Endocrine

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Author:
rclee06
ID:
141929
Filename:
Endocrine
Updated:
2012-03-16 12:38:53
Tags:
wusop
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Description:
Gestational Diabetes
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  1. Complications if hyperglycemia is untreated in the 2nd or 3rd trimester
    • Fetal macrosomia
    • Birth Injury
    • Maternal Hypertension
    • Maternal preeclampsia
    • Future diabetes and/or obesity in child
  2. Patients at high risk of GDM
    • Overweight
    • Family History
    • > 40 years old
    • Personal history of GDM
    • Glycosuria
  3. When do you check BG in a 50 gram OGTT and what is the level needed to continue further testing?
    • 1 hour post load
    • > 140
  4. What are the levels for the 100 g OGTT? How many are needed for a diagnosis?
    • Fasting > 95
    • 1 hr > 180
    • 2 hr > 155
    • 3 hr > 140
    • 2 of the 3 need to be met or exceeded
  5. When should women at high risk be screened for T2DM?
    At the first visit
  6. Between 24-28 weeks gestation what test should be performed?
    • 75 g OGTT
    • FPG > 92
    • 1 h > 180
    • 2 h > 153
  7. How many times a day should a woman with previous diagnois check her blood sugar?
    • 8 x a dam
    • Fasting
    • 2 Premeal
    • 3 Post meal
    • 1 bedtime
    • 1 nighttime
  8. How many times a day should a woman diagnosed with GDM check her blood sugar?
    • 4 times
    • 1 fasting
    • 3 post prandial
  9. What are the biophysical test of fetal well being? When do these tests start?
    • Fetal movement counting (at 28 weeks)
    • Non-stress test (BIW)
    • Contraction stress test (QW)
    • Ultrasonographic profile (QW)
    • Start at 28 weeks for patients with high risk and 34 for normal patients
  10. What are the blood glucose goals of a GDM woman?
    • Fasting < 95
    • 1 h < 130
    • 2 h < 120
  11. What are some characterstics of gestational diabetes?
    • Lower fasting levels
    • Modestly elevated postprandial levels
    • Maternal hyperinsulinemia
  12. What are some consequences for the mother during pregnancy?
    • Diabetic retinopathy
    • Renal dysfunction
    • Chronic hypertension
    • Preeclampsia
    • Thyroid Disorder
    • DKA
    • Dyslipidemia
    • Cardiovascular disease
    • Hypoglycemia
  13. When is ketoacidosis risk greatest?
    • 3rd trimester of pregnancy
    • Fetal loss can occur
  14. What are considerations for retinopathy in pregnant women?
    • Check before conception
    • If evident of retionpathy before conception treat with laser therapy
  15. Will proteinuria increase or decrease in pregnancy?
    • Increase
    • May cause chronic hypertension and complications for mother
    • Increase risk of morbidity for child and mother
    • Increased risk of preterm birth and fetal growth restriction
  16. What are some possible problems for the neonate?
    • Birth Injury
    • Hyperbilirubinemia
    • Cardiomypoathy
    • Polycythemia
    • Hypoglycemia
    • Respiratory distress
    • Hypoclacemia
  17. At what levels should you consider adjusting the mother's medications?
    • Fasting > 105
    • 1 h > 155
    • 2 h > 130
  18. What are requirments for MNT in pregnant women?
    • Eat 6 times a day (3 meals, 3 snacks)
    • Carbs should not account for > 50% of total diet
    • 2000-2200 calories per day
    • Total weight gain: 22-26 pounds
  19. What types of exercise should be avoided in pregnant women?
    • Resistance training
    • Lower body weight-bearing exercise
  20. How often should they work out?
    • 30 minutes most days of the week
    • Walking, prenatal aerobics class, swimming
  21. What is the only FDA approved treatment in pregnancy?
    Insulin
  22. Goal post prandial blood glucose on insulin
    70-120 mg/dL
  23. What type of insulin has been studied the most in pregnancy?
    Rapid acting-- lower risk of delayed post prandial hypoglycemia
  24. What are indications for insulin therapy
    • F > 105 AND/OR
    • 1H > 155 AND/OR
    • 2 HR > 130
    • Two or more abnormal measurements over 1-2 weeks
  25. Recommended insulin dosing
    • 1st trimester: 0.8 u/kg
    • 2nd trimester: 1 u/kg
    • 3rd trimester: 1.2 u/kg
  26. Who would most benefit from oral medications in pregnancy?What medications have shown this?
    • Women with a BG between 140-180 on the first OGTT
    • Metformin and glyburide
  27. C section
    EFW > 4500
  28. EFW < 4500
    Manage according to standard practices
  29. EFW 4000-4500
    Counsel patient regarding trial labor
  30. How often should you monitor finger stick BG during labor?
    Every 1-2 hours
  31. When should patients in labor be started on D52?
    When expected to last longer than 6 hours
  32. Insulin dripd uring labot?
    If FSBGs are > 120

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