mod 3 Flashcards
(162 cards)
1
Q
What is Diabetes Mellitus?
A
Endocrine disorder in which the pancreas cannot produce adequate insulin to regulate glucose levels
Includes both Type 1 and Type 2 diabetes.
2
Q
What is Gestational Diabetes Mellitus?
A
Any degree of glucose intolerance or abnormal glucose metabolism with the onset occurring during pregnancy.
3
Q
When is insulin released?
A
When the sugar level of the blood is high, insulin is released to regulate blood glucose levels.
4
Q
What is the usual concern in Diabetes Mellitus?
A
Hyperglycemia.
5
Q
What is the goal of treatment for diabetes during pregnancy?
A
Controlling balance between insulin and blood glucose to prevent hyper/hypoglycemia.
6
Q
Why does Gestational Diabetes Mellitus (GDM) happen?
A
Resistance to insulin caused by the effect of maternal hormones on beta cells of the pancreas.
7
Q
Can a non-diabetic pre-pregnancy develop Gestational Diabetes Mellitus?
A
Yes, less than 5% (2–3%) of non-diabetic patients develop GDM during pregnancy.
8
Q
What are the major maternal risks associated with Gestational Diabetes Mellitus?
A
- Hypertension and/or preeclampsia
- UTI
- Ketoacidosis
- Labor dystocia or obstructed delivery
- Postpartum hemorrhage
- Hematoma and lacerations.
9
Q
What fetal risks are associated with Gestational Diabetes Mellitus?
A
- Congenital anomalies
- Perinatal death
- Macrosomia
- Intrauterine growth retardation (IUGR)
- Birth injury
- Hypoglycemia
- Polycythemia
- Hyperbilirubinemia
- Hypocalcemia.
10
Q
What is Type 1 Diabetes Mellitus characterized by?
A
Destruction of the beta cells in the pancreas that usually leads to absolute insulin deficiency.
11
Q
How is Type 2 Diabetes Mellitus managed?
A
Dependent on oral hypoglycemic agents and synthetic insulin together with diet and exercise.
12
Q
What is impaired glucose homeostasis?
A
A state between ‘normal’ and ‘diabetes’ where the body is no longer using or secreting insulin properly.
13
Q
What are the signs of maternal hypoglycemia?
A
- Shaking/tremors
- Sweating
- Pallor
- Disorientation
- Hunger
- Blurred vision.
14
Q
What are the signs of maternal hyperglycemia?
A
- Fatigue
- Flushed skin
- Dry mouth
- Frequent urination
- Rapid, deep respirations
- Drowsiness
- Depressed reflexes.
15
Q
What is the normal serum glucose level?
A
80–120 mg/dL.
16
Q
What is the diagnostic value for pre-diabetic fasting blood glucose?
A
101–125 mg/dL.
17
Q
What is the procedure for diagnosing diabetes?
A
A blood sample is taken to check glucose levels; fasting for 8 to 12 hours is required.
18
Q
What does glycosuria indicate?
A
The kidneys begin to excrete quantities of glucose in the urine to lower serum glucose levels.
19
Q
What causes polyuria in diabetes?
A
Increased urination due to osmotic action of glucose in the urine.
20
Q
What is the effect of maternal vascular impairment on the fetus?
A
Poor placental perfusion leading to perinatal death.
21
Q
What is the risk of having a macrosomic fetus?
A
Stimulates production of insulin, leading to potential complications during delivery.
22
Q
What are the nursing responsibilities for blood glucose monitoring?
A
- Wash hands before puncturing
- Use sides of fingers for puncture
- Wipe away the first drop of blood.
23
Q
Fill in the blank: The presence of glucose in urine is referred to as _______.
A
glycosuria.
24
Q
True or False: Gestational diabetes can signal an increased risk for type 2 diabetes later in life.
A
True.
25
What technique should be used to decrease sensation of pain during injections?
Use sides of fingers instead of ends
26
What should be done with the first drop of blood during a blood test?
Wipe away the first drop
27
What is the purpose of the Oral Glucose Challenge Test?
To check for risk of GDM
28
At what gestational weeks is the Oral Glucose Challenge Test typically performed?
24–38 weeks AOG
29
What fasting serum glucose level confirms a diagnosis of diabetes?
126 mg/dL or above
30
What non-fasting serum glucose level indicates diabetes?
200 mg/dL or above
31
What is the glucose load ingested during the Oral Glucose Challenge Test?
50-g glucose load
32
What serum glucose level after 1 hour indicates the need for a 100-g, 3-hour fasting glucose tolerance test?
>140 mg/dL
33
What fasting glucose level indicates GDM if 2/4 abnormal blood samples are found?
>95 mg/dL
34
What does Glycosylated Hemoglobin (HbA1C) measure?
The average glucose level over the past 4–6 weeks
35
What is the upper normal level of HbA1C?
6% of total hemoglobin
36
What happens to glucose attached to hemoglobin as blood sugar increases?
It increases
37
When was insulin produced synthetically?
1921
38
What is the gold standard for management of diabetes?
Insulin administration
39
What type of insulin is combined with short-acting insulin for diabetes management?
Intermediate type
40
What occurs in early pregnancy that affects insulin levels?
Lower synthetic insulin
41
What hormones stimulate normal insulin production during early pregnancy?
Estrogen and progesterone
42
In late pregnancy, why is there a higher need for synthetic insulin?
Increased glucose used by woman and fetus
43
What is the recommended starting insulin dose distribution?
2/3 in the morning, 1/3 in the evening
44
What should be avoided in pregnancy regarding oral hypoglycemic agents?
They can cross the placenta and are teratogenic
45
What is the correct order for drawing insulin?
Inject air to intermediate insulin first, then to regular insulin
46
What should be done with insulin before administration to avoid pain?
Warm at room temperature
47
How should insulin be injected to minimize leakage?
Inject slowly (2-4 seconds)
48
What should patients with hypoglycemia consume?
A glass of milk and crackers
49
What is the recommended action for hyperglycemia?
Assess urine for ketones and inform healthcare provider
50
How often should blood glucose be monitored?
At least 4 times a day
51
What is the normal creatinine clearance value?
0.7-1 mg/dL
52
What does the Lecithin-Sphingomyelin (L:S) ratio determine?
Fetal lung maturity
53
What is the expected L:S ratio for a mature fetus?
1:2
54
What is the preferred method of delivery for patients with GDM?
Vaginal birth
55
What is the risk associated with cesarean birth in GDM patients?
Higher risks including exacerbated hyperglycemia
56
What happens to maternal glucose levels after delivery?
They usually return to normal
57
What is the risk for women who had diabetes pre-pregnancy?
50-60% risk for developing Type 2 DM later in life
58
What dietary control should be maintained during pregnancy?
Adequate glucose intake to prevent hypoglycemia
59
What is the recommended weight gain during pregnancy for women with GDM?
25-30 lbs
60
What is a potential nursing diagnosis related to GDM?
Risk for ineffective tissue perfusion
61
What should be monitored closely in cases of hydramnios?
Uterine contraction and risk for hemorrhage
62
What is the recommended weight gain during pregnancy to limit fetus size?
25-30 lbs
63
What is the minimum caloric intake recommended for pregnant women?
1800 calories
64
What macronutrient distribution is recommended in a 1800–2400 calorie diet?
* 20% protein (CHON)
* 40-50% carbohydrates (CHO)
* 30% fats
65
What should pregnant women do to prevent hypoglycemia during the night?
Encourage protein and complex carbohydrates at night
66
True or False: Pregnant women are most vulnerable to hypoglycemia at night.
True
67
What types of foods are recommended for pregnant women to maintain stable glucose levels?
* Rice
* Breads
* Oats
* Spaghetti
* Cassava
* Potatoes
* Egg
* Whole grain toast
* Hummus
* Whole grain crackers
68
What are the benefits of exercise during pregnancy?
* Lowers blood sugar
* Helps with weight control
* Improves glucose metabolism
* Provides cardiopulmonary benefits
69
What should be done if uterine contractions occur during exercise?
Stop walking, hydrate, and rest in a side-lying position
70
What is the percentage of pregnant women who use illegal drugs?
20-30%
71
List some fetal effects of cocaine use during pregnancy.
* Hyperarousal state
* Increased STIs
* Spontaneous abortion
* Abruptio placenta
* Pre-eclampsia
* Premature labor
72
True or False: Marijuana use during pregnancy can lead to reduced milk production.
True
73
What are the effects of tobacco use during pregnancy?
* Low maternal perfusion
* Abruptio placenta
* Preterm labor
* Increased risk of SIDS
74
What are the risks associated with alcohol use during pregnancy?
* Spontaneous abortion
* Fetal alcohol spectrum disorder (FASD)
* Intrauterine growth restriction (IUGR)
75
Fill in the blank: HIV is transmitted from _______.
[person-to-person]
76
What is the significance of the CD4 count in HIV patients?
A CD4 count below 500 cells/mm3 indicates risk for opportunistic infections
77
What is the role of antiretroviral therapy (ART) in HIV-positive pregnant women?
Decreases viral load and reduces transmission risk to the infant
78
What are early symptoms of HIV in pregnant women?
* Fatigue
* Anemia
* Diarrhea
* Progressive weight loss
79
What substance abuse treatment groups are available for pregnant women?
* Alcoholics Anonymous (AA)
* Cocaine Anonymous (CA)
* Heroin Anonymous (HA)
* Marijuana Anonymous (MA)
* Nicotine Anonymous (NicA)
* Narcotics Anonymous (NA)
* Pills Anonymous (PA)
80
What are common withdrawal symptoms from substance abuse?
* Nausea and vomiting
* Diarrhea
* Abdominal pain
* HPN (Hypotension)
* Shivering
81
What is the most serious STI affecting pregnant women and their infants?
HIV/AIDS
82
What is the effect of caffeine on pregnant women?
Stimulates CNS and cardiac function, crosses the placental barrier
83
What should be monitored during labor for women with a history of substance abuse?
Electronic fetal monitoring, contractions, and fetal heart tones (FHT)
84
What is the risk of maternal-fetal transmission of HIV if untreated?
15-35%
85
True or False: HIV is curable.
False
86
What CD4 count is usually associated with a higher chance for opportunistic infections?
<200 cells/mm3
## Footnote
A CD4 count lower than 200 cells/mm3 indicates a higher risk for opportunistic infections.
87
What is a key preventive measure against opportunistic infections?
Maintain a higher CD4 count
## Footnote
A higher CD4 count helps in reducing the chances of opportunistic infections.
88
What are risk factors for opportunistic infections?
* Multiple sexual partners
* Bisexual partners
* IV drug use with shared needles
* Blood transfusion
* Vertical transmission
## Footnote
These factors increase the exposure to HIV and other infections.
89
True or False: HIV can be transmitted through saliva.
False
## Footnote
The presence of the virus in saliva is extremely low, making transmission via saliva unlikely.
90
What are some maternal complications associated with HIV?
* Intrapartum and postpartum hemorrhage
* Poor wound healing
* GU infections
* Fever
* Swollen lymph nodes
* Recurrent respiratory tract infections
* Oral candidiasis
* Preterm births
* Small for gestational age
* Failure to thrive
* Enlarged spleen and liver
## Footnote
These complications arise due to the effects of HIV on the immune system.
91
What is the normal range for CD4 cell count?
>500 T4 cells/mm3
## Footnote
Maintaining a CD4 count above this level is crucial for immune health.
92
What does the Polymerase Chain Reaction (PCR) test check for in HIV diagnosis?
Level of antigens in the blood
## Footnote
PCR tests are important for detecting the presence of HIV antigens.
93
What is the most commonly used screening test for HIV?
Enzyme-Linked Immunosorbent Assay (ELISA)
## Footnote
A positive ELISA test requires a confirmatory test, such as the Western blot.
94
What is the purpose of administering Zidovudine (AZT)?
Prevents progressive deterioration of the immune system
## Footnote
Zidovudine is administered to reduce the risk of opportunistic infections.
95
What are the potential adverse effects of Zidovudine?
* Nausea
* Loss of appetite
* Paresthesia
* Headache
* Fever
* Agranulocytopenia
* Thrombocytopenia
## Footnote
These side effects necessitate careful monitoring during treatment.
96
What is the role of Rh immune globulin (RhIG) in pregnancy?
Prevents the mother from forming natural antibodies against Rh-positive blood
## Footnote
RhIG is administered to Rh-negative women to prevent Rh sensitization.
97
What happens during Rh sensitization?
The mother forms antibodies against Rh-positive blood
## Footnote
This immune response can lead to hemolytic disease of the newborn in subsequent pregnancies.
98
What fetal effects can result from hemolysis due to Rh sensitization?
* Enlarged liver and spleen
* Vascular hypertonicity
* Congestive heart failure
* Hydrops fetalis
* Anemia
* Hyperbilirubinemia
## Footnote
These conditions arise from the destruction of fetal red blood cells.
99
What does the Doppler velocity of fetal middle cerebral artery indicate?
Predicts fetal anemia or destruction of fetal RBCs
## Footnote
Monitoring this velocity helps assess the risk of hemolytic disease.
100
What is the significance of a high ratio in anti-D antibody titer?
Indicates Rh sensitization
## Footnote
A ratio of 1:16 or above necessitates monitoring and potential interventions.
101
Fill in the blank: HIV can be transmitted through _______.
Body secretions
## Footnote
This includes semen, vaginal fluids, and breastmilk.
102
What is the goal of medical management for HIV?
Maintain the CD4 cell count at greater than 500 cells/mm3
## Footnote
This goal is critical for sustaining the immune system.
103
What procedure is used to determine the blood type of the baby?
PUBS
## Footnote
PUBS stands for Percutaneous Umbilical Blood Sampling.
104
What is the purpose of injecting RBCs directly into a vessel in the fetal cord?
Restore fetal RBCs
105
When should RBCs be given to the fetus?
When hematocrit levels are less than 30% intravascularly/intraperitoneally
106
How much washed red cells are typically used in fetal transfusion?
75–150 mL
107
What is a potential complication of the procedure involving RBC injection?
Lacerations in cord blood vessel
108
What is the most common type of anemia during pregnancy?
Iron-deficiency anemia
109
What is pseudoanemia?
A condition where blood volume expands during pregnancy slightly ahead of the red cell count
110
What is the normal hemoglobin level for the 1st trimester of pregnancy?
<11 g/dL
111
What dietary factors contribute to iron-deficiency anemia in pregnancy?
Low iron diet, heavy menstrual periods, unhealthy weight-reducing programs
112
What is a characteristic of iron-deficiency anemia?
Microcytic and hypochromic anemia
113
What are common symptoms of iron-deficiency anemia?
Pallor, fatigue, lethargy, headache, tachycardia
114
What is pica?
Persistent craving and compulsive eating of non-food substances
115
What dietary recommendations are made for iron-deficiency anemia?
Eat a diet high in iron and vitamins, such as organ meats, shellfish, spinach, legumes
116
What is the recommended daily dosage of folic acid for pregnant women?
400 mcg daily; 800 mcg for those currently pregnant
117
What are the maternal complications of folic acid-deficiency anemia?
Spontaneous abortion, abruptio placenta, neural tube defects
118
What is pregnancy-induced hypertension (PIH)?
Condition with vasospasm during pregnancy leading to hypertension
119
What are the clinical manifestations of PIH?
Hypertension, proteinuria, and edema
120
What is the cure for pregnancy-induced hypertension?
After birth of the infant
121
What is the significance of elevated diastolic blood pressure in preeclampsia?
Indicates the degree of peripheral arterial spasm present
122
What is mild preeclampsia characterized by?
BP of 140/90 mmHg with proteinuria 1+ or 2+
123
What is a common dietary advice for iron supplementation?
Take iron supplements with orange juice or a vitamin C supplement
124
What is the effect of vasospasm in PIH on fetal health?
Reduced fetal nutrient and oxygen supply
125
What are the risk factors for developing pregnancy-induced hypertension?
Women of color, multiple pregnancies, primiparas younger than 20 or older than 40
126
True or False: The body requires more blood volume during pregnancy, leading to increased risk of anemia.
True
127
Fill in the blank: The highest need for iron during pregnancy is in the _______.
third trimester
128
What defines REECLAMPSIA?
Abnormal assessment results taken on two occasions, at least 6 hours apart at bed rest.
129
What is the blood pressure threshold for diagnosing high blood pressure in REECLAMPSIA?
BP of 160/110 mmHg or above.
130
What constitutes proteinuria in the context of REECLAMPSIA?
3+ or 4+ proteinuria, or 5g/24h urine collection.
131
What is the significance of extreme edema in REECLAMPSIA?
It indicates severe depletion of albumin in the blood.
132
What are the characteristics of pitting edema?
Edematous tissue can be indented; scored as follows:
* 1+: slight indentation
* 2+: moderate indentation
* 3+: deep indentation
* 4+: remains after removal of finger.
133
What indicates non-pitting edema?
Edematous tissue cannot be indented with finger pressure; caused by excess lymphatic fluid.
134
What are common additional signs and symptoms of REECLAMPSIA?
* Reduced urine output/oliguria (400–600 mL per 24 hours)
* Severe epigastric pain, nausea, and vomiting
* Shortness of breath, coughing, and dyspnea from pulmonary edema
* Visual disturbances
* Severe headache, hyperreflexia, and ankle clonus.
135
What is the laboratory value for platelet count in REECLAMPSIA?
Platelet count <100,000.
136
What is ECLAMPSIA?
Most severe stage of PIH with a high maternal mortality rate of 20%.
137
What are the phases of a tonic-clonic seizure in ECLAMPSIA?
Tonic Phase (20 seconds) and Clonic Phase (up to 1 minute).
138
What is the role of antihypertensive drugs in managing REECLAMPSIA?
Promotes vasodilation.
139
What is the therapeutic range for magnesium sulfate?
5–8 mg/dL.
140
What are signs of magnesium sulfate toxicity?
* Blood pressure decreased
* Urine output decreased (oliguria)
* Respiratory depressions <12
* Patellar reflex absent.
141
What is the antidote for magnesium toxicity?
Calcium gluconate.
142
What nursing diagnosis is associated with REECLAMPSIA?
Ineffective tissue perfusion related to vasoconstriction of blood vessels.
143
What are nursing interventions for mild PIH?
* Promote bed rest at home
* Lateral recumbent position
* Good nutrition
* Monitor antiplatelet therapy.
144
What is the significance of a premonition or aura in ECLAMPSIA?
It indicates that a seizure is about to occur.
145
How should a patient be positioned during a seizure?
Turn the woman on her side to prevent aspiration.
146
What is the recommended management for postpartum hypertension?
Monitor blood pressure.
147
Fill in the blank: Severe epigastric pain, nausea, and vomiting may indicate ______.
abdominal edema and ischemia to pancreas and liver.
148
True or False: A cesarean section is preferred over a normal spontaneous delivery in cases of proteinuria, edema, and hypertension.
False.
149
When does ENTION typically occur after delivery?
10–14 days after delivery
150
When does ENTION usually occur in relation to birth?
In the first 48 hours after birth
151
What should be monitored in a patient with ENTION?
BP
152
Which of the following is a sign of DM?
A) Weight gain
B) Metabolic alkalosis
C) Hypoglycemia
D) Polydipsia
D) Polydipsia
153
Which test is more accurate for diagnosing DM?
HbA1C
154
What is the most useful health teaching regarding insulin for a pregnant client with DM?
Rotate injection sites
155
Caloric needs of a pregnant client with DM should mainly consist of:
Carbohydrates
156
Which age group is at risk of substance abuse during pregnancy?
Young adults with abusive parents
157
What is the confirmatory test in the diagnosis of HIV?
Western blot test
158
When should RhIG be administered to protect the succeeding pregnancy?
In the first 72 hours after delivery
159
Which health teaching will benefit a pregnant client taking iron supplements?
Take the iron tablets with orange juice
160
The following are triad symptoms of PIH except:
Proteinuria
161
What is the drug of choice in PIH?
Magnesium sulfate
162
What is an appropriate intervention when a pregnant client with PIH experiences seizures?
Turn the head to the side
