OB exam 1- Comps of Antepartum Flashcards
GDM pathophys
in 1st trimester there is a decreased need for insulin b/c hormones enhance insulin production & tissue response to insulin then late in the 1st, there is an increased need for insulin b/c hormones act like insulin antagonists
where does the fetus get insulin from
because glucose crosses the fetal membrane, the fetus produces its own insulin based on the glucose in mother’s blood
by the end of pregnancy, how much does insulin need increase
double or triple
maternal risks of GDM
-polyhydramnios d/t increased fetal urine
-preeclampsia / eclampsia
-ketoacidosis (main reason for still birth)
-dystocia (difficult birth)
-increased susceptibility to infections (UTI, yeast, ret)
fetal / neonatal risks w/ DM
-perinatal mortality
-congenital anomalies
-macrosomia
-growth restriction
-res distress
-polycythemia
-hypoglycemia after birth
-hyperbilirubinemia
when is a women screened for GDM
low risk: 24 to 28 wks
high risk: as early as possible
1hr glucose tolerance test
women comes into office and drinks a 50g glucose drink within 10-15 mins and then 1 hr later draw blood to test glucose, if >140 then further testing is needed
pt does not need to be fasting before
3hr glucose tolerance test
if 1hr is failed then women are recommended to eat a high carb diet for several days and then fast before coming into the office for a blood draw -> after the draw pt will drink a 100g glucose drink within 10-15 mins -> after finishing blood will be drawn 1hr later, 2hrs later and 3hrs later
if 2 out of the 4 levels are elevated they will get diagnosed w/ GDM
3hr GTT failing glucose marks
fasting >/95
1hr >180
2hr > 155
3hr >140
treatment goals for GDM
-diet therapy and exercise
-glucose monitoring
-insulin therapy
glucose goals for GDM
fasting <95
2hr post meals <120
to help provent macrosomia
nursing mgt of a GDM pt
-assessment of glucose
-nutrition counseling (consult RD)
-ed about the disease & mgt
-ed about how to monitor glucose & administer insulin (+overdoses risk)
-assess the fetus w/ ultrasounds every 4 wks, daily fetal movement counts and NST
-give support
when would we delivery a baby before 39 wks
complications
baby is too large
mom’s blood sugars are not staying within range
how often should you assess glucose during labor
every hour bc the stress of labor can impact glucose levels
continue to check after delivery
GDM mgt postpartum
-assess glucose and recognize maternal insulin requirements drop significantly
-encourage breastfeeding
-follow up at 6wks to check levels, if still high then dx of type 2
iron deficiency anemia
d/t inadequate iron intake, pt will feel tired and wont handle bleeding well (dx at lower then 11)
tx: iron supplement during pregnancy
sickle cell anemia
-recessive autosomal disease
-decreased O2 present d/c sickling
tx: prevent crisis by treating w/ IV fluids, 02 abx, folic acid and analgesics
folic acid deficiency anemia
-RBC fail to divide in the absence of folic acid putting the baby at high fetal risk of neural tube defects like SB
tx: women of childbearing age should take 400mcg of folic acid daily then during pregnancy take 1mg folate daily
what is the ideal nursing goal for substance abuse
prevention
what needs to be screened for in all pregnancies
HIV bc mother could have it without knowing
what is an important part of care for a substance abuse pt
-educating on the affects on herself as well as the baby
-establishing a trusting, non judgmental relationship
if a mother finds out she has HIV while pregnant, what is the next step
give mother antiretrovirals to reduce risk of transmission to baby (mother to baby is a vertical transmission)
what should be avoided as much as possible if a person has HIV
invasion procedures
a women with high risk is screened for HIV initially after finding out she was pregnant and the screen came back negative, what should you expect to be ordered later in pregnancy
during the 3rd trimester, re test for HIV
