TLO 2.3 Nutrition & Fluid Balance Obstretrics

Question 1

Pathophysiology diabetes

Answer 1

Type 1 or Type 2 diabetes

Question 2

Complications that may occur?

Answer 2

Preexisting diabetes & pregnancy

Question 3

Nursing care client with preexisting diabetes

Answer 3

• Assessment
• Diagnostic testing
• Skin care
• Diet
• Exercise
• Insulin
• Glucose monitoring
• Intrapartum period
• Postpartum period

Question 4

Gestational diabetes

Answer 4

• LGS
• Pathophysiology
• Risk factors for development of gestational diabetes
• Screening for gestational diabetes
• Antepartum period
• Intrapartum period
• Postpartum period

Question 5

Diabetes & Pregnancy - Insulin is released by?

Answer 5

it is released by the pancreas and is essential for carbohydrate metabolism

Question 6

In EARLY pregnancy insulin is released in response to:

Answer 6

to serum glucose levels increases, and fat is stored for use later in pregnancy

Question 7

Type 1

Answer 7

Glucose can not get into the cell, because NO INSULIN is produced by the body

Question 8

LATER in pregnancy placental hormones cause what?

Answer 8

it causes insulin resistance to provide an abundant supply of glucose for the growing fetus

Question 9

Glucose & insulin

Answer 9

Normally insulin opens receptors and escorts glucose into cells

Question 10

Type 1 diabetes:

Answer 10

The pancreas dose not produce insulin so none is available, patients with type 1 diabetes have to take insulin

Question 11

Type 2 diabetes:

Answer 11

Insulin is produced but cells are insulin resistant

Question 12

Increased Maternal Risks:

Effect = Hypertension; preeclampsia - Probable Cause:

Answer 12

Unknown - but, Hypertension; preeclampsia increased even without renal or vascular impairment

Question 13

Increased Maternal Risks:

Effect = Urinary tract infections - Probable Cause:

Answer 13

Increased bacterial growth in nutrient-rich urine

Question 14

Increased Maternal Risks:

Effect = Ketoacidosis (risk for mother & fetus) - Probable Cause:

Answer 14

Uncontrolled hyperglycemia or infection; MOST COMMON IN WOMEN WITH TYPE 1 DIABETES

Question 15

Increased Maternal Risks:

Effect = Labor dystocia; cesarean birth; uterine atony with hemorrhage after birth - Probable Cause:

Answer 15

Hydramnios secondary to fetal osmotic diuresis caused by hyperglycemia; uterus is overstretched

Question 16

Increased Maternal Risks:

Effect = Birth injury to maternal tissues (hematoma, lacerations) - Probable Cause:

Answer 16

Fetal macrosomia (large NB) causing difficult birth

Question 17

Increased Fetal & Neonatal Risks:

Effect = Congenital anomalies - Probable Cause:

Answer 17

Maternal hyperglycemia during organ formation in first trimester

Question 18

Increased Fetal & Neonatal Risks:

Effect = Perinatal death - Probable Cause:

Answer 18

Poor placental perfusion because of maternal vascular impairment, primarily in women with type 1 diabetes

Question 19

Increased Fetal & Neonatal Risks:

Effect = Macrosomia (>4000g) - Probable cause:

Answer 19

Fetal hyperglycemia stimulating production of insulin to metabolize carbohydrates; excess nutrients transported to fetus

Question 20

Increased Fetal & Neonatal Risks:

Effect = Intrauterine fetal growth restriction - Probable cause:

Answer 20

Maternal vascular impairment

Question 21

Increased Fetal & Neonatal Risks:

Effect = Preterm labor; premature rupture of membranes; preterm birth - Probable cause:

Answer 21

Overdistention of uterus caused by hydramnios and large fetal size at preterm gestation

Question 22

Increased Fetal & Neonatal Risks:

Effect = Birth injury - Probable cause:

Answer 22

Large fetal size; shoulder dystocia or other difficult delivery

Question 23

Increased Fetal & Neonatal Risks:

Effect = Hypoglycemia - Probable cause:

Answer 23

Neonatal hyperinsulinemia after birth when maternal glucose is no longer available but newborn insulin production remains high

Question 24

Increased Fetal & Neonatal Risks:

Effect = Polycythemia - Probable cause:

Answer 24

Fetal hypoxemia stimulating erythrocyte production

Question 25

Increased Fetal & Neonatal Risks: | Effect = Hyperbilirubinemia - Probable cause:

Answer 25

Breakdown of excessive red blood cells after birth

Question 26

Increased Fetal & Neonatal Risks: | Effect = Hypocalcemia - Probable cause:

Answer 26

Transfer of calcium abruptly stopped at birth; reduced fetal parathyroid function

Question 27

Increased Fetal & Neonatal Risks: | Effect = Respiratory distress syndrome - Probable cause:

Answer 27

Delayed maturation of fetal lungs; inadequate maturation of fetal lungs; inadequate production of pulmonary surfactant; slowed absorption of fetal lung fluid

Question 28

IUGR

Answer 28

In

Question 29

Nursing care client with preexisting diabetes Assessment:

Answer 29

1. Type of diabetes: type 1 or type 2 (need to know) 2. Clients understanding of disease, including diet, blood sugar monitoring, diabetes & pregnancy 3. Teaching needs (is their BS under control) 4. Support systems (if type 2, may not be taking insulin, but other meds., inter fears w/pregnancy)

Question 30

Diagnostic testing

Answer 30

Glycosylated hemoglobin measures glycemic control over time

Question 31

**nsulin needs in pregnancy**

Answer 31

- 1st trimester-insulin needs usually decline, the woman my experience nausea, vomiting and decreased food intake, this may lead to hypoglycemia - 2nd & 3rd trimester-insulin needs increase when the placental hormones cause insulin resistance

Question 32

Skin Care

Answer 32

- Foot care (feet get bigger) and general skin care are very important. - Daily bath should include good perineal and foot care. - Tight clothing should be avoided and shoes and slippers should fit properly

Question 33

Diet is based on.....

Answer 33

blood glucose levels.

Question 34

Energy needs are based on....

Answer 34

...30 calories per kilogram per day.

Question 35

Approximately what % calories, carbohydrates, proteins & fat are needed

Answer 35

Approximately 30% of calories should be from carbohydrates, 12-20% from proteins, and 40% from fat.

Question 36

The best time to exercise is?

Answer 36

after meals when the blood sugar is rising. - The HCP should monitor carefully for complications. - Studies do not show that exercise is beneficial to women with preexisting diabetes

Question 37

Intrapartum Period

Answer 37

- Monitor for dehydration, hypoglycemia, hyperglycemia - Blood glucose is measured every hour maintained at 80-110 mg/dl - Continuous fetal monitoring - Mother in upright or side lying position - NOT on back causes "Supine Hypotension" - Observation for macrosomic infant

Question 38

Complications for newborn

Answer 38

-Hypoglycemia after exposure to high levels of glucose the fetus produces more insulin. -When the supply of glucose stops at birth the infants blood glucose falls rapidly because it continues to produce a high level of insulin. -Neonatal blood glucose should be maintained above 50 mg/dl NOTE: The fetus is NOT a diabetic, insulin increases when the Mother ingests more sugar - Breast feeding is a good for hypoglycemic patients

Question 39

Postpartum period

Answer 39

- During the postpartum period insulin requirements decrease - Women are encouraged to breast feed - Observation for complications, preeclampsia, eclampsia (pre-eclampsia), hemorrhage infection

Question 40

Gestational Diabetes

Answer 40

approx 24wks - 1. Placenta produces hormones (estrogen, cortisol and human placental lactogen) 2. These hormones inhibit the functioning of insulin 3. Blood glucose levels increase

Question 41

Effects on Fetus

Answer 41

- Mother's blood brings extra glucose to the fetus - Fetus makes more insulin to handle the extra glucose - Extra glucose becomes stored as fat fetus becomes larger than normal

Question 42

Risk Factors

Answer 42

- Overweight - Maternal age over 25 years - Previous outcome associated with GDM e. g macrosomia - GDM previous pregnancy - H/O glucose tolerance - H/O diabetes in a close relative - Member of high risk ethnic group

Question 43

**Screening for Gestational Diabetes

Answer 43

``` It two or more levels are met or exceeded positive for GD Fasting >95 mg/dl 1-hr >180 mg/dl 2-hr >155 mg/dl 3-hr >140 mg/dl ``` NOTE: 100g = 190 mg/dl

Question 44

Antepartum Period

Answer 44

Diet Exercise Monitoring Blood Glucose Levels Insulin Again those women who performed regular exercise showed improvement in their BS control even above that of diet alone

Question 45

Intrapartum Period

Answer 45

- Glucose monitoring to maintain blood glucose below 110 mg/dl - Regular insulin if necessary (some gestational diabetic will have IV) - Maintenance IV fluids - Routine fetal activity and fetal heart assessment - Observation for macrosomia (large fetus)

Question 46

Postpartum Period

Answer 46

Care of infant observe for hypoglycemia In most women blood sugar returns to normal levels gestational diabetic may have to check BS one more time after birth