Gestational Diabetes

Question 1

describe pregestational diabetes

Answer 1

type 1- no insulin production
type 2- decreased insulin production
*both will have greatly increased diabetic complications

Question 2

what is IUFD

Answer 2

intrauterine fetal demise is loss of fetus in utero

Question 3

what is HCS also known as

Answer 3

HPL

Question 4

what is IUGR

Answer 4

intrauterine growth restriction

Question 5

what is gestational diabetes

Answer 5

carbohydrate intolerance (variable severity)
may require insulin for regulation
4-14% of all pregnant women

Question 6

does gestational diabetes persist after pregnancy

Answer 6

it may

50% of gestational will convert to type 2 following pregnancy

Question 7

when is gestational considered resolved

Answer 7

about 15-24 hrs after placenta delivers

Question 8

risk factors of gestational diabetes

Answer 8

hx of gestational dm, family hx of dm, previous infant > 9 lbs, previous IUFD, obesity, >25 yrs

Question 9

patho of gestational diabetes

Answer 9

human chorionic sommatomamotropin (HCS) causes insulin resistance

Question 10

insulin needs in 2nd and 3rd trimester

Answer 10

increase in HCS causes need for MORE insulin

Question 11

describe glucose in relation to fetus

Answer 11

primary fuel for fetus, glucose crosses placenta, insulin does NOT cross

Question 12

what causes gestational diabetes

Answer 12

sensitivity to HCS or HPL

Question 13

potential maternal morbidity with diabetes

Answer 13

preeclampsia, infection, postpartum bleeding, cesarean section

Question 14

describe the maternal morbidity causes

Answer 14

preeclampsia; due to vascular inflammation
infection; due to increases glucose
postpartum bleeding; due to large fetus
cesarean section; due to large infant

Question 15

potential fetal morbidity with diabetes

Answer 15

macrosomia, IUGR, neonatal hypoglycemia, decrease in surfactant

Question 16

describe the fetal morbidity causes

Answer 16

macrosomia/birth trauma; d/t maternal hyperglycemia
IUGR; poor placental perfusion
neonatal hypoglecemia; monitor BS 3 hrs after birth

Question 17

higher circulating glucose=

Answer 17

LOWER SURFACTANT production

Question 18

decrease in surfactant…

Answer 18

5x greater risk of respiratory distress

Question 19

what is amniocentesis

Answer 19

test amniotic fluid to determine if fetus has enough surfactant to be born (usually done when woman comes in preterm and she is contracting)

Question 20

signs and symptoms of gestational diabetes

Answer 20

hydramnios, macrosomnia/ increased fundal ht, persistent glycosuria, ketonuria

Question 21

what is hydramnios

Answer 21

too much amniotic fluid

Question 22

what do you want the non fasting glucose level below

Answer 22

130

Question 23

if nonfasting glucose is ___ then immediately diabetic and no need for OGTT

Answer 23

200

Question 24

if > 200 lbs at prenatal entry…

Answer 24

assess glucose (GST) at first visit AND then also at 24 weeks

Question 25

if low risk or normal weight at prenatal entry...

Answer 25

GST between 24 and 28 weeks of pregnancy

Question 26

how does GST work

Answer 26

glucose screening test administer 50 g of glucose no fast, if >130 mg/dL then need a 3 hr OGTT

Question 27

how is OGTT done

Answer 27

fast check initial, 1 hr, 2 hr, and 3 hr if two of four glucose levels are elevated then diabetic

Question 28

treatment for gestational diabetes

Answer 28

diet (50% from carbs), exercise, daily BG log (1-4x a day)

Question 29

diet if obese and normal wt

Answer 29

obese: 1500 cal restriction normal: 2400 cal restriction

Question 30

drugs for gestational diabetes

Answer 30

oral hypoglycemic drugs | insulin

Question 31

oral hypoglycemic drugs for gestational

Answer 31

Glyburide: sulfonylurea(increases insulin production from beta cells) Metformin: biguanidine (decreases gluconeogenesis in liver and decreases glucose)

Question 32

insulin regimen for gestational

Answer 32

2:1 ratio, NPH and regular taken before dinner and breakfast

Question 33

how do insulin needs change towards end of pregnancy

Answer 33

during pregnancy: insulin needs continue to increase during labor: may/may not need insulin during postpartum: decrease at 24 hr after loss of placenta due to DECREASE in HPL

Question 34

important nursing care for gestational diabetes

Answer 34

EDUCATION poor glycemic control effects dietary teaching and exercise review

Question 35

prenatal care for gestational dm

Answer 35

prenatal care every 2 wks until 3rd trimester (then every week) routine non stress test to ensure placenta not damaged

Question 36

what should be regularly checked for diabetes

Answer 36

check Lecithin-sphingomyelin ratio | L/S ratio for lung maturity

Question 37

what happens if L/S ratio is low

Answer 37

will NOT deliver because surfactant is too low

Question 38

what needs to be monitored at birth if gestational diabetes

Answer 38

monitor for hypoglycemia at birth

Question 39

DKA in gestational

Answer 39

diabetic ketoacidosis neurological squeale due to ketosis perinatal mortality= 90% if DKA maternal mortality=5-15% if DKA