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ATI Fetal Well-being

Maternal/Newborn

QuestionAnswer
ASSESSMENT OF FETAL WELL BEING p. 53 8/03/13
Biophysical Profile BPP fetus 8 – 10 normal ; 6 equivocal; less than 4 abnormal
Five variables 2 for each normal 0 for abnor
1. Reactive FHR (reactive nonstress test = 2; non-r = 0)
2. Fetal breathing movements a. At least 1 episode of 30 sec in 30 min = 2 b. Absent or less than 30 sec = 0 3. Gross body movements
3. Gross body movements a. at least 3 body or limb extensions with return to flexion in 30 min = 2 b. less than 3 episodes = 0
4. Fetal tone a. At least 1 episode of extension with return to flexion = 2 b. Lack of flexion or absent of movement = 0
5. Amniotic fluid volume a. At least 1 pocket of fluid that measures at least 1 cm in 2 perpendicular planes = 2 b. Pockets absent or less than 1 cm = 0
Potential Dx Nonreactive stress test
Potential Dx xNonreactive stress test
Potential Dx Oligo/polyhydraminos
Potential Dx Suspected fetal hypoxemia/ hhypoxia
Potential Dx PROM
Potential Dx Maternal infection
Potential Dx >fetal movement
Potential Dx IUGR
NST 3rd tri Assess intact fetal CNS
NST 3rd tri Clients with DM Rules out fetal death 2x/week until 28 weeks
REACTIVE if FHR accelerates to 15BPM for at least 15 sec Occurs at least 2x/ 2o min
NONREACTIVE FHR doesn’t accelerate for 40 min If not, anticipate CST and/or BPP
Nursing Ax NST: Seat in reclining chair Apply gel Apply 2 belts Instruct to push button/fetal movement If fetus sleeps, 3 sec vibracoustic
Disadvantages NST High rate false nonreactive results Fetus asleep Fetal immaturity Maternal meds Chronic smoking
CONTRACTION STRESS TEST CST NIPPLE STIMULATION
NIPPLE STIMULATION (one only) 2 – 3 MIN = OXYTOCIN = CONTRACTION Repeat after 5 min rest Must obtain 3 contractions/ 40 -60 sec in 10 minutes >placental blood flow/contraction
Indications CONTRACTION STRESS TEST CST high-risk preg (postterm, gestational DM) Nonreactive sress test
CONTRACTION STRESS TEST CST Client presentation  Decreased Fetal move  IUGR  Postmaturity  Gest DM  Preg-induced HT  Maternal chronic HT
Fetal Lung Test Lecithin/sphingomyelin (L/S) ratio
Lecithin/sphingomyelin (L/S) ratio 2;1 fetal lung maturity 2.5:1 or 3:1 for DM Presence of phospatidylglycerol (PG) Absence of PG = fetal resp distress
Amniocentesis Explain prc Obtain inf concent Empty bladder Supine w/ wedge under rt hip – displace uterus off inf vena cava. Drape all but abd Ultrasound
Amniocentesis Post proc Report leakage, bleeding at site/vag/ contractions/dec fetal movement/fever, chills Plenty fluids 24 h post
Amniocentesis Complications Amniotic fluid emboli Mat/fet hemorrhage Fetomaternal hemorr Rh isoimm Featl damage
Amniocentesis Complications Fetal death Maternal damage PROM Miscarriage, preterm del Leakage
Amniocentesis Vitals/FHR baselines – document Antiseptic prior to local Take maternal BP/FHR Prepare client for needle pressure, not hold breath
Amniocentesis Monitor BP, FHR thruout and 30 following proc Rest 30 min Admin RhoGAM if Rh-neg
Amniocentesis Nursing Ax Monitor vitals, temp, resp status, FHR, contractions, vag dis
PRENATAL TESTING HIGH RISK Percutaneous umbilical blood sampling (PUBS) cordocentesis Kleinhauer-Betke – ensures blood is from fetus CBC w/ diff
PRENATAL TESTING HIGH RISK Indirect Coombs’ for Rh antibodies
Indirect Coombs’ for Rh antibodies hCH and Inhibin A 1. High hCH and Inhibin A = Downs Low estriol – Downs
Indirect Coombs’ for Rh antibodies 2. AFP – neural tube defects b/w 16 – 18 wks High – tube defect Low – Downs
Created by: jba314NURN218
 

 



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