T4 - Endocrine Metabolic Disorders (Josh)

Question 1

– – is caused by lack of insulin or lack of insulin effect.

Answer 1

Diabetes Mellitus

***Key to optimal pregnancy outcome is strict glucose control

Question 2

— — is an absolute insulin insufficiency and requires administration of exogenous insulin.

— — is insulin resistence with varying degrees of insulin deficiency.

Answer 2

Type 1 DM

Type 2 DM

Question 3

Risk factors for Gestational Diabetes Mellitus (GDM)

Answer 3

obesity

aging

sedentary lifestyle

HTN

prior GDM

Question 4

Gestational DM:

Class — can be controlled via diet.

Class — requires meds.

Answer 4

A1

A2

Question 5

Gestational DM:

Woman has two or more abnormal values with normal fasting blood sugar.

Answer 5

Class A1

Question 6

Gestational DM:

Woman was not known to have diabetes before pregnancy, but requires medication for blood glucose control.

Answer 6

Class A2

Question 7

Pregestational DM:

Onset of disease occurs after age 20 and duration of illness is

Answer 7

Class B

Question 8

Pregestational DM:

Onset of disease occurs b/t 10-19 years old or duration of 10-19 years or both.

Answer 8

Class C

***NOTE: Class A-C generally have GOOD PREG outcomes

Question 9

Pregestational DM:

Onset of disease occurs at 20 years or both.

Answer 9

Class D

***Note: Class D-T will have vascular complications

Question 10

Pregestational DM:

Client has developed diabetic nephropathy.

Answer 10

Class F

Question 11

Pregestational DM:

Client has developed Retinitis Proliferans

Answer 11

Class R

Question 12

Pregestational DM:

Client has had a Renal Transplant

Answer 12

Class T

Question 13

During the first trimester, pregnancy — insulin production.

Answer 13

increases

***can cause hypoglycemia

Question 14

What conditions lead to hypoglycemia in pregnancy?

Answer 14

Fetus takes lots of mom’s glucose

N/V can drop blood glucose

Human Placental Lactogen (HPL) is secreted
**an insulin antagonist

Question 15

By the 2nd and 3rd trimesters, insulin requirements —

Answer 15

increase

***as much as 4 x’s the usual amount

Question 16

With expulsion of placenta, what happens to body’s insulin needs?

Answer 16

abrupt drop of hormones and return to prepregnant state –> insulin needs DECREASE

Question 17

When are insulin needs greatest during pregnancy?

Answer 17

wks 36-40

Question 18

Maternal Risks w/ DM

Answer 18

Worsening of pre-existing disease (vascular or renal probs)

Hypoglycema first half of preg

Hyperglycemia (Ketoacidosis) in 2nd and 3rd trimesters

Polyhydramnios

Pre-eclampsia

Dystocia

***all these probs are more common with Type 1 DM

Question 19

When does fetus start producing own insulin?

Answer 19

baby pancreas produces own insulin by 10 WEEKS gestation

Question 20

Diabetes affects on fetus

Answer 20

Macrosomia

LGA

IUGR r/t maternal vascular probs

Delayed Lung Maturity

Hypoglycemia after birth

Neural Tube and Skeletal Defects

Question 21

Screening and Testing to Rule Out Gestational DM

Answer 21

50 gram Oral Glucose Tolerance Test

3 Hr Oral Glucose Tolerance Test (OGTT)

Question 22

Oral Glucose Tolerance Test:

How to perform 50 Gram OGTT

Answer 22

No fasting

Routine for all clients at 24-28 wks

50 g of oral glucose cola drink and blood drawn one hour later

Glucose > 130-140 mg/dL is positive and will follow up with 3 Hr Test

Question 23

Oral Glucose Tolerance Test:

How to perform 3 Hr OGTT

Answer 23

Load up on CHO

Fast after midnight

100 g glucola –> blood drawn at fasting, 1, 2, and 3 hrs

Positive if 2 OR MORE VALUES equal or exceed

Question 24

What values are we looking for with 3 Hr OGTT?

BOOK

Answer 24

Fasting = 60-99
1 hr = 100-129
2 hr =

Question 25

What values are we looking for w/ 3 Hr OGTT? ***her PPT slides***

Answer 25

Fasting =

Question 26

If 1 hr (50 g) OGTT is 140?

Answer 26

140 = do a 3 hr exam to further evaluate GDM

Question 27

What is an acceptable fasting blood sugar level?

Answer 27

60-90 mg/dL

Question 28

3 Hr OGTT: Two elevations greater --- than indicates diabetes.

Answer 28

140 mg/dL

Question 29

What is a good number for Blood Glucose?

Answer 29

Fasting = 60-90 1 hr = 130-140 2 hr =

Question 30

Hgb A1C: Levels --- indicate good blood sugar control. Levels --- indicates fair control Levels --- indicate poor control.

Answer 30

Good = 2.5 - 5.9% Fair = 6-8% Poor = > 8%

Question 31

What is Euglycemia?

Answer 31

Glucose of 65-95 before meal Glucose of 130-140 one hr after meal

Question 32

Calories: Non-obese pregnant client needs --- Obese client needs ---

Answer 32

35 cal/kg/day 25 cal/kg/day

Question 33

Diet for DM: How many meals per day?

Answer 33

3 x's day w/ 2-3 snacks

Question 34

Diet for DM: How many carbs? Protein? Fat?

Answer 34

carbs = no more than 55% protein = 20% fat = 25%

Question 35

Diet for DM: What type of snack is important to prevent drop in Blood Sugar during night?

Answer 35

night snack high in protein

Question 36

Insulin Therapy: --- of daily insulin dose is given at breakfast.

Answer 36

2/3 **combo of intermediate or long-acting and short-acting

Question 37

Insulin Therapy: --- of daily insulin is given in evening.

Answer 37

1/3 ** combo of long and short-acting

Question 38

--- are seldom used during pregnancy.

Answer 38

Oral DM meds

Question 39

S/S of Hypoglycemia

Answer 39

Nervousness HA Shaking/Irritability Hunger Blurred Vision Diaphoresis

Question 40

Treatment for Hypoglycemia: What can we do if glucose is

Answer 40

drink 15 mg simple carbs * **whole milk * **hard candy Rest 15 mins and recheck If > 60, eat a meal w/ protein to stabilize glucose level

Question 41

What is hyperglycemia?

Answer 41

> 130 mg/dL

Question 42

S/S of Hyperglycemia

Answer 42

Skin dry and flushed Thirsty w/ frequent urination Kussmaul respiration w/ fruity odor

Question 43

Fetal Surveillance for DM:

Answer 43

MSAFP at 15-20 wks gestation US for anomalies Fetal ECG at 20-22 wks BPP NST 1-2 times weekly from 34 wks Daily kick counts from 28 wks

Question 44

Management of Diabetes during Labor and Birth

Answer 44

Regular Insulin via IV piggyback Hourly glucose checks ***maintain

Question 45

Why are glucose checks done more frequently during Second Stage of Labor?

Answer 45

Voluntary pushing requires more energy

Question 46

Why is maintaining integrity of nipples an areola important w/ DM patients?

Answer 46

they are more prone to infection than a normal client

Question 47

Contraceptives for DM Client

Answer 47

Oral contraceptives contraversal r/t effect on carb metabolism and risk of thrombus Instead, use: - Barrier Method - IUD

Question 48

Risk Factors for Gestational DM

Answer 48

Family history of DM Native Americans Maternal Obesity Previous LGA baby Previous unexplained stillbirth

Question 49

S/S of Hypoglycemia in Neonate

Answer 49

Jittery Tremors Hypotonia Unstable Temp

Question 50

How much weight loss can Hyperemesis cause?

Answer 50

at least 5% or prepregnancy weight

Question 51

When does Hyperemesis ususally begin?

Answer 51

at 4 wks and lasts up to 20 wks

Question 52

Possible causes of Hyperemesis

Answer 52

Increasing Estrogen levels Increasing Progesterone levels Increasing hCG levels Hyperthyroidism Esophageal Reflux

Question 53

Can psycho-social factors like ambivalence cause hyperemesis?

Answer 53

Yes

Question 54

With hyperemesis, how do we want them to eat?

Answer 54

every 2-3 hrs sometimes w/out liquids bland to begin with

Question 55

What are the Fetal Risks associated w/ Hyperemesis?

Answer 55

IUGR Anomalies Death from hypoxia or maternal ketoacidosis

Question 56

What are signs of starvation that can alert us to hyperemesis?

Answer 56

Muscle wasting Jaundice Bleeding Gums (Vit. Deficiency)

Question 57

Mgmt of Hyperemesis

Answer 57

IV Fluids NPO until dehydration resolved and for 48hrs after vomiting has stopped I's and O's (including emesis) Daily Weights Small, frequent meals once 48 hrs w/ no vomiting

Question 58

Maternal PKU: What levels of Phenylalanine do we want?

Answer 58

2-6 mg/dL