Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

difference between screening v diagnostic tests

A

screening = gives more info about the odds
diagnostic = confirms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

when is cell free DNA tested during pregnancy

A

10 weeks gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

when is first trimester multiple marker testing done

A

10-13 weeks gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

genetic screening tests during 2nd tri (3)

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

when does second tri multiple marker genetic screening take place

A

15-22 weeks gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

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

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

2 reasons moms might have serial fetal sonograms to monitor growth

A

HTN
diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

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

A

2 cm +
5-25 cm +

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what action is taken for score of 6 on BPP

A

further testing and action depends on gestational age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what action is taken for score of 4 on BPP

A

if >36 wks deliver
if <32 wks repeat test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what is included on modified BPP
-amniotic fluid volume (>2 cm) -non stress test (reactive)
26
IUGR
intrauterine growth restriction
27
macrosomia
large baby
28
2 types of IUGR
-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)
29
what babies are most likely to be macrosomic
babies of diabetic moms
30
invasive procedures for diagnosis (3)
-amniocentesis -chorionic villi sampling -percutaneous umbilical cord blood sampling (PUBS)
31
at how many weeks gestation can you do an amniocentesis how long does it take to get results
14+ weeks can take 2 wks to get results
32
at how many weeks gestation can you do a chorionic villi sampling
10-12 wks +
33
risks of amniocentesis and chorionic villus sampling (5)
-infection -bleeding -accidentally poking cord, placenta, or baby -could go into labor -slight increase risk club foot (amnio)
34
what is talipes equinovarus
technical name for club foot (slight risk with amniocentesis)
35
aftercare instructions amniocentesis
-tell dr if fever, contractions, bleeding, leaking fluid -drink lots of water -rest
36
what is chorionic villus sampling
testing trophoblasts (fetal DNA) implanted in endometrium
37
why would a mom do chorionic villus sampling instead of amniocentesis
-mom could terminate pregnancy (abortion) if found out abnormalities -can do CVS sooner than amnio
38
what does PUBS test for (in 2nd/3rd tri)
-fetal DNA -fetal acid base balance -fetal Hgb and Hct count (anemia)
39
risks of PUBS
-high risk for injuring fetal blood vessels -in OR, setup for emergency C-section if needed
40
difference b/w hypoxemia and hypoxia
hypoxemia: low O2 in blood hypoxia: low O2 in tissues for aerobic metabolism
41
byproduct of anaerobic metabolism (without O2)
lactic acid (hard on neurological tissues)
42
what are fetal "reserves"
extra O2/nutrients baby has stored for times of hypoxemia/hypoxia
43
what could cause decreased O2 supply in fetus (4)
-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
nursing interventions for fetal hypoxemia/hypoxia
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
side effect of epidural that causes decreased maternal cardiac output
quick vasodilation, drops bp
46
3 category responses to fetal hypoxemia
category 1: normal (green) category 2: indeterminate (yellow) category 3: impending decompensation (red)
47
characteristics of category 1 FHR pattern
-normal baseline (110-160 bpm) -moderate baseline FHR variability -no late/variable decels -maybe early decels -maybe accelerations
48
characteristics of category 2 FHR pattern
-baseline rate -minimal FHR variability -recurrent variable decels
49
what part of hand do you palpate contraction with
fingertips
50
characteristics of category 3 FHR pattern
-absent FHR variability -recurrent late decels -recurrent variable decels -bradycardia -sinusoidal pattern
51
monitoring techniques of FHR and contractions
-intermittent auscultation: fetoscope, doppler -electronic fetal monitoring 1. external: ultrasound transducer (doppler), toco (for contractions) 2. internal: spiral electrode, IUPC
52
who can't use spiral electrode
mom who is HIV+
53
when can you use internal electronic fetal monitoring
after ROM
54
nursing intervention after insertion of IUPC
put mom in semi-fowlers and record mmHg on left and right sides
55
2 graphs on monitor paper for electronic fetal monitoring how long is one dark red line to another
upper graph: reflects fetal heart rate (time and bpm) lower graph: uterine activity (time and mmHg) red line to red line: 60 secs
56
UA
uterine activity
57
what is measured in UA in electronic monitoring (4)
-frequency -duration -intensity -resting tone
58
normal # of contractions in 10 min period
2-5/10 min
59
tachysystole # of contractions in 10 min period
>5/10 min
60
what unit of time is frequency contractions measured in
MINUTES
61
normal duration contraction
45-80 secs
62
abnormal duration contraction
>90 secs
63
what unit of time is contraction duration measured in
SECONDS
64
what unit is contraction intensity measured in
mild/moderate/firm (with palpation) mmHg (w/ IUPC use)
65
normal intensity of contraction during 1st stage labor and 2nd stage labor
1st stage: 40-70 mmHg 2nd stage: >80 mmHg
66
normal resting tone of uterus between contractions
soft 10 mmHg
67
normal relaxation time between contractions during 1st stage labor and 2nd stage
1st: >60 sec 2nd: >45 sec
68
what is considered abnormal relaxation time between contractions
less than 30 sec
69
how to determine contraction frequency
count from beginning of one contraction to beginning of next
70
how to determine contraction duration
count from beginning of one contraction til end of same contraction
71
how to determine intensity of contraction
strength at its peak IUPC = mmHg
72
how to determine resting tone contraction
tension in uterus between contractions baseline
73
what do monte video units evaluate in labor
adequacy of labor (contractions are good enough to change cervix) *must have IUPC
74
how to determine monte video units
peak contraction pressure (intensity) - baseline uterine pressure (resting tone)
75
what # MVUs are adequate for labor to progress
>200
76
fetal heart rate in average bpm within 10 min time frame
baseline fetal heart rate
77
how many heart beats is considered an acceleration in FHR (and shouldn't be counted in baseline FHR)
15 beats = acceleration
78
what is considered normal baseline FHR, tachycardia and bradycardia
normal: 110-160 brady: <110 tachy: >160
79
types variability in FHR
absent: undetectable minimal: <5 bpm moderate: 6-25 bpm (ideal) marked: >25 bpm
80
what causes decreased variability in FHR (6)
-fetal sleep cycle (about 20 mins) -narcotics, tranquilizers, analgesics -severe fetal tachycardia -prematurity -cardiac/CNS abnormalities -hypoxemia/hypoxia
81
what causes increased variability in FHR (2)
-early mild hypoxemia -fetal stimulation (uterine palpation, fetal activity, street drugs)
82
what is considered an acceleration in FHR (same as variability, always considered good)
-increase of 15 bpm+ -onset to peak <30 sec -duration > 15 sec < 2 min
83
categories of decelerations in FHR (4)
early late variable prolonged
84
VEAL CHOP mnemonic for FHR accels/decels
Variable: Cord compression Early: Head compression Acceleration: Oxygenated Late: poor placental perfusion
85
what classifies as a variable decel
<30 secs from baseline to peak (frequently V or U shaped)
86
nursing interventions for variable decels in FHR (4)
-reposition (lateral, knee chest, trendelenburg) -possible amnioinfusion -possible maternal O2 -rule out prolapsed cord with cervical exam
87
nursing intervention for early decels in FHR
none needed
88
what classifies as late decels in FHR
-begin after contraction begins -returns to baseline after end of contraction -repetitive
89
nursing interventions for late decels in FHR
-maternal position change (lateral, elevate legs) -hydration -anxiety reduction, breathing techniques -meds -modified pushing techniques -maternal oxygen
90
what classifies as prolonged decel in FHR
-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
nursing interventions prolonged decel in FHR
-reposition (lateral, knee chest, trendelenburg) -possible amnioinfusion -possible maternal O2 -rule out prolapsed cord
92
antepartum test of fetal well being with EFM looking for accels (2)
non stress test contraction stress test
93
what is considered reactive in a non-stress test
2 accels (15 bpm within for 15 secs) in 10 mins *good, mom can go home
94
what is considered nonreactive in a non-stress test
no accels *needs more testing
95
possible results from contraction stress test (3)
-negative: no late decels (can go home) -positive: late decels w/ >50% contractions (more tests) -equivocal: late decels w/ <50% contractions (more tests)
96
what happens in contraction stress test
stimulated 3 contractions in 10 mins to see FHR response

leadership management (32 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions