Chapter 29 Flashcards by Fatima Avila

METABOLIC CHANGES IN PREGNANCY
-Pregnancy is a natural state of _____ upheaval
-It is characterized by complex alterations in what?

-endocrine
-maternal glucose metabolism, insulin production, & metabolic homeostasis

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METABOLIC CHANGES IN PREGNANCY
-What happens during the second & third trimesters?

Pregnancy exerts a “diabetogenic effect” on the maternal metabolic status –> insulin resistance that causes high blood sugar

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METABOLIC CHANGES IN PREGNANCY
-What does mom have to regulate?

Her body & baby’s body

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METABOLIC CHANGES IN PREGNANCY
-Describe what happens in a diabetogenic effect

Baby starts making its own insuling around 26-28 (imbalance STARTS HERE)
Placental hormones cause:
-INCREASED insulin resistance –> block insulin so glucose goes to baby
-DECREASED glucose tolerance
DECREASED hepatic glycogen stores
-INCREASED hepatic glucose production

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METABOLIC CHANGES IN PREGNANCY
-Why do the diabetogenic effects happen?

So that more sugar can stay in mom’s blood & go to the baby

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METABOLIC CHANGES IN PREGNANCY
-What does placental expulsion at birth cause?

An abrupt drop in levels of placental hormones, cortisol, & insulinase

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METABOLIC CHANGES IN PREGNANCY
-Maternal tissues (slowly/quickly) regain their prepregnancy sensitivity to insulin

Quickly

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DIABETES MELLITUS
-Incidence worldwide is growing at a _____ rate
-It affects ___-___% of pregnancies
-Pregnancy complicated by diabetes is considered what?

-rapid
-6-7
-High risk

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DIABETES MELLITUS
-What is the key/goal for DM before conception & throughout pregnancy?

Strict maternal glucose control

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DIABETES MELLITUS: Pathogenesis
-This is a group of metabolic disease characterized by what?
-What does it result from?

-HYPERglycemia (too much glucose in blood)
-defects in insulin secretion, insulin action, or both

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DIABETES MELLITUS: Pathogenesis
-How does the body compensate for inability to convert glucose into energy?

By burning muscle & fat to gain energy

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DIABETES MELLITUS: Pathogenesis
-Over time, diabetes causes significant changes in what two circulations?

Microvascular (eyes, kidneys, nerves) & macrovascular circulations

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DIABETES MELLITUS
-What does Hemoglobin A1c tell us?
-Can we use it in pregnancy?

-the average blood sugar over 3 months (pregnancy is 9 months)
-You can use it if mom has underlying issues or if you want background info

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DIABETES MELLITUS
-Mom should be doing what instead?

Taking blood sugar 3-4 times a day

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DIABETES MELLITUS
-What is the 1 hour Glucose Challenge Test (GCT)
-What if it comes back high?

-Mom takes drink, wait an hour, draw blood
-Do 3 hour test

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DIABETES MELLITUS
-What is the 3 hour glucose challenge test?
-If _____ of them come back elevated, what does it mean?

-Fast, take drink, BS at 1 hour, 2 hours, and 3 hours
-two; she has gestational diabetes

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DIABETES MELLITUS: Type 1
-This accounts for what percent of cases?
-Describe onset.
-What is it?

-5-10% of all DM cases
-Abrupt onset at young age
-Absolute insulin deficiency –> body can’t make insulin

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DIABETES MELLITUS: Type 2
-This account for what percent of all DM cases?
-What is the cause?
-What is it?

-90-95%
-Unknown but has strong genetic/lifestyle predisposition
-Insulin resistance & relative insulin deficiency

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DIABETES MELLITUS: Pregestational DM
-What is this?

Label given to Type 1 or Type 2 Dm that existed prior to pregnancy

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DIABETES MELLITUS: Gestational DM
-What is this?
-When does first onset occur?

-Carbohydrate intolerance
-during pregnancy

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PREGESTATIONAL DM
-About ____% of pregnancies have preexisting DM
-______ counseling should happen

-10%
-preconception

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PREGESTATIONAL DM
-What is the mom at risk for/complications? (7)

Preeclampsia
Disproportionate increase in shoulder, trunk, & chest size
Increase risk of c/s
Polyhydramnios
Infections (UTI)
DKA
Hypo/hyperglycemia

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PREGESTATIONAL DM
-What is the fetus at risk for? (6)

Macrosomia (large baby)
IUFD (stillbirth)
Congenital malformations
Respiratory distress
Extreme prematurity
Hypoglycemia at birth –> insulin but no glucose supply

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PREGESTATIONAL DM
-Perinatal mortality rate is ____ times higher for women with diabetes than for women who do not have this disease

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**PREGESTATIONAL DM** -What therapy can these moms be on?

Metformin & insulin

**PREGESTATIONAL DM** -Describe management

First we start with diet, teaching, & monitoring --> then metformin if not controlled --> then insulin if not controlled

**PREGESTATIONAL DM** -During labor we can hang what? -What should we encourage?

-IV insuling or metformin -Exercise

**PREGESTATIONAL DM CARE**: *Assessment* -We must do a complete ______ examination & thorough _____ -Routine prenatal _____ tests & _____ _____ _____ level

-physical; evaluation -laboratory; glycosylated hemoglobin A1c

**PREGESTATIONAL DM CARE**: *Assessment* -What does iron deficiency anemia in diabetic patients elevate? -What levels are controlled?

-HbA1c -plasma glucose

**PREGESTATIONAL DM CARE**: *Antepartum Care* -How often should monitoring occur in the last trimester?

1-2 times per week

**PREGESTATIONAL DM CARE**: *Antepartum Care* -What is the primary goal?

Achieving & maintaining normal glucose (euglycemia)

**PREGESTATIONAL DM CARE**: *Antepartum Care* -What is the normal glucose range?

60-105 mg/dL BEFORE meals & 140 mg/dL or less 1 HOUR POST PRANDIAL

**PREGESTATIONAL DM CARE**: *Antepartum Care* -What three things should mom do?

1. Diet & exercise 2. Insulin therapy 3. Self-monitoring of blood glucose (SMBG)

**PREGESTATIONAL DM CARE**: *Antepartum Care* -______ testing should be done. -There may be complications that require ______ -____ surveillance should be done.

-Urine -hospitalization -Fetal

**PREGESTATIONAL DM CARE**: *Antepartum Care* -What should be determined during this time? -When is the optimal timing when mom has good glycemic control?

-birth date & mode -39-40 weeks

**PREGESTATIONAL DM CARE**: *Intrapartum Care* -We should be monitoring for what three things?

Dehydration, hypoglycemia, hyperglycemia

**PREGESTATIONAL DM CARE**: *Intrapartum Care* -What should be carefully monitored?

Blood glucose levels

**PREGESTATIONAL DM CARE**: *Intrapartum Care* -Continuous ______ -______ infusions, including what?

-EFM -IV; NS or LR

**PREGESTATIONAL DM CARE**: *Intrapartum Care* -What is possible for macrosomia?

Cesarean birth

**PREGESTATIONAL DM CARE**: *Postpartum Care* -What happens to insulin requirements during the first 24 hours? -What does this require?

-They drop substantially -1/2 insulin

**PREGESTATIONAL DM CARE**: *Postpartum Care* -There is a risk of hemorrhage due to what?

Uterine distention

**PREGESTATIONAL DM CARE**: *Postpartum Care* -Women with diabetes are encoruaged to feed their baby's how?

Breastfeeding

**PREGESTATIONAL DM CARE**: *Postpartum Care* -What should you do?

1. Concraceptive method education 2. Continuous monitoring

**PREGESTATIONAL DM CARE**: *Postpartum Care* -These women have a higher risk of developing what?

Diabetes later in life & in future pregnancies

**GESTATIONAL DM** -Women with strong risk factors should be screened when in pregnancy?

Earlier; before 24-28 weeks

**GESTATIONAL DM** -What is the Two-step screening method that is recommended by ACOG?

1. 1-hour, 50g oral glucose 2. 3-hour, 100-g oral glucose (OGTT)

**GESTATIONAL DM** -What is considered a positive 1-hour screen?

Glucose of 130-140 mg/dL or higher

**GESTATIONAL DM** -What is a positive 3-hour glucose test?

Diagnosed with GDM if TWO OR MORE values are met or exceeded

**GESTATIONAL DM** -What is an alternative one-step screening method?

75-g OGTT

**GESTATIONAL DM** -What are the maternal risks? (3)

1. Preeclampsia (9.8% well controlled, 18% not well controlled) 2. C-section (17-25%) 3. Development of Type 2 diabetes later in life (up to 70%)

**GESTATIONAL DM** -What are fetal risk factors? (3)

1. Macrosomia 2. Birth trauma 3. Electrolyte imbalances --> neonatal hypoglycemia & hyperinsulinemia

**GESTATIONAL DM**: *Antepartum Care* -What is the goal?

Strict blood glucose control

**GESTATIONAL DM**: *Antepartum Care* -What can the mom do? (4)

1. Diet modification 2. Exercise 3. Self-monitoring of blood glucose 4. Pharmacologic therapy

**GESTATIONAL DM**: *Antepartum Care* -______ surveillance is important

Fetal

**GESTATIONAL DM**: *Antepartum Care* -Women who require insulin or oral hypoglycemic agents for BG control should have what?

Twice-weekly NSTs beginning at 32 weeks of gestation

**GESTATIONAL DM**: *Intrapartum Care* -How often should blood glucose levels be monitored in labor? -Maintain levels at what? -Infuse _____ if needed

-Every hour -80-110 mg/dL -insulin

**GESTATIONAL DM**: *Postpartum Care* -When do normal glucose levels return?

After birth

**GESTATIONAL DM**: *Postpartum Care* -There is a high risk for what in future pregnancies?

Recurrent GDM

**GESTATIONAL DM**: *Postpartum Care* -ACOG recommends assessing all women who had GDM for _______ intolerance with a ______, _____ OGTT OR what at ______ weeks PP

-carbohydrate -75-g, 2 hour -fasting plasma glucose level -6-12 weeks PP

**HYPEREMESIS GRAVIDARUM** -Normal N/V complicates what percent of all pregnancies? -When does it typically begin? -When does it usually resolve?

-50-80% -4-10 weeks -20 weeks

**HYPEREMESIS GRAVIDARUM** -What is it? -What percent of pregnancies does it occur in?

-Excessive, prolonged vomiting -0.3-3%

**HYPEREMESIS GRAVIDARUM** -It is accompanied by what 5 things?

1. Weight loss 2. Electrolyte imbalance 3. Nutritional deficiencies 4. Ketonuria 5. Dehydration

**HYPEREMESIS GRAVIDARUM** -Is this managed outpatient?

No, they should be admitted for IV hydration & medications

**HYPEREMESIS GRAVIDARUM** -What is the usual treatment?

Zofran PO then reglin pump (small dose throughout the day)

**HYPEREMESIS GRAVIDARUM** -What are the clinical manifestations? (5)

1. Significant weight loss & dehydration 2. Dry mucous membranes 3. Decreased BP (HYPOtension) 4. Increased pulse rate (tachycardia) 5. Poor skin tugor & pale skin

**HYPEREMESIS GRAVIDARUM** -You want to ask what about the episodes?

Severity, frequency, & duration

**HYPEREMESIS GRAVIDARUM** -You want to determine if ______ is happening

Ketonuria

**HYPEREMESIS GRAVIDARUM** -What is the psychosocial assessment?

The role of anxiety

**HYPEREMESIS GRAVIDARUM** -Describe initial intervention

IV therapy to correct F&E imbalances --> medications

**HYPEREMESIS GRAVIDARUM** -What is the last resort?

Enteral or parenteral nutrition

**HYPEREMESIS GRAVIDARUM** -What should be the follow up?

See how they are tolerating PO

Chapter 29 Flashcards

Endocrine and Metabolic Disorders (71 cards)