T4 - Endocrine Metabolic Disorders (Josh) Flashcards Preview

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Flashcards in T4 - Endocrine Metabolic Disorders (Josh) Deck (58):
1

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

Diabetes Mellitus

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

2

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

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

Type 1 DM

Type 2 DM

3

Risk factors for Gestational Diabetes Mellitus (GDM)

obesity

aging

sedentary lifestyle

HTN

prior GDM

4

Gestational DM:

Class --- can be controlled via diet.

Class --- requires meds.

A1

A2

5

Gestational DM:

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

Class A1

6

Gestational DM:

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

Class A2

7

Pregestational DM:

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

Class B

8

Pregestational DM:

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

Class C

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

9

Pregestational DM:

Onset of disease occurs at 20 years or both.

Class D

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

10

Pregestational DM:

Client has developed diabetic nephropathy.

Class F

11

Pregestational DM:

Client has developed Retinitis Proliferans

Class R

12

Pregestational DM:

Client has had a Renal Transplant

Class T

13

During the first trimester, pregnancy --- insulin production.

increases

***can cause hypoglycemia

14

What conditions lead to hypoglycemia in pregnancy?

Fetus takes lots of mom's glucose

N/V can drop blood glucose

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

15

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

increase

***as much as 4 x's the usual amount

16

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

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

17

When are insulin needs greatest during pregnancy?

wks 36-40

18

Maternal Risks w/ DM

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

19

When does fetus start producing own insulin?

baby pancreas produces own insulin by 10 WEEKS gestation

20

Diabetes affects on fetus

Macrosomia

LGA

IUGR r/t maternal vascular probs

Delayed Lung Maturity

Hypoglycemia after birth

Neural Tube and Skeletal Defects

21

Screening and Testing to Rule Out Gestational DM

50 gram Oral Glucose Tolerance Test

3 Hr Oral Glucose Tolerance Test (OGTT)

22

Oral Glucose Tolerance Test:

How to perform 50 Gram OGTT

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

23

Oral Glucose Tolerance Test:

How to perform 3 Hr OGTT

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

24

What values are we looking for with 3 Hr OGTT?

***BOOK***

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

25

What values are we looking for w/ 3 Hr OGTT?

***her PPT slides***

Fasting =

26

If 1 hr (50 g) OGTT is 140?

140 = do a 3 hr exam to further evaluate GDM

27

What is an acceptable fasting blood sugar level?

60-90 mg/dL

28

3 Hr OGTT:

Two elevations greater --- than indicates diabetes.

140 mg/dL

29

What is a good number for Blood Glucose?

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

30

Hgb A1C:

Levels --- indicate good blood sugar control.

Levels --- indicates fair control

Levels --- indicate poor control.

Good = 2.5 - 5.9%

Fair = 6-8%

Poor = > 8%

31

What is Euglycemia?

Glucose of 65-95 before meal

Glucose of 130-140 one hr after meal

32

Calories:

Non-obese pregnant client needs ---

Obese client needs ---

35 cal/kg/day

25 cal/kg/day

33

Diet for DM:

How many meals per day?

3 x's day w/ 2-3 snacks

34

Diet for DM:

How many carbs?

Protein?

Fat?

carbs = no more than 55%

protein = 20%

fat = 25%

35

Diet for DM:

What type of snack is important to prevent drop in Blood Sugar during night?

night snack high in protein

36

Insulin Therapy:

--- of daily insulin dose is given at breakfast.

2/3

**combo of intermediate or long-acting and short-acting

37

Insulin Therapy:

--- of daily insulin is given in evening.

1/3

** combo of long and short-acting

38

--- are seldom used during pregnancy.

Oral DM meds

39

S/S of Hypoglycemia

Nervousness

HA

Shaking/Irritability

Hunger

Blurred Vision

Diaphoresis

40

Treatment for Hypoglycemia:

What can we do if glucose is

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

41

What is hyperglycemia?

> 130 mg/dL

42

S/S of Hyperglycemia

Skin dry and flushed

Thirsty w/ frequent urination

Kussmaul respiration w/ fruity odor

43

Fetal Surveillance for DM:

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

44

Management of Diabetes during Labor and Birth

Regular Insulin via IV piggyback

Hourly glucose checks

***maintain

45

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

Voluntary pushing requires more energy

46

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

they are more prone to infection than a normal client

47

Contraceptives for DM Client

Oral contraceptives contraversal r/t effect on carb metabolism and risk of thrombus

Instead, use:

- Barrier Method
- IUD

48

Risk Factors for Gestational DM

Family history of DM

Native Americans

Maternal Obesity

Previous LGA baby

Previous unexplained stillbirth

49

S/S of Hypoglycemia in Neonate

Jittery

Tremors

Hypotonia

Unstable Temp

50

How much weight loss can Hyperemesis cause?

at least 5% or prepregnancy weight

51

When does Hyperemesis ususally begin?

at 4 wks and lasts up to 20 wks

52

Possible causes of Hyperemesis

Increasing Estrogen levels

Increasing Progesterone levels

Increasing hCG levels

Hyperthyroidism

Esophageal Reflux

53

Can psycho-social factors like ambivalence cause hyperemesis?

Yes

54

With hyperemesis, how do we want them to eat?

every 2-3 hrs

sometimes w/out liquids

bland to begin with

55

What are the Fetal Risks associated w/ Hyperemesis?

IUGR

Anomalies

Death from hypoxia or maternal ketoacidosis

56

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

Muscle wasting

Jaundice

Bleeding Gums (Vit. Deficiency)

57

Mgmt of Hyperemesis

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

58

Maternal PKU:

What levels of Phenylalanine do we want?

2-6 mg/dL