HYPEREMESIS GRAVIDARIUM **Pernicious vomiting during Pregnancy
Hyperemesis Gravidarium Etiology Increased levels of HCG
Assessment • Persistent nausea and vomiting • Weight loss from 5 - 20 pounds • May become severely dehydrated with oliguria increased specific gravity, and dry skin • Depletion of essential electrolytes • Metabolic alkalosis -- Metabolic acidosis • Starvation
Nursing 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 increaseproduction of insulin.
Counterbalanced by: • Placenta’s production of Human Chorionic Somatomammotropin (HCS) • Increased levels of progesterone and estrogen--antagonistic to insulin • 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 asType 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
Increase morbidity • Increase Congenital Anomalies • neural tube defect (AFP) • Cardiac anomalies • Spontaneous Abortions • Large for Gestation Baby, LGA • Increase risk of RDS FETAL COMPLICATIONS
Effects of Pregnancy on the Diabetic • Insulin Requirements are Altered • First Trimester--may drop slightly • Second Trimester-- Rise in the requirements • Third 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. Diet Therapy • dietary management must be based on BLOOD GLUCOSE LEVELS • Pre-pregnant diet usually will not work II. Insulin Regulation • maintaining optimal blood glucose levels require careful regulation of insulin. Sometimes placed on insulin pump. III. 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 prematurity • NST • Ultrasound • L / S ratio
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