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126 Prepare Exam 3 > TLO 2.3 Nutrition & Fluid Balance Obstretrics > Flashcards

TLO 2.3 Nutrition & Fluid Balance Obstretrics Flashcards

1
Q

Pathophysiology diabetes

A

Type 1 or Type 2 diabetes

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2
Q

Complications that may occur?

A

Preexisting diabetes & pregnancy

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3
Q

Nursing care client with preexisting diabetes

A
  • Assessment
  • Diagnostic testing
  • Skin care
  • Diet
  • Exercise
  • Insulin
  • Glucose monitoring
  • Intrapartum period
  • Postpartum period
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4
Q

Gestational diabetes

A
  • LGS
  • Pathophysiology
  • Risk factors for development of gestational diabetes
  • Screening for gestational diabetes
  • Antepartum period
  • Intrapartum period
  • Postpartum period
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5
Q

Diabetes & Pregnancy - Insulin is released by?

A

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

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6
Q

In EARLY pregnancy insulin is released in response to:

A

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

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7
Q

Type 1

A

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

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8
Q

LATER in pregnancy placental hormones cause what?

A

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

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9
Q

Glucose & insulin

A

Normally insulin opens receptors and escorts glucose into cells

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10
Q

Type 1 diabetes:

A

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

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11
Q

Type 2 diabetes:

A

Insulin is produced but cells are insulin resistant

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12
Q

Increased Maternal Risks:

Effect = Hypertension; preeclampsia - Probable Cause:

A

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

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13
Q

Increased Maternal Risks:

Effect = Urinary tract infections - Probable Cause:

A

Increased bacterial growth in nutrient-rich urine

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14
Q

Increased Maternal Risks:

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

A

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

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15
Q

Increased Maternal Risks:

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

A

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

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16
Q

Increased Maternal Risks:

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

A

Fetal macrosomia (large NB) causing difficult birth

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17
Q

Increased Fetal & Neonatal Risks:

Effect = Congenital anomalies - Probable Cause:

A

Maternal hyperglycemia during organ formation in first trimester

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18
Q

Increased Fetal & Neonatal Risks:

Effect = Perinatal death - Probable Cause:

A

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

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19
Q

Increased Fetal & Neonatal Risks:

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

A

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

20
Q

Increased Fetal & Neonatal Risks:

Effect = Intrauterine fetal growth restriction - Probable cause:

A

Maternal vascular impairment

21
Q

Increased Fetal & Neonatal Risks:

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

A

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

22
Q

Increased Fetal & Neonatal Risks:

Effect = Birth injury - Probable cause:

A

Large fetal size; shoulder dystocia or other difficult delivery

23
Q

Increased Fetal & Neonatal Risks:

Effect = Hypoglycemia - Probable cause:

A

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

24
Q

Increased Fetal & Neonatal Risks:

Effect = Polycythemia - Probable cause:

A

Fetal hypoxemia stimulating erythrocyte production

25
Q

Increased Fetal & Neonatal Risks:

Effect = Hyperbilirubinemia - Probable cause:

A

Breakdown of excessive red blood cells after birth

26
Q

Increased Fetal & Neonatal Risks:

Effect = Hypocalcemia - Probable cause:

A

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

27
Q

Increased Fetal & Neonatal Risks:

Effect = Respiratory distress syndrome - Probable cause:

A

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

28
Q

IUGR

A

In

29
Q

Nursing care client with preexisting diabetes Assessment:

A
  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)
30
Q

Diagnostic testing

A

Glycosylated hemoglobin measures glycemic control over time

31
Q

nsulin needs in pregnancy

A
  • 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
32
Q

Skin Care

A
  • 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
33
Q

Diet is based on…..

A

blood glucose levels.

34
Q

Energy needs are based on….

A

…30 calories per kilogram per day.

35
Q

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

A

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

36
Q

The best time to exercise is?

A

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
37
Q

Intrapartum Period

A
  • 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
38
Q

Complications for newborn

A

-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

39
Q

Postpartum period

A
  • During the postpartum period insulin requirements decrease
  • Women are encouraged to breast feed
  • Observation for complications, preeclampsia, eclampsia (pre-eclampsia), hemorrhage infection
40
Q

Gestational Diabetes

A

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
41
Q

Effects on Fetus

A
  • 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
42
Q

Risk Factors

A
  • 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
43
Q

**Screening for Gestational Diabetes

A 
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

44
Q

Antepartum Period

A

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

45
Q

Intrapartum Period

A
  • 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)
46
Q

Postpartum Period

A

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

126 Prepare Exam 3 (1 decks)

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