What are the three possible types of diabetes in pregnancy? - ANSWERS1. pre-existing type 1 diabetes (insulin dependent); typically diagnosed in childhood
2. pre-existing type 2 diabetes (insulin resistant); typically diagnosed in adulthood
3. gestational diabetes; occurs only in pregnancy; u...
What are the three possible types of diabetes in pregnancy? - ANSWERS1. pre-existing
type 1 diabetes (insulin dependent); typically diagnosed in childhood
2. pre-existing type 2 diabetes (insulin resistant); typically diagnosed in adulthood
3. gestational diabetes; occurs only in pregnancy; usually goes away once the baby is
born; typically doesn't develop until halfway through the pregnancy
What are maternal effects of pre-existing diabetes? - ANSWERS-higher risk for
spontaneous abortion, hypertension, preeclampsia, UTIs
-hydramnios
-labor dystocia (dysfunctional labor)
-ketoacidosis develops earlier
What are fetal effects of pre-existing diabetes? - ANSWERS-congenital malformations
-fetal size (macrosomia - fetus size over 4000g (8lbs.13oz) or SGA - small for
gestational age)
What effects can display on newborns of diabetic mothers? - ANSWERS-hypoglycemia
(insulin doesn't cross placenta but oral diabetic meds do); fetal pancreas is producing
insulin to combat maternal hyperglycemia, which still happens after the fetus is born,
causing hypoglycemia
-hypocalcemia
-hyperbilirubinemia
-respiratory distress syndrome
What is gestational diabetes? What is a primary cause? - ANSWERSdiabetes
diagnosed in the second or third trimester of pregnancy that was not clearly overt
diabetes before gestation
cause:
-placental hormones can cause increased insulin resistance
What are some risk factors for gestational diabetes? - ANSWERS-over age 35
-obesity
-multiple gestation (more than one fetus)
-prior gestational diabetes
-history of large infants
,T/F: Gestational diabetes can cause congenital malformations in the fetus -
ANSWERSFalse; because gestational diabetes develops after the first trimester (after
20 weeks), it is NOT associated with major congenital malformations of the fetus
When are gestational diabetes screenings typically done during pregnancy? What are
the types of screenings? - ANSWERSdone between 24-28 weeks of gestation
glucose challenge test (GCT or 1-hour test) is done first, then oral glucose tolerance
test (OGTT or 3-hour test)
What is the glucose challenge test (GCT)? - ANSWERSscreening tool for gestational
diabetes; aka 1 hour test (will be the initial test given)
fasting is not necessary before testing; 50g of oral glucose solution is given to the client
and a blood sample is taken 1 hour later
if blood glucose is 140 mg/dL, 3-hour OGTT is recommended
What is the oral glucose tolerance test (OGTT)? - ANSWERSgold standard screening
for diagnosing gestational diabetes; fasting is required from midnight on the day prior to
the test
fasting blood glucose level is drawn; then client ingests 100g of oral glucose solution
and plasma glucose levels are determined at 1, 2, and 3 hours
What implementations for gestational diabetes should be done during pregnancy?
Postpartum? - ANSWERSduring pregnancy:
-monitor blood glucose levels
-maintain stable glucose levels (insulin drip as needed)
postpartum:
-rarely is there a need to monitor maternal glucose levels postpartum
-re-evaluate insulin needs
What are signs/symptoms we can assess for cardiac disease in pregnant patients? -
ANSWERS-higher levels of fatigue
-coughing/shortness of breath
-s/s of congestive heart failure (dependent edema, crackles)
-factors that may increase cardiac workload
What implementations can be made to help treat pregnant patients with cardiac
disease? What implementations during labor? - ANSWERSpregnant patients:
-limit physical activity
-avoid excessive weight gain
-prevent anemia (iron supplements, vitamin C)
-prevent infection
How is HIV transmitted? How can it be transmitted to the baby (perinatally)? -
ANSWERSit can be transmitted through sexual exposure or infected blood/tissue
perinatal exposure can happen via maternal secretions, such as breastfeeding
What care can we give to HIV patients antepartum? During labor? -
ANSWERSantepartum:
-give antiretroviral medications
during labor:
-give IV Zidovudine
-no artificial rupture of membranes (AROM)
-no internal monitoring
What care can we give to newborns of HIV-infected mothers? - ANSWERS-carefully
bathe the infant before any vaccinations given
-note that just because mother is positive does not mean that the baby is as well
-undergo neonatal testing and/or prophylaxis as prescribed
What medications are given for the treatment of gonorrhea prophylactically? What is
given to the newborn? - ANSWERSerythromycin is given prophylactically
eye ointment is given to newborns to prevent blindness in those exposed to gonorrhea
from mother; given in the 1st hour after birth (state law - must be given to every
newborn)
Why is it important to catch syphilis early in pregnancy? What is given to treat this? -
ANSWERSsyphilis (VDRL/RDR) is important to catch early because it can cause many
congenital malformations while the fetus is developing
treat mother with penicillin to prevent these malformations
What are TORCH infections? - ANSWERSperinatal infections that account for 2-3% of
congenital anomalies in pregnant women
T - toxoplasmosis
O - other (syphilis, varicella, parvovirus)
R - rubella
C - cytomegalovirus
H - herpes
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