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Class 4 Diabetes and PIH Flashcards

(47 cards)

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1
Q

Gestational diabetes is associated with what?

A
  • Advanced maternal age
  • Obesity
  • Family hx of DM
  • Hx of stillbirth, neonatal malformation, or macrosomia
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2
Q

When do Gestational diabetes present? When is it most prevalent? and when does it end?

A
  • When patient cannot mount sufficient insulin response during pregnancy.
  • 2nd and 3rd trimesters
  • After delivery
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3
Q

Major acute complications with GD

A
  • DKA
  • Hyperglycemia (type 2)
  • Hypoglycemia
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4
Q

GD is associated with what 3 complications?

A
  • Gestational HTN
  • Polyhydramnios
  • C-Section
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5
Q

What is the best way to prevent fetal structure abnormalities?

A

-Early glycemic control

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6
Q

Normal A1C? Risk of vascular disease A1C?

A
  • 4-6%

- 6.5%

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7
Q

What risk factors are associated with stiff joint syndrome?

A
  • Type 1 diabetes
  • Short stature
  • Joint contractures
  • Tight skin
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8
Q

What makes direct laryngoscopy difficult with DM in preggos?

A

-C-spine rigidity of atlanto-occipital joint

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9
Q

Maternal insulin requirements progressively ______ during the 2nd and 3rd trimester & ______ at the onset of labor and after delivery.

A
  • Increase

- Decrease

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10
Q

Preanesthetic evaluation considerations?

A
  • SQ insulin is unpredictable
  • IV insulin more flexible
  • Preop blood sugar
  • Evaluate for end organ damage
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11
Q

What is the biggest concern for DM end organ damage?

A

-Diabetic Autonomic Neuropathy

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12
Q

Diabetic autonomic neuropathy can cause what problem for the preggo?

A
  • HTN
  • Ortho hypotension
  • Painless MI
  • Decreased response to meds
  • Decreased HR variability
  • Resting tachycardia
  • Neurogenic bladder
  • Gastroperesis
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13
Q

Intraop blood glucose should be in what range?

A

100-180

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14
Q

2 ways to administer introp insulin?

A
  • Half of daily dose then sliding scale

- Continuous infusion (plasma glucose/desired range = units/hr)

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15
Q

Patients on NPH insulin are at great risk of anaphylaxis from what drug?

A

-Protamine

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16
Q

What meds take longer to clear in a diabetic preggo?

A

-Local anesthetics (use less)

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17
Q

How does GD effect the placenta?

A

Reduces uteroplacental blood flow 35-45%

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18
Q

GD put patients at a great risk for what 3 problems?

A
  • Superimposed preeclampsia
  • Diabetic nephropathy
  • DKA
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19
Q

How do DKA ketones effect the fetus?

Study These Flashcards
A

-Decrease fetal O2

20
Q

Obese women need ______ local anesthetic in the epidural to achieve same block as non obese

21
Q

what are the 4 categories of preggo hypertension?

Study These Flashcards
A
  • Chronic HTN
  • Pregnancy induced
  • Preeclampsia / Eclampsia
  • Preeclampsia w/ chronic
22
Q

name the top 3 causes of maternal mortality in order?

Study These Flashcards
A
  • Thromboembolism
  • Non obstetric injuries
  • Hypertension
23
Q

What type of hypertension causes the most morbidity?

Study These Flashcards
A

-Superimposed preeclampsia

24
Q

Maternal diastolic BP over 110 is associated with what 2 things?

Study These Flashcards
A
  • Placental abruption

- fetal growth restriction

25
Pregnancy induced HTN is defined as what? When does it begin? End?
- Sustained SBP>140, DBP>90 - Later in pregnancy - Resolves 12 weeks postpartum
26
What is preeclampsia?
- New onset HTN after 20 weeks gestation or early postpartum | - Has Renal or other systemic involvement
27
Beside HTN what other symptoms can be seen with preeclampsia?
- Proteinuria - Oliguria - Headaches - Visual disturbances - Increased LFTs - Thrombocytopenia - ABD Pain - Edema - Rapid weight gain
28
Maternal risk factors for preeclampsia.
- 1st pregnancy - younger than 18 - Older than 35 - hx of preeclampsia - African american - Twins - Chronic HTN - Renal disease - Diabetes - Anti-phospholipid
29
Why might preeclampsia patients be difficult to intubate?
-Upper airway edema
30
Cardiac problems with preeclampsia
- Increased CO and SVR - Normal CVP - Reduced plasma volume
31
Respiratory problems for preeclampsia
-Pulmonary edema
32
Renal problems with preeclampsia
- Protienuria - Decrease GFR and CrCl - BUN increases w/ severity - Decreased blood flow - Acute renal failure
33
Oliguria and renal failure may occur in the absence of ______. Be careful w/ hydration as to not cause_____.
Hypovolemia | Pulmonary edema
34
Uterine effects of preclampsia
- Hypersensitivity to oxytocin - Preterm labor - Blood flow reduced - Abruption - Activity increased
35
What is the leading cause of maternal death in PIH?
Intercranial hemorrhage
36
Fetal complications of preclampsia / PIH
- Abruption - Growth restrictions - Premature delivery - Death
37
What is HELLP syndrome?
- Hemolysis - Elevated Liver enzymes - Low platelets
38
When does HELLP occur and what are the symptoms? And what is the cure?
- Before 36 weeks - Malaise, epigastric pain, N/V - Delivery
39
When is hemostasis a problem?
- < 40,000 | - Rate of fall is important
40
Drug of choice for preeclampsia prevention of seizures? Plasma levels? What is the reversal?
- Mag sulfate - Keep plasma level between 4-6 - Calcium
41
What are the goals for PIH and preeclamptic patients
- Control BP - Prevent seizures - Delivery
42
What drugs are used to control BP?
- Hydralizine - Labetelol - Nitro - Nifedipine - Esmolol
43
What will you see for mag toxicity?
-5-10 = long PR, wide QRS -11-14 = Depressed tendon reflexes -15-24 = SA, AV blocks respiratory paralysis >25 cardiac arrest
44
Advantages of epidural?
- Gradual onset of blockade - Avoids neonatal depression - Reduce HTN = improve uterine blood flow
45
Intubation considerations with PIH and preeclampsia?
- Blunted laryngeal response due to pretreatment of BP lowering drugs - Airway edema
46
How does Mag effect succs?
-Potentiates its effects
47
MgSO4 _____response to vasconstrictors and ______ catecholamine release after sympathetic stimulation
- Blunts | - Inhibits

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