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Flashcards in T4 - Advance Organizer (Josh) Deck (67):
1

How many times per day does a mom need to do a kick count?

High Risk = 2-3 x's day

Low Risk = 1-2 x's day

2

How many times per day does a mom need to do a kick count?

High Risk = 2-3 x's day

Low Risk = 1-2 x's day

3

How many fetal movements should mom feel in a one hour kick count?

5-6

4

No fetal movements within -- is serious and requires a visit to doctor.

12 hrs

5

Why would diabetic mom need less insulin during first trimester?

Baby taking up some blood sugar

N/V can cause sugar loss

Human Placental Lactogen (HPL) is secreted (it's an insulin antagonist)

6

What happens to insulin requirements in 2nd and 3rd Trimesters?

increases by as much as 4 x's normal need

7

What weeks of gestation are insulin needs the highest?

36-40 wks

8

Which A1c levels show good control?

fair control?

poor control?

Good = 2.5-5.9%

Fair = 6-8%

Poor = > 8%

9

What is normal HCT in pregnancy?

Hgb?

HCT = 33

Hgb = 11

10

--- increases Iron absorption.

--- decreases iron absorption.

Vit C

Milk, Tea, and Coffee

11

How much Folic Acid should mom receive during pregnancy?

400 mg/day

12

What is a Reactive NST?

2 Accels (15x15) in 20 min period

***if less than 32 wks, 10x10

13

During labor, what glucose level do we want to maintain for mom?

14

During labor, monitor glucose ----.

hourly

***more in second stage b/c voluntary pushing requires more energy

15

--- helps stabilize blood sugar postpartum.

Breastfeeding

16

Why do we need to maintain the integrity of diabetic mom's nipples if she's breastfeeding?

diabetics are more prone to infection so any cracks can lead to mastitis

17

What happens to insulin needs upon expulsion of placenta?

fall dramatically

18

What levels are we looking for in the 1 hr (50g) OGTT?

19

How many fetal movements should mom feel in a one hour kick count?

5-6

20

No fetal movements within -- is serious and requires a visit to doctor.

12 hrs

21

Why would diabetic mom need less insulin during first trimester?

Baby taking up some blood sugar

N/V can cause sugar loss

Human Placental Lactogen (HPL) is secreted (it's an insulin antagonist)

22

What happens to insulin requirements in 2nd and 3rd Trimesters?

increases by as much as 4 x's normal need

23

What weeks of gestation are insulin needs the highest?

36-40 wks

24

Which A1c levels show good control?

fair control?

poor control?

Good = 2.5-5.9%

Fair = 6-8%

Poor = > 8%

25

What is normal HCT in pregnancy?

Hgb?

HCT = 33

Hgb = 11

26

What numbers constitute a positive 3 hr OGTT?

> 140 or > 145

***avoid caffeine and smoking for 12 hrs before test

27

How much Folic Acid should mom receive during pregnancy?

400 mg/day

28

What is a Reactive NST?

2 Accels (15x15) in 20 min period

***if less than 32 wks, 10x10

29

During labor, what glucose level do we want to maintain for mom?

30

During labor, monitor glucose ----.

hourly

***more in second stage b/c voluntary pushing requires more energy

31

Why is infant of diabetic mom at risk for hypoglycemia shortly after birth?

Baby has been dealing with mom's high glucose levels in utero

When placental supply is cut off, the baby has all this excess insulin and a much lower supply of glucose

***remember, baby pancreas produces insulin at 10 wks gestation

32

Why do we need to maintain the integrity of diabetic mom's nipples if she's breastfeeding?

diabetics are more prone to infection so any cracks can lead to mastitis

33

What happens to insulin needs upon expulsion of placenta?

fall dramatically

34

What levels are we looking for in the 1 hr (50g) OGTT?

35

If 1 Hr OGTT is positive, what do we do?

Do a three hour test

36

When is the 3 hr (100 G) OGTT positive for diabetes?

when two or more values are met

37

3 Hr (100 g) OGTT Values:

Fasting =
1 hr =
2 hr =
3 hr =

Fasting = > 95
1 hr = > 180
2 hr = > 155
3 hr = > 140

38

What are the targeted glucose levels during pregnancy in relation to meals?

Fasting = 60-99

1 hr post meal = 100-129

2 hr post meal =

39

2/3 of daily insulin is given at -- and 1/3 is given at --

breakfast

evening

40

When would we do a C/S for HSV2 client?

if active lesions are present in the birth canal

41

Which type of diabetic meds are seldom used during pregnancy?

oral meds

42

Instructions regarding exercise for diabetic pregnant client?

Monitor Closely

15-30 mins walking for 4-6 times/wk

Snack of protein or complex carb BEFORE exercise

Monitor glucose before, during, and after exercise

43

What numbers constitute a positive 3 hr OGTT?

> 140 or > 145

***avoid caffeine and smoking for 12 hrs before test

44

What test is given to newborn of HIV mom?

ELISA test which looks for presence of HIV antibodies

45

What does MSAFP look for?

Alpha Fetoprotein, which is produced in FETAL gestational tract and liver

increasing levels are detectable in maternal serum b/t 14-34 wks

46

What are elevated levels of Alpha Fetoprotien indicative of?

Neural Tube defects

Abdominal Wall defects

47

Cocaine can lead to ------

placental abruption

48

Why is infant of diabetic mom at risk for hypoglycemia shortly after birth?

Baby has been dealing with mom's high glucose levels in utero

When placental supply is cut off, the baby has all this excess insulin and a much lower supply of glucose

***remember, baby pancreas produces insulin at 10 wks gesttaion

49

What serum glucose level are we looking for in newborn?

40-60

50

How do we treat hypoglycemia in newborn?

early and often breastmilk

formula

D5W

***NGT if can't suck well

51

When is the greatest risk for a mom who has cardiac insufficiency?

28-32 wks b/c fluid volume peaks

52

S/S of Cardiac Decompensation

Fatigue

Dyspnea, Cough (feels smothered)

Weak, thready pulse

Tachycardia (> 100)

Bradycardia (> 25)

Orthopnea

Crackles at base of lungs

Cyanosis

53

What should we remember for a cardiac client during 2nd stage of labor?

no pushing or bearing down

54

What will the FHR strip look like for a cardiac patient mom?

late decels due to poor placental perfusion

55

Where can a client contract Toxoplasmosis?

Raw Meat

Cat Litter

56

What does RPR test for?

Syphillis

**could lead to spontaneous abortion or PTL

57

When would we do a C/S for HSV2 client?

if active lesions are present in the birth canal

58

When should HIV mom get medications?

Zidovudine after 14 wks gestation orally

IV during labor

59

When should infant get ZDV if mom had HIV?

~ 6 months (weeks???)

60

Delivery plan for HIV mom

No pitocin to avoid lacerations

no scalp electrodes

no episiotomy

no breastfeeding

61

What test is given to newborn of HIV mom?

ELISA test which looks for presence of HIV antibodies

62

When are pregnant women screened for Hep B?

all are screened early on

at risk screened in 3rd trimester

63

What is treatment for newborn r/t Hep B mom?

given immune globuline at birth to prevent skin surface contamination

repeated at 1 and 6 months

64

Cocaine can lead to ------

placental abruption

65

What if mom is less than 32 weeks and has complications from HELLP?

give corticosteroids to help with fetal lung development

66

What if mom is > 34 wks and has complications from HELLP?

go ahead and deliver

67

Question 27

Question 27