into the main IV line and titrated Maintain glucose levels less than 110mg/dl

Question 51

During the first 24 hours postpartum, insulin requirements (_______) substantially, because the main source of insulin resistance, the (________) hormones, are (__________)

Answer 51

During the first 24 hours postpartum, insulin requirements (decrease) substantially, because the main source of insulin resistance, the (placental) hormones, are (reduced)

Question 52

Women with preexisting diabetes usually require only (___) to (___) of their most recent pregnancy insulin dose on the first postpartum day

Answer 52

Women with preexisting diabetes usually require only (1/3) to (1/2) of their most recent pregnancy insulin dose on the first postpartum day

Question 53

What causes hemorrhaging to be a risk in diabetic postpartum complications?

Answer 53

The mothers uterus was overdistended, like in polyhydramnios, or macrosomia or overstimulated from oxytocin

Question 54

Are women with diabetes encouraged to breastfeed?

Answer 54

Yes, but apparently bottle is more common (according to Reid)

Question 55

Women with GDM (Gestational diabetes Mellitus) have (________) risks than women with pregestational DM. However, the risks GDM have are still significant. Specify the risk percentages of each: -Preeclampsia: -Cesarean birth: -Type 2 DM later in life:

Answer 55

Women with GDM (Gestational diabetes Mellitus) have (fewer) risks than women with pregestational DM. -Preeclampsia: 9.8% if well controlled, 18% if not controlled -Cesarean birth: 17-25% -Type 2 DM later in life: 70%

Question 56

Fetal risks as a result of maternal hyperglycemia are: -Risk for neonatal (_______________) -Risk for fetal Hyper(_________)

Answer 56

-Risk for neonatal (hypoglycemia) -Risk for fetal hyper(insulinemia)

Question 57

When are most women screened for GDM?

Answer 57

24-28 weeks

Question 58

For blood glucose screening during prenatal care to test for GDM, ACOG recommends the 2-step screening method. What is the 2-step screening method?

Answer 58

-Mother drinks a 50g oral glucose load (OGTT: Oral Glucose Tolerance Test) -1 hour later, her plasma glucose is measured -A glucose value of 130-140mg/dl is considered positive -After a positive result, a second 3-hour test is done with 100g of oral glucose taken on another day

Question 59

During the 2nd step of the 2-step screening method for GDM, a patient is positive for GDM if two or more values are met or exceeded after ingesting the 100g oral glucose. List those values for each category: Fasting: 1-hour 2-hour 3-hour

Answer 59

Fasting: 95mg/dl or 105mg/dl 1-hour: 180mg/dl or 190mg/dl 2-hour: 155mg/dl or 165mg/dl 3-hour: 140mg/dl or 145mg/dl

Question 60

The standard diabetic diet for a pregnant patient involves intaking what amount of kcalories/day?

Answer 60

2000-2500 kcal/day

Question 61

What is a typical schedule for self-monitoring glucose daily?

Answer 61

Monitor/Record glucose when: -Fasting -1 or 2 hours after each meal

Question 62

Pharmacological therapy is begun when despite nutritional/exercise therapy: -Fasting plasma levels are persistently greater than: -1-hour post-meal levels are persistently greater than: -2-hour post-meal levels are persistently greater than:

Answer 62

-Fasting plasma levels are persistently greater than: 95mg/dl -1-hour post-meal levels are persistently greater than: 140mg/dl -2-hour post-meal levels are persistently greater than: 120mg/dl

Question 63

What is the recommended pharmacological treatment drug for GDM?

Answer 63

Insulin

Question 64

Aside from Insulin, what are 2 drugs used for blood glucose control in GDM?

Answer 64

-Metformin -Glyburide

Question 65

Metformin works by decreasing (_______) (_______) production and increasing peripheral (___________) to insulin

Answer 65

Metformin works by decreasing (hepatic) (glucose) production and increasing peripheral (resistance) to insulin

Question 66

For women with GDM who have well-controlled blood glucose levels, (__________) fetal testing isn't regularly performed unless there are signs of (_____________), a history of prior (________), or signs of macrosomia.

Answer 66

For women with GDM who have well-controlled blood glucose levels, (antepartum) fetal testing isn't regularly performed unless there are signs of (hypertension), a history of prior (stillbirth), or signs of macrosomia.

Question 67

If a woman with GDM has signs of hypertension, macrosomia, or a hx of prior stillbirth, at how many weeks gestation would NST be given? What should they be monitored for?

Answer 67

32-weeks' gestation Monitored for polyhydramnios (a consequence of fetal hyperglycemia)

Question 68

During the birthing process (intrapartum) blood glucose levels are monitored every (_ to _) hours to maintain blood glucose levels between (__ and ___) mg/dl

Answer 68

During the birthing process (intrapartum) blood glucose levels are monitored every (1 to 2) hours to maintain blood glucose levels between (80 and 110) mg/dl

Question 69

Even though most women with GDM return to normal glucose levels after birth, up to (___) will have DM or impaired glucose metabolism during postpartum screening

Answer 69

Even though most women with GDM return to normal glucose levels after birth, up to (1/3) will have DM or impaired glucose metabolism during postpartum screening

Question 70

Women with GDM have a chance as high as (___)% of developing type 2 DM within (__ to __) years

Answer 70

Women with GDM have a chance as high as (70)% of developing type 2 DM within (10 to 20) years

Question 71

(______) and (________) complicate 50% to (__)% of all pregnancies and typically begin at 4 to (___) weeks gestation. Luckily, they are usually confined to (___) weeks gestation

Answer 71

(Nausea) and (vomiting) complicate 50% to (80)% of all pregnancies and typically begin at 4 to (10) weeks gestation. Luckily, they are usually confined to (20) weeks gestation

Question 72

When vomiting during pregnancy becomes excessive enough to cause (______) loss, (___________) imbalance, nutritional deficiencies, and (_____)urea, the disorder is termed what?

Answer 72

When vomiting during pregnancy becomes excessive enough to cause (weight) loss, (electrolyte) imbalance, nutritional deficiencies, and (Keton)urea, the disorder is termed Hyperemesis Gravidarum

Question 73

(___________) gravidarum occurs in 0.3% to (__)% of pregnancies and usually begins in the (__) trimester. (__)% of women unfortunately experience this throughout the pregnancy

Answer 73

(Hyperemesis) gravidarum occurs in 0.3% to (3)% of pregnancies and usually begins in the (1st) trimester. (10)% of women unfortunately experience this throughout the pregnancy

Question 74

Several maternal characteristics are associated with developing hyperemesis gravidarum: -(_______) Maternal Age -(____)parity -BMI of (______________) -Low (_________________)

Answer 74

Several maternal characteristics are associated with developing hyperemesis gravidarum: -(Young) Maternal Age -(Nulli)parity -BMI of (less than <18.5 or greater than >25) -Low (socioeconomic status)

Question 75

Women with asthma, migraines, hyperthyroid disorders, and psychological illness all have an increased risk of developing what pregnancy issue?

Answer 75

Hyperemesis Gravidarum

Question 76

What are the 2 trademark signs for Hyperemesis Gravidarum (besides hyperemesis)

Answer 76

-Significant weight loss -Dehydration

Question 77

What are signs of dehydration in a woman with Hyperemesis Gravidarum?

Answer 77

-Dry mucous membranes -Decreased blood pressure -Increased pulse rate -Poor skin turgor

Question 78

Whenever a pregnant woman has nausea and vomiting, the most important initial lab test to screen for is a determination of what?

Answer 78

Ketonuria

Question 79

Medications can be used if Nausea and Vomiting are out of control. What is the mainline drug of choice used for tx of N/V in pregnancy?

Answer 79

Diclegis

Question 80

What is the drug Diclegis used for, and what is it a combination of?

Answer 80

Diclegis is used for N/V treatment in pregnant woman Diclegis is a combination of pyridoxine (Vitamin B6) and doxylamine (Unisom)

Question 81

What are the other 3 brand name drugs for the tx of N/V in pregnancy?

Answer 81

-Benadryl -Zofran -Reglan

Question 82

Avoiding an empty stomach helps fight Hyperemesis Gravidarum. How frequently should you eat? What should you separate and how often should you alternate?

Answer 82

Eat every 2-3 hours Separate liquids from solids and alternate every 2-3 hours

Question 83

The thyroid undergoes physiological changes during pregnancy, including an increase in (____) and an increase in T3 and T4 production levels of (___)%.

Answer 83

The thyroid undergoes physiological changes during pregnancy, including an increase in (size) and an increase in T3 and T4 production levels of (50)%.

Question 84

Why is diagnosis hyperthyroidism in pregnancy difficult?

Answer 84

Because many of the signs and symptoms of hyperthyroidism (nausea, anxiety, fatigue, increased heart rate) are all common pregnancy experiences

Question 85

Hyperthyroidism in pregnancy is rare, with a rate between 0.4% and (__)% of births. In most cases, Hyperthyroidism in pregnancy is caused by (______) disease

Answer 85

Hyperthyroidism in pregnancy is rare, with a rate between 0.4% and (1.7)% of births. In most cases, Hyperthyroidism in pregnancy is caused by (graves) disease

Question 86

S/S of Hyperthyroidism are: -(_____) intolerance -(________)sis -Fatigue -Anxiety -(_________) Lability -(_____)cardia

Answer 86

-(Heat) intolerance -(Diaphore)sis -Fatigue -Anxiety -(Emotional) Lability -(Tachy)cardia

Question 87

What are 3 signs to differentiate Hyperthyroidism from Pregnancy?

Answer 87

-Weight loss -Goiter -Pulse rate greater than 100 beats/min

Question 88

The two primary drugs used to treat Hyperthyroidism in pregnancy are?

Answer 88

-PTU (propylthiouracil) -MMI (methimazole)

Question 89

Hypothyroidism complicates between 0.2% and (__)% or pregnancies, so its even more rare than hyperthyroidism. Hypothyroidism is also associated with (____________) and risk of miscarriage.

Answer 89

Hypothyroidism complicates between 0.2% and (1.2)% or pregnancies, so it's even more rare than hyperthyroidism. Hypothyroidism is also associated with (infertility) and risk of miscarriage.

Question 90

Characteristic symptoms of hypothyroidism are: -Weight (_____) -Lethargy -(_________) in exercise (__________) -(_____) intolerance

Answer 90

-Weight (gain) -Lethargy -(Decrease) in exercise (tolerance) -(Cold) intolerance

Question 91

What is used to treat Hypothyroidism?

Answer 91

Thyroid hormone supplements like Synthroid (Levothyroxine)

Question 92

What is the goal of drug therapy for Hypothyroidism?

Answer 92

To maintain the TSH level at the lower end of the normal range for pregnant women

Question 93

Phenylalanine Hydroxylase (PAH) Deficiency is a sign of cognitive impairment. It is an inborn error of (__________) that is caused by an (___________) recessive trait that creates what?

Answer 93

Phenylalanine Hydroxylase (PAH) Deficiency is a sign of cognitive impairment. It is an inborn error of (metabolism) that is caused by an (autosomal) recessive trait that creates insufficient activity in PAH, an enzyme

Question 94

An inadequate amount of or abnormal activity of the PAH enzyme impairs the body's ability to do what?

Answer 94

Metabolize the amino acid Phenylalanine that is found in all protein foods

Question 95

What toxic effect occurs in the body due to PAH deficiency?

Answer 95

The body cannot metabolize Phenylalanine found in protein, which causes a toxic buildup of PHA in the bloodstream, which interferes with brain development

Question 96

Experts recommend that maternal PHA levels be less than (__)mg/dl for at least (__) months before conception, and range between (__) and (__) mg/dl throughout pregnancy

Answer 96

Experts recommend that maternal PHA levels be less than (6)mg/dl for at least (3) months before conception, and range between (2) and (6) mg/dl throughout pregnancy

Question 97

If breastfeeding safe for women with PHA deficiency?

Answer 97

Yes, as long as the baby DOESN'T ALSO have the deficiency