ch. 18 fetal assessment Flashcards

1
Q

fetal assessment 1st trimester (6)

A

1) viability: 20 weeks

2) beta HCG:
- doubles Q2 days in 1st 10 days of pregnancy
- peaks 60-90 days POST CONCEPTION
- accurate marker
- needs 48 hours between tests

3) progesterone: level testing

4) ultrasound:
- 10 to 13 6/7 weeks
- indication: crown rump length (after 8 weeks, can opt for genetic testing)

5) gestational age (due date)

6) genetic screening options
- nuchal folds, serum testing (DNA assay, chorionic villi, maternal serum alpha fetoprotein, amniocentesis)

TIP:
- increased nuchal folds + 3 mm -> can indicate trisomy 13/18/21 (Down syndrome)
- amniocentesis: after 20 weeks
- HCG (supports corpus luteum to produce more estrogen/progesterone) peaks: 7-11 weeks then placenta takes over
- corpus luteum: produces progesterone

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2
Q

progesterone levels (normal levels, low level, ____ _____ secretes progesterone until…, if low give, extra)

A
  • normal pregnancy levels: 10-25 ng/mL
  • low levels: SAB and ectopic pregnancies
  • corpus lutetium secretes progesterone until 6-8 weeks gestation, then placenta takes over
  • PO/intravaginal progesterone given if NOT
  • testing not needed after 12 weeks

TIP:
- if low, risk of miscarriage, cervical insufficiency

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3
Q

review: crown to rump measurement

A

measurement from top of fetal crown (head) to bottom of the rump (buttocks)

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4
Q

nuchal translucency testing (what, screen, look at, accurate)

A

combination of U/S and maternal serum testing
- screen fetus: 11wks 1d - 13wks 6d
- looks at nuchal folds
- >3mm (82-87%) accurate for detecting: trisomy 21 (Down syndrome), trisomy 13/18

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5
Q

fetal assessment 2nd trimester (3)

A
  • MSAFP: quad screen
  • amniocentesis (remove 20-30cc fluid) after 20wk
  • ultrasound indication: dating/anatomy

TIP:
- ultrasound done 10-13 wks for 1st trimester
- ultrasound done 18-22 wks for 2nd trimester

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6
Q

amniocentesis (indication, when, 2 components (5)

A
  • indication: done to assess fetal lung maturity, genetic study
  • when: 34-36 weeks (adequate surfactant 36 wks)
  • 2 components surfactant:
    (a) phospholipids
    (b) lowers alveoli surface tension
    (c) stabilizes alveoli
  • L/S ratio 2:1
  • PG: 36 weeks, indicates lung maturity
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7
Q

what does L/S stand for

A

lecithin sphingomyelin

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8
Q

nursing care during amniocentesis (8)

A
  • obtain baseline VS before & after procedure
  • assess needle insertion site for fluid leakage (amniotic fluid)
  • monitor fetal heart rate for 20-30 minutes
  • observe for MATERNAL HYPOTENSION
  • administer rhogam if mom Rh negative
  • instruct mother on signs of labor (fever)
  • engage in light activities for 24 hours (lay low)
  • encourage fluids
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9
Q

basis for fetal monitoring (what, decrease in ____ ____ due to (4))

A

oxygen supple must be maintained to prevent fetal compromise

decrease in oxygen supply d/t:
- reduction of blood flow through maternal vessels
- reduction in oxygen content in maternal blod
- alterations in fetal circulation
- reduction in blood flow to intervillous space in placenta

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10
Q

2 indications basis for monitoring

A

1) uterine activity: monitoring provides information on uterine contractions (how often, how intense, duration)

2) fetal compromise: goals of intrapartum FHR monitoring are to IDENTIFY and DIFFERENTIATE normal (reassuring) patterns from the abnormal (non reassuring) patterns, which can be indicative of fetal compromise

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11
Q

monitoring techniques (2)

A

1) intermittent auscultation
2) electronic fetal monitoring

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12
Q

intermittent auscultation (3, disadvantage)

A
  • listen to fetal heart sounds at periodic intervals to assess FHR (doppler)
  • easy to use, inexpensive, less invasive than EFM (listen for full minute)
  • doppler probe provides closer uterine proximity, making it easier to auscultate the FHR when the woman is obese or early in gestation

disadvantage:
- does not provide permanent record (no continuous stretch, cerebral palsy -> #1 cause is premature baby

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13
Q

electronic fetal monitoring (3)

A

1) external monitoring
- U/S transducer
- toco transducer (tacodynamometer): one monitor contraction, the other monitors baby
- wireless external monitor: portable monitor

2) internal monitoring:
- spiral electrode: internal fetal scalp lead
- intrauterine pressure catheter (IUPC): measures contractions
- Montevideo units (MVUs)

3) display:
- FHR upper section
- UA lower section
- each small square represents 10 SECONDS

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14
Q

baseline fetal heart rate (4)

A

average rate: 110-160 bpm during 10 minute segment that excludes:
- periodic or episodic changes
- periods of MARKED variability
- segments of the baseline that differ by more than 25 bpm

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15
Q

types of fetal variability (4)

A

1) absent variability:
- amplitude range undetectable
- ex: 150 -> 150 -> 150 -> 150
- NOT GOOD

2) minimal variability:
- <5 bpm change
- ex: 150 -> 145 -> 152 -> 149
- CAUTION, monitor baby
- reflects sleep state or IV fent/morphine IVP (compromise)

3) moderate variability:
- 6 to 25 bpm (98%)
- GOOD, BEST

4) marked variability:
- >25 bpm change
- ex: 150 -> 176 -> 148 -> 155
- BABY STRUGGLING

TIP: fetal monitoring mostly R -> R

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16
Q

tachycardia FHR

A

> 160 bpm x 10 minutes or more (10 min. interval)

17
Q

bradycardia FHR

A

<110 bpm x 10 minutes or more (10 min. interval)

18
Q

periodic & episodic changes in FHR

A
  • periodic changes: occurring with uterine contractions
  • episodic changes: non periodic changes, not associated with UCs
  • accelerations (GOOD): fetal well being
19
Q

types fetal heart tones (VEAL CHOP)

A

1) Variable -> cord compression (emergent)
2) Early decels -> head compression (good)
3) Accelerations -> oxygenation of fetus (good)
4) Late decels -> placental insufficiency (decreased perfusion/oxygenation to baby)
prolonged deceleration -> lasting more than 2 minutes, less than 10 minutes (caution)

20
Q

fetal heart rate category 1 (what, baseline, viability, decels, accels)

A

(GREEN LIGHT)
normal FHR patterns in the normal range of 110-160 bpm
- baseline FHR: 110-160
- variability: moderate
- late/variable decels: absent
- early decels: present or absent
- accel: present or absent

21
Q

fetal heart rate category 2 (what, baseline, viability, decels, accels)

A

(YELLOW LIGHT)
indeterminate FHR patterns
- bradycardia not accompanied by absence of baseline variability
- tachycardia
- minimal or absence of baseline variability not accompanied by recurrent decels
- variability: marked (fluctuation >25 bpm)
- accelerations: no response to fetal stimulation
- periodic or episodic decelerations

22
Q

fetal heart rate category 3 (what, baseline, viability, decels, accels)

A

(RED LIGHT EMERGENT)
abnormal FHR patterns described as nonreassuring
- nonreassuring FHR patterns associated with fetal hypoxemia
- hypoxemia can deteriorate to severe fetal hypoxia
- variability: abscense of baseline
- recurrent/late decels
- bradycardia
- SINUSOIDAL PATTERN: wave (little) (RED FLAG)

23
Q

FHR monitoring: 5 essential components of nursing mgmt of abnormal patterns

A

1) baseline rate
2) baseline variability
3) acceleration
4) decelerations
5) changes or trends over time

24
Q

FHR monitoring: nursing mgmt abnormal patterns (what, 9)

A

corrective measures must be taken immediately to improve fetal oxygenation -> INTRAUTERINE RESUSCITATION
- assist women to side lying (lateral) position
- increase maternal blood volume by increasing the rate of primary IV infusion
- fetal scalp stimulation and vibro-acoustic stimulation
- umbilical cord acid base determination
- fetal scalp blood sampling (vaginal exam)
- amnioinfusion (recreate amniotic sac W/ NS)
- tocolytic therapy: too much contraction
- client/family teaching
- DOCUMENTATION

25
Q

tocolytic therapy (3)

A
  • given to slow down and reduce contractions

1) beta memetics: terbutaline, ritodrine
2) calcium channel blockers: nifidipine
3) magnesium sulfate

26
Q

cord blood gas indication (2)

A

1) compare baby blood type to mother
2) uterine environment analysis: neutral, toxic, hypoxic, alkaline?

GET pH OF

27
Q

fetal heart rate patterns (4)

A

1) early decelerations: response to fetal head compression (good)
2) late decelerations: due to uteroplacental insufficiency (not good)
3) variable decelerations: due to umbilical cord compression (not good)
4) prolonged delerations: lasting more than 2 minutes but less than 10 minutes (caution)