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NURS 4500: Midterm Material > Class 3: Gestational Diabetes and Pre-Existing Diabetes > Flashcards

Class 3: Gestational Diabetes and Pre-Existing Diabetes Flashcards

1
Q

define: gestational conditions

A
  • disorders that did not exist before pregnancy
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2
Q

what are 3 classifications of diabetes

A
  • type 1
  • type 2
  • gestational diabetes
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3
Q

what is gestational diabetes

A
  • any degree of glucose intolerance with onset or recognition during pregnancy
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4
Q

what risks does GDM provide to the pregnant person and fetus (14)

A
  • 2x risk of HTN disorders (pre-eclampsia)
  • infection
  • trauma and injuries during birth
  • macrosomia
  • c-section birth
  • should dystocia
  • pre-maturity
  • fetal and neonatal hypoglycemia
  • IUGR
  • intrauterine fetal death
  • fetal lung immaturity
  • hyperbilirubinemia
  • hypocalcemia
  • polycythemia
  • birth trauma
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5
Q

what are risk factors for developing GDM (10)

A
  • age > 35
  • BMI > 30
  • prediabetes
  • high risk groups
  • parents and sibling w T2DM
  • personal history of GDM
  • previous infant >4 kg birthweight (macrosomia)
  • on glucocorticoids
  • acanthosis nigricans or PCOS
  • current pregnancy –> fetal macrosomia or polyhydramnios
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6
Q

what populations are at high risk for developing GDM

A
  • african
  • arab
  • asian
  • hispanic
  • indigenous
  • south asian
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7
Q

universal screening for GDM is done when?

A
  • screen all pregnant people between 24-28 weeks
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8
Q

what is the preferred approach for screening & diagnosing GDM

A
  • random non-fasting 50g OGTT
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9
Q

what BG lvl is normal vs GDM after a random non-fasting 50g OGTT?

A
  • normal = 1hr PG <7.8
  • GDM = 1hr PG > 11.1
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10
Q

what is included in antepartum mngmt of GDM (5)

A
  • diet **
  • exercise **
  • monitoring BG lvls **
  • insulin therapy
  • fetal surveilance (freq and degree depend on several factors)

*** = first line, trial for 2 weeks

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11
Q

what is included in intrapartum mngmt of GDM (3)

A
  • monitor glucose
  • hydration
  • fetal monitoring
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12
Q

what is included in postpartum mngmt of GDM (4)

A
  • encourage chest/breastfeeding for at least 4 months (helps stabilize newborn BG, decreases r/o birther T2DM)
  • screening for T2DM during the first 6 weeks to 6 months postpartum
  • education re: planning for another pregnancy
  • stop insulin and diabetic diet
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13
Q

what are glycemic targets for fasting? 1hr PP? 2hr PP?

A
  • fasting: 3.8-5.2
  • 1hr PP: 5.5-7.7
  • 2hr PP: 5-6.6
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14
Q

expected weight gain in pregnancy depends on…

A
  • starting BMI
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15
Q

for a BMI of 18.5-24.9 “normal weight”, what is expected weight gain?

A
  • 11.5-16 kg OR 25-35 lbs
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16
Q

what education/counselling is given during prenatal visit regarding GDM (2)

A
  • kick counts
  • S&S of infection, HTN, other
17
Q

what FH assessments are included in prenatal visits r/t GDM (5)

A
  • FHR
  • SFH
  • leopold’s maneuvers
  • fetal mvmts
  • enhanced fetal monitoring (BPP, NST)
18
Q

what physical assessments are done in prenatal visits r/t GDM (5)

A
  • refer back to class 2 for details for routine prenatal care physical exam
  • general appearance
  • BMI
  • VS
  • urine dip & UA
19
Q

what history/subjective assessment is done in prenatal visits r/t GDM (3)

A
  • routine prenatal care history/interview
  • ask how coping mentally
  • specific history for person w GDM
20
Q

what is T2DM

A
  • group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both
21
Q

T2DM may be caused by either or both of the following (2)

A
  • impaired insulin secretion
  • inadequate insulin action in target tissues
22
Q

what are risks and complications of pre-gestational diabetes (7)

A
  • perinatal mortality
  • congenital malformations
  • HTN
  • preterm delivery
  • large for gestational age infants
  • c-section birth
  • neonatal morbidities
23
Q

describe preconception counselling for pregestational DM (4)

A
  • folic acid**
  • optimize glucose mngmt prior to pregnancy
  • review meds in prep for pregnancy
  • review complications of diabetes
24
Q

what are fetal and newborn risks of pregestational DM (6)

A
  • large for gestational age infants
  • macrosomia
  • sudden still birth
  • congenital anomalies
  • birth injuries
  • hypoglycemia birth
25
Q

what is strongly encouraged for pregestational diabetes

A
  • preconception counseling
26
Q

what is included in assessment for GDM (4)

A
  • interview
  • physical exam
  • lab tests
  • fetal health surveilance
27
Q

what lab tests are done for GDM (5)

A
  • routine prenatal tests
  • 24-hr urine protein
  • Cr Cl
  • HbA1C
  • retinal exam
28
Q

what is included in fetal health surveilance for GDM (5)

A
  • FHR
  • SFH
  • leopold’s maneuvers
  • fetal mvmts/kick counts
  • enhanced fetal monitoring (NST, BPP) in late 2nd and 3rd trimester depends on indiv circumstances
29
Q

what is included in antepartum care for GDM (6)

A
  • diet
  • exercise
  • monitor BG levels
  • insulin therapy
  • complications requirinh hospitalization
  • determination of birth date and mode of delivery
30
Q

what is included in intrapartum care for GDM

A
  • close monitoring of BG lvls and dehydration
31
Q

what is included in postpartum care for GDM (4)

A
  • insulin requirements decrease substantially in immediate postpartum period
  • chest/breastfeeding
  • monitor for postpartum complications
  • family planning and contraception
32
Q

describe insulin needs in 1st semester (2)

A
  • need is reduced d/t increased insulin production by pancreas and increased peripheral sensitivity
  • NV and decreased food intake by mother and glucose transfer to embryo and fetus contribute to hypoglycemia
33
Q

escribe insulin needs in 2nd trimester

A
  • insulin need increases as placental hormones, cortisol, and insulinase act as insulin antagonists = decreased effect of insulin
34
Q

describe needs of insulin in 3rd trimester

A
  • insulin requirements gradually increase until about 36 weeks of gestation
35
Q

describe needs of insulin on day of birth

A
  • maternal insulin requirements drop drastically to approach prepregnancy levels
36
Q

describe insulin requirements when breastfeeding

A
  • maintains lower insulin requirements
37
Q

describe insulin needs of nonbreastfeeding pregnant people

A
  • returns to pre-pregnancy levels in 7-10 days
38
Q

GDM and pre-existing DM can …

A
  • increase risk in pregnancy of poor outcomes for both pregnant person and fetus/newborn
39
Q

what is particularly important for those w pre-existing diabetes and those who had GDM in a previous pregnancy

A
  • preconception care

NURS 4500: Midterm Material (19 decks)

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