NSG 233 Exam #3 Questions And Answers 2023

NSG 233 Exam #3 Questions And Answers 2023 Differentiate the types of diabetes mellitus and their respective risk factors in pregnancy. - ANS 1) type 1 DM - usually have an absolute insulin deficiency. Caused by autoimmune or unknown. Prone to ketoacidosis. 2) type 2 DM- individuals who are insulin resistant and usually have relative insulin deficiency. Etiology is unknown. Classic signs polyuria, polydipsia, and polyphagia. Many people with type 2 are obese or have an increase of fat in the abdominal area. other risk factors are aging, sedentary lifestyle, hypertension, and prior gestational diabetes. 3) Pregestational diabetes - is the label sometimes given to type 1 or 2 diabetes that existed before pregnancy. 4) GDM - is any degree of glucose intolerance with its onset or first recognition during pregnancy. Compare insulin requirements during pregnancy, the postpartum period, and lactation. - ANS A) first trimester - Insulin need is reduced because of increased insulin production by the pancreas and increased peripheral sensitivity; nausea, vomiting, and decreased food intake by mother and glucose transfer to embryo/fetus contributes to hypoglycemia. B) Second trimester: Insulin need increases as placental hormones, cortisol, and insulinase act as insulin antagonists, decreasing the effectiveness of insulin. C)Third trimester: insulin requirements gradually increase increase until about 36 wks of gestation. D) Day of delivery: maternal insulin requirement drop drastically to approach prepregnancy levels. E) Breastfeeding mother maintains lower insulin requirements, as much as 25% less than prepregnancy; insulin need of nonbreastfeeding mother returns to prepregnancy levels in 7 to 10 days. F) at weaning of breastfeeding infant, mother's insulin need returns to prepregnancy levels. Identify maternal and fetal risks or complications associated with diabetes in pregnancy. - ANS A) Maternal risks/complications: GDM with an A1c 6 there is a 28% increase in early pregnancy loss. Cesarean birth - failure to progress or failure of descent. Preterm birth & labor. Ketoacidosis in 2nd & 3rd trimesters. Hypoglycemia occurs during sleep early in pregnancy when hepatic production of glucose is dimished and peripheral use of glucose is enhanced. Hyadramnios - 10x more likely. Hypertensive disorders - preeclampsia, eclampsia. UTI. severe diabetes. B) Fetal risks/complications - Stillbirth. Congenital anomalies 6% - 10% increase. CNS defects - anencephaly, open spina bifida. Cardiac defects - Ventricular septal defects (VSD) & transposition of the great vessels. Caudal regression - 200 to 400x due to diabetic mothers. Macrosomia. Hypoglycemia. Respiratory distress syndrome. Polycythemia. Hyperbilirubinemia. Develop a plan of care for the pregnant woman with pregestational or gestational diabetes. - ANS ... Compare the management of a pregnant woman with hyperthyroidism with one has hypothyroidism. - ANS Hyperthyroidism - Tx propylthiouracil (PTU), B-Adrenergic blockers, Radioactive iodine must not be used to diagnose because it compromises the fetal thyroid. Thyroideectomy Hypothyroidism - TX Levothyroxine (L-thyroxine [synthroid]) BOTH: need assistance with coping with the discomforts and frustrations associated with symptoms of the disorder. both must adapt and wear appropriate clothing, avoiding enviromental temperatures that cause them harm