Term
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Definition
| complex disorder of carbohydrate metabolism caused primarlily by a partial or complete lack of insulin secretion of the the pancreas |
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Term
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Definition
| Insulin deficient. Insulin dependence. onset in childhood of ya |
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Term
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Definition
| Insulin resistant or deficient. can be diet controlled or require insulin. onset after 40 yrs. associated with obesity and sedentry lifestyle |
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Term
| Gestational Diabeges (GDM) |
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Definition
| onset of glucose intolerance first diagnosed during pregnancy |
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Term
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Definition
90-95% is type 2
5-10% is type one
7% of all pregnancies |
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Term
| If a patient has GDM, what disease may they develop and when? |
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Definition
| 20-50% liklihood of developing diabetes in the next 5-10 years. |
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Term
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Definition
insulin released in response to serum glucose increase
hypoglycemia influenced by N/V and anorexia |
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Term
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Definition
Insulin need increased due to HPL produced by the placenta that creates an increased resistance to insulin in maternal cells which decrease glucose tolerance.
NO PLACENTAL HORMONE INCREASES MATERNAL GLUCOSE LEVEL |
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Term
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Definition
Overweight
Maternal age >25 years
Previous GDM or infant >4.4 kg (8.8lbs)
Family hx of GDM or type 2 Dm
Ethnic groups include: African, native indian, hispanic, south or east asain, or pacific island ancestry |
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Term
| Why is a previous large infant (>8.8lbs) create a risk for GDM? |
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Definition
| the large infant may have been because of UNDIAGNOSED GDM. |
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Term
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Definition
higher risk for preeclampsia
ketoacidosis
uti
overdistention of the uterus
large fetus |
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Term
| What does overdistention of the uterus include? |
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Definition
| hydramnios, dystocia, difficult labor, cesarean birth, and postpartum hemorrhage |
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Term
| Fetal/Neonatal Effects of GDM |
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Definition
Cogenital anomaly
perinatal death
hypo: glycemia and calcemia
Hyperbilirubinemia
respiratory distress syndrome |
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Term
| Screening for GDM includes: |
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Definition
Fasting Blood Sugar
Oral Glucose tolerance test |
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Term
| Normal for Fasting and nonfasting blood sugar |
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Definition
Fasting: <126 mg/dl
Nonfasting: <200 mg/dl |
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Term
| Abnormal for OGTT and procedure |
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Definition
ingest 100g of oral glucose solution
1 hr: <180
2 hr: <155
3 hr: <140
Fasting: <95 |
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Term
| When is the fasting blood sugar given? |
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Definition
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Term
| if the patient fails the fasting blood suger, does it indicate 100% that the patient has GDM? |
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Definition
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Term
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Definition
Preconception Care (fewer complications)
Diet recommendations (Prenatal vitamins, folic acid)
Drink plenty of water
Take prenatal vitamin with folic acid
Self monitoring of blood glucose
Regular exercise
Fetal Surveillance |
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Term
| What does fetal surveillance include? |
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Definition
kick counts
regular ultrasounds |
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Term
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Definition
simple sugars found in concentrated sweets are eliminated
obese woman may be prescribed a smaller percentage of carbohydrates
carbohydrates should be adequate to prevent ketosis in all women.
caloried divided among 3 meals and snacks |
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Term
| How to increase effective communication |
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Definition
ask specifically about the feelings and concerns the woman will have ("What are your major concerns?")
be an active listener and allow time to express theirself
convey acceptance of feelings
share emotions may help promote positive feelings. |
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Term
| How to provide opportunities for control |
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Definition
plan for the woman to make her own decisions
allow to select foods
allow as much flexibility as possible when scheduling stressful events |
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Term
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Definition
knowledge
ask to demonstrate how she monitors BG
assess understanding of diet
knowledge of potential complications |
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Term
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Definition
| Risk for ineffective health maintenance |
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Term
| Teaching self care skills |
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Definition
spring loaded lancets
use side of the finger,
cleanse area with warm water
waste first drop
difference in onset, peak, and duration of action of insulin
how to mix insulins |
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Term
| Teaching dietary management of GDM |
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Definition
review and clarify
avoid simple sugars like candy cake cookies, juice |
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Term
| Teaching over hypoglycemia GDM |
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Definition
15g of carbohydrate if can swallow and retest in 15 minutes, then repeat is >70
(1/2 cup fruit juice/regular soft drink, crackers, sugar or honey 1TBSP, and 3-4 glucose tablets)
Teach family to inject glucagon |
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Term
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Definition
shakiness
sweating
pallor
disorientation
HA
hunger
blurred vision |
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Term
| Teaching over Hyperglycemia of GDM |
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Definition
| notify physician of any infections |
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Term
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Definition
fatigue
flushed hot skin
dry mouth excessive thirst
polyuria
rapid deep respirations, acetone breath
drowsiness, HA
depressed reflexes |
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Term
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Definition
Fairly rare condition, cannot hold ANYTHING DOWN.
Persistent uncontrollable vomiting |
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Term
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Definition
first weeks of pregnancy
5/1000 pregnancies |
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Term
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Definition
loss of 5% or more of prepregnancy weight
dehydration
^ hematocrit, blood and uine ketones, BUN, liver enzymes
decreased lytes: K, Na, Cl and
vitamin k and thiamine deficiency |
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Term
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Definition
Vitamin (ginger roots)
Antiemetics: phenergan, zofran, reglan (not fda approved but have to do something)
Steroids: methylprednisolone
IV fluids (worry about muscle weakness: hypokalemia. CHECK LEVELS)
TPN
enteral nutrition via a feeding tube |
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Term
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Definition
Avoid noxious stimuli (strong flavors, odors)
Small frequent meals
Fluids in between meals
No laying down for 2 hours after eating
encourage low fat foods and easily digested carbs |
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Term
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Definition
I&O
increased urine specific gravity >0.025
weigh daily |
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Term
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Definition
small food portions
attractively presented foods
no strong odors
low fat foods and easily digested carbs (i.e. fruit, bread, cereals, rice, pasta)
soups and other liquids between meals so do not overly distend stomach
sit upright after meals for 2 hours |
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Term
| Nutrition and Fluid balance |
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Definition
salt foods
potassium and mg rich foods
IV fluids and TPN possible |
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Term
| Emotional Support Barriers |
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Definition
lack of support, and sympathy
many believe it is psychological |
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