Hyper / Hypo Disorders. HYPEREMESIS GRAVIDARIUM **Pernicious vomiting during Pregnancy Pregnancy.
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Transcript of Hyper / Hypo Disorders. HYPEREMESIS GRAVIDARIUM **Pernicious vomiting during Pregnancy Pregnancy.
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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