Hyper / Hypo Disorders

HYPEREMESIS GRAVIDARIUMHYPEREMESIS GRAVIDARIUM

**Pernicious vomiting during **Pernicious vomiting during PregnancyPregnancy

Hyperemesis GravidariumHyperemesis Gravidarium

EtiologyEtiology

Increased levels of HCGIncreased levels of HCG

AssessmentAssessment

Persistent nausea and vomitingWeight loss from 5 - 20 poundsMay become severely dehydrated with

oliguria increased specific gravity, and dry skin

Depletion of essential electrolytesMetabolic alkalosis -- Metabolic

acidosisStarvation

Nursing Care / InterventionsHyperemesis GravidariumNursing Care / InterventionsHyperemesis Gravidarium

Control vomiting

Maintain adequate nutrition and electrolyte balance Allow patient to eat whatever she wants If unable to eat – Hyperalimentation

Combat emotional component – provide emotional support

Weigh daily

Check urine for output, ketones

Diabetes in Pregnancy

Diabetes creates special problems which affect pregnancy in a variety of ways.

Successful delivery requires work of the entire health care team

Endocrine Changes During

Pregnancy

There is an increase in activity of maternal pancreatic islets which result in increaseincrease production of insulin.

Counterbalanced by:a. Placenta’s production of Human

Chorionic Somatomammotropin (HCS)

b. Increased levels of progesterone and estrogen--antagonistic to insulin

c. Human placenta lactogen – reduces effectiveness of circulating insulin

d. Placenta enzyme-- insulinase

GESTATIONAL DIABETES

Diabetes diagnosed during pregnancy, but unidentifable in non-pregnant woman

Known as Type III Diabetes - intolerance to glucose during pregnancy with return to normal glucose tolerance within 24 hours after delivery

**Treatment--Controlled mainly by DIET.** no use of Oral Hypoglycemics

Effects of Diabetes on the Pregnancy

MATERNAL Increase incidence of INFECTION

Fourfold greater incidence of Pre-eclampsia

Increase incidence of Polyhydramnios

Dystocia – large babies

Rapid Aging of Placenta

FETAL COMPLICATIONSFETAL COMPLICATIONS

Increase morbidity

Increase Congenital Anomalies neural tube defect (AFP)Cardiac anomalies

Spontaneous Abortions

Large for Gestation Baby, LGA

Increase risk of RDS

Effects of Pregnancy on the Diabetic

Insulin Requirements are AlteredFirst Trimester--may drop slightlySecond Trimester-- Rise in the

requirementsThird Trimester-- double to quadruple by

the end of pregnancy

Fluctuations harder to control; more prone to DKA

Possible acceleration of vascular diseases

Key Point to Remember!

If the insulin requirements do not rise as pregnancy progresses that is an indication that the placenta is not functioning well.

Test Yourself?

Mrs. R.’s is 31 weeks gestation and her insulin requirements have dropped. What additional test could be performed to assess fetal well-being? a. L/S ratio b. Estriol levels c. Oxytocin Challenge Test

Interventions /Nursing Care I. I. Diet TherapyDiet Therapy

– dietary management must be based on BLOOD GLUCOSE LEVELS

– Pre-pregnant diet usually will not work

II. Insulin RegulationII. Insulin Regulation– maintaining optimal blood glucose levels require

careful regulation of insulin. Sometimes placed on insulin pump.

III. Blood Glucose MonitoringIII. Blood Glucose Monitoring– teach how to keep a record of results of home

glucose monitoring

IV. EXERCISE– A consistent and structured exercise

program is O.K.

V. MONITOR FETAL WELL-BEING– The objective is to deliver the infant

as near to term as possible and prevent unnecessary prematurityNSTUltrasoundL / S ratio

THE END

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