Diabetes unit2
- 1. Diabetes
- 2. Etiology Complex disorder of CHO metabolism Type I – IDDM Type II – NIDDM Glucose Intolerance Gestational Diabetes
- 3. Effects of Diabetes Mellitus on Pregnancy Placental hormones - hPL and somatotropin Hydramnios Gestational hypertension Ketoacidosis Preterm Labor Cord Prolapse Stillborn
- 4. Effects-continued Hypoglycemia UTI Monilia Dystocia
- 5. Fetal Neonatal Effects Congenital malformations neural tube defects caudal regression syndrome cardiac defects Correlates directly with the degree of maternal hyperglycemia in the first trimester
- 6. Fetal Neonatal Effects-continued Macrosomia Birth Trauma Preterm birth Perinatal death Fetal Asphyxia RDS Polycythemia IUGR
- 7. Fetal Neonatal Effects- continued Hyperbulirubemia Hypoglycemia Hypocalcemia Subsequent childhood obesity
- 8. Pregestational Diabetes Prior to pregnancy Need stable disease state Glycosylated hemoglobin HbA1C Preconceptual Counseling Important
- 9. Fetal Survillance Sonograms AFP Fetal echocardiogram NST-BPP ?amnio?
- 10. Gestational Diabetes Onset during pregnancy Usually develops after 20 weeks gestation Risk factors: obesity chronic hypertension family history past hx of GDM over 25 multifetal pregnancy
- 11. Screening Glucose challenge test at 24-28 weeks Glucose tolerance test: diagnosis made if FBS is abnormal or if two or more of the following values occur: Fasting, greater than 95mg/dl 1 hr, greater than 180mg/dl 2 hr, greater than 155mg/dl 3 hr, greater than140mg/dl
- 12. Nursing Considerations Focuses on maintaining glucose control Effective communication Effective teaching
- 13. Recognizing Hyperglycemia and Hypoglycemia Hypoglycemia Shakiness Sweating Pallor; cold clammy skin Disorientated Hunger Headache Blurred vision Hyperglycemia Fatigue Flushed skin Dry mouth, thirsty Frequent urination Rapid deep respirations Drowsiness Depressed reflexes
- 14. Intrapartal Management Maintain glycemic control IV-normal saline Regular insulin or Lispro insulin if needed Fetal surveillance 50% dextrose solution
- 15. Postpartum Management Insulin needs decline Monitor glucose level Breastfeeding Monitor for pp hemorrhage Teaching
- 16. Cardiac Disease Heart disease = decrease cardiac reserve Pregnancy increases blood volume and cardiac output Antibiotics Classified by functional capacity
- 17. Antepartum Nursing actions are based on the severity of the disease Patient education Dietary management Adequate sleep Signs of decompensation fatigue, cough, dyspnea, edema, rales, murmer
- 18. Intrapartum Monitor closely IV / VS/Lung sounds/ medications I&O Side lying Oxygen Forceps / Vacuum
- 19. Post partum Rapid fluid shift Long hospitalization Assess for CHF Breastfeeding
- 20. Hypertensive Disorders of Pregnancy Gestational hypertension Preeclampsia Eclampsia Chronic hypertension
- 21. Preeclampsia Develops after 20 weeks gestation Proteinuria Result of generalized vasospasm/etiology unknown Mild preeclampsia may be managed at home rest frequently BP monitoring daily weights daily urine for protein fetal assessment kick counts diet
- 22. Severe Preeclampsia BP 160/110 Delivery usually necessary Antepartum management/improve placental blood flow bed rest / left lateral antihypertensive medications Apresoline Magnesium sulfate to prevent seizures
- 23. Eclampsia Extension of severe preeclampsia Generalized seizures Magnesium sulfate drug of choice to control seizures Seizures stimulate uterine irritiability/monitor for ROM, signs of labor, placenta abruptio
- 24. HELLP Hemolysis Elevated Liver enzymes Low Platelletes Misdiagnosed as gallbladder problem Stabilize, deliver
- 25. Thyroid Disorders Hypothyroidism increased TSH, low thyroid hormone Hyperthyroidism low TSH, increased thyroid hormone propylthiouracil thyroidectomy
- 26. Adolescent pregnancy High risk Early adolescent 11-14 Middle adolescent 15-17 Late adolescent 18-19
- 27. Adolescent risks LBW Anemia CPD No PNC STI’s PIH Abruptio placentae
- 28. Pregnancy over 35 Fertility decreases Poor implantation Ectopic Chromsomal abnormalities Special tests
- 29. Multiple Gestations Monozygotic maternal identical one ovum, one sperm # of amnions and chorions will depend on when division occurred
- 30. Twin placenta
- 31. Twin Placentas
- 32. Dizygotic two ovum two sperm Two separate conceptions
- 33. Maternal Risks Increased workload of the heart Hydramnois Gestational hypertension Abnormal positions, presentations Uterine atony
- 35. Fetal Risks Congenital anomalies SGA Preterm birth Abruptio after first birth