Antepartum complications pregestational onset

at risk pregnancies include

diabetes, HIV, anemia, heart disease

diabetes mellitus

endocrine disorder of carb metabolism with either issue producing or utilizing insulin

gestational diabetes

insufficient insulin production d/t pregnancy

pathophysiology of gestational DM during 1st trimester

decreased need for insulin bc hormones enhance insulin production and tissue response to insulin

pathophysiology of gestational DM late in 1st trimester and later

increased need for insulin bc hormones act like insulin antagonist

maternal risks of gestational DM

polyhydramnios, preeclampsia, eclampsia, ketoacidosis, dystocia, increased infection, retinopathy

polyhydramnios d/t

increase in fetal urine

fetal/neonatal risks with gestational DM

perinatal mortality, congenital anomalies, macrosomia, IUGR, RDS, polycythemia, hypoglycemia after delivery, hyperbilirubinemia

hypoglycemia after delivery can occur bc why

baby is used to increased levels of glucose from mom and the baby still makes a lot of insulin to regulate itself even when cord is cut

screening for DM in pregnancy includes

assessing risk at first visit

if low risk-

screen glucose levels at 24-28 weeks

if high risk-

screen as early as possible if mom is obese, fam hx, had GDM before, HTN, glucose in urine

one hour glucose tolerance test for GDM

given 50 g glucose drink and blood tested 1 hr later- if glucose >140 mg/dL, we need more testing

three hour glucose tolerance test for GDM steps (if failed 1 hr test)

1. fasting level drawn

2. drink 100 g glucose drink

3. 1 hr, 2 hr, 3 hr blood draw taken

-if 2 levels are failed, GDM is diagnosed

treatment goals for GDM

maintain equilibrium for insulin, healthy mom and baby

treatment for GDM may include

diet therapy, exercise, glucose monitor, insulin therapy

goals for glucose to prevent macrosomia in infant

-fasting

nursing management antepartal for GDM

assess glucose, nutrition counseling, education about monitoring and giving insulin, fetal assessment, support bc can turn into T2DM

nursing management intrapartal for GDM

assess fetus and mom for timing of delivery, assess glucose hourly

nursing management postpartal for GDM

assess glucose, encourage breastfeeding

when should we reassess glucose levels postpartum

6 wks to make sure BS is not still elevated. If so, classify pt with T2DM

iron deficiency anemia

inadequate iron intake, concentration issue in pregnancy

treatment for iron deficiency anemia

iron supplement

sickle cell anemia

recessive autosomal disease that causes sickling of RBCs when decreased O2

treatment for sickle cell anemia

IV fluids, O2 abx, folic acid, analgesics

folic acid deficiency anemia

RBCs fail to divide with low folic acid and can cause neural tube defects

treatment for folic acid deficiency anemia

childbearing age women take 400 mcg daily before, and 1 mg daily during pregnancy

substance abuse problems in pregnancy

prevention and teaching is key, establish a trusting relationship

signs of substance abuse in pregnancy

unusual complaints, hx abuse, depression, STI, prior drug use, poor nutritional status, mood swings, hallucinations, falls, cirrhosis, hepatitis

what medication is given prophylactically to mom if have HIV/AIDs and why

ZDV to decrease transmission risk of mom to baby

nursing guidelines for HIV/AIDs

educate and prevent, universal precautions, ZDV, assist with elective cesarean, encourage bottle feed, support

why would we encourage bottle feeding in a HIV positive mom

breastmilk can transmit HIV to baby

cardiac disorders in pregnancy

congenital heart disease, peripartum cardiomyopathy, eisenmenger syndrome, mitral valve prolapse

peripartum cardiomyopathy

LV dysfunction that occurs in last month of pregnancy (edema, cough, chest pain, fatigue)

eisenmenger syndrome

left to right shunting that leads to pulmonary HTN

what to remember about cardiac patients in pregnancy

increased CO, HR, and blood volume

antepartum management for cardiac patients

monitor cardiac functional capacity, vital signs, signs of cardiac decompensation (cough, dyspnea, edema, murmur, palpitations, rales, weight gain)

what factors could increase stress on the heart that we should monitor for antepartum

anemia, infection, lack of support, home and career demands

antepartum activity management for cardiac patients

restricted activities, 8-10 hrs sleep, rest periods

antepartum frequency of visits for cardiac patients

every 2 weeks during 1st half of pregnancy, then every week

antepartum diet for cardiac patients

high iron, high protein, low sodium

intrapartum management for cardiac patients

assess VS and lungs, encourage side lying, external fetal monitoring, O2/diuretics/digitalis/analgesics PRN, epidural recommended, short pushes

postpartum management for cardiac patients

assess VS, encourage side lying/semi fowlers, activity gradually increase, stool softeners, good diet