Module 9 (Exam 3) Diabetes Flashcards Preview

Semester Three - Half Two - Nursing 212 > Module 9 (Exam 3) Diabetes > Flashcards

Flashcards in Module 9 (Exam 3) Diabetes Deck (28):
1

Gestational Diabetes

A classification of diabetes with onset or first recognition during pregnancy

2

Polyhydramnios

Greater than normal amounts of amniotic fluid

3

Carbohydrate Metabolism

  1. Insulin
    1. Beta cells of pancreas
    2. Makes glucose available to body cells
  2. Diabetes
    1. Inadequate insulin and/or inability to use insulin for carbohydrate metabolism

4

Type I Diabetes

Insulin deficiency

Exists prior to pregnancy

5

Type II Diabetes

Insulin resistance

6

Incidence of gestational diabetes

Prevalence varies in direct proportion to prevalence of type II diabetes in a given segment of society

7% incidence

7

GDB Risk Factors

  • BMI greater than 25-29 (overweight) or greater than 29 (obese)
  • Chronic HTN
  • Maternal age greater than 25
  • Family history of diabetes
  • History fetal macrosomia
  • Unexplained fetal death in utero
  • Multigestation

8

Early pregnancy diabetogenesis

  • Insulin sensitivity
  • Little alteration in maternal metabolic rate
  • Potential for hypoglycemia

9

Late pregnancy diabetogenesis

  • Insulin resistance
  • Placental hormones block insulin usage
  • Potential for hyperglycemia
  • Placental hormones favor fetal growth
  • Human placental lactogen and progesterone and estrogen

10

Why do insulin needs decline during the 1st trimester?

Insulin sensitivity

11

Why do insulin needs dramatically increase during the 2nd and 3rd trimesters?

  • Insulin resistance peaks
  • Placental blockers hamper insulin usage

12

Why do insulin needs dramatically decrease postpartum?

Placental delivery negates hPL

13

Screening for GDM

  • Glucose Challenge Test
    • Routine screening at 24-28 weeks gestation
    • 50G oral glucose solution
    • 1 hour postprandial blood draw
  • Acceptable level is greater than 140mg/dl
  • Finding of greater than or equal to 140mg/dl calls for a Oral Glucose Tolerance Test

14

Oral Glucose Tolerance Test

  • Fasting blood glucose
  • 100G oral glucose solution
  • Postprandial blood draws every hour X 3

Diagnostic Criteria:

Fasting: greater than 95mg/dl

1 hour: greater than 180 mg/dl

2 hours: greater than 155mg/dl

3 hours: greater than 140mg/dl

15

What conditions must be met for a diagnosis of GDB?

Elevated fasting plasma glucose level

OR

Two or more elevated postprandial plasma glucose levels

16

Medical Management of GDB

 

  1. Goal: Euglycemia (FBG is less than 95mg/dl)
  2. Glucose monitoring
  3. Dietary monitoring
  4. Exercise
  5. Pharmacologic intervention
    1. Insulin
    2. Oral agents may be acceptable (Glyburide/glucophage)

17

Delivery of a baby whose mother has GDB

  1. Amniocentesis to assess lung maturity
    1. LS ratio 2:1 in non-diabetic woman - 3:1 in a diabetic woman
    2. PG must be present
  2. Delivery at 38-39 weeks
    1. R/t decline in placental function

18

Nursing management of GDB

  1. Self-care instruction and support
  2. Lifestyle modification
  3. Dietary Management
  4. Approach a caloric restriction with caution
  5. Refer to a registered dietician or nutritionist
  6. Guidelines: carbohydrate counting, exchange system

19

Hyperglycemia symptoms

  1. Fatigue, drowsiness
  2. Hot, dry skin
  3. Thirst, dry mouth
  4. Frequent urination
  5. Rapid, deep respiration
  6. Headache
  7. Fruity breath

20

Hypoglycemia

  1. Tremors
  2. Diaphoresis
  3. Cold, clammy skin
  4. Hunger
  5. Blurred vision
  6. Disorientation
  7. Irritability

21

Effects on the infant of a diabetic mother

  1. Excessive glucose in utero
  2. Stimulates development of RBCs
  3. Polycythemia leads to neonatal hyperbilirubinemia
  4. Stimulates pancreatic growth
  5. Large pancreas results in more insulin
  6. Insulin acts as a growth hormone that leads to fetal macrosomia
  7. Insulin delays surfactant production therefore increasing the potential for respiratory distress syndrome

22

Delivery and PP for the infant of diabetic mother

  1. Risk for birth related complications including pre-term birth and macrosomia
  2. Impaired respirartory function r/t delayed surfactant production
  3. Risk for hypoglycemia r/t increase in insulin production
  4. Risk for hyperbilirubinemia r/t polycthemia

23

Pre-exisiting diabetes concerns (type 1)

  1. Increased risk for spontaneous abortion and fetal malformations
  2. Preeclampsia
  3. Polyhydramnios
    1. Uterine overdistention, fetal polyuria

24

Criteria for Fasting BG

Greater than 95mg/dL

If this criterion is met, GBD is diagnosed

25

Criteria for 1 hour BG

Greater than 180mg/dL

this plus one other abnormal value = GBD

26

Criteria for 2 hour BG

Greater than 155 mg/dL

this plus one other abnormal value = GBD

27

Criteria for 3 hour BG

Greater than 140 mg/dL

this plus one other abnormal value = GBD

28

Criteria for Glucose Challenge Test (GCT)

Acceptable level is less than 140 mg/dL

Finding of greater than or equal to 140 mg/dL

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