Concurrent disorders during pregnancy chapter 26 SPC nursing
Episodes of hypoglycemia may occur during the first 20 weeks of pregnancy with increased insulin release. Levels of placental hormones rise sharply after 20 weeks and create resistance to insulin in maternal cells and change in maternal insulin needs throughout pregnancy
Women with type 1 diabetes melliuts have a greater risk for preeclampsia, urinary tract infections, and ketosis
because maternal hyperglycemia during the first trimester increases the risk for congenital anomalies in the fetus a mojor goal of management is to establish normal blood glucose levels before conception
Fetal growth depends on the condition of maternal blood vessels and blood glucose levels. With no vascular impairment and adequate placental perfusion, the infant is likely to be of normal size with normal maternal glucose levels or large (macrosomia) with high maternal glucose levels. With high maternal glucose levels and vacular impairment, placental perfusion may be compromised and the fetus may be growth restricted.
In addition to congenital anomalies, the infant of a diabetic mother is at increased risk for hypoglycemia, hypocalcemia, hyperbilirubinemia, and respiratory distress syndrome.
THe maternal effects of GDM include increased riskd for UTI, hydramnios, premature rupture of membranes, and the development of preeclampsia
GDM is responsible for two major complications for the fetus or neonate-fetal macrosomia and neonatal hypoglycemia
GDM can usually be treated by diet and exercise. Insulin may be started if blood glucose remains high.
Cardiovascular changes that occur in normal pregnancy impose an additional burden that may result in cardiac decompensation if the expectant mother has a preexisting heart disease.
The primary goal of pregnancy management of heart disease is to prevent the development of congestive heart failure. Limiting the womans activity, weight gain, and preventing anemia and infection helps cardiac demand to not exceed cardiac reserves.
Intrapartum and postpartum management of heart disease focuses on preventing fluid overload, which can cause a sharp rise in cardiac effort.
Iron supplementation is needed during pregnancy because most women do not have sufficient iron stores to meet the demands of pregnancy
Folic acid deficiency is associated with an increased risk for spontaneous abortions, abruptio placentae, and fetal anomalies, such as neural tube defects. A folic acid supplement may be necessary to prevent maternal and fetal effects.
Sickle cell disease is worsened by pregnancy changes and a primary goal is to prevent sickle cell crisis during pregnancy
Laboratory values for thalassemia are similar to those of iron deficiency, but administration of iron is risky because increased iron absorption and storage make the woman susceptible to iron overload
Although women with SLE can have a normal pregnancy and give birth to a normal newborn, the pregnancy must be treated as high risk because of the increased incidence of abortion, fetal death during the first trimester, and possible exacerbation of the disease.
APS is a cluster of clinical entities and is associated with an increased risk for thrombosis fetal loss, and low platelets. Preeclampsia has a higher incidence in women with APS.
THe managment of epilepsy is complicated by the teratogenic effects of anticonvulsant medications. Alterations in epilipsy therapy may be possible may be possible to reduce teratogenic effects on the fetus
Viral infections that occur during pregnancy can be transmitted to the fetus in two ways: across the placenta or by exposure to organisms during birth. Although they are mild or even subclinical in the mother, viral infections can have serious effects for the fetus
HIV is a retrovirus that gradually causesa decrease in the effectiveness of the maternal immunity, often over many years in the treated woman. Maternal treatment with ZDV, sometimes with other antiretroviral medications, can substantially reduce infection of the fetus for the fetus
Specific pregnancy and postbirth treatment of nonviral infections such as toxoplasmosis, group B streptococcus infection, and TB reduce long term maternal and newborn complications
The newborn should be started on ZDV 6 to 12 hours after birth. The mother will be continued on previous antiantiretroviral therapy, or maternal therapy may be delayed until her CD4 levels decline to less than 500to 600 cells/mm3
difficult or prolonged labor
Normal blood glucose levels
Development of antibodies in response to infection or immunization
Substance that stimulates production of fat.
List the four classic signs of diabetes?
Polyuria (excess urine output)
Polyphagia (excess appetite)
Why is maintenace of a normal blood glucose level before and during early pregnancy particularly important
Hypoglycemia and hyperglycemia are associated with more spontaneous abortions and congenital malformations.
What are the effects of maternal vascular involvment on the fetus/newborn of a diabetic mother?
With no vascular impairment, hyperglycemia can lead to macrosomia. Vascular impairment limits glucose and oxygen transport to the fetus and may result in intrauterine growth restriction.
Do insulin needs increase, decrease, or remain stable during the following times? WhY?
THey decrease in the 1st trimester because of reduced maternal food intake and uptake of glucose by embryo/fetus
Do insulin needs increase, decrease, or remain stable during the following times? WhY?
2nd and 3rd trimester
THey increase in the 2nd and 3rd trimester because of matenal insulin resistance and greater food intake.
Do insulin needs increase, decrease, or remain stable during the following times? WhY? Labor
They usually decrease during labor because of exertion and lack of food intake. Euglycemia is maintained with IV infusion of insulin and glucose
Do insulin needs increase, decrease, or remain stable during the following times? WhY? Postpartum
They decrease in the postpartum period because of loss of hormones from placenta that caused insulin resistance
When would the physician want a pregnant woman to have an oral glucose tolerance test?
If her glucose challenge test (a screening test) os 140 mg/dl or higher, she needs the diagnostic 3-hour oral glucose tolerance test.
Why is it important to give a pregnant woman who has diabetes as many choices as possible?
To increase her sense of of control and the likelihood that she will adhere to the therapeutic recommendations
Why is it recommended that a woman who has hypoglycemia avoid sucrose or unrefined sugar, such as candy?
These sugars raise blood glucose levels quickly to high levels and alter glucose control for many hours
List early signs and symptoms of congestive heart failure
Rales, dyspnea on exertion, cough hemoptysis progresssive edema tachycardia
Janet is 26 year old woman who is 30 week pregnant with her first baby. She has rheuamatic heart disease. SHe had to stop working at her desk job at 20 weeks of pregnancy because of fatigue. SHe has no problems when sitting quietly, but tasks such as making her bed or gathering laundry to wash cause her to have slight chest pain and a rapid heartbeat. SHe complains that she always feels tired. What class of heart disease do her symptoms suggest?
What anticoagulant is recommended if one is needed during pregnancy? WHy?
Heparin is the anticoagulant of choice because it does not cross the placenta
Why are labor and the immediate postpartum period especially dangerous for a woman wha has heart disease?
Each labor contraction causes up to 500ml of blood to be shifted from the uterus and placenta to the central circulartion. Approximately 500 ml of blood returns to the central circulation when the placenta delivers. The added blood volume increases the diseased hearts workload and can result in congestive heart failure.
A woman who is 32 weeks pregnant and has class II heart disease visits teh antepartal clinic for a routine visit. YOu find that she has gained 7 pounds since her last visit. Is her weight gain normal? what possibilites shoud you consider
Her excess weight gain may be caused by excess foo flid retention from cardiac decompenstation or excess salt intake or preeclampsia. Thus you must assess her diet and assess for other signs and symptoms of cardiac decompensation and preeclampsia
Why is it important to take folic acid before and during pregnancy?
Folic acid is needed for cell duplication and the growth of the fetus and placenta. FOlic acid deficiency is associated with a higher incidence of neural tube defects. It is difficult to get the required pregnancy amount by diet alone and folic acid is often destroyed by cooking
Why does maternal sickle cell make fetal death more likely?
Placental infarctions occur that decrease the exchange surface of the placenta
List pregnancy associated risks for the woman who has systemic lupus erythematosus
Fetal loss prematurity preeclampsia renal complications
Why is drug managment of the woman who has epilepsy difficult during pregnancy
Many anticonvulsants are associated with significant fetal abnormalities. Yet without the drugs, grand mal seizures are more likely to occur, which can cause fetal hypoxia acidosis and death.
What nursing care is appropriate for the HIV infected pregnant woman?
Support grieving and retention of patient control; promote wellness (nutrition, rest, activity avoidance of crowds and poor sanitary conditions skin care; teach tthat breastfeeding is containdicated; reinforce medication information
THe test used to screen for gestational diabetes is the
Glucose challenge test
THe best evaluation for the patient goal of accurate insulin administratrion is that she will?
Accuratly withdraw, mix, , and inject insulin
Rheumatic hear disease is usually preceded by with infection?
The primary fetal risk when the mother has any type of anemia is?
reduced oxygen delivery
intrapartum nursing care for a woman who has sickle cell disease focuses on?
maintaining oxygenation and preventing dehydration
When caring for a pregnant woman with systemic lupus erythematosus, clinic nurse must especially observe for development of?
elevated blood pressure
Choose the appropiate infant care teaching for the woman who gave birth by cesarean because of active herpes
Thoroughly wash your hands before handling the infant
THe nurse should expect the HIV infected pregnant woman to receive?
Expected drug treatment for a pregnant woman who has TB is?