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\author{hellokitty2000}
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  /Title (high-risk-disorders-part-i-final.pdf)
  /Creator (Cheatography)
  /Author (hellokitty2000)
  /Subject (High Risk Disorders Part I (final) Cheat Sheet)
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        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{High Risk Disorders Part I (final) Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{hellokitty2000} via \textcolor{DarkBackground}{\uline{cheatography.com/117012/cs/21800/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}hellokitty2000 \\
  \uline{cheatography.com/hellokitty2000} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 16th February, 2020.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
  www.readability-score.com
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Hypertensive Disorders of Pregnancy}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}•\textasciicircum{}5-10\% of pregnancies\textasciicircum{} •\textasciicircum{}↑maternal-fetal morbidity \& mortality worldwide\textasciicircum{} •{\emph{Risk of maternal/fetal injury related to CNS irritability}}\textasciicircum{}•{\emph{seizures}}•{\emph{placental abruption}}•{\emph{IUGR}}\textasciicircum{}} \tn 
% Row Count 5 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Preeclampsia}}  \tn
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\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}•after 20 weeks •BP \textgreater{} 140/90 x 2 •with or without proteinuria {\bf{(PCR \textgreater{} 0.3)}}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}{\bf{severe features:}} •thrombocytopenia •liver failure (LFTs 2x normal) •new renal insufficiency (serum creatinine \textgreater{} 1.1 mg/dL) •pulmonary edema •new onset cerebral or visual disturbance} \tn 
% Row Count 7 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Pathophysiology of Preeclampsia}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}inadequate vascular remodeling →{\bf{⬇}} placental perfusion \& hypoxia → endothelial cell dysfunction → vasospasm \& ↓ tissue perfusion} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}•HTN •IUGR •h/a •hyperreflexia •seizures •scotoma •epigastric pain} \tn 
% Row Count 7 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Preeclampsia RISK Factors}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}•Primipara \textless{} 19 yrs or \textgreater{} 40 yrs •Previous hx of PEC •Family hx of PEC •Multiples •Obesity •African descent} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}•Pregestational Diabetes •Chronic Hypertension •Renal disease •First pregnancy with new partner •Thrombophilia} \tn 
% Row Count 6 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Assessment Preeclampsia}}  \tn
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\mymulticolumn{1}{x{17.67cm}}{34yo G4P3 @ 34 weeks with BP 142/88, 145/90} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}Labs? ➡•CBC •platelets •ALT/AST •creatinine •uric acid •u/s •NST •24hr urine •PCR} \tn 
% Row Count 4 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}Prenatal follow-up? ➡•Weekly visits with AFI •BP 2x week •NST 2x week •platelets and LFTS weekly •FKC •Consider IOL @ 37 weeks} \tn 
% Row Count 8 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\} Counseling? ➡{\bf{•Risks of IUGR •abruption •oligohydramnios ↕  •Warning signs: •h/a •visual changes •epigastric pain ➡ risk of seizure}}} \tn 
% Row Count 12 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Preeclampsia with Severe Features}}  \tn
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\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}•BP \textgreater{}160/\textgreater{}110 •Severe features} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}Hospitalized until birth ➡•Bedrest •Code cart nearby •Quiet calm low light •Padded side rails?} \tn 
% Row Count 4 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}Frequent assessment Vitals ➡•q 10 Assess edema, clonus, DTRs •HA, visual changes •Epigastric pain (liver is getting involved) •Foley – strict I\&O •Fetal well-being •Platelets, liver enzymes} \tn 
% Row Count 9 (+ 5)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}If \textless{} 34-37 weeks, steroids for lung maturity} \tn 
% Row Count 11 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Magnesium Sulfate: Seizure Prophylaxis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}•Decreases neuromuscular irritability •Decreases CNS irritability •Promotes maternal vasodilation} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}{\bf{Watch for magnesium toxicity}} •Loss of knee-jerk reflexes •Respirations \textless{}12 p/min •Urine output \textless{}30ml/hr •Cardiac or respiratory arrest •Toxic serum levels \textgreater{}9 mg/dL \textasciicircum{}•Therapeutic range 5-9 mg/dL\textasciicircum{} •Sign of fetal distress {\bf{•Calcium Gluconate is the antidote \textasciicircum{}•10\% Calcium gluconate 10cc, IV\textasciicircum{}}}} \tn 
% Row Count 10 (+ 7)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Management of Preeclampsia}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}•MAG: 4g loading dose, then 2g/hr to depress (not eliminate) reflexes •Strict I\&O (consider Foley) q hour •BP check q 15-30 mins \{\{nl\}\}•Pulse Ox, Lung Sounds •DTRs, Clonus, and hand grasps •FLUID RESTRICTION •Control hypertension\textasciicircum{}•BP meds via IV meds if severe •Continue observations 24-48hrs PP •Symptoms usually resolve within 48 hours PP\textasciicircum{}} \tn 
% Row Count 8 (+ 8)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Practice Question}}  \tn
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\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}You are caring for a 34yo G2P1 who was admitted for IOL at 36 weeks for PEC with severe features. After you administer the Mag Sulfate bolus, the patient reports that she feels "sleepy and a little nauseated."  You also notice that the variability of the FHR tracing is now minimal.administer the Mag Sulfate bolus, the patient reports that she feels "sleepy and a little nauseated." You also notice that the variability of the FHR tracing is now minimal.\{\{nl\}\}•What is your first action? •What would you assess? •What would you anticipate? •What monitoring is necessary for this patient?} \tn 
% Row Count 13 (+ 13)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{ECLAMPSIA}}  \tn
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\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}•Onset of seizure activity or coma in pregnancy {\bf{without}} CNS lesion \{\{fa-square-o\}\}•{\bf{Treat}} with Magnesium Sulfate + PEC measures \{\{nl\}\}  \{\{fa-square-o\}\}•Assessment ➡ \textasciicircum{}↑HTN precedes seizure followed by hypotension and collapse •Coma may occur •Labor may begin, putting fetus in great jeopardy\textasciicircum{}} \tn 
% Row Count 7 (+ 7)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}•{\bf{Expect}} postictal non-reassuring FHR tracing.  Allow in utero resuscitation for 20-30 mins. \{\{fa-square-o\}\}•C/S risk of maternal cerebrovascular hemorrhage!}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Eclampsia}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{•Patent airway \& patient safety •ABCs •Side rails up •Call for help!\textasciicircum{}Do not leave!\textasciicircum{} •Suction •Prevent aspiration •Fetal Monitoring •Maternal VS •Meds\textasciicircum{}(O2)\textasciicircum{}} \tn 
% Row Count 4 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Chronic Hypertension in Pregnancy}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}Diagnosis➡•{\bf{Before}} pregnancy or diagnosed {\bf{before}} 20 weeks. •Use of anti-hypertensives before pregnancy\{\{nl\}\}\{\{fa-square-o\}\}•Monitor ➡Labs, u/s, NST AFI, IOL (37-38 weeks) •Persists \textgreater{} 12 weeks postpartum\{\{nl\}\} \{\{fa-square-o\}\}•Risk: IUGR, PTL, placental abruption, renal failure, CHF, CVA, and superimposed PEC •Low dose ASA (12-36wks) \{\{nl\}\}\{\{fa-square-o\}\}•Mild-moderate: no evidence of improved outcomes with meds •CHTN with superimposed PEC} \tn 
% Row Count 10 (+ 10)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Chronic HTN with superimposed Preeclampsia}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}•HTN {\bf{before}} 20 weeks with new onset {\bf{proteinuria}} •Worsening HTN plus one\{\{nl\}\}\{\{fa-square-o\}\}1•New onset of sx\{\{fa-square-o\}\}2•Thrombocytopenia\{\{fa-square-o\}\}3•↑liver enzymes\{\{fa-square-o\}\}4•Pulmonary Edema\{\{fa-square-o\}\}5•New onset renal insufficiency \textasciicircum{}{\bf{•↑morbidity for mom \& fetus}}\textasciicircum{}} \tn 
% Row Count 7 (+ 7)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Gestational Hypertension in Pregnancy}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}•Elevated BP \textgreater{} 20 weeks •\textgreater{}140/\textgreater{}90 •No proteinuria •25\% will develop PEC •If persists \textgreater{} 12 weeks PP ➡ CHTN} \tn 
% Row Count 3 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{HELLP}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}•{\bf{H}}emolysis •{\bf{E}}levated •{\bf{L}}iver Enzymes •{\bf{L}}ow •{\bf{P}}latelets (\textless{}100K) \{\{nl\}\}\{\{fa-square-o\}\}•Laboratory diagnosis with PEC •Non-specific clinical presentation •Prompt delivery on dx vs. wait 48hrs for steroids if \textless{} 37wks \{\{nl\}\}\{\{fa-square-o\}\}•Life threatening •Pulmonary edema •Acute renal failure •{\bf{DIC}} •Abruption •Liver failure, hemorrhage •ARDS •Sepsis •Stroke} \tn 
% Row Count 9 (+ 9)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{PEC, Chronic HTN, Gestational HTN}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}{\bf{Preeclampsia}} •After 20 weeks •BP \textgreater{}140/\textgreater{}90 x2 •Proteinuria and/or severe features \{\{nl\}\}\{\{fa-square-o\}\}{\bf{Chronic Hypertension}} •Before 20 weeks •\textgreater{}140/\textgreater{}90 \{\{nl\}\}\{\{fa-square-o\}\}{\bf{Gestational Hypertension}} •After 20 weeks •\textgreater{}140/\textgreater{}90} \tn 
% Row Count 6 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{PEC with severe features, HELLP}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}Preeclampsia with severe features •BP \textgreater{}160/\textgreater{}110 x2 or severe features •Magnesium Sulfate* •Seizure precautions \{\{nl\}\}\{\{fa-square-o\}\}HELLP •May not have s/s of PEC •High maternal and fetal mortality •Progresses rapidly} \tn 
% Row Count 5 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
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\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Medications you need to know (table 27-5)}}  \tn
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\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}•Labetalol •Nifedipine •Methyldopa •Hydralazine •Magnesium Sulfate\textasciicircum{}•Calcium Gluconate\textasciicircum{} •No ACE inhibitors •Avoid Methergine for PPH} \tn 
% Row Count 4 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{HTN Disorders in Pregnancy}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}{\bf{Intrapartum Care}} ➡•Maternal-Fetal VS •Continuous EFM  •Epidural? •Fluid restriction? •Quiet, dark, environment\{\{nl\}\}•Emergency drugs, 02 @ 10L, suction ready •Magnesium Sulfate\textasciicircum{}•Calcium gluconate\textasciicircum{}} \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}{\bf{Adverse Outcomes}} ➡•{\bf{Restricted fetal growth •Placental abruption}} •Preterm birth •Early degeneration of placenta} \tn 
% Row Count 8 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Case Study}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{Your client, Julie, is a G3 P2002 at 39 weeks of gestation. She presented to the high risk labor and delivery triage are an hour ago. Her blood pressure has been steadily increasing for the past 3 weeks. Today her blood pressure was 160/110, and she presents to the triage area with complaints of a severe headache and "spots in my vision." Her cervical exam is 2 cm/80\%/-2 firm midposition.} \tn 
\mymulticolumn{1}{x{17.67cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}•What type of pregnancy hypertensive disorder do you suspect Julie may have? •What other priority information is it important for the nurse to assess and gather?} \tn 
% Row Count 12 (+ 12)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
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\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Case Study cont.}}  \tn
% Row 0
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\mymulticolumn{1}{x{17.67cm}}{Julie is admitted to the labor and delivery unit for induction for preeclampsia. The provider orders magnesium sulfate: 4 gram IV loading dose and then 2 grams/hour maintenance dose. Julie asks, "What is this medication for? Will it affect my baby?"} \tn 
\mymulticolumn{1}{x{17.67cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}What is the nurse's best reply?} \tn 
% Row Count 7 (+ 7)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Endocrine \& Metabolic Disorders of Pregnancy}}  \tn
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\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}•Pre-existing DM type 1 \& 2 •GDMa-1 •GDMA-2 •Hyperemsis gravidarum •Hyper \& hypo thyroidism •PKU} \tn 
% Row Count 3 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Maternal Insulin \seqsplit{ResistancePathophysiology}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}•Metabolic changes in pregnancy ➡ \{\{fa-square-o\}\}•Normal pregnancy alters maternal glucose metabolism, insulin production, and metabolic homeostasis \{\{nl\}\}\{\{fa-square-o\}\}•Glucose is the primary fuel for the fetus\{\{fa-square-o\}\}•Glucose crosses the placenta, insulin does not\{\{nl\}\}\{\{fa-square-o\}\}•Insulin needs↓during the first trimester\textasciicircum{}\{\{fa-square-o\}\}•Risk of hypoglycemia for IDM patients\textasciicircum{} \{\{nl\}\}\{\{fa-square-o\}\}•Diabetogenic effect in second and third trimesters\textasciicircum{}\{\{fa-square-o\}\}•↑insulin resistance\{\{fa-square-o\}\}•Placental hormones act as insulin antagonists\textasciicircum{}\{\{nl\}\}\{\{fa-square-o\}\}•Expulsion of the placenta drops insulin requirements} \tn 
% Row Count 14 (+ 14)
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\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Changing insulin needs during  pregnancy.}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{17.67cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/hellokitty2000_1581777472_Picture1.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Gestational Diabetes (GDM)}}  \tn
% Row 0
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\mymulticolumn{1}{x{17.67cm}}{} \tn 
% Row Count 0 (+ 0)
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\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}•Gestational Diabetes ➡•Common-Hispanic, Native American, Asian, African American •Diagnosed 2nd trimester with 1 and 3 hr. GTT •Screening algorithm •High risk should screen early \newline \{\{nl\}\}\{\{fa-square-o\}\}•GDMA1- well controlled with diet •GDMA2- need meds}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Gestational Diabetes (GDM)}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}•Gestational DM ➡•Common-\textasciicircum{}Hispanic, Native American, Asian, AA\textasciicircum{}•DX 2nd trimester with 1 \& 3 hr. GTT •Screening algorithm •↑risk should screen early \{\{nl\}\}\{\{fa-square-o\}\}•GDMA1- well controlled with diet •GDMA2- need meds} \tn 
% Row Count 6 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Gestational DM}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{17.67cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/hellokitty2000_1581777750_Picture1.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Fetal Implications}}  \tn
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\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}•Glucose crosses the placenta •↑ fetal insulin production in response to high glucose  from maternal circulation\{\{nl\}\}\{\{fa-square-o\}\}•Fetal macrosomia •Labor risks\textasciicircum{}•Maternal Risks •Fetal Risks\textasciicircum{} •Newborn Risks} \tn 
% Row Count 5 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{GDM Nursing Plans and Interventions}}  \tn
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\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}•Patient Counseling\textasciicircum{}•Pathology of disease\textasciicircum{} •Low-glycemic diet •Exercise •Teach/Demonstrate\textasciicircum{}•Glucose monitoring •Insulin Administration\textasciicircum{}\{\{nl\}\}\{\{fa-square-o\}\}•Signs of hypo- and hyperglycemia \& immediate actions to be taken if signs noted •Fetal surveillance} \tn 
% Row Count 6 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{NCLEX HINT}}  \tn
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\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}•{\bf{Glucose Screen}} Gold standard is 3hr GTT.\{\{fa-square-o\}\}•GDMA1 – Diet controlled GDMA2 – on medication (metformin, glyburide, insulin)} \tn 
% Row Count 4 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Pregestational Diabetes}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}{\bf{Monitoring and TX}}➡•Blood Sugar Testing •Dietary Counseling •Exercise •Insulin •Oral hypoglycemic •Fetal monitoring •IOL →SVB or C/S \{\{nl\}\}\{\{fa-square-o\}\}{\bf{Risks and Consequences}}➡•IUFD •Congenital malformations •Macrosomia   •RDS •Infections  •Polyhydramnios  •PEC, CHTN  •Hyperglycemia  •DKA} \tn 
% Row Count 7 (+ 7)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Pregestational Diabetes}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}{\bf{Intrapartum}}➡ •Testing q hour •Fluids and insulin\textasciicircum{}•(70-100 mg/dl) •Risks?\textasciicircum{} •Polyhydramnios •Macrosomia \{\{nl\}\}\{\{fa-square-o\}\}{\bf{Postpartum}}➡ •First 24hrs: ↓insulin demands\textasciicircum{}•$\frac{1}{2}$ dosage of insulin\textasciicircum{} •PPH •Infections •Breastfeeding  •Family planning} \tn 
% Row Count 6 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Hyperemesis Gravidarum}}  \tn
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\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}•Severe and persistent NVP •Weight loss, electrolyte imbalance, nutritional deficiencies and ketonuria. \{\{nl\}\}\{\{fa-square-o\}\}•Idiopathic/Multifactorial •Can be a debilitating complex metabolic disorder •Linked to Hydatidiform mole} \tn 
% Row Count 6 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Hyperemesis Gravidarum-Assessment}}  \tn
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\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}•Persistent vomiting before 9 weeks •Ketonuria •Dehydration •\textgreater{} 5\% weight loss •Altered nutritional status •Electrolyte imbalance (hypokalemia)} \tn 
% Row Count 4 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Hyperemesis Gravidarum Dietary Modification}}  \tn
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\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}•Small frequent meals •Don't over eat •Eat what sounds good •Avoid triggers (odors) •Avoid spicy •Bland, low fat\{\{nl\}\}\{\{fa-square-o\}\}•Cold may be more tolerable than warm •Drink from a cup with a lid and straw •Carbonated beverages- real ginger ale} \tn 
% Row Count 6 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{p{1.687 cm} x{13.496 cm} p{1.687 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{17.67cm}}{\bf\textcolor{white}{NCLEX HINT}}  \tn
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\SetRowColor{LightBackground}
\mymulticolumn{3}{x{17.67cm}}{\{\{fa-square-o\}\}Research has found that infection by H. Pylori is a possible causative factor in hyperemesis.\{\{nl\}\}\{\{fa-square-o\}\}Other pregnancy and non-pregnancy risk factors for hyperemesis include:} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
 & \{\{fa-square-o\}\}•first pregnancy•prior hx HG•hyperthyroid disorders•multiple gestation•trisomy \seqsplit{21•triploidy•obesity•female} fetus &  \tn 
% Row Count 9 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{8.635 cm} x{8.635 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Hyper or Hypo thyroid?}}  \tn
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\SetRowColor{LightBackground}
\{\{fa-square-o\}\}HYPER•Rare in pregnancy \{\{nl\}\}\{\{fa-square-o\}\}HYPER•Labs: elevated T4 \{\{nl\}\}\{\{fa-square-o\}\}HYPO•Risks: PEC, miscarriage, GHTN, placental abruption, preterm birth, stillbirth \{\{nl\}\}\{\{fa-square-o\}\}HYPO•Tx: Levothyroxine \{\{nl\}\}\{\{fa-square-o\}\}HYPER•Miscarriage, preterm birth, stillborn, infants with goiter, hypo/hyper thyroidism \{\{nl\}\}\{\{fa-square-o\}\}HYPO•Med interaction: Fe & \{\{fa-square-o\}\}HYPER•Thyroid storm \{\{nl\}\}\{\{fa-square-o\}\}HYPO•Labs: elevated TSH \{\{nl\}\}\{\{fa-square-o\}\}HYPO•SX: weight gain, lethargy, cold intolerance \{\{nl\}\}\{\{fa-square-o\}\}HYPER•SX: weight loss goiter, tachycardia \{\{nl\}\}\{\{fa-square-o\}\}HYPER•Tx: PTU/methimazole \{\{nl\}\}\{\{fa-square-o\}\}HYPO•Risk: fetal neuropsych damage \{\{nl\}\}\{\{fa-square-o\}\}HYPER•Breastfeeding issue \{\{nl\}\}\{\{fa-square-o\}\}HYPER•Med reaction: pruritus skin rash \tn 
% Row Count 22 (+ 22)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{PKU}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{\{\{fa-square-o\}\}•Inborn error of metabolism caused by an autosomal recessive trait that creates a deficiency in the enzyme {\bf{phenylalanine hydrolase}}, \{\{nl\}\}which impairs the body's ability to metabolize foods with protein \{\{nl\}\}\{\{fa-square-o\}\}•If unrecognized, can cause cognitive impairment \{\{nl\}\}\{\{fa-square-o\}\}•Prompt diagnosis and therapy with a phenylalanine-restricted diet significantly decreases the incidence of cognitive impairment.  \{\{nl\}\}\{\{fa-square-o\}\}•Women with PKU may be advised against breastfeeding because their milk contains a high concentration of phenylalanine.} \tn 
% Row Count 12 (+ 12)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Question}}  \tn
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\mymulticolumn{1}{x{17.67cm}}{You are counseling a woman with PKU who is planning to go off her birth control.  Which statement indicates the need for further teaching?} \tn 
\mymulticolumn{1}{x{17.67cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}A. "I should eat like a vegan to avoid problems with my baby's brain." \{\{nl\}\}B. "I'll have to be monitored throughout the pregnancy." \{\{nl\}\}C. "I may not be able to breastfeed my baby." \{\{nl\}\}D. "The placenta will help protect my baby from phenylalanine."} \tn 
% Row Count 9 (+ 9)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\end{document}