Maternal/Newborn
Endocrine
Endocrine
TRUE or FALSE: Maternal insulin crosses the placenta
FALSE - maternal glucose crosses the placenta, but maternal insulin does NOT
This means that the fetus must produce its own insulin
High risk for hypoglycemia post-delivery if mother has uncontrolled DM because the infant will be used to producing large amounts of insulin to regulate BG
Early sexual development
Before 9yrs in boys
Before 6-7yrs in girls
When does surfactant form and mature in a fetus?
What condition halts surfactant production??
Maturation = 37 weeks
High/uncontrolled BG in DM/GDM halts surfactant production
What is the difference between bronchitis and bronchiolitis?
What is often the cause of these infections?
Bronchitis = inflammation of bronchi
Bronchiolitis = inflammation of bronchioles (smaller airways)
RSV is often the cause
Maternal Hypothyroidism is managed during pregnancy with _______ which should be taken in the _______ on an _________
Levothyroxine
Morning
EMPTY STOMACH
Diabetes insipidus is the under-secretion of what hormone?
What are some S/S of this condition?
Undersecretion of ADH
S/S = dilute urine, dehydration, thirst, hypotension, hypernatremia (from loss of water)
What is the difference between periodic breathing & apnea?
Periodic breathing = 5-10 second respiratory pauses followed by compensatory rapid shallow breathing
Apnea = >20 second respiratory cessation
What are the 3 classic manifestations of Epiglottitis?
What should you never do when someone is suspected to have epiglottitis?
NEVER examine throat with tongue depressor or place supine = will cause further or complete obstruction
What impact does maternal diabetes mellitus have on the fetus?
Lung surfactant impaired = increased risk for respiratory distress
Macrosomia = will be LGA (>4kg)
Increased risk for jaundice + hypoglycemia
What is the difference between Cushing's Disease and Cushing's Syndrome?
Disease = overproduction of adrenal gland hormones
Syndrome = overuse of steroids ("Syndrome = Steroids")
Amniocentesis can be used to determine fetal lung maturity at ____weeks gestation because this is when ________begins.
35 weeks because practice breathing begins which causes surfactant + amniotic fluid to mix
Laryngotracheobronchitis AKA "Croup"
Management
- Can be managed at home if mild (no stridor at rest)
- Maintaining an airway
- Humidified mist (hot shower mist)
- Corticosteroids
- Fluids, supplemental oxygen
Hyperthyroidism during pregnancy CAN/CANNOT be treated. Why?
Bonus Points (+100) - what condition can hyperthyroidism lead to in pregnancy if undiagnosed?
CANNOT be treated because antithyroid medications cross the placenta which can lead to congenital hypothyroidism in the fetus leading to enlarged thyroid gland (goiter) which can obstruct the infant's airway
Hyperthyroidism can lead to heart failure if undiagnosed as the extra blood volume during pregnancy along with the rapid heart rate and BP from hyperthyroidism puts extra pressure on the heart
The thyroid gland's main job is regulation of ______. Hypothyroidism leads to the signs and symptoms of ______ and is treated with _____. Hyperthyroidism leads to _______ signs and symptoms.
Regulation of metabolism
Hypothyroidism = decreased metabolism - cold intolerance, lethargy, dry skin, constipation, weight gain, bradycardia, decreased BP
Treatment of hypo - levothyroxine
Hyperthyroidism = increased metabolism - heat intolerance, tremors, diaphoresis/facial flushing, tachycardia, increased BP, weight loss, exophthalmos
A newly pregnant woman is asking why it is important that she receive the influenza vaccine during pregnancy. As the nurse you will educate her that influenza vaccination is important because...
Influenza, especially during the early weeks of pregnancy can be very dangerous to the fetus especially with a high fever which can lead to miscarriage
Cystic Fibrosis is a genetic condition that causes ______. This condition is diagnoses through ______ and requires management through _______.
Causes excess mucus production especially in the lungs and pancreas
Diagnosis = sweat chloride test (>=70 is considered positive)
Management = chest physiotherapy (chest percussion, vibration, deep breathing, coughing), bronchodilators (BEFORE any chest physiotherapy), Oxygen therapy, pancreatic enzymes, vitamin supplements, etc.
A woman with gestational diabetes is told that she has polyhydramnios. As the nurse you understand that this condition is ______. You also know that this can lead to complications during and after pregnancy including _______. One way to prevent one of the most severe complications is to ______.
Excess amniotic fluid - caused by shift of fluid from high BG
Complications = fetal malpresentation, SOB (from enlarged uterus), PP hemorrhage, cord prolapse
Prevention = manual ROM/induction before 39 weeks to prevent cord prolapse
DKA is a complication of _____. It is caused by _____ and manifests as _______. Treatment of DKA includes __________.
Type 1 DM
Causes = insufficient insulin, acute stress, poor DM management which leads to breakdown of fat for energy & production of ketones
Manifestations = hyperglycemia (>300), glycosuria, acidosis, kussmaul respirations, fruity acetone breath, weight loss, etc.
Treatment = ICU admission, cardiac monitoring, IV fluids + regular insulin, NPO
A women with Cystic Fibrosis just had her first child via C-section. What might have been the reason that a cesarean was required for delivery?
Follow-up question: the mother asks the nurse if she can start breastfeeding now, as the nurse you tell her....
Those with cystic fibrosis, similar to those with COPD, may not have enough energy and respiratory capacity to push.
As the nurse you should educate the mother that with CF she has excess sodium in her secretions, including breastmilk, so breastfeeding is not recommended as it can lead to hypernatremia in the infant
Describe the asthma action plan and what medications are used to manage asthma
Asthma action plan = utilizes peak flow meter to measure respiratory status and need for intervention through Green, yellow, and red zones
Green zone = well controlled
Yellow zone = caution/warning of attack - use rescue inhaler
Red zone = emergency - use rescue inhaler + may need to go to ED
Medications = Bronchodilators (Short-acting = albuterol; long-acting = salmeterol; long-acting anticholinergic = ipratropium bromide) Anti-inflammatories (Steroids = fluticasone, methylprednisolone, etc.)
AIM = Albuterol, Ipratroprium, Methylprednisolone