ATI: Assessment of Fetal Well-Being

Question 1

When performing an external abdominal ultrasound, the client must be sure to have her bladder emptied or full?

Answer 1

The bladder should be full

Question 2

A transvaginal ultrasound is used for what?

Answer 2

• To detect ectopic pregnancies
• To identify fetal abnormalities
• To establish gestational age

Remember:Ultrasound is the most reliable way to establish gestatinal age

Question 3

You are preparing a client for an external abdominal ultrasound. What do you do?

Answer 3

• Ask the client to drink 1 quart of water to fill the bladder (allows for better visual)
• Ask the client to lay supine
• Apply gel to the client’s abdomen (make sure it is at room temperature)

Question 4

What is the best position for a client who will be undergoing transvaginal ultrasound?

Answer 4

Lithotomy position

Question 5

A biophysical profile (BPP) uses a combination of what?

Answer 5

Fetal Heart Rate monitoring (nonstress test) + ultrasound to detect physiological and physical characteristics of the fetus

Question 6

A biophysical profile is useful when we have which potential diagnosis?

Answer 6

• Polyhydramnios or oligohydramnios
• A nonreactive nonstress test
• Suspected fetal hypoxemia or hypoxia

Question 7

What scores are given during a BPP?

Answer 7

• 8-10: Normal, low risk of fetal asphyxia
• 4-6: Abnormal, suspect chronic fetal asphyxia
• Less than 4: Abnormal, strongly suspect chronic fetal asphyxia

Question 8

What is a nonstress test?

Answer 8

Monitors FHR to fetal movement, used in 3rd trimester

Question 9

What are the instruments needed for a nonstress test

Where are they attached?

Answer 9

• Tocotransducer (monitor uterine contractions)
• Doppler transducer (used to monitor FHR)

Both are attached externally

Question 10

How can a nonstress test give false nonreactive results?

Answer 10

The fetus may be sleeping during the test, the fetus may also be immature, or the mother could have taken some medications or substances that may have caused less fetal movement

Question 11

When and why should we use a fetal nonstress test?

Answer 11

• When: 3rd trimester
• Why: to determine fetal CNS development

Question 12

If a fetus is sleeping during the fetal nonstress test, what is an intervention we can do to wake the fetus up?

Answer 12

Apply a vibroacoustic stimulator sound source for about 3 seconds

Question 13

What are the results of a reactive nonstress test?

Answer 13

FHR acceleration of at least 15/min, for at least 15 seconds, 2 or more times in 20 minutes

For less than 32 weels: 10/min, for at least 10 seconds, 2 or more times in 20 minutes

Question 14

What if an NST in nonreactive?

Answer 14

We do a BPP

Question 15

What do we do if there is a negative nipple stimulated contraction test?

Answer 15

We initiate oxytocin stimulated test

Question 16

What is an oxytocin stimulated contraction test?

Answer 16

IV oxytocin is given to the mother to stimulate uterine contractions

Question 17

What does the nurse do if there is hyperstimulation of the uterine contraction secondary to oxytocin stimulation during the contraction test?

Answer 17

• Monitor contractions lasting for more than 90 seconds or every 2 min
• Administer tocolytics
• Mantain bed rest
• Monitor for 30 min to make sure contractions have stopped and preterm labor has not begun

Question 18

If the CST is positive, what can we expect to see?

Answer 18

Late decelerataions within 50% or more contractions

Remember: negative, normal finding should not have any late decelerations

Question 19

When can amniocentesis be safely performed?

Answer 19

After 14 weeks

Ensure this is done with US guidance

Question 20

Preprocedure considerations for amniocentesis?

Answer 20

Empty bladder

Question 21

What is the standard procedure after amniocentesis for those clients that are Rh -?

Answer 21

Admin Rho(D)

or RhoGAM

Question 22

What are the variables that are assessed in BPP?

There are 5

Answer 22

1. Fetal Heart Rate
2. Fetal Tone
3. Fetal Breathing
4. Fetal Movements
5. Amniotic Fluid Volume