ch 11 - preexisting conditions

preexisting condition

a disease or disorder present before conception that can affect pregnancy or be affected by pregnancy.

pregestational diabetes

type 1 or type 2 diabetes that existed before pregnancy.

diabetes in pregnancy - first trimester insulin need

insulin needs can decrease and hypoglycemia is more likely.

diabetes in pregnancy - second and third trimester insulin need

insulin requirements usually increase because pregnancy becomes more insulin resistant.

poor early glycemic control

increases the risk of fetal congenital anomalies.

hyperglycemia

abnormally high blood glucose.

hypoglycemia

abnormally low blood glucose.

hypoglycemia - manifestations

nervousness, headache, weakness, shaking, irritability, hunger, blurred vision, sweaty or clammy pale skin, tingling, and tachycardia.

hypoglycemia - common causes

too much insulin, skipped or late meals, and increased exercise.

hypoglycemia - treatment

if glucose is below about 70 mg/dl and the client can swallow, give about 15 g of fast-acting carbohydrate and recheck.

diabetic ketoacidosis (dka)

acute metabolic emergency involving hyperglycemia, ketones, dehydration, electrolyte loss, and acidosis.

dka - manifestations

thirst, polyuria, nausea/vomiting, abdominal pain, headache, drowsiness, flushed dry skin, rapid breathing, weak rapid pulse, and fruity or acetone breath.

dka - pregnancy significance

can cause fetal death and requires emergency treatment.

dka - treatment

insulin, iv fluids, electrolyte replacement, laboratory monitoring, and treatment of the underlying trigger.

diabetes - maternal risks

hypoglycemia, hyperglycemia, dka, infection, hypertension/preeclampsia, polyhydramnios, and operative birth risk.

diabetes - fetal and neonatal risks

congenital anomalies, macrosomia or iugr, stillbirth, birth trauma, prematurity, respiratory problems, and neonatal hypoglycemia.

fetal macrosomia in diabetes

maternal hyperglycemia increases fetal glucose exposure and fetal insulin production, promoting excessive growth.

diabetes - urine glucose

not a reliable measure of blood glucose during pregnancy.

diabetes - urine ketones

useful when intake is poor, illness occurs, or glucose is elevated.

hyperthyroidism

excess thyroid hormone activity.

graves disease

autoimmune disease and the most common cause of hyperthyroidism in pregnancy.

hyperthyroidism - manifestations

heat intolerance, sweating, fatigue, anxiety, emotional lability, tachycardia, weight loss, and goiter.

hyperthyroidism - laboratory pattern

elevated t3/t4 with suppressed tsh.

hypothyroidism

insufficient thyroid hormone activity.

hypothyroidism - manifestations

cold intolerance, fatigue or lethargy, anorexia, and other low-metabolic symptoms.

hypothyroidism - treatment

levothyroxine with ongoing thyroid monitoring.

levothyroxine and iron

separate by at least 4 hours because iron decreases thyroid hormone absorption.

maternal pku

maternal phenylalanine hydroxylase deficiency in which high phenylalanine levels can harm the fetus.

maternal pku - management

strict phenylalanine-restricted diet before and during pregnancy and avoidance of aspartame.

nyha class i

cardiac disease with no limitation of physical activity.

nyha class ii

slight limitation; symptoms occur with ordinary activity.

nyha class iii

marked limitation; symptoms occur with less-than-ordinary activity.

nyha class iv

symptoms occur with any physical activity and may be present at rest.

cardiac decompensation

failure of the heart to meet the increased circulatory demands of pregnancy.

cardiac decompensation - manifestations

increasing fatigue, dyspnea, feeling of smothering, moist cough, palpitations, crackles, weak rapid irregular pulse, tachypnea, generalized edema, and cyanosis.

cardiac disease - nursing goal

reduce cardiac workload and prevent decompensation.

cardiac disease - nursing teaching

recognize decompensation symptoms, prevent/treat infection, avoid straining, manage anemia, balance activity and rest, and monitor closely postpartum.

iron-deficiency anemia

the most common anemia in pregnancy, caused by inadequate iron for hemoglobin production.

iron-deficiency anemia - manifestations

fatigue, pallor, and reduced exercise tolerance may occur.

folate-deficiency anemia

anemia caused by inadequate folate.

sickle cell hemoglobinopathy

inherited disorder involving abnormal hemoglobin and sickling of red blood cells.

sickle cell disease - pregnancy concerns

pain crises, anemia, hypoxia, infection risk, and increased maternal-fetal stress.

thalassemia

inherited disorder of hemoglobin synthesis.

asthma

chronic inflammatory airway disorder with reversible bronchoconstriction.

asthma - manifestations

wheezing, dyspnea, chest tightness, and cough.

asthma - pregnancy priority

maintain maternal oxygenation because fetal oxygenation depends on maternal oxygen status.

cystic fibrosis

inherited disorder causing thick secretions, chronic pulmonary disease, and nutritional concerns.

epilepsy

neurologic disorder characterized by recurrent seizures.

epilepsy - pregnancy nursing focus

maintain seizure control, support medication adherence, monitor medication changes, and prevent injury.

multiple sclerosis

central nervous system demyelinating disorder with exacerbations and remissions.

multiple sclerosis - manifestations

weakness, paresthesias, visual complaints, and loss of coordination.

multiple sclerosis - pregnancy pattern

symptoms may improve during pregnancy, with increased risk of exacerbation postpartum.

bell palsy

acute peripheral facial nerve paralysis.

systemic lupus erythematosus (sle)

chronic multisystem autoimmune inflammatory disease.

sle - manifestations

myalgias, fatigue, weight changes, fever, and multisystem flares.

sle - pregnancy risks

preeclampsia, preterm birth, fetal growth restriction, and fetal loss.

myasthenia gravis

autoimmune neuromuscular disorder causing fluctuating skeletal-muscle weakness.

myasthenia gravis - serious concern

respiratory or bulbar muscle weakness can become life threatening.

substance use disorder

continued substance use despite related physical, social, or interpersonal problems.

dual diagnosis

substance use disorder plus another psychiatric disorder.

tobacco - pregnancy effects

placenta previa, placental abruption, pprom, and decreased maternal thyroid function are listed by the instructor.

alcohol - pregnancy effect

significantly increases the risk of birth defects.

marijuana - pregnancy effect

associated with iugr in the instructor material.

opioids - pregnancy effects

iugr, placental abruption, meconium passage, preterm labor, and fetal death.

cocaine - pregnancy effects

preterm labor, pprom, placental abruption, preeclampsia, iugr, low birth weight, and small-for-gestational-age infants.

methamphetamine - pregnancy effects

preterm birth, placental abruption, congenital brain/heart malformations, low birth weight, microcephaly, and decreased length.

substance use screening

use nonjudgmental, matter-of-fact questions about substance, amount, route, frequency, last use, withdrawal, and treatment needs.

substance use treatment barriers

stigma, fear of legal consequences, cost, transportation, childcare, housing instability, and limited treatment access.