Exam 3 Diabetes

Question 1

Which women in White’s classification generally have positive pregnancy outcomes as long as their BG levels are controlled?

Answer 1

Classes A-C

Question 2

Class A1

Answer 2

Woman has 2 or more abnormal values with normal fasting BS. BG levels are diet controlled

Question 3

Class A2

Answer 3

Woman has not been known to have diabetes before pregnancy but requires medication for BG control

Question 4

Class B

Answer 4

Onset of dz occurs after age 20 and duration of illness is less than 10 years

Question 5

Class C

Answer 5

Onset of dz occurs between 10-19 or duration is 10-19 years

Question 6

Class D

Answer 6

Onset of dz occurs at less than 10 years of age or duration of illness greater than 20 years

Question 7

Class F

Answer 7

Pt developed diabetic nephropathy

Question 8

Class R

Answer 8

Pt developed retinitis proliferans

Question 9

Class T

Answer 9

Pt has had a renal transplant

Question 10

Risk factors for GDM

Answer 10

Family hx, stillbirth, malformed or macrocosmic fetus, obesity, HTN, glycosuria, older than 25

Question 11

When is GDM usually diagnoses?

Answer 11

2nd half of pregnancy

Question 12

Who should be screened for GDM?

Answer 12

All preg women not known to have pre gestational DM

Question 13

What are the 2 different screening methods for GDM?

Answer 13

1. Oral glucose tolerance test

2. 3 hour OGTT

Question 14

Management of GDM is based on what?

Answer 14

BG not urine glucose

Question 15

GDM diets are individualized to what?

Answer 15

Increased fetal requirements, pre-pregnancy weight, dietary habits, overall health, ethnic background, lifestyle, stage of pregnancy, nutrition

Question 16

Dietary goal with GDM

Answer 16

Provide weight gain consistent with normal preg, prevent ketoacidosis, and minimize wide fluctuations of blood glucose levels

Question 17

First trimester calories for GDM

Answer 17

2200

Question 18

Second and third trimester calories for GDM

Answer 18

2500

Question 19

Standard diabetic diet for GDM

Answer 19

3 meals and 1-3 snacks, on time, never skip

Question 20

Four hours without food intake increases the risk of what?

Answer 20

Hypoglycemia

Question 21

Bedtime snack to prevent hypoglycemia and ketosis

Answer 21

25 grams of carbs with some protein and fat

Question 22

Ideal diet breakdown for GDM

Answer 22

55% carbs
20% protein
25% fat (less than 10% saturated)

Question 23

Good food groups for GDM

Answer 23

Complex carbs, high in fiber and starch and protein to help regulate the BG level by a more sustained glucose release

Question 24

Recommended exercise for GDM

Answer 24

Aerobic with resistance training for at least 30 min most days of the week, non-weight bearing activities such as arm exercises or recumbent bicycle

Question 25

When is the best time to exercise

Answer 25

After meals when glucose level is rising

Question 26

Insulin needs during 1st trimester

Answer 26

Decreases

Question 27

Insulin needs during 2nd and 3rd trimesters

Answer 27

Increases

Question 28

Insulin needs during labor

Answer 28

Vary

Question 29

What is the most commonly prescribed oral agent for GDM?

Answer 29

Glyburide

Question 30

How safe is glyburide during pregnancy?

Answer 30

Minimal amounts cross the placenta

Question 31

When are antepartum women instructed to monitor their BS?

Answer 31

Rising in the morning, after breakfast, before and after lunch, after dinner, bedtime

Question 32

When are BG levels monitored intrapartumly?

Answer 32

Hourly

Question 33

When do most women with GDM return to normal BG levels?

Answer 33

After childbirth

Question 34

What is the risk for GDM in the woman's next pregnancy?

Answer 34

35-75%

Question 35

What is the woman's risk for developing type 2 DM in the next 20 years?

Answer 35

35-60%

Question 36

What is associated with an increased risk of miscarriage concerning GDM?

Answer 36

Poor glycemic control around the time of conception and in the early weeks of pregnancy

Question 37

Poor glycemic control in women without vascular dz increases the risk of what?

Answer 37

Fetal macrosomia

Question 38

Macrosomia

Answer 38

A birth weight more than 400-4500 grams or greater

Question 39

Characteristics of babies born to women with GDM

Answer 39

Disproportionate increase in shoulders, trunk, and chest size. May cause shoulder dystocia. Increased risk for cesarean birth

Question 40

Polyhydramnios concerning GDM

Answer 40

Frequently develops during the 3rd trimester, unknown cause

Question 41

What is the most important cause of perinatal loss in a diabetic pregnancy?

Answer 41

Congenital malformation

Question 42

What is the incidence of congenital malformations related to?

Answer 42

The severity and duration of the diabetes

Question 43

Common birth injuries associated with diabetic pregnancies

Answer 43

Brachial plexus palsy, facial nerve injury, humerus or clavicle fracture, cephalhematoma

Question 44

What are infants at risk for at birth?

Answer 44

Hypoglycemia, hyperbilirubinemia, respiratory distress

Question 45

What are the major causes of cardiac dz in preg women?

Answer 45

Cardiomyopathy and congenital heart dz

Question 46

Class I heart dz

Answer 46

Asymptomatic without limitation of physical activity

Question 47

Class II heart dz

Answer 47

Symptomatic with slight limitation of activity

Question 48

Class III heart dz

Answer 48

Symptomatic with marked limitation of activity

Question 49

Class IV heart dz

Answer 49

Symptomatic with inability to carry on any physical activity without discomfort

Question 50

Maternal cardiac dz risk group 1

Answer 50

* Mortality rate less than 1% - Corrected tetralogy of fallot - Pulmonic/tricuspid dz - Mitral stenosis - Patent Ductus Arteriosis - Ventricular septal defect - Atrial septal defect

Question 51

Maternal cardiac dz risk group 2

Answer 51

* Mortality rate 5-15% - Artificial valves - Mitral stenosis (classes 3-4) - Atrial fibrillation - Uncorrected tetralogy of fallot - Aortic coarctation (uncomplicated) - Aortic stenosis - Previous MI - Marfan syndrome w/ normal aorta

Question 52

Maternal cardiac dz risk group 3

Answer 52

* Mortality rate 25-50% - Aortic coarctation (complicated) - Endocarditis - Marfan syndrome w/ aortic involvement - Eisenmenger syndrome - Pulmonary HTN

Question 53

S/S of cardiac decompensation are taught when?

Answer 53

At the first prenatal visit and reviewed at each subsequent visit

Question 54

The heart dz pregnant women should increase her intake of what?

Answer 54

Fluids and fiber, may be given a stool softener

Question 55

Subjective S/S of cardiac decompensation

Answer 55

Increased fatigue, dyspnea, smothering feeling, frequent cough, palpitations, generalized edema

Question 56

Objective S/S of cardiac decompensation

Answer 56

Irregular, weak, rapid pulse, progressive generalized edema, crackles at base of lungs after 2 inspirations and exhalations that do not clear after coughing, Orthopnea, rapid respirations greater than or equal to 25 breaths per min, moist frequent cough, cyanosis of lips and nail beds

Question 57

How is cardiac function supported intrapartumly?

Answer 57

By keeping head and shoulders elevated and body parts resting on pillows

Question 58

What kind of labor is preferred for women with cardiac dz?

Answer 58

Spontaneous or induced labor followed by vaginal birth

Question 59

Which position usually facilitates positive hemodynamics during labor?

Answer 59

Side lying

Question 60

What kind of oxygen is important during labor with cardiac dz?

Answer 60

Mask

Question 61

Why are C-Sections not recommended for heart dz?

Answer 61

Risk of dramatic fluid shifts, sustained hemodynamic changes, increased blood loss

Question 62

What is given immediately after birth to prevent hemorrhage?

Answer 62

Oxytocin

Question 63

What should not be used in heart dz pts after delivery?

Answer 63

Methergine, it causes HTN

Question 64

What is the most hemodynamically difficult period for heart dz pts after birth?

Answer 64

The first 24-48 hours

Question 65

Activity after labor for heart dz pts

Answer 65

Progressive ambulation is permitted as tolerated

Question 66

hat is the most common medical disorder of pregnancy affecting 20-60% of women?

Answer 66

Anemia

Question 67

Normal hematocrit range in nonpreg woman

Answer 67

37-47%

Question 68

Normal hematocrit values for preg women with adequate iron

Answer 68

33%

Question 69

Anemia in pregnancy is defined as what?

Answer 69

Hemoglobin less than 11% in the 1st and 3rd trimesters and less than 10.5% in the 2nd trimester

Question 70

What is considered severe anemia?

Answer 70

A hemoglobin level less than 6-8%

Question 71

Primary chronic dz of brain reward and motivation

Answer 71

Substance abuse

Question 72

Current standard of care during pregnancy for women addicted otto opioids

Answer 72

Methadone maintenance