1
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2
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- Already has decreased cardiac reserves
- Pregnancy increases the demands
- Increased blood volume and increased cardiac output = increase stress on
the heart
- Mitral valve stenosis at risk for CHF
- MVP usually tolerate pg well
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3
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- Class 1-Asymptomatic
- Class 2-Asymptomatic at rest, symptoms with heavy physical activity
- Class 3 – Moderate to marked limitation of physical activity. Symptoms
with less than ordinary Physical Activity
- Class 4 – Inability to carry on any physical activity without
discomfort. Even at rest there is
cardiac insufficiency
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4
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- Assess heart at every visit
- Level of fatigue
- Identify factors that increase strain
- Anemia
- Infection
- Household & career demands
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5
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- Note the following:
- Cough
- Dyspnea
- Edema
- Murmers
- Palpation
- Rales
- Fluid retention
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6
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- Nutrition
- Increased iron needs
- Protein
- Decrease sodium
- Encourage normal weight gain
- Rest is critical
- Medications
- Avoid Infections
- Frequent prenatal visits
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7
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- Goal is decrease exertion
- Eval v/s
- Pulse >100, RR >25 = Cardiac Decompensation
- Lungs for rales
- Semi Fowlers or side-lying with shoulders elevated
- O2, diuretics, dig, abx as indicated
- Continuous fetal monitoring
- Open Glottis Pushing
- Epidural
- Assisted delivery may be indicated
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8
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- Extravascular fluid has to return to the blood stream
- Increases blood volume
- Increased cardiac output
- Physiological adaptation places great strain on the heart
- Decompensation usually within 48 hours
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9
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- Diabetogenic Effect of Pregnancy:
- System of checks and balances of glucose production and use of glucose
is stressed by the growing fetus
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10
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- Alters insulin requirements
- 1rst trimester: may be decreased d/t n&v, hPL, fetal needs are low
- 2nd trimester: glucose storage (mom) increases and baby
usage increases. Insulin needs
increase
- Delivery: May need IV insulin
- PP: once placenta delivers, insulin needs drop dramatically!!!
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11
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- Glucosuria
- Ketoacidosis
- Vascular disease may progress more rapidly
- HTN
- Nephropathy
- Retinopathy
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12
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- Carry higher risk for Preeclampsia/eclamsia
- Hyperglycemia can lead to ketoacidosis
- Yeast
- UTI
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13
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- Congenital anomalies
- LGA
- Advanced DM may see IUGR
- Post delivery hypoglycemic in 2-4 hours
- Respiratory distress syndrome
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14
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- Increase in the amniotic fluid volume occurring in 10-20% of pregnant
diabetic women.
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15
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- Increased glucose availability causes increased weight of fetus
- Decrease risk by tight glucose control in mom
- Fasting 70-100 mg/dl
- After meals 120 mg/dl
- Risk is traumatic birth injuries
- Shoulder dystocia
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16
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- 24 – 28 weeks
- 1° gtt
- 50 g glucose
- If over 130 mg/d at 1°…
- 3° gtt
- 100 g glucose
- Fasting 95 mg/dl
- 1° 180 mg/dl
- 2° 155 mg/dl
- 3° 140 mg/dl
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17
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- Any fasting over 126 = high risk for DM
- HgA1C of 9.2-11.1% have 23 % chance of malformation
- MSAFP
- U/S 18 weeks (anomalies and age)
- U/S 28 weeks (macrosomia & IUGR)
- 28 weeks kick counts
- 32 weeks NST 2 times/week
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18
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- Diet 300 kcal/day increase gradually over trimesters
- HS snack high protein with complex carb
- Glucose monitoring
- Insulin needs decreased
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19
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- Monitor glucose q hour
- Goal is to prevent neonatal hypoglycemia
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20
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- Needs decrease
- May not need at all
- Monitor glucose
- If breastfeeding cannot take an oral agent
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21
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- GDM frequently have insulin D/C’d
- Monitor Glucose levels
- Reassess in 6 weeks
- Normal levels should be assessed q 3 years
- High risk for developing DM
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