NUR 406 Exam 15
- dynamics of high-risk pregnancy- closely interwoven relationships of four factors
Answer physiology of pregnancy, pathology of the complication, psychology of pregnancy, psychology of illness
- in a normal women's pregnancy, increased insulin resistance begins in 2nd half of pregnancy
Answer the placenta produces increased amounts of human placental lactogen, estrogen, progesterone, and other hormones
hormones cause increased resistance to insulin maternal insulin demands rise as much as threefold (thought to be related to a combination of hormonal antagonism to insulin and placental degradation of insulin)
- in a diabetic pregnant woman
Answer unable to increase production of insulin, pan- creas unable to produce sufficient insulin, insulin not being used effectively
fails to meet the "diabetogenic" stress of the advancing pregnancy especially complicating in the late 2nd and 3rd trimesters when insulin demands increase
- without adequate insulin
Answer glucose circulates in the blood stream, unable to enter the cells
the energy-starved cells catabolize fats and proteins for energy causing; ketosis from fat wasting, negative nitrogen balance from protein breakdown and muscle tissue wasting
- 1 hr GTT
Answer done between 24-28 weeks, oral glucose test, in the office, anytime of day, nonfasting, 50g
- 3 hr GCT 1 / 3
Answer done if is 1 hr GTT was abnormal, do after 3 days of 150g CHO and overnight fast
130-140 mg/dl screen late 1st trimester if hx of insulin resistance, age >40, prior stillbirth, miscar- riage or macrosomic or malformed infant instruct pt to eat high CHO diet for three days and then fast overnight
- management of diabetes
Answer strict regulation of maternal glucose levels is essential to optimal perinatal outcome
insulin is usually the drug of choice in continuing or initiating glycemic therapy during pregnancy carefully review oral hypoglycemic agents as some are contraindicated in pregnancy main goal is dietary control blood glucose should remain between 70-100 mg/dl after fasting and <120 mg/dl 2 hrs p meals
- monitor fetal activity for diabetic patient
Answer starting at 28 weeks
- assess fetal growth with ultrasound for diabetic patient
Answer 18 and 28 weeks
- offer serum alpha fetoprotein screening for diabetic patient
Answer 16-20 weeks
- nonstress test in diabetic patient
Answer starting at 28 weeks, done weekly twice weekly at 32 weeks if nonreactive, biophysical profile done 2 / 3
- most common medical disorder of pregnancy
Answer anemia
- hemodilution
Answer physiologic anemia of pregnancy
- amount of ferrous sulfate supplement needed
Answer 30-60 mg/day between meals with orange juice
- problems caused by lack of iron supplements
Answer maternal risk for infection and pp hemorrhage, fetal/neonatal risk for prematurity, stillborns, SGA, hypoxia during labor, neonatal death
- class 1 cardiac disease
Answer asymptomatic at normal levels of activity, no limitations of physical activity, no symptoms of cardiac insufficiency
- class 2 cardiac disease
Answer symptomatic with increased levels of activity, slight limitation on physical activity causes fatigue, dyspnea, palpitations, and/or anginal pain
- class 3 cardiac disease
Answer symptomatic with normal levels of activity; moderate to marked limitations on physical activity, comfortable at rest but less than ordinary physical activity causes fatigue, dyspnea, anginal pain or palpitations
- class 4 cardiac disease
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