diabetes mellitus and pregnancy
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Transcript of diabetes mellitus and pregnancy
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DIABETES MELLITUS
An endocrine disorder of carbohydrate metabolism,
resulting from inadequate production or use of Insulin.
Overview
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DIABETES MELLITUS
4 Cardinal Signs of DM:
1. Polyuria (with glycosuria)2. Polydipsia
3. Polyphagia
4. Weight loss
Overview
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Early Pregnancy:
Insulin release accelerates
Significant hypoglycemia may occur
Increase in fat stores
Late Pregnancy:
Placental hormones rise sharply
Insulin resistance happens
Insulin insufficency occurs
May have episodes of hyperglycemia
Switch from CHO metabolism to gluconeogenesis
Effects of Pregnancy on
Fuel Metabolism
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DM may be difficult to control because insulinrequirements are changeable.
1. During the first trimester, the need for insulin
frequently decreases.2. N/V may cause dietary fluctuations
3. Insulin requirements increase
4. Increased energy needs during labor5. Decrease in insulin requirement occurs after the
passage of the placenta
Influence of PregnancyOn Diabetes
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The pregnancy of a woman who has diabetes
carries higher risk of complications
Influence of Diabeteson Pregnancy Outcome
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Type 1 or IDDM
Type 2 or NIDDM
Gestational Diabetes
Other specific types
Classifications of Diabetes Mellitus
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DIABETES MELLITUS
A condition of abnormal
glucose metabolism that
arises during pregnancy.
Possible signal of an
increased risk for type 2
diabetes later in life.
Gestational Diabetes Mellitus
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DIABETES MELLITUS
Overweight or obesity Chronic hypertension
Maternal age older than 25 years
Family history of diabetes
Previous birth of a large infant (> 4000g)
Previous birth of an infant with unexplainedcongenital anomalies
Previous unexplained fetal death
Gestational diabetes in previous pregnancy
Multifetal pregnancy
Fasting serum glucose > 140 mg/dl or random
serum glucose > 200 mg/dl
Risk Factors for GDM
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aternal RisksHydramniosPreeclampsia-eclampsia
EffectsFetal Neonatal RisksCongenital anomalies
LGARDS
Polycythemia
Hyperbilirubinemia
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DIABETES MELLITUS
History
How long has she had the disease?
How does she maintain normal bloodglucose?
Is she familiar with ways to monitor
blood glucose and administer insulin?
ssessment
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DIABETES MELLITUS
Physical Examination
Baseline ECG should be obtained
Evaluation for retinopathy
Weight and BP monitoring
Fundal height should be measured
ssessment
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DIABETES MELLITUS
SCREENING TESTS
Glucose Challenge Test (GCT)The woman should ingest 50g of oral glucose
solution.One hour later a blood sample is taken.
If the blood glucose concentration is 140mg/dl or greater, a 3-hour oral glucosetolerance test is recommended.
Some practitioners use a lower cutoff of 130or 135 mg/dl to identify more women at risk.
ssessment
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DIABETES MELLITUS
SCREENING TESTS
Oral Glucose Tolerance Test (OGTT)
The woman must fast from midnighton the day of the test.
The woman should ingest 100g of
oral glucose solution.
Plasma glucose levels are thendetermined at 1, 2, and 3 hours.
ssessment
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DIABETES MELLITUSssessment
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DIABETES MELLITUS
Oral Glucose Tolerance Test (OGTT) Gestational diabetes is the diagnosed if the fasting
blood glucose level is abnormal or if two or more of
the following values occur on the OGTT:
Fasting, > 95 mg/dl
1 hr, > 180 mg/dl
2 hrs, > 155 mg/dl
3 hrs, > 140 mg/dl
ssessment
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DIABETES MELLITUS
Monitoring a Woman with Diabetes
A woman should use a home test kit to
determine if she is pregnant at the earliest
possible time.
The measurement of glycosylated hemoglobin
is used to detect the degree of hyperglycemia
present.
HbA1c is measured.
Ophthalmic examination
ssessment
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DIABETES MELLITUS
Risk for ineffective tissue perfusion related to
reduced vascular flow.
Imbalanced nutrition, less than body
requirements, related to inability to use glucose.
Risk for ineffective coping related to required
change in lifestyle.
Risk for infection related to impaired healing
accompanying condition.
Nursing Diagnoses
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DIABETES MELLITUS
Deficient fluid volume related to polyuria
accompanying disorder.
Deficient knowledge related to difficult and
complex health problem.
Health seeking behaviors related to voiced need
to learn home glucose monitoring.
Deficient knowledge related to therapeutic
regimen necessary during pregnancy.
Nursing Diagnoses
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DIABETES MELLITUS
Demonstrate competence in home glucose monitoringand administration of insulin before home managementis initiated.
Describe a plan for meeting dietary recommendationsthat fits family lifestyle and food preferences.
Identify signs and symptoms of hypoglycemia and
hyperglycemia and the management required for each.
Verbalize knowledge of fetal surveillance proceduresand keep scheduled appointments for testing.
Planning
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IMPLEMENT TION
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DIABETES MELLITUS
MAJOR GOALS:
1. To maintain physiologic equilibrium of insulin
availability and glucose utilization during
pregnancy
2. To ensure an optimally healthy mother and
newborn.
ntepartal Nursing Management
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1. Dietary Regulation
Simple sugars in concentrated sweets should be
eliminated
For obese women, a small percentage of CHO isrecommended
Calories should be divided among 3 meals and at
least 3 snacks
ntepartal Nursing Management
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2. Exercise
Exercise and active lifestyle can improve
cardiorespiratory fitness
ntepartal Nursing Management
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3. Blood Glucose Monitoring
ntepartal Nursing Management
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4. S/Sx of Maternal Hypo/Hyper glycemia
ntepartal Nursing ManagementSigns / Symptoms of
Maternal Hypoglycemia:
Signs / Symptoms of
Maternal Hyperglycemia:
-Shakiness (Tremors)
-Fatigue
- Sweating - Flushed, hot skin
- Pallor; cold, clammy skin - Dry mouth, polydipsia
- Disorientation; irritability - Polyuria
- Headache - Rapid, deep respirations,
acetone breath
- Hunger - Drowsiness, headache
-Blurred vision
-Depressed reflexes
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ntepartal Nursing Management5. Insulin administration
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DIABETES MELLITUS
5. Evaluation of Fetal Status
AFP screening
Ultrasound
BPP
NST Contraction test
ntepartal Nursing Management
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Maternal insulin requirements fall during
postpartal period.
Antihyperglycemics contraindicated during
breastfeeding.
Postpartum adjustment
Postpartal Nursing Management
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Increasing Effective Communication
Providing Opportunities for Control
Providing Normal Pregnancy Care
Other Nursing Considerations
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The woman and at least one support person candemonstrate competence in home glucose monitoring andadministration of insulin
The woman can describe a satisfactory plan for meetingher individual dietary requirements
The woman and at least one support person can list thesigns and symptoms of hypoglycemia and hyperglycemiaand describe the initial management of these conditions
The woman can verbalize knowledge of the reason for fetalsurveillance procedures and keeps appointments for tests.
Expected Outcomes
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Murray, S. & McKinney, E. (2006). Foundations of
maternal-newborn nursing (4th ed.). USA:
Saunders Elsevier.
Pilitteri, A. (2010), Maternal & child health nursing:
Care of the childbearing & childrearing family
(6th ed.). Philippines: Lippincott Williams &
Wilkins.
REFERENCES