Maternity week 3-1 Flashcards
(49 cards)
Diabetes Defined
Disease process marked by impaired production of, or impaired response to, insulin.
Disease process leads to hyperglycemia.
Chronic, untreated disease causes secondary effects in multiple body systems.
pre-gestational diabetes
existed before pregnancy
Gestational Diabetes
Glucose intolerance/onset in pregnancy
GDMA1= diet-controlled; GDMA2 =medication controlled
Affects up to 10% of pregnancies in U.S.
Diabetes 2/2 Other causes:
Diabetes 2/2 Other causes: drug-induced, disease/procedure-induced
Diabetes in Pregnancy
Pregestational Diabetes vs. Gestational Diabetes Mellitus (GDM)
GDM dx confers risk of dx. of Type II DM Postpardum (this just means they had it before but didn’t know it. preg did not cause diabetes):
Up to 10% of pregnant people w/ GDM will receive GDM dx postpartum
30-65% of pregnant people w/ GDM will receive GDM dx 10-20 yrs later
GDM Risk Factors
Previous pregnancy affected by GDM
Hx of infant >9#
Member of ethnic group with high risk
Obesity
Physical inactivity
PCOS
Hypercholesteremia
1st deg relative w/ diabetes
HTN
Diabetes Risk Assessment:
Nursing Care
No history of glucose intolerance
Younger than 25 years old
Normal body weight
No family history (first-degree relative) of diabetes
No history of poor obstetric outcomes
Not from an ethnic/racial group with a high prevalence of diabetes
GDM Sub-types
CLASS A-1 (GDMA1 or A1GDM):
2 abnormal values on OGTT
Diet-controlled
Fasting blood glucose normal
CLASS A-2 (GDMA2 or A2GDM):
Medication controlled.
No dx of pre-gestational diabetes
Metabolic Changes in Pregnancy
1st trimester - more sensitive to insulin, in 2nd and 3rd, starts to drop.
“Diabetogenic” Effect of Pregnancy
Metabolism directed towards supplying adequate nutrition to the fetus
Increased resistance to insulin: estrogen, progesterone, human chorionic somatomam-motropin (Hcs), cortisol, human placental lactogen released by placenta
Compensatory increased production of insulin by the pancreas
Post Partum: Return to pre-pregnant metabolism
1st trimester
goes up = estrogen /progesterone stimulate beta cells to increase insulin production
Increased insulin sensitivity
Increased glucose metabolism/dec blood glucose
Increase in glycogen stores and decrease in glucose production
Pre-gestational DM= inc risk hypoglycemia
2nd and 3rd Trimesters
Increased insulin resistance
Increased hepatic production of glucose
How is extra glucose stored
by fetus?
Gestational Diabetes Screening
1st tri screening for high risk clients
Inconsistent practices
Routine screening: 24-28 weeks
GLT
GTT if indicated by abnormal GLT (ACOG: 2 step approach)
Testing:
Glucose Load vs. Glucose Tolerance
Oral Glucose Load Test (OGLT or GLT)
*Administer 50g oral glucose (Glucola) p.o.
*Draw1 hour venous blood glucose (bg) *Refer for GTT if bg >139 mg/dL
*Some labs do 75g load/2 hour bg
Oral Glucose Tolerance Test (OGTT or GTT)
*Draw fasting venous blood glucose
*Administer 100 g oral glucose p.o.
*Draw 1 hour, 2 hour, 3 hour bg
Testing:
Glucose Load vs. Glucose Tolerance cont’d
GTT normal values
*Fasting bg <95 mg/dL
*One hour bg <180 mg/dL
*Two hour bg <155 mg/dL
*Three hour bg <140 mg/dL
Two elevated bg=GDM dx
Complications of GDM: Pregnant Person
Polyhydramnios (hydramnios): hyperglycemia= inc fetal diuresis
Abnormal blood glucose
Pre-eclampsia/GHTN
Ketoacidosis
C-Section
Instrument assisted delivery (vac, forcep)
Shoulder dystocia
SAB
Infections: UTI, chronic monilial vaginitis
Complications of GDM: Fetus/Neonate
Congenital anomalies: hyperglycemia in 1st tri.:
NDS (neural tube defects, usually from folic acid)
Anencephaly/microcephaly
Cardiac anomolies
Macrosomia
Preterm birth
Fetal asphyxia
IUGR
Perinatal Death
RDS
Polycythemia
Hyperbilirubinemia
Hypoglycemia
Childhood Obesity/Carb Intolerance
Screenings Throughout Pregnancy
Fundal Height
Blood Tests for genetic screening
Ultrasound for physical anomalies
Echocardiogram for heart anomalies
Lab Tests: U/A and Culture, Serum Glucose, Glycosylated Hgb (A1c), Electrolytes and Renal Function
Perinatal Diabetes Nursing Care
Pre-gestational counseling for clients w/ DM
Complete OB hx
Serum lab tests: HgA1C thyroid function, nephropathy, and retinopathy
Urine screen (POC - point of care = at the bedside)
Teach: dietary modifications, changes in activity, blood glucose monitoring/med administration PRN, home BP monitoring
Refer to dietrician/nutritionist per provider order
Patient Education: Nutrition
Follow prescribed diet plan
Divide daily food intake: 3 meals, 2 -3 snacks
Eat bedtime snack to prevent hypoglycemia NOC
Avoid refined sugar foods
Don’t skip meals or snacks
High dietary fiber foods
Avoid alcohol and nicotine
Patient Education: Glycemic Index - don’t need to know this
Measures effects of food on bg (lower GI=lower BG):
Low:55 or less
Medium:56–69
High:70 or above
Variables that affect GI: cooking time, how processed, how ripe
Patient Education: Nutrition/Glycemic Load - don’t need to know this
(Grams of carbohydrate X Glycemic Index)/100 = Glycemic Load
Low GL: 10 or less
Medium GL: 11 to 19
High GL: 20 or higher
More precise than GI=effect on BG + how fast it enters blood stream
Patient Education: Target Blood Glucose in PG
Pre-meal or Fasting = 60-99
Post-meal 1 hr = 100 - 129
Post-meal 2 hr < or = 120
Hypoglycemic Agents: Insulin
Insulin preferred med for GDMA2 (ACOG):
Weight based dosing
Does not cross placenta
Decreased in 1st tri
Divided dosing
Long-acting or intermediate-acting: up to 24 hour effect
+
Short-acting:
Novolog/Humalog,“clear”: 3-6 hour effect
Hypoglycemic Agents: Oral Meds
2nd line
May be easier for clients to manage
Glyburide
Promising data
2.5 mg-20mg QD or BID
Does not cross placenta
Metformin: Less frequently recommended; ***crosses placenta
