Pregnancy at Risk - Diabetes

Question 1

What are the 4 classifications for DM?

Answer 1

Type 1
Type 2
Other
Gestational

Question 2

Who is considered a high risk during pregnancy (r/t diabetes)?

Answer 2

Women with Type 1 DM

Question 3

What is the key to postive pregnancy outcomes for pts. with diabetes?

Answer 3

Excellent glycemic control

Question 4

Diabetes is a chronic multisystem disese r/t what?

Answer 4

Abnormal insulin production
Impaired insulin utilization
Or both

Question 5

What can trigger the onset of gestational diabetes?

Answer 5

Extra metabolic demands

Question 6

Gestational diabetes may develop in pregnant women with risk factors for what?

Answer 6

Diabetes 2

Question 7

What happens to the glucose of a woman with gestational diabetes after she gives birth?

Answer 7

It usually returns to normal

Question 8

Babies born to a mom who had gestational diabetes are usually how many pounds at birth?

Answer 8

> 10 lbs

Question 9

What hormone enables energy use and storage and decreaes blood glucose concentration?

Answer 9

Insulin

Question 10

In pregnancy, ______ can cause insulin resistance

Answer 10

Progesterone

Question 11

Human placental growth hormone modifies what?

Answer 11

The metabolic state of the mother during pregnancy to facilitate the energy supply of the fetus

Question 12

Human placental growth hormone is made by what?

Answer 12

The placenta

Duh! (:

Question 13

When does type 1 DM usually begin?

Answer 13

In childhood

Question 14

Type 1 diabetes has a _____ onset

Answer 14

Rapid

Question 15

What is the cause of type 1 DM?

Answer 15

Unknown cause

-There is no pancreatic production of insulin

Question 16

In type 2 DM, does the pancreas form insulin?

Answer 16

Yes; it forms SOME

Question 17

In what age group does type 2 DM usually occur in?

Answer 17

Adults

Question 18

How can type 2 DM be controlled?

Answer 18

By diet and exercise

Question 19

What are secondary complications of type 2 DM?

Answer 19

Blindness
Heart attack
Stroke
Amputation

Question 20

Maternal complications associated with diabetes

Answer 20

Hydramnios rates 10x greater (>PROM)
Infection rates higher (UTI and yeast)
Ketoacidosis can = fetal death

Question 21

Preconception counseling for diabetes

Answer 21

Parter should be involved
FInances considered
Contraception issues require attention an dteaching
Type 2 DM pts. and Gestational diabetes can safely take on Glyburide, a sulfonyurea agent, or SQ insulin. Other agents cross placena and may be teratogenic

Question 22

Fetal and neonatal complications r/t gestational diabetes

Answer 22

• Stillbirth >36wks
• Congenital anomaly 6-10% per pregnancy with cardiac, CNS, and skeletal most common
• Macrosomia >4000 gm, birh injuries, C/S
• IUGR r/t maternal vascular disease and increased risk for BDS
• Neonatal hypoglycemia, F&E imbalances, hyperbilirubinemia, and polycythemia

Question 23

Sulfonylureas stimulate _______ production

Answer 23

Insulin

Question 24

Insulin needs during pregnancy

Answer 24

• Lower in 1st trimester d/t increased production by pancreas and increased peripheral insulin sensitivity
• Increased in the 2nd trimester d/t maternal hormones acting as insulin antagonists
• Dramatic increases by 3rd trimester
• Levels off at 36 wks
• By delivery, maternal needs significantly drop

Question 25

MSAFP

Answer 25

Found in both fetal serum and also amniotic fluid - Pursue potential medical interventions - Begin planning for a child w/ special needs - Start adressing anticipated life changes - Identify support groups - Make a decision about carrying child to term

Question 26

Blood glucose monitoring during pregnancy

Answer 26

Key to control | Daily urine ketone checks to pick up on ketoacidosis early on

Question 27

Normal blood glucose during pregnancy

Answer 27

60-120 mg/dl

Question 28

Fetal non-stress test

Answer 28

Simple, non-invasive test performed in pregnancies >28 wks gestation

Question 29

When is a fetal NST done?

Answer 29

If baby not moving like usual If overdue If suspect placenta is not functioning adequately If high risk for any reason

Question 30

What can a fetal NST indicate?

Answer 30

- Baby is not recieving enough O2 because placental or umbilical cord problems - Fetal distress

Question 31

HbA1C

Answer 31

Blood glucose attatches to a hemoglobin in the RBCs RBCs live 3 mos When HGB/RBC is measured, it reflects average BG for prior 2-3 mos

Question 32

What is the normal HbA1C?

Answer 32

4-6%

Question 33

What level of HbA1C is diagnostic of diabetes?

Answer 33

>6.5%

Question 34

When might an HbA1C be inaccurate?

Answer 34

If pt. is also anemic

Question 35

How often should HbA1C test done?

Answer 35

Q 3 months

Question 36

When is a contraction stress test done?

Answer 36

At 34 wks

Question 37

Contraction stress test

Answer 37

Oxytocin given IV Monitor HR and contractions O2 levels may drop, causing HR to drop

Question 38

Biophysical progile (BPP)

Answer 38

Measures baby's HR, muscle tone, movement, breathing, and the amount of amniotic fluid - NST - Fetal ultrasound

Question 39

Teaching for diabetes during pregnancy?

Answer 39

Decrease stressors- need strict daily routine Diet = 3 meals, 3 snacks, never skip Acitivty= mild exercise Insulin = appropriate dose to maximize glucose levels and reduce hypoglycemia Rest= set sleep schedule; planned rest BG = Keep between 60-120 depending on meals and time of day

Question 40

Fetal surveillance

Answer 40

EDD established Measure MSAFP between 16-18 wks d/t high rate of neural tube defects Fetal echo to detect cardiac problems by 22 wk Beginning at 28 wks, NST weekly In presence of non-reactive NST, order a CST or BPP

Question 41

Nursing care of pt. with diabetes who is pregnant: History

Answer 41

``` Age diagnosed Glycemic control Diet and activity Insulin use Medical and OB Hx ```

Question 42

Nursing care of pt. with diabetes who is pregnant: Assesment

Answer 42

``` Knowledge base Motivation Support systems S&S Weight Labs (UA, urine C&S, BG, Hgb, A1c) ```

Question 43

____% of gestational diabetics develop DM later

Answer 43

50%

Question 44

When is gestational diabetes usually diagnosed?

Answer 44

in the 2nd and 3rd trimester as maternal intake and pregnancy hormones increase insulin resistance

Question 45

Risk factors for gestational diabetes

Answer 45

``` Prior deliveries >4500 gm >25 yrs Obesity Family hx of type 2 DM Polyhydramnios Unexplained stillbirth ```

Question 46

Glucose tolerance test

Answer 46

BG measured at intervals after the pt/ drinks a concentrated carbohydrate drink GTT- high risk women initially and 24-28 wks BS >139 goes to 2 hour GTT

Question 47

Management of GDM

Answer 47

Managed like type 1 or 2 wirh focus on glycemic control Diet and exercise (usually) Less likely to require c/s

Question 48

If you have GDM, it is typical in future pregnancies with an _____ onset

Answer 48

Earlier