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Chapter 19: Pre-gestational ProblemsDiabetes

Type 1 diabetesdevelops because of beta cell destruction and generally results in an absolute insulindeficiency

Type 2 diabetesthe most common form, results from a combination of an insulin secretory defect andinsulin resistance

Gestational diabetesdiabetes during pregnancy; these women are at a higher risk for developing

diabetes later on in lifeGestational Diabetes

Pathophysiology with the increased metabolic rate and onset of placental hormones !hp"# could affectthe pregnancy of a diabetic pregnancy or could precipitate the onset of gestational diabetes

$iskso %ncreased rates of miscarriageo &igher incidence of preeclampsiao "arge babieso &igher 'esarean section rateso %ncreased risk for congenital anomalies rate

%nsulin needso $elatively stable in the 1 st trimester o %ncrease in 2nd and ( rd trimester o )ecrease after birth to those levels prior to pregnancy

*+ll women need to be screened for gestational diabetes during pregnancy between 2 and 2- weeksgestation

$andom glucose tolerance test !GTT#, then 1 hour later plasma glucose %f these are over 12. then a ( hour GTT is ordered %f they fail 2/ of these then they are diagnosed with gestational diabetes %nterventions

o Teach 0/0 of hypoglycemia and hyperglycemiao Teach procedures to test serum glucose ! . 12.#o Teach pt3 to avoid infectionshygeineo Teach pt3 to e4ercise to help with glucose controlo 5onitor fetuso 5onitor nutritional status to include calories, glucose, fluids, and insulin during pregnancy, labor

and delivery, and pp +ntepartal . 12. per glucometer, tests for fetal well being !60, 70T, '0T# "abor and )eliverymonitor 8&$, hourly 90 readings, position on maternal side, may re:uire %

insulin Postpartumloss of placental hormones, less insulin or none re:uired, assess for hypoglycemia and

infection, family planning !pills controversial and 6%) contraindicated#Cardiac Diseases

$heumatic heart diseaseinflammatory connective tissue disease that can involve the heart,

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o 'ardiac stress during the 2 nd and ( rd trimesters, most dangerous time is in 2- (2 weekso 9lood volume peaks and the heart may be unable to compensate

0/0 of deteriorating cardiac functiono 'ougho )yspneao =dema/fluid retentiono Progressive orthopneao

Palpitationso $aleso 'yanosis of nail bedso Tachycardia, irregular pulseo %ncreased plasma volumeo %ncreased '>

+ntepartal 'are for the cardiac patiento 0, weigh weekly, avoid e4cessive weight gaino =?G periodicallyo %@>s, dietincreased iron, increased protein, decreased sodiumo $estsemi fowlers; side lyingo +void people with infectionso 'ardiac meds that are continued with pregnancy

)igo4inwithout risk %nderoldoesnAt appear to cause fetal abnormalities

7itroglycerineunknown&eparinshouldnAt take after labor begins but is safe during pregnancy'oumadinassociated with fetal anomalies, heparin should be used instead"asi4decrease fluid e4cessProphylactic antibiotics

%ntepartal 'areo +de:uate pain relief o aginal delivery with epidural/o4ygen/forceps or vacuum e4tractor o +void bearing down effortso $eport immediately pulse greater than 1.. and/or $$ greater than 2

Postpartum 'areo +ssess for 0/0 of cardiac decompensationo ?eep pain under controlo Gradual increase in activitynot to stress ' systemo 0emi 8owlerAs positiono +ssess for a motherAs help with caring for infant

'lassificationso 'lass %asymptomatic with ordinary activityo 'lass %%ordinary activities cause fatigue/dyspneao 'lass %%%severe fatigue/dyspnea, limitationso 'lass % dyspnea at rest, best to avoid pregnancy

Anemia 1B 2BC of all pregnancies, -.C iron deficiency +nemia present if hemoglobin drops below 1. or &ct falls below (.C %ron )eficiency +nemiae4pansion of plasma without e4pansion of maternal hemoglobin

o 0usceptible to infections, tires easily, at risk for PP hemorrhage, preeclampsia

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o Prenatal vitaminso %ron rich dieto 0een often in younger women

8olic +cid )eficiency +nemiao 7eeded for )7+ and $7+ synthesis and cell duplicationo )eficiency linked with neural tube defectso 9est sources of folic acid fresh leafy green veggies, >D, red meats, fish, poultry, legumes

0ickle 'ell +nemiarecessive autosomal disorder; sickling of blood cells