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high risk OB > diabetes in pregnancy > Flashcards

diabetes in pregnancy Flashcards

(69 cards)

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1
Q

complications with fetus in pregnancy (diabetic)

A

-fetal death (pre-gest DM)
-birth defects (pre-gest DM)
-IUGR (pre-gest DM)
-macrosomia
-birth trauma
-NN hypoglycemia
-NN polycythemia/hyperbilirubinemia
-NN resp distress
-childhood obesity
-development metabolic diseases in lifetime (obesity, HTN, CVD, T2DM)

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2
Q

polycythemia

A

too many red blood cells

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3
Q

complications for mom in pregnancy (diabetic)

A

-hypoglycemia (early pregnancy)
-DKA
-retinopathy (pre-gest DM)
-nephropathy (pre-gest DM)
-vasculopathy (pre-gest DM)
-HTN disorders
-polyhydramnios/hydramnios
-infection
-preterm labor/birth
-PPH (bc of big baby)
-trauma

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4
Q

type DM:
-absolute insulin deficiency
-immune

A

T1DM

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5
Q

type DM:
-defective insulin secretion and insulin resistance
-due to lifestyle

A

T2DM

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6
Q

diabetes diagnosed in 2nd or 3rd tri that was not clearly overt diabetes prior to gestation

A

gestational

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7
Q

how does early pregnancy effect insulin production

A

-increased insulin production
-increased tissue sensitivity to insulin
(storing up insulin for later growth)
*easier to be hypoglycemic

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8
Q

how does later pregnancy effect insulin production

A

-increase insulin antagonistic hormones
-decreased tissue sensitivity
*easier to be hyperglycemic

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9
Q

factors that trigger DKA in pregnancy

A

-fasting hyperglycemia
-infection
-stress
-emesis
-dehydration
-gastroparesis
-meds (sympathomimetics, steroids)

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10
Q

what are tocolytics for
what kind of med is it

A

break up contractions
ex: terbutaline (sympathomimetic)

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11
Q

how can sympathomimetics and steroids trigger DKA

A

increase glucose levels

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12
Q

how do vascular complications with diabetes affect the fetus

A

impaired blood flow to placenta

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13
Q

recommended A1C for preconception care

A

<6.0-6.5

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14
Q

screening for gestational diabetes for women with and without risk factors for T2DM

A

-with risk factors: at preconception or 1st prenatal visit
-without risk factors: 24-28 weeks screening

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15
Q

*diagram for 2 step gestational diabetes screening

A
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16
Q

step 1 of 2 step GDM screening

A

1 hour (50 g) oral glucose screen
-if neg (<130): routine prenatal care
-if pos (>130): 2nd step

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17
Q

step 2 of 2 step GDM screening

A

normal diet and exercise for 3 days before test
NPO for 12 hours before test
3 hour (100 g) OGTT
-neg: routine care
-pos: if 2 or more values are exceeded
(fasting: 95+, 1 hour: 180+, 2 hour: 155+, 3 hour: 140+)

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18
Q

blood glucose range recommended during pregnancy

A

60-140

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19
Q

what big HTN disorder does any type of diabetes increase the risk for

A

pre-eclampsia

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20
Q

1st tri care for woman with PGDM

A

-early sonogram (confirm due date, assess for anomalies)
-monitor for S+S complications
-lots of pt education

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21
Q

what kind of diabetes is shown through 1st tri

A

only pregestational DM

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22
Q

what is considered hypoglycemia during pregnancy

A

<70

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23
Q

example of 15 grams carbs

A

4 oz juice/soda

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24
Q

Tx for blood sugar of 60-70

A

15 g carbs

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25
Tx for blood sugar of 40-60
30 g carbs (1/2 liquid, 1/2 solid)
26
2nd tri care for PGDM/GDM (screenings)
-MSAFP @16-18 weeks (looking for NTD) -fetal ECG @18-22 weeks, 34 weeks -ultrasound q4-6weeks (growth, anomalies, hydramnios, possible doppler blood flow)
27
sick day management guidelines
-continue insulin as ordered -check urine ketones q4-6h -check BS q1-2h -consume liquid or soft foods -sip 15-30 g carbs/hr during periods vomiting -notify HCP if liquids not tolerated -notify HCP S+S of ketoacidosis -notify HCP if BS >200 -notify HCP if urine ketones >moderate
28
S+S ketoacidosis to report to HCP
-abdominal pain -N/V -polyuria/polydipsia -fruity breath -tachypnea -altered mental status -leg cramps
29
meal plan recommendations for PGDM and GDM moms
-based on prepregnancy BMI and nutritional status -40% carbs, 20% protein, 40% fat -3 meals + 3 snacks -large bedtime snack to avoid hypoglycemia
30
why do you have to be careful for mom with PGDM/GDM with vascular disease doing exercise
shunts blood flow away from baby
31
exercise recommendations for PGDM/GDM moms
-best time exercise is 10-20 min after meal -don't exercise if pos urine ketones, BS >200 -walking/aerobic 30 mins/day
32
how many times do pregestational diabetic moms have to monitor capillary BS
5-8 times/day -fasting, 1-2 hour pp, bedtime, 2-3 am
33
how many times do gestational diabetic moms have to monitor capillary BS
atleast 4 times/day -fasting, 1-2 hour pp
34
when during pregnancy do you need: -less insulin -more insulin
less: 13-20 weeks EGA more: 20 weeks-birth
35
risk with continuous subq insulin infusion (CSII)
pump failure resulting in DKA
36
preferred med for managing diabetes in pregnancy
insulin
37
oral antidiabetic med options during pregnancy (2)
-metformin (drug of choice) -glyburide
38
3rd tri care for PGDM/GDM moms
-delivery an option if needed -kick counts -NST/BPP/AFI: 28-32 weeks, 1-2x/week -ultrasound for growth (small/large) -monitor for vascular complications (esp T1DM)
39
when is it ok to await spontaneous labor or induce at 40 weeks
-well controlled diabetes -no comorbidities -reassuring fetal testing *no going past term
40
when should there be an early birth (36-38 weeks or earlier)
-vasculopathy -nephropathy -poor glucose control -prior fetal loss -prior macrosomia -fetal compromise
41
when should there be a C/S
-baby estimated weight >4500 g (9-10 lbs) -OB indications
42
L&D considerations for diabetic moms (IVs, BP, baby)
-mainline IV NS -IVPB D5 (when labor begins or BS<70) -IVPB reg insulin in NS -check BS q1-4h -maintain BS between 70-110 -IV bolus prn (NS only, give slowly) -continuous EFM -monitor for failure to descend/progress -anticipate shoulder dystocia -anticipate need for neonatal resuscitation
43
postpartum care considerations for diabetic moms
-dramatic drop for insulin needs first 24 hours -risk hemorrhage (uterine distention from LGA, hard to palpate fundus if obese) -risk for infection -delayed lactogenesis -DC IV insulin
44
benefits breastfeeding for diabetic moms
-better BS control -reduces risk infant for developing DM
45
when should the 2 step glucose test be repeated after birth
-4-12 weeks PP (or after breastfeeding stopped) -1 year PP -q3-5years -prior to another pregnancy
46
nursing care for DKA
-fluids -insulin -electrolyte replacement (esp K) -O2 -EFM (also tells you mom's perfusion status) -uterine activity (dehydration can cause Cxs)
47
IDM
infant of diabetic mother
48
effects of hypo/hyperglycemia in fetus during later pregnancy
-fetal hyperinsulinemia -excessive growth (esp shoulders and body) -inhibited release of surfactant -hypoxia (increased RBC production to compensate, leads to NN polycythemia)
49
effects of hypo/hyperglycemia in fetus during early pregnancy
-spontaneous abortion -congenital malformations (cardiac, CNS, GU, skeletal)
50
cues of shoulder dystocia during labor and delivery
-slowing of progress of labor -more than 60 secs from head to body being born -external rotation doesn't occur -when head emerges, it retracts against perineum (turtle sign) -palpation of overlapping suture lines and edema of baby's head during vaginal exam
51
proactive plan for shoulder dystocia (prepare for all diabetic moms)
-big room size -position for birth (squatting) -anesthesia (epidural) -episiotomy -empty bladder
52
Tx for shoulder dystocia
-call for help -mcroberts maneuver (knees to ears) -suprapubic pressure if those don't work: -woods maneuver ("screw maneuver", hands on baby's scapula and clavicle, rotating shoulders toward fetal chest) if that doesn't work: -gaskin maneuver (all 4s)/running start position
53
maternal risks with shoulder dystocia
-PPH -extended episiotomy -rectal injuries
54
neonatal risks with shoulder dystocia
-asphyxia -brachial plexus injury -fracture of humerus/clavicle
55
white's classification of diabetes: A1 -onset -fasting BS -2 hr pp BS -Tx
onset: gestational fasting BS: <105 2 hr pp BS: <120 Tx: diet and exercise
56
white's classification of diabetes: A2 -onset -fasting BS -2 hr pp BS -Tx
onset: gestational fasting BS: >105 2 hr pp BS: >120 Tx: insulin
57
white's classification of diabetes: B -onset -duration -vascular disease -Tx
onset: 20+ yo duration: <10 yrs vascular disease: none Tx: insulin
58
white's classification of diabetes: C -onset -duration -vascular disease -Tx
onset: 10-19 yo duration: 10-19 yrs vascular disease: none Tx: insulin
59
white's classification of diabetes: D -onset -duration -vascular disease -Tx
onset: <10 yo duration: >20 (?) vascular disease: benign retinopathy Tx: insulin
60
white's classification of diabetes: F -onset -duration -vascular disease -Tx
onset: any duration: any vascular disease: nephropathy Tx: insulin
61
white's classification of diabetes: R -onset -duration -vascular disease -Tx
onset: any duration: any vascular disease: proliferative retinopathy Tx: insulin
62
white's classification of diabetes: H -onset -duration -vascular disease -Tx
onset: any duration: any vascular disease: heart Tx: insulin
63
risk factors for type 2 diabetes which would indicate the need to screen the pregnant woman at her first prenatal visit
-morbid obesity -family history -gestational diabetes in previous pregnancy
64
how should woman prepare for 3 hr OOGT
atleast 3 days unrestricted diet and normal physical activity no smoking or caffeine for 12 hrs before
65
positive results for GDM from 3 hr OOGT
fasting: 95 1 hr pp: 180 2 hr pp: 155 3 hr pp: 140
66
target BS levels for pregnant woman with diabetes -fasting -before meal -1 hr pp -2 hr pp -2 am -6 am
-fasting: 60-95 -before meal: 60-105 -1 hr pp: <140 -2 hr pp: <120 -2 am-6 am: >60
67
recommendation for follow up testing of a woman who had gestational diabetes following the birth of the baby
-4-12 wks postpartum (or after breastfeeding stops) -1 year after birth -every 3-5 years -before another pregnancy
68
Tx for BS of 60-70 in pregnant woman
15 g carbs (4 oz juice/soda)
69
Tx for BS of 40-60 in pregnant woman
30 g carbs (1/2 solid, 1/2 liquid) *adding protein reduces risk rebound hypoglycemia

high risk OB (14 decks)

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