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What are some interpartum care measures for mothers with Diabetes Mellitus? (4)
- 1) Blood glucose levels and hydration must be carefully controlled during labor
- •IV fluids
- •Typically continuous insulin infusion – regular (short-acting) insulin only
- 2) Target of 80-120 mg/dl during labor
- 3) Continuous fetal monitoring
- 4) NICU may be present
These are all interpartum care measures for mothers with ____ _____.
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What type of insulin is typically used in the continuous infusion for intrapartum care of mothers with DM.
Only regular (short-acting) insulin is used in the ______ infusion for intrapartum care of mothers with DM
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What's the target range of blood glucose when using a continuous insulin infusion during labor of a mothers with DM.
The target range of _____ _____when using a continuous insulin infusion during labor of mothers with DM is 80-120 mg/dl.
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Name some postpartum care measures in mothers with DM. (4)
- 1) Careful BG monitoring due to rapidly declining insulin needs after delivery of placenta
- 2) Higher rate of hemorrhage and postpartum infection
- 3) Patient teaching about management of DM with nursing
- 4) Contraceptive counseling (they should plan there pregnancy)
These are all postpartum care measures in mothers with ____ ____.
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What is the % of all diabetic pregnancies that are considered Gestational Diabetes
75% of all diabetic pregnancies are considered ______ Diabetes.
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What 2 risk factors are increased with gestational diabetes?
- 1) Likely to recur in subsequent pregnancies
- 2) Increased risk for development of overt diabetes later in life
These are likely to happen if a mother is diagnosed with what complication?
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What are 2 maternal risks with Gestational Diabetes?
- 1) Onset of hypertensive disorders
- 2) Fetal macrosomia
These are 2 maternal risks with _____ _____.
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What are some fetal risks with Gestational Diabetes? (7)
- 1) ***Hypoglycemia
- 2) Hypocalcemia
- 3) Hyperbilirubinemia
- 4) Thrombocytopenia
- 5) Polycythemia
- 6) ***Respiratory distress syndrome (RDS)
- 7) No increased risk of congenital malformations
These are all fetal risks with ______ ______.
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All pregnant women should be screened for GDM by what 3 ways?
- 1) History
- 2) Risk factors
- 3) Lab screening of glucose levels
These things should be done to screen for what in pregnant women?
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You may differ lab screening for Gestational Diabetes on low-risk women. What would be considered low-risk? (4)
- 1) Younger than 25
- 2) No family history of DM
- 3) Not members of a high prevalence ethnic or racial group
- 4) No history of abnormal glucose tolerance or adverse obstetric outcomes usually associated with GDM
These are all indications that you could do what with lab screening for Gestational Diabetes?
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When should you screen for GDM?
You should you screen for ___ at the 1st prenatal visit and then at 24-28 weeks
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To test for GDM an oral glucose load of 50 g is given followed by a plasma glucose measurements 1 hour later. What is considered a positive screen for GDM.
Values greater that 140 mg/dl are considered a poistive screen for ____.
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If a mother has a positive screen for GDM it is followed by what
If a mother has a positive screen for GDM it is followed by a 3-hour 100g glucose load (with blood draws fasting and at 1, 2, and 3 hours)
NOQ
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During the 3-hour 100g glucose load screen for GDM how many of the fasting, 1, 2, 3 hour blood draws must be elevated to be considered a positive screen for GDM.
If 2 or more of the blood draws during the 3-hour 100g glucose load are elevated then it is considered a positve screen for _____.
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What are some antipartum care measures for Gestational Diabetes? (5)
- 1) Dietary consult
- 2) Home BG monitoring
- –Same target values as with Type 1 and 2 DM
- 3) Exercise after meals
- 4) Insulin therapy if necessary
- 5) NSTs starting around 36 weeks or earlier
These are all antipartum care measures for what disorder in pregnancy.
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Name some intrapartum care measures for mothers with GDM? (2)
- 1) Blood glucose monitoring at every 2 hours
- 2) IV fluids with glucose are not typically given
These are intrapartum care measures for mothers with ____.
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What should the blood glucose levels be in itrapartum care of mothers with GDM and why?
Blood glucose levels should be 80-120mg/dl to decrease the risk of neonatal hypoglycemia in mothers with ____.
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Name some postpartum care measures for mothers with GDM? (2)
- 1) Breastfeeding encouraged
- 2) Patient teaching since increased risk of recurring GDM with subsequent pregnancies and Type 2 DM later in life
These are both postpartum care measures for mothers with ____.
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Name some assessment findings of newborrns of diabetic mothers. (5)
- 1) Full rosy cheeks with a ruddy skin color
- 2) Short neck appearance
- 3) Buffalo hump over the nape of the neck
- 4) Large/full shoulders
- 5) Excessive subcutaneous fat tissue/fat extremities
These are all assessment findings of newborrns of ________ mothers.
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Name some signs of hypoglycemia in newborns born to diabetic mothers. (11)
- 1) Listlessness
- 2) Hypotonia
- 3) Apathy
- 4) Poor feeding
- 5) Apneic episodes
- 6) Cyanosis
- 7) Temperature instability
- 8) Pallor and sweating
- 9) Tremors
- 10) Irritability
- 11) Seizures
These are all signs of _______ in newborns born to diabetic mothers
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Nursing management of diabetic mothers should focus on what?
Management of _____ mothers should focus on early detection and initiation of therapy
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What baseline labs should be gotten in diabetic mothers? (3)
Baseline serum calcium, magnesium, and billirubin levels should be gotten in ______ mothers.
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What are some ongoing assessments of newborns of diabetic mothers? (4)
- 1) Birth injuries
- 2) Respiratory stability
- 3) Hypoglycemia
- 4) Hypocalcemia (tremors, hypotonia, high-pitched cry, apnea, seizures), hyperbilirubinemia, polycythemia
These are some ongoing assessments of newborns of _____ mothers
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Name some nursing managements of newborns of diabetic mothers? (5)
- 1) Monitor blood glucose levels qhr X 4 hrs, then q3-4 hrs or prn
- •Value should be >40 mg/dl
- 2) Monitor temp frequently and maintain a neutral thermal environment
- 3) Initiate early feedings q2-3 hrs to support newborn’s hyperinsulin state
- 4) Cluster care and allow for rest to help infant conserve energy
- 5) Family support and teaching
These are nursing managements of newborns of ______ mothers.
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What should the value of blood glucose be in newborns born to diabeltic mothers.
The value of blood glucose should be >40 mg/dl in newborns born to _____ mothers.
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What does the American Academy of Pediatrics (AAP) recommend as far as breasfeeding.
The ____ recomends exclusive breastfeeding or human milk feeding for the first 6 months of life and that breastfeeding or human milk feeding continue as the sole source of milk for the next 6 months.
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If infants are weaned from breast milk before 12 months of age what should they receive?
Infants should receive iron-fortified infant formula, not cow’s milk if they are weaned when?
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Name some things that make human breast milk superior to any alternative. (4)
- 1) Nutrients are ideally balanced and more easily absorbed
- 2) Changes over time to meet newborn/infant’s changing nutritional needs
- 3) Contains growth factors that promote brain and GI system development
- 4) Provides immune factors that fight illness and allergens
These things are all facts that pertain to what
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Breastfeeding is ______ safe and always fresh
bacteriologically
NOQ
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Breastfeeding decreases the incidence of (6)
- 1) Decreased incidence and severity of certain infectious diseases
- 2) Decreased incidence of SIDS
- 3) Decreased incidence of Type 1 and Type 2 DM
- 4) Decreased incidence of lymphoma, leukemia, Hodgkin disease
- 5) Decreased risk of obesity and hypercholesterolemia
- 6) Decreased incidence and severity of allergies and asthma
These things all happen as a result of what?
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Breastfeeding can also enhance what in infants? (2)
- 1) Slightly enhanced cognative development
- 2) Enhanced jaw development
These are effects of what?
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Breastfeeding can have an _______ effect during painful prcedures.
_______ can have an analgesic effect during painful prcedures
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When is breastfeeding conraindicated? (5)
- 1) Newborns who have galactosemia
- 2) Mothers with active TB or HIV infections
- 3) Mothers who are positive for human T-cell lymphotropic virus type I or type II
- 4) Mothers receiving chemotherapy or radioactive isotopes
- 5) Maternal use of drugs of abuse
These would be conraindications to what?
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Normal breastfeeding patters in infants:
1) How often in 24 hours
2) Need to feed every ___ hours during the day and every ___ hours during the night
3) They should be feed whenever they what?
4) Duration is highly variable but it averages ____-____ minutes or ___-___ minutes per breast
- 1) 8-12 times in 24 hours
- 2) Need to feed every 3 hours during the day and every 4 hours during the night
- 3) They should be feed whenever they express feeding ques.
- 4) Duration is highly variable but it averages 30-40 minutes or 15-20 minutes per breast
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What signals that feeding is completed?
Decrease in infant sucking and softening of breast will signals What?
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Normal feeding patters in formula feed infants:
1) How often in 24 hours?
2) They should be fed every __-___ hours with about ____-____ mls at a time
3) An increases in appetite will be noted around ___-__ days, __ weeks, __ weeks, __ months, and __ months
4) During this increase in appetite the feeding should increase in amount by about ___ ml
- 1) 6-8 feedings/24 hrs
- 2) Should be fed q3-4 hours, usually about 15-30 mls at a time
- 3) Increases in appetite will be noted around 7-10 days, 3 weeks, 6 weeks, 3 months, and 6 months
- 4) Amount of formula with each feeding should be increased to about 30 ml to meet baby’s needs
These feeding patters are whats expected in a baby that is _____ fed.
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