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leadership management > assessment of fetal well being *OB* > Flashcards

assessment of fetal well being *OB* Flashcards

1
Q

3 levels of ultrasound

A

-standard/basic (routine)
-limited (looking for specifics)
-specialized (detailed)

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2
Q

indications for sonograms (6)

A

-fetal life, growth, characteristics, anomalies
-placental position and function
-adjunct to other invasive tests
-fetal well being (AFI, BPP)
-doppler blood flow
-identification of fetal position

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3
Q

tests for determining viability of pregnancy during 1st trimester (4)

A

-quantitative beta hCG (doubles q2d in 1st tri)
-progesterone levels (allows for implantation in endometrium)
-vag ultrasound (presence of gestational sac, cardiac movement, EDB)
-genetic screens (cell free DNA, 1st tri multiple marker)

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4
Q

difference between screening v diagnostic tests

A

screening = gives more info about the odds
diagnostic = confirms

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5
Q

when is cell free DNA tested during pregnancy

A

10 weeks gestation

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6
Q

how does cell free DNA testing work and what does it test for

A

-uses maternal blood which contains fetal DNA
-tests for trisomy 13, 18, 21 (down syndrome)
-tests for abnormalities of sex chromosomes
*best for women who have risk factors for chromosomal disorders

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7
Q

when is first trimester multiple marker testing done

A

10-13 weeks gestation

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8
Q

what does 1st tri multiple marker testing test for

A

-uses maternal blood
-looks for increased NT (nuchal translucency)
-testing for trisomy 13, 18, 21 (down syndrome)

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9
Q

genetic screening tests during 2nd tri (3)

A

-second tri multiple marker (quad screen)
-NTD screen
-standard sonogram

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10
Q

when does second tri multiple marker genetic screening take place

A

15-22 weeks gestation

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11
Q

what does second tri multiple marker genetic screening test for

A

-mother’s blood:
-down syndrome
-trisomy 18
-neural tube defect

-sonogram: major physical defects

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12
Q

what protein does 2nd tri multiple marker genetic screening test for in maternal blood
increased protein = increased risk fetus has neural tube defect

A

MSAFP (maternal serum alpha fetal protein)

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13
Q

what is required for accurate assessment in NTD screening during 2nd tri

A

-EGA
-maternal age, weight, race, # fetuses

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14
Q

what does the standard sonogram during the 2nd tri look for (abdominal ultrasound with full bladder)

A

-fetal life
-fetal #
-fetal presentation
-gross fetal anatomy
-gestational age and growth
-amniotic fluid volume (shows perfusion to kidneys)
-placenta (location, graded)
-uterine anatomy (fibroids, abnormalities)

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15
Q

nursing considerations for sonogram during 2nd tri (4)

A

-full bladder
-position (pillow under neck and knees, if 20 wks or more: wedge under R hip)
-position display screen so mom and partner can see
-have bedpan/bathroom available

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16
Q

2 reasons moms might have serial fetal sonograms to monitor growth

A

HTN
diabetes

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17
Q

3rd tri fetal assessments (4)

A

-fetal movement assessment/ kick counts (best test)
-electronic fetal heart rate monitor (nonstress and stress test)
-amniotic fluid volume/index
-biophysical profile (BATMaN)

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18
Q

BATMaN mnemonic for biophysical profile in 3rd tri

A

Breathing (atleast 1 episode or 30 secs)
Amniotic fluid volume (2 cm+)
Tone (tucked)
Movement (3+ in 30 mins)
-a-
Nonstress test (should be reactive)

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19
Q

important teaching about fetal alarm signal to pt in 3rd tri

A

-if no fetal movement in 12 hrs, go see dr
-if less than 3 movements in 1 hr, go see dr

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20
Q

how deep should amniotic fluid volume be
how deep should amniotic fluid volume index be

A

2 cm +
5-25 cm +

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21
Q

interpretation of 3rd tri BPP results

A

8-10: normal, low risk chronic asphyxia
6: suspect chronic asphyxia
4: suspect chronic asphyxia
0-2: strongly suspect chronic asphyxia

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22
Q

what action is taken for score of 6 on BPP

A

further testing and action depends on gestational age

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23
Q

what action is taken for score of 4 on BPP

A

if >36 wks deliver
if <32 wks repeat test

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24
Q

what action is taken for score of 2 on BPP

A

extend testing time to 2 hr
if score is persistently less than 4, deliver asap

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25
Q

what is included on modified BPP

A

-amniotic fluid volume (>2 cm)
-non stress test (reactive)

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26
Q

IUGR

A

intrauterine growth restriction

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27
Q

macrosomia

A

large baby

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28
Q

2 types of IUGR

A

-symmetric: baby is small everywhere (caused by genetics or chronic decreased perfusion)
-nonsymmetric: head is normal but abdomen is small (caused by poor placental perfusion due to maternal HTN, diabetes, etc)

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29
Q

what babies are most likely to be macrosomic

A

babies of diabetic moms

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30
Q

invasive procedures for diagnosis (3)

A

-amniocentesis
-chorionic villi sampling
-percutaneous umbilical cord blood sampling (PUBS)

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31
Q

at how many weeks gestation can you do an amniocentesis
how long does it take to get results

A

14+ weeks
can take 2 wks to get results

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32
Q

at how many weeks gestation can you do a chorionic villi sampling

A

10-12 wks +

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33
Q

risks of amniocentesis and chorionic villus sampling (5)

A

-infection
-bleeding
-accidentally poking cord, placenta, or baby
-could go into labor
-slight increase risk club foot (amnio)

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34
Q

what is talipes equinovarus

A

technical name for club foot
(slight risk with amniocentesis)

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35
Q

aftercare instructions amniocentesis

A

-tell dr if fever, contractions, bleeding, leaking fluid
-drink lots of water
-rest

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36
Q

what is chorionic villus sampling

A

testing trophoblasts (fetal DNA) implanted in endometrium

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37
Q

why would a mom do chorionic villus sampling instead of amniocentesis

A

-mom could terminate pregnancy (abortion) if found out abnormalities
-can do CVS sooner than amnio

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38
Q

what does PUBS test for (in 2nd/3rd tri)

A

-fetal DNA
-fetal acid base balance
-fetal Hgb and Hct count (anemia)

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39
Q

risks of PUBS

A

-high risk for injuring fetal blood vessels
-in OR, setup for emergency C-section if needed

40
Q

difference b/w hypoxemia and hypoxia

A

hypoxemia: low O2 in blood
hypoxia: low O2 in tissues for aerobic metabolism

41
Q

byproduct of anaerobic metabolism (without O2)

A

lactic acid (hard on neurological tissues)

42
Q

what are fetal “reserves”

A

extra O2/nutrients baby has stored for times of hypoxemia/hypoxia

43
Q

what could cause decreased O2 supply in fetus (4)

A

-reduced blood flow through maternal vessels (hemorrhage)
-reduced O2 content in maternal blood (sickle cell anemia)
-reduced blood flow to intervillous space in placenta (contractions, or placental separation from uterus)
-alterations in fetal circulation (compression of umbilical cord)

44
Q

nursing interventions for fetal hypoxemia/hypoxia

A
  1. notify dr
  2. maximize maternal cardiac output:
    -lateral position
    -hydration w/ IV fluid bolus (500 mL)
    -possible vasoconstrictor meds
    -decrease anxiety
  3. maximize placental blood flow:
    -decrease contractions (decrease or dc pitocin; dose of terbutaline)
    -decrease anxiety
  4. maximize maternal oxygenation:
    -O2 @8-10 L/min via nonrebreather
  5. eliminate source of stressor
    -decrease contractions
    -relieve umbilical cord compression (position change, amnioinfusion, rule out cord prolapse)
45
Q

side effect of epidural that causes decreased maternal cardiac output

A

quick vasodilation, drops bp

46
Q

3 category responses to fetal hypoxemia

A

category 1: normal (green)
category 2: indeterminate (yellow)
category 3: impending decompensation (red)

47
Q

characteristics of category 1 FHR pattern

A

-normal baseline (110-160 bpm)
-moderate baseline FHR variability
-no late/variable decels
-maybe early decels
-maybe accelerations

48
Q

characteristics of category 2 FHR pattern

A

-baseline rate
-minimal FHR variability
-recurrent variable decels

49
Q

what part of hand do you palpate contraction with

A

fingertips

50
Q

characteristics of category 3 FHR pattern

A

-absent FHR variability
-recurrent late decels
-recurrent variable decels
-bradycardia
-sinusoidal pattern

51
Q

monitoring techniques of FHR and contractions

A

-intermittent auscultation: fetoscope, doppler

-electronic fetal monitoring
1. external: ultrasound transducer (doppler), toco (for contractions)
2. internal: spiral electrode, IUPC

52
Q

who can’t use spiral electrode

A

mom who is HIV+

53
Q

when can you use internal electronic fetal monitoring

A

after ROM

54
Q

nursing intervention after insertion of IUPC

A

put mom in semi-fowlers and record mmHg on left and right sides

55
Q

2 graphs on monitor paper for electronic fetal monitoring
how long is one dark red line to another

A

upper graph: reflects fetal heart rate (time and bpm)
lower graph: uterine activity (time and mmHg)
red line to red line: 60 secs

56
Q

UA

A

uterine activity

57
Q

what is measured in UA in electronic monitoring (4)

A

-frequency
-duration
-intensity
-resting tone

58
Q

normal # of contractions in 10 min period

A

2-5/10 min

59
Q

tachysystole # of contractions in 10 min period

A

> 5/10 min

60
Q

what unit of time is frequency contractions measured in

A

MINUTES

61
Q

normal duration contraction

A

45-80 secs

62
Q

abnormal duration contraction

A

> 90 secs

63
Q

what unit of time is contraction duration measured in

A

SECONDS

64
Q

what unit is contraction intensity measured in

A

mild/moderate/firm (with palpation)
mmHg (w/ IUPC use)

65
Q

normal intensity of contraction during 1st stage labor and 2nd stage labor

A

1st stage: 40-70 mmHg
2nd stage: >80 mmHg

66
Q

normal resting tone of uterus between contractions

A

soft
10 mmHg

67
Q

normal relaxation time between contractions during 1st stage labor and 2nd stage

A

1st: >60 sec
2nd: >45 sec

68
Q

what is considered abnormal relaxation time between contractions

A

less than 30 sec

69
Q

how to determine contraction frequency

A

count from beginning of one contraction to beginning of next

70
Q

how to determine contraction duration

A

count from beginning of one contraction til end of same contraction

71
Q

how to determine intensity of contraction

A

strength at its peak
IUPC = mmHg

72
Q

how to determine resting tone contraction

A

tension in uterus between contractions
baseline

73
Q

what do monte video units evaluate in labor

A

adequacy of labor (contractions are good enough to change cervix)
*must have IUPC

74
Q

how to determine monte video units

A

peak contraction pressure (intensity) - baseline uterine pressure (resting tone)

75
Q

what # MVUs are adequate for labor to progress

A

> 200

76
Q

fetal heart rate in average bpm within 10 min time frame

A

baseline fetal heart rate

77
Q

how many heart beats is considered an acceleration in FHR (and shouldn’t be counted in baseline FHR)

A

15 beats = acceleration

78
Q

what is considered normal baseline FHR, tachycardia and bradycardia

A

normal: 110-160
brady: <110
tachy: >160

79
Q

types variability in FHR

A

absent: undetectable
minimal: <5 bpm
moderate: 6-25 bpm (ideal)
marked: >25 bpm

80
Q

what causes decreased variability in FHR (6)

A

-fetal sleep cycle (about 20 mins)
-narcotics, tranquilizers, analgesics
-severe fetal tachycardia
-prematurity
-cardiac/CNS abnormalities
-hypoxemia/hypoxia

81
Q

what causes increased variability in FHR (2)

A

-early mild hypoxemia
-fetal stimulation (uterine palpation, fetal activity, street drugs)

82
Q

what is considered an acceleration in FHR (same as variability, always considered good)

A

-increase of 15 bpm+
-onset to peak <30 sec
-duration > 15 sec < 2 min

83
Q

categories of decelerations in FHR (4)

A

early
late
variable
prolonged

84
Q

VEAL CHOP mnemonic for FHR accels/decels

A

Variable: Cord compression
Early: Head compression
Acceleration: Oxygenated
Late: poor placental perfusion

85
Q

what classifies as a variable decel

A

<30 secs from baseline to peak
(frequently V or U shaped)

86
Q

nursing interventions for variable decels in FHR (4)

A

-reposition (lateral, knee chest, trendelenburg)
-possible amnioinfusion
-possible maternal O2
-rule out prolapsed cord with cervical exam

87
Q

nursing intervention for early decels in FHR

A

none needed

88
Q

what classifies as late decels in FHR

A

-begin after contraction begins
-returns to baseline after end of contraction
-repetitive

89
Q

nursing interventions for late decels in FHR

A

-maternal position change (lateral, elevate legs)
-hydration
-anxiety reduction, breathing techniques
-meds
-modified pushing techniques
-maternal oxygen

90
Q

what classifies as prolonged decel in FHR

A

-FHR decrease of >15 bpm for >2 min but <10 min
-isolated episode of cord compression, hypoTN, excessive uterine activity, vagal stimulation
*fetal distress

91
Q

nursing interventions prolonged decel in FHR

A

-reposition (lateral, knee chest, trendelenburg)
-possible amnioinfusion
-possible maternal O2
-rule out prolapsed cord

92
Q

antepartum test of fetal well being with EFM looking for accels (2)

A

non stress test
contraction stress test

93
Q

what is considered reactive in a non-stress test

A

2 accels (15 bpm within for 15 secs) in 10 mins
*good, mom can go home

94
Q

what is considered nonreactive in a non-stress test

A

no accels
*needs more testing

95
Q

possible results from contraction stress test (3)

A

-negative: no late decels (can go home)
-positive: late decels w/ >50% contractions (more tests)
-equivocal: late decels w/ <50% contractions (more tests)

96
Q

what happens in contraction stress test

A

stimulated 3 contractions in 10 mins to see FHR response

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