41 terms

hypertension and diabetes in pregnancy

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hypertension: CNS changes result in
hyperreflexia, headache, seizures, intracranial hemorrhage (rare), increased intraocular pressure (retinal detachment)
hypertension: renal changes result in
oliguria, renal vasoconstriction, renal necrosis
hypertension: hemologic changes
thrombocytopenia, placenta abruption, acute disseminated intravascular coagulation
hypertension: Subcapsular hematoma of the liver
can palpate liver- upper quad abdominal stabbing pain
fetal-neonatal risk when mother is hypertensive during pregnancy
-SGA
-fetal hypoxia
-fetal malnutrition
-prematurity
-perinatal mortality/preeclampsia
-perinatal mortality/eclampsia
-hypermagnesemia
Mild Preeclampsia
-BP >140/90
-proteinuria 1 to 2+
-weight gain
-edema in upper extremities
Severe Preclampsia
- >160/100
- proteinuria 3 -4 +
- increase in serum creatine
-visual disturbances
-Headache
-hyperreflexia, clonus
- edea, epigastric pain
-thrombocytopenia
=DELIEVER BABY
eclampsia
signs: severe epigastric pain, hyperreflexia, headache, hemoconcentration
- may occur up to 48 hr postpartum
-time for c-section
HELLP stands for
H-hemolysis
EL- elevated liver enzymes
LP- low platelet count
whats the only cure for preeclampsia
delivery of fetus
with preeclampsia what do you monitor for
dipstick urine, 24 hr urine, liver enzymes, CBC, clotting, renal profile, chemistry, non stress test, biophysical profile
recommendations on home care for mother with hypertension during pregnancy
-rest periods in left lateral position
-f/u every 3-4 days
-kick counts
-monitor BP/weight/urine/protein
-remote fetal monitoring
hospital care with magnesium sulfate
central nervous system depressant
-will be on bed rest bc they can fall.
-PREVENTS seizures
-1g in 25mL
when a mother in labor and is on magnesium sulfate, the oxytocin
will need to be increased
magnesium sulfate main goal
prevent seizures
magnesium sulfate antidote
calcium gluconate
signs of magnesium sulfate toxicity
-Depressed reflexes (Deep tendon reflexes)
-Respiratory depression/paralysis
-Newborn toxicity
-Decreased BP, Cardiac Arrest
-Muscle weakness-
do you continue magnesium sulfate after birth?
yes for 24 hrs
most frequently used antihypertensive medication
Hydrazine - is safe
calcium channel blocker used as an antihypertensive medication
Nifedipine - promotes uterine relaxation and used in labor and causes bp to go down
beta adrenergic blocker used as an antihypertensive agent
Labetalol - causes vasodilation arterioles without changing cardiac output. Need to monitor for signs of bradycardia. Monitor blood pressure and urine output.
Betamethasone (better choice) or dexamethasone does what
matures fetal lungs -- give 24 hrs before birth
nursing care for hypertensive mothers
make quiet non stimulating environment, padded side rails, suction equipment, O2, call button in reach, EM medication tray, EM delivery pack, bed rest laying on side, monitor fetal activity, BP Q 1-4 Hr, monitor output and protein, deep tendon reflex, edema, and mg sulfate toxicity
postpartum management for hypertensive moms
-Usually improve after delivery
-Seizures can occur during first 48 hours
-Magnesium Sulfate is continued/24 hrs
-Antihypertensive medication continued
-Monitor for HELLP, liver rupture,DIC
-If BP continues to be elevated further evaluation is needed
diabetes mellitus pathophysiology
-Disorder of the carbohydrate metabolism
-Protein and fat metabolized to meet energy needs
-Hyperglycemia or hypoglycemia damages small blood vessels in the body (kidneys, heart, eyes)
what week does the embryo secrete its own insulin?
10 weeks
early pregnancy and metabolism
-Estrogen & Progesterone stimulate insulin production
-Decreased hepatic glucose production
-Lower fasting glucose levels
late pregnancy and metabolism
-Placental hormones (estrogen, progesterone, hPL) increase
-Insulin resistance occurs
-Diabetogenic Effect
type I diabetes
-beta islet cell destruction
-insulin-dependent, autoimmune disorder
type II diabetes
-insulin resistance, insulin deficiency
-Associated with obesity
adverse material effects due to preexisting DM
-ketoacidosis
-spontaneous abortion
-preeclampsia
-hydramnios
-macrosomia (big baby)
Adverse fetal effects in preexisting diabetes
Congenital defects
LGA
SGA
Intrauterine growth restriction
Adverse neonatal effects in moms with preexisting diabetes mellitus
Hypoglycemia
Hypocalcemia and Hyperbiirubinemia
Respiratory Distress Syndrome
evaluation of glycemic control is done by
hemoglobin A1C
insulin therapy for mom during pregnancy
regular and NPH. decrease in 1st trimester, increase significantly 2nd and 3rd, labor =tight control w/ insulin drop, and postpartum monitor closely as needs to decrease
Risk Factors of GDM
Age > 25
Multifetal pregnancy
Prior macrosomic (big baby > 9lbs) or stillborn infant
Obesity
Chronic Hypertension
Previous birth of large infant (>4000 g)
Family history (close relatives)
Gestational diabetes in previous pregnancy
Diagnosis of GDM
Urine testing at every prenatal visit
Glucose Challenge 24-28wks
> 140 mg/dL = positive
3 hours Glucose Tolerance Test if nec.
Glycosylated Hemoglobin (HbA1c)
Treatment of GDM
diet therapy (30-25 kcal/kg/day and proteins and complex carbs) and insulin therapy
how to evaluate fetal status
Daily evaluation fetal activity @ 28wks
Kick counts
Nonstress testing
Contraction Stress test
Ultrasound at 18 & 28 wks
Biophysical Profile as necessary
Amniocentesis for fetal lung maturity
Special Needs of Diabetic Mother
dietary regulation, glucose and ketone monitoring, insulin administration
Dietary Modification for mom with GDM
Avoid sugar
Emphasize complex carbohydrates
Emphasize foods high in fiber
No weight loss or fasting
Adequate carbohydrate intake prevents starvation ketosis/fetal brain damage
2,000 calorie/day diet
Maintain blood glucose levels/normal
Four to six meals with snacks
Carbohydrate intake fairly evenly distributed through the day
Dietitian consultation