Fichas
Chapter 11
Fichas del conjunto (43)
- 1What is gestational diabetesAny degree of glucose intolerance with onset or first recognition occurring during pregnancy
- 2Class A Gestational Diabetes (White's classification)Woman has 2 or more abnormal values on OGTT but her fasting and postprandial glucose values are diet controlled
- 3Class B Gestational Diabetes (White's classification)Woman was not known to have diabetes before pregnancy but now requires either insulin or oral hypoglycemics for blood glucose control
- 4Glucose crosses the placenta? (T/F)True
- 5Insulin crosses the placenta? T/FFalse
- 6Around the_____ week of gestation the fetus begins to produce its own _______Around the 10TH week of gestation the fetus begins to produce its own INSULIN
- 7During the 1st trimester, metabolic changes occur, caused by rising levels of estrogen and progesterone. These hormones stimulate the production of insulin, causing fasting glucose levels to fall by approximately ________?10%
- 8As a result of normal metabolic changes. Pregnant women with _________ diabetes, are prone to ______ during the first trimester.As a result of normal metabolic changes. Pregnant women with INSULIN-DEPENDENT diabetes, are prone to HYPOGLYCEMIA during the first trimester.
- 9During the first trimester insulin needs ______Decrease
- 10During the second trimester insulin needs ______Begin to increase
- 11During the third trimester insulin needs ______double or even quadruple
- 12Insulin needs usually level off after _____ weeks of gestation36
- 13Day of birth: insulin needs _____Drop drastically, approaching prepregnancy levels
- 14Insulin needs of a non-breastfeeding mother are ______back to normal in 7-10 days after birth
- 15The insulin needs of a breast feeding mother generally return to normal after _______Weaning
- 16Breastfeeding causes a _____ in insulin needsdecrease
- 17Target blood glucose during pregnancy Fasting60-105 mg/dL
- 18Target blood glucose during pregnancy 1 hr postmealless than 140
- 19Target blood glucose during pregnancy 2 hr postmealless than 120
- 20Target blood glucose during pregnancy 2 am to 6 amabove 60
- 21When is hyperglycemia most likely to be identified in relation to meals, and why?2-hours postmeal, blood glucose levels peak ~2hrs after a meal
- 22Signs and symptoms hypoglycemiaTIRED
tachycardia
irritability
restless
excessive hunger
diaphoresis - 23No increase in risk of birth defects has been found among infants of woman who develop GDM after the first trimester. Why?Critical period of organ formation has already passed
- 24A BMI of _____ also contributes to the development of congenital defects even without GDMgreater than 30
- 25Care management for GDM includes:Screening for GDM
(early for those with strong risk factors, and at 24-28 weeks gestation in general) - 26Indicators that warrant early GDM screening include:BMI over 30
Hx of GDM in previous pregnancy
Family Hx of diabetes
Hx of macrosomic stillborn
Hx of infant over 4500g - 27Screening for GDM consists of a 50g glucose load followed by a plasma glucose test 1 hr later. Fasting not required. What is considered a positive result?a glucose value of 130-140 or higher
- 28In cases of a positive GDM screen, a 2step test is performed. In the 2nd step, a 100g glucose load is delivered and followed with a 3hr oral glucose tolerance test (OGTT) Positive 3hr results include:3hr mark 140 or above
2hr mark 155 or above
1hr mark 180 or above - 2924-28 week screening consists of a 75g OGTT and is considered positive if ....One value is met or exceeded
Fasting (pre 75g glucose load) 92 mg/dL
1 hr 180 mg/dL
2 hr 153 mg/dL - 30Antepartum interventions for GDM includediet & exercise
monitoring blood glucose
pharmacological therapy
fetal surveillance - 31Antepartum blood glucose goals for GDM arefasting 65-95
1 hr post meal 130-140 max
2 hr post meal less than 120 - 32Antepartum dietary goals for GDM armstandard diabetic
30 kcal/kg/day
Carbs not to exceed 50% caloric intake - 33Pharmacologic therapy for GDM includesinsulin therapy if fasting exceeds 95, or 2hr exceeds 120
Oral hypoglycemics in patients unwilling to comply with insulin, or not mentally competent - 34What is the preferred oral hypoglycemic in GDM patients?Glyburide, only minimal amounts cross the placenta and blood glucose control in moderate GDM matches insulin
- 35Does metformin cross the placenta?Yes, although disturbance of the fetus has not been recorded. It is often used in place of glyburide.
- 36Fetal surveillance is recommended in which GDM patientsSevere GDM
Hypertension
hx of stillbirth
suspected macrosomia - 37Fetal surveillance consists oftwice weekly fetal nonstress test (NST)
beginning at week 32 of gestation - 38Intrapartum interventions for GDM includeHourly glucose monitoring
insulin infusion
avoiding dextrose solutions (D5W etc) - 39Intrapartum blood glucose goals are80-120 mg/dL
- 40Is GDM an indicator for cesarean birth?Not by itself, but cesarean birth may be indicated in the presence of preeclampsia or macrosomia
- 41What are some postpartum risks for GDM patients?35-75% risk of GDM in next pregnancy
35-60% chance of type 2 DM in next 20 years - 42Most women's blood glucose_____________after birth involving GDMreturns to normal levels
- 43What is macrosomiaa child born over 4000 g (8lbs 13ozs)
greater than 90th percentile
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- Nursing Fichas sobre Chapter 11, creado por Tim Krueger el 30/09/2020.
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- Tim Krueger
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