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What are some interpartum care measures for mothers with Diabetes Mellitus? (4)
- 1) Blood glucose levels and hydration must be carefully controlled during labor
- •IV fluids
- •Typically continuous insulin infusion – regular (short-acting) insulin only
- 2) Target of 80-120 mg/dl during labor
- 3) Continuous fetal monitoring
- 4) NICU may be present
These are all interpartum care measures for mothers with ____ _____.
What type of insulin is typically used in the continuous infusion for intrapartum care of mothers with DM.
Only regular (short-acting) insulin is used in the ______ infusion for intrapartum care of mothers with DM
What's the target range of blood glucose when using a continuous insulin infusion during labor of a mothers with DM.
The target range of _____ _____when using a continuous insulin infusion during labor of mothers with DM is 80-120 mg/dl.
Name some postpartum care measures in mothers with DM. (4)
- 1) Careful BG monitoring due to rapidly declining insulin needs after delivery of placenta
- 2) Higher rate of hemorrhage and postpartum infection
- 3) Patient teaching about management of DM with nursing
- 4) Contraceptive counseling (they should plan there pregnancy)
These are all postpartum care measures in mothers with ____ ____.
What is the % of all diabetic pregnancies that are considered Gestational Diabetes
75% of all diabetic pregnancies are considered ______ Diabetes.
What 2 risk factors are increased with gestational diabetes?
- 1) Likely to recur in subsequent pregnancies
- 2) Increased risk for development of overt diabetes later in life
These are likely to happen if a mother is diagnosed with what complication?
What are 2 maternal risks with Gestational Diabetes?
- 1) Onset of hypertensive disorders
- 2) Fetal macrosomia
These are 2 maternal risks with _____ _____.
What are some fetal risks with Gestational Diabetes? (7)
- 1) ***Hypoglycemia
- 2) Hypocalcemia
- 3) Hyperbilirubinemia
- 4) Thrombocytopenia
- 5) Polycythemia
- 6) ***Respiratory distress syndrome (RDS)
- 7) No increased risk of congenital malformations
These are all fetal risks with ______ ______.
All pregnant women should be screened for GDM by what 3 ways?
- 1) History
- 2) Risk factors
- 3) Lab screening of glucose levels
These things should be done to screen for what in pregnant women?
You may differ lab screening for Gestational Diabetes on low-risk women. What would be considered low-risk? (4)
- 1) Younger than 25
- 2) No family history of DM
- 3) Not members of a high prevalence ethnic or racial group
- 4) No history of abnormal glucose tolerance or adverse obstetric outcomes usually associated with GDM
These are all indications that you could do what with lab screening for Gestational Diabetes?
When should you screen for GDM?
You should you screen for ___ at the 1st prenatal visit and then at 24-28 weeks
To test for GDM an oral glucose load of 50 g is given followed by a plasma glucose measurements 1 hour later. What is considered a positive screen for GDM.
Values greater that 140 mg/dl are considered a poistive screen for ____.
If a mother has a positive screen for GDM it is followed by what
If a mother has a positive screen for GDM it is followed by a 3-hour 100g glucose load (with blood draws fasting and at 1, 2, and 3 hours)
During the 3-hour 100g glucose load screen for GDM how many of the fasting, 1, 2, 3 hour blood draws must be elevated to be considered a positive screen for GDM.
If 2 or more of the blood draws during the 3-hour 100g glucose load are elevated then it is considered a positve screen for _____.
What are some antipartum care measures for Gestational Diabetes? (5)
- 1) Dietary consult
- 2) Home BG monitoring
- –Same target values as with Type 1 and 2 DM
- 3) Exercise after meals
- 4) Insulin therapy if necessary
- 5) NSTs starting around 36 weeks or earlier
These are all antipartum care measures for what disorder in pregnancy.
Name some intrapartum care measures for mothers with GDM? (2)
These are intrapartum care measures for mothers with ____.
- 1) Blood glucose monitoring at every 2 hours
- 2) IV fluids with glucose are not typically given
What should the blood glucose levels be in itrapartum care of mothers with GDM and why?
Blood glucose levels should be 80-120mg/dl to decrease the risk of neonatal hypoglycemia in mothers with ____.
Name some postpartum care measures for mothers with GDM? (2)
- 1) Breastfeeding encouraged
- 2) Patient teaching since increased risk of recurring GDM with subsequent pregnancies and Type 2 DM later in life
These are both postpartum care measures for mothers with ____.
Name some assessment findings of newborrns of diabetic mothers. (5)
- 1) Full rosy cheeks with a ruddy skin color
- 2) Short neck appearance
- 3) Buffalo hump over the nape of the neck
- 4) Large/full shoulders
- 5) Excessive subcutaneous fat tissue/fat extremities
These are all assessment findings of newborrns of ________ mothers.
Name some signs of hypoglycemia in newborns born to diabetic mothers. (11)
- 1) Listlessness
- 2) Hypotonia
- 3) Apathy
- 4) Poor feeding
- 5) Apneic episodes
- 6) Cyanosis
- 7) Temperature instability
- 8) Pallor and sweating
- 9) Tremors
- 10) Irritability
- 11) Seizures
These are all signs of _______ in newborns born to diabetic mothers
Nursing management of diabetic mothers should focus on what?
Management of _____ mothers should focus on early detection and initiation of therapy
What baseline labs should be gotten in diabetic mothers? (3)
Baseline serum calcium, magnesium, and billirubin levels should be gotten in ______ mothers.
What are some ongoing assessments of newborns of diabetic mothers? (4)
- 1) Birth injuries
- 2) Respiratory stability
- 3) Hypoglycemia
- 4) Hypocalcemia (tremors, hypotonia, high-pitched cry, apnea, seizures), hyperbilirubinemia, polycythemia
These are some ongoing assessments of newborns of _____ mothers
Name some nursing managements of newborns of diabetic mothers? (5)
- 1) Monitor blood glucose levels qhr X 4 hrs, then q3-4 hrs or prn
- •Value should be >40 mg/dl
- 2) Monitor temp frequently and maintain a neutral thermal environment
- 3) Initiate early feedings q2-3 hrs to support newborn’s hyperinsulin state
- 4) Cluster care and allow for rest to help infant conserve energy
- 5) Family support and teaching
These are nursing managements of newborns of ______ mothers.
What should the value of blood glucose be in newborns born to diabeltic mothers.
The value of blood glucose should be >40 mg/dl in newborns born to _____ mothers.
What does the American Academy of Pediatrics (AAP) recommend as far as breasfeeding.
The ____ recomends exclusive breastfeeding or human milk feeding for the first 6 months of life and that breastfeeding or human milk feeding continue as the sole source of milk for the next 6 months.
If infants are weaned from breast milk before 12 months of age what should they receive?
Infants should receive iron-fortified infant formula, not cow’s milk if they are weaned when?
Name some things that make human breast milk superior to any alternative. (4)
- 1) Nutrients are ideally balanced and more easily absorbed
- 2) Changes over time to meet newborn/infant’s changing nutritional needs
- 3) Contains growth factors that promote brain and GI system development
- 4) Provides immune factors that fight illness and allergens
These things are all facts that pertain to what
Breastfeeding is ______ safe and always fresh
Breastfeeding decreases the incidence of (6)
- 1) Decreased incidence and severity of certain infectious diseases
- 2) Decreased incidence of SIDS
- 3) Decreased incidence of Type 1 and Type 2 DM
- 4) Decreased incidence of lymphoma, leukemia, Hodgkin disease
- 5) Decreased risk of obesity and hypercholesterolemia
- 6) Decreased incidence and severity of allergies and asthma
These things all happen as a result of what?
Breastfeeding can also enhance what in infants? (2)
- 1) Slightly enhanced cognative development
- 2) Enhanced jaw development
These are effects of what?
Breastfeeding can have an _______ effect during painful prcedures.
_______ can have an analgesic effect during painful prcedures
When is breastfeeding conraindicated? (5)
- 1) Newborns who have galactosemia
- 2) Mothers with active TB or HIV infections
- 3) Mothers who are positive for human T-cell lymphotropic virus type I or type II
- 4) Mothers receiving chemotherapy or radioactive isotopes
- 5) Maternal use of drugs of abuse
These would be conraindications to what?
Normal breastfeeding patters in infants:
1) How often in 24 hours
2) Need to feed every ___ hours during the day and every ___ hours during the night
3) They should be feed whenever they what?
4) Duration is highly variable but it averages ____-____ minutes or ___-___ minutes per breast
- 1) 8-12 times in 24 hours
- 2) Need to feed every 3 hours during the day and every 4 hours during the night
- 3) They should be feed whenever they express feeding ques.
- 4) Duration is highly variable but it averages 30-40 minutes or 15-20 minutes per breast
What signals that feeding is completed?
Decrease in infant sucking and softening of breast will signals What?
Normal feeding patters in formula feed infants:
1) How often in 24 hours?
2) They should be fed every __-___ hours with about ____-____ mls at a time
3) An increases in appetite will be noted around ___-__ days, __ weeks, __ weeks, __ months, and __ months
4) During this increase in appetite the feeding should increase in amount by about ___ ml
- 1) 6-8 feedings/24 hrs
- 2) Should be fed q3-4 hours, usually about 15-30 mls at a time
- 3) Increases in appetite will be noted around 7-10 days, 3 weeks, 6 weeks, 3 months, and 6 months
- 4) Amount of formula with each feeding should be increased to about 30 ml to meet baby’s needs
These feeding patters are whats expected in a baby that is _____ fed.