Gestational diabetes

• 1. occurs in pregnancy (during the

second or third trimester) in clients
not previously diagnosed as diabetic
and occurs when the pancreas cannot
respond to the demand for more
insulin
2. pregnant women should be
screened for gestational diabetes
between 24 to 28 weeks of
pregnancy
3. A 3 hour OGTT is
performed to confirm
gestational diabetes mellitus
4. gestational diabetes
frequently can be treated by
diet alone, however some
clients may need insulin
5. Most women with
gestational diabetes return
to euglycemic state after
delivery, however, these
individuals have an
increased risk of developing
DM in their lifetimes
Predisposing conditions to
gestational diabetes
1. older than 35 years
2. obesity
3. multiple gestation
4. family history of diabetes
mellitus
Assessment
-excessive thirst
-hunger
-weight loss
-frequent urination
- blurred vision
-recurrent UTI and vaginal yeast infection
-glycosuria and ketonuria
-signs of gestational hypertension
-polyhydramnios
-large fetus for gestational age
Interventions
1. employ, diet, insulin
(if diet cannot control
blood glucose levels),
exercise, and blood
glucose
determinations to
maintain blood glucose
levels between 65
mg/dL and 130 mg/dL
2. Observe
for signs of
hyperglycemi
a, glycosuria
and
ketonuria
and
hypoglycemi
a
3. Monitor weight
4. Increase calorie intake as
prescribed, with adequate insulin
therapy so that glucose moves into
the cells
5. assess for signs of maternal
complications such as preeclampsia
(hypertension, proteinuria, and
edema)
6. monitor for signs of infection
7. Instruct the client to
report burning and pain
on urination, vaginal
discharge or itching, or
any other signs of
infection to the health
care provider
8. assess fetal status and
monitor for signs of fetal
compromise
Woman
who is
drug
dependen
t
Substance
abuser- is one
who uses
drugs for
pleasure
Drug
dependentsomeone who
craves a
particular drug
for
psychological
and physical
well-being
Characteristics if a drug
dependent woman
-woman is in the
youngest age group
-they may have less
traditional lifestyle than
others
-they may come late
for prenatal care
-they may have
difficulty following
prenatal instructions
Management
1. Anticipatory
guidance and
nursing support
during pregnancy
2. interdisciplinary
team approach
3. discouraged
breastfeeding
(drugs is secreted
in breastmilk)
Drugs Commonly used
during pregnancy
Cocaine- derived from
erythrxylon coca, a
plant grown almost
exclusively in South
America
Alkaloidal cocaine-a
concentrated mixture,
produces an even more
rapid and intense “high”
when it is inhaled
Manifestations:
-vasoconstriction
-increased
respiratory and
cardiac rate
-increase blood
pressure
-severely
compromise
placental circulation
Effects to infants
-intracranial hemorrhage
-withdrawal syndrome of
tremulousness, irritability
and muscle rigidity
-learning deficits
Amphetamines- has
a pharmacologic
effect similar to
cocaine. It is a drug
easily and cheaply
manufactured
Effects to infants:
-signs of jitteriness
-poor feeding at
birth
Marijuana and Hashishare obtained from the
hemp plant, cannabis
Manifestations
-tachycardia
-sense of well being
-loss of short term
memory
-increase respiratory
infection
-reduce milk production
Effects to
infants
-learning
deficits
Sexually
transmitte
d diseases
and
pregnancy
The woman with
candidiasis
Signs and symptoms
-thick, cream cheese like
vaginal discharge
-extreme pruritus
-vagina appears red and
irritated
Candidiasis-causes
vaginal infection
spread by the fungus
Candida albicans
Risk factors:
-women being
treated with an
antibiotic for another
infection
-women with
gestational diabetes
-women with HIV
Management
1. treat the infection
during pregnancy
2. local application of an
antifungal cream:
Miconazole (Monistat) or
Clotrimazole (GyneLotrimin)
3. Caution the women to
telephone their primary
health care provider
before using over the
counter preparation for
candidiasis
The woman
with
Trichomonia
sis
Trichomonas vaginalis-is a
single-cell protozoan spread
by coitus
Signs and symptoms
-yellow gray frothy vaginal
discharge
Management
1. assess for
the presence
of
trichomonias
is infections
2. administer
medication.
Metronidazol
e (Flagyl),
topical
Clotrimazole
The
woman
with
bacterial
vaginosis
Bacterial vaginosis- is
a local infection of the
vagina by the
invasion, most
commonly of
Gardnerella
organisms
Signs and symptoms
-gray and fish-like
odor discharges
-intense pruritus
Management
1. application of
vaginal topical
cream
The Woman
with
Chlamydia
trachomatis
Chlamydia
infection- is
one of the
most
common type
of vaginal
infections
seen during
pregnancy. It
is caused by
gramnegative
intracellular
parasite
Signs and
symptoms
-heavy graywhite vaginal
discharge
Manageme
nt
1.
administrati
on of
erythromyci
n or
amoxicillin
The woman with
syphilis
Syphilis is a sytemic
disease caused by the
spirochete treponema
pallidum
Signs and symptoms
-painless ulcer (chancre)
on the vulva or vagina
-placenta appears
impervious to the
disease organism before
18 weeks of pregnancy
Management
1. infection of benzathine
penicillin G is the drug of
choice for the treatment
of syphilis during
pregnancy. After therapy,
the woman may
experience a sudden
episode of hypotension,
fever, tachycardia and
muscle aches, this is
called a JARISCHHERXHEIMER reaction
The woman with a Herpes infection
Genital herpes infectionis a sexually transmitted
disease caused by the
herpes simplex virus
(HSV) type 2
Signs and
symptoms
-painful, small,
pinpoint
vesicles
surrounded by
erythema on
the vulva or in
the vagina 3 to
7 days after
exposure
Management:
1. hot sitz bath
2. application of warm, moist
tea bags to the lesions
3. administration of acyclovir
(Zovirax) in an ointment or
oral form
4. women with active lesions
from a primary infection may
be scheduled for a ceasarean
birth. If no lesion are present,
a vaginal birth is preferable
The
woman
with
Gonorrhea
Gonorrheais a sexually
transmitted
disease
caused by
the gramnegative
coccus
Neisseria
gonorrhoea
e
Signs and
symptoms
-yellow
green
vaginal
discharge
Management
1. traditionally been treated
with amoxicillin and probenecid,
the incidence of penicillinaseproducing strains has made this
traditional therapy ineffective
2. oral cefixime and ceftriaxone
sodium IM are now the drug of
choice
3. sexual partner should be
treated as well to prevent
reinfection
The
woman
with
Human
papilloma
virus
infection
Human
papilloma
virus- causes
fibrous tissue
overgrowth
on the
external
vulva
(condyloma
acuminatum)
Signs and symptoms
-lesion appear as
discrete papillary
structure
-large cauliflower-like
lesions
Management
1. application of trichloroacetic
acid (TCA) or bichloroacetic
acid (BCA) to the lesions
weekly
2. large lesions may be
removed by laser therapy,
cryocautery or knife excision
3. Hot sitz bath and application of lidocaine cream maybe
soothing during the postpartal period
4. caesearean delivery maybe performed when vulvar lesion
is present at the time of birth
5. women who have had one episode of infection should be
conscientious about having yearly papsmear for the rest of
their lives
The
woman
with a
group B
streptococ
ci
infection
Streptococcus B infection perhaps occurs at a
higher incidence during pregnancy than herpes
type 2 or gonorrhea. Infection develops within the
cervix or vagina and the mother usually
experiences no symptoms. Consequences can be
urinary tract infection and intra-amniotic infection.
Management
1. women are screened for the
infection at 35 to 38 weeks of
pregnancy by a vaginal culture
and treated with broad spectrum
penicillin such as ampicillin
2. women who experience
rupture of membranes at less
than 37 weeks of pregnancy are
treated with intravenous IV
ampicillin
The woman
with Human
Immunodeficie
ncy virus
infection
A. Description
1. HIV is the causative agent of AIDS
2. Women infected with HIV may first
show symptoms at the time of
pregnancy or possibly develop lifethreatening infections because normal
pregnancy involves suppression of the
maternal immune system
3. Zidovudine
(Retrovir) is
recommended for
the prevention of
maternal-to-fetal
HIV transmission
and is administered
orally beginning
after 14 weeks
gestation,
intravenously
during labor, and in
the form of syrup to
the newborn for 6
weeks after birth
B. Transmission
1. Sexual exposure
to genital secretions
of an infected
person
2. Parenteral
exposure to
infected blood and
tissue
3. Perinatal
exposure of an
infant to infected
maternal secretions
through birth or
breast-feeding
C. Risk to the mother: a
mother with HIV is managed
as high risk because she is
vulnerable to infections
D. Diagnosis
1. Test used to determine the presence the presence of antibodies to HIV include
enzyme-linked immunosorbent assay (ELISA), western blot and immunofluorecence
assay (IFA)
2. A single reactive ELISA test by itself cannot
be used to diagnose HIV and the test should
be repeated with the same blood sample, if
the result is again reactive, follow up tests
using Western blot or IFA should be done
3. Positive western
blot or IFA is
considered
confirmatory for
HIV
4. A positive ELISA
that fails to be
confirmed by
western blot or IFA
should not be
considered
negative and
repeat negative
and repeat testing
should be done in
3 to 6 months
Stage 1
-fever
-headache
-lymphadenopathy
-myalgia
Stage 2
-infection is active
but asymptomatic
and may remain
so far years
-clients may
experience
outbreak of
herpes zooster
(shingles)
-client may
experience
transient
thrombocytopenia
Stage 3
-client is symptomatic
-immune dysfunction is evident
-all body systems can show
signs of immune dysfunction
-integumentary and
gynecological problems are
common
Stage 4
-advanced infection
-client vulnerable to common bacterial
infections
development of opportunistic infections
-serious immune compromise
Interventions
- prevent
opportunistic
infections
-avoid
procedures
that increase
the risk of
perinatal
transmission,
such as
amniocentesis
and fetal scalp
sampling
-if the fetus
has not
been
exposed to
HIV in
utero, the
highest risk
exist during
delivery
through the
birth canal
The newborn
and HIV
Neonates born to
HIV positive clients
may test positive
because antibodies
received from the
mother may persist
for 18 months after
birth, all neonates
acquire maternal
antibody to HIV
infection, but not
all acquire infection
Interventions:
-bath the baby carefully before
any invasive procedure, such
as the administration of vitamin
K, heel sticks, or venipunctures,
clean the umbilical cord stump
meticulously every day until
healed
-the newborn
can room
with the
mother
administer
zidovudine to
the newborn
as prescribed
for the first 6
weeks of life