Week 12 TUES

Question 1

• transducer emits high frequency sound waves, placed on mothers abdomen and moved to see the fetus
• standard component of prenatal care

Answer 1

ultrasonography

Question 2

uses sound waves to examine the flow of blood in blood vessels

Answer 2

doppler ultrasonography

Question 3

glycoprotein produced initally by the yolk sac and fetal gut, and later predominantly by the fetal liver

Answer 3

Alpha-fetoprotein analysis

Question 4

what uses ultrasound in 1st trimester between 11-14 wks, allows for early detection and diagnosis of some fetal chromosomal and structural abnormalities

Answer 4

Nuchal translucency screening

Question 5

transabdominal puncture of the amniotic sac to obtain a sample of amniotic fluid for analysis and can determine chromosomal abnormalities and several hereditary metabolic defects in fetus before birth

Answer 5

Amniocentesis

Question 6

indirect measurement of uteroplacental function

Answer 6

nonstress test

Question 7

What does a nonstress test measure for the fetus

Answer 7

measures fetal heart rate patterns in response t fetal mov’t

Question 8

NST procedure

Answer 8

• mother eats a meal or has a snack to stimulate fetal activity
• place in left lateral recumbent position to avoid supine hypotension syndrome
• external electronic fetal monitoring device applied to moms abdomen
• 2 belts w/ a sensor that records uterine activity and fetal heart rate
• procedure last 20-30 min

Question 9

NST nursing management

Answer 9

• have mother empty bladder and eat a snack
• obtain baseline fetal monitor strip over 15-20 minutes
• during test observe signs of fetal activity w/ concurrent acceleration of the fetal HR
• reactive or nonreactive

Question 10

Biophysical profile (BPP)

Answer 10

test used during pregnancy to check the health of the baby in the womb. It combines an ultrasound with a non stress test to measure the baby’s well-being. The BPP looks at five thing
- fetal breathing - fetal tone
- body mov’t - amniotic fluid level
- heart rate

Question 11

What is the scoring system for BPP

Answer 11

Each area gets a score (usually 0 or 2), and the total helps doctors know if the baby is doing well or needs more monitoring. The maximum score is 10, with 8 to 10 generally being healthy.

Question 12

What is primary powers

Answer 12

• The primary stimulus powering labor is contractions
• cause complete dilation and effacement of the cervix during first stage of labor

Question 13

What is secondary powers

Answer 13

• use of intrabdominal pressure (voluntary muscle contracted) exerted by the woman as she pushes and bears down during 2nd stage of labor

Question 14

uterine contractions

Answer 14

involuntary, rhythmic and intermittent w/ period of relaxation between contraction

Question 15

thinning and shortening of the cervix as the body prepares for delivery

Answer 15

effacement

Question 16

process of the cervical opening up to allow the baby to pass through the birth canal

Answer 16

dilation

Question 17

Early labor dilation and contractions

Answer 17

0-3 cm dilation
- last 30 secs, occur every 5-7min

Question 18

Active labor dilation

Answer 18

4-7 cm dilation

Question 19

Transition stage

Answer 19

8-10cm dilation

Question 20

3 phases of contraction

Answer 20

• increment
• acme
• decrement

Question 21

increment

Answer 21

build-up of contraction

Question 22

acme

Answer 22

peak

Question 23

decrement

Answer 23

descent/ relaxation of uterine muscle fibers

Question 24

Maternal Physiologic responses to labor

Answer 24

• Labor: the process by which the birth canal is prepared to allow the fetus to pass from the uterine cavity to the outside world
• Increased heart rate (increases by 10-20bpm)
• Cardiac output increases (12-31% 1st stage of labor and 50% in 2nd stage of labor)
• BP increases by up to 35mmHg during contractions
• WBC increase (? 2/2 to tissue trauma)
• RR increases (need more O2)
• Gastric motility/food absorption decreases
• Can increase likelihood of emesis and nausea
• Mild temperature elevation
• Increased basal metabolic rate and blood glucose levels decrease
• Muscle aches and cramps

Question 25

Fetal physiologic responses to labor

Answer 25

- Periodic fetal heart rate changes (FHR) - Decrease in circulation & perfusion secondary to uterine contractions - Increase in arterial CO2 pressure - Decrease in fetal breathing movements throughout labor - Decrease in fetal oxygen pressure with decrease in partial pressure of oxygen (PO2)

Question 26

What is the purpose of FHR monitoring

Answer 26

- determine rate and rhythm of fetal HR - normal 11-160

Question 27

What is the purpose of continuous electronic fetal monitoring

Answer 27

detect fetal FHR changes EARLY!

Question 28

Indications for continuous electronic fetal monitoring

Answer 28

- women receiving oxytocin infusion - epidural anesthesia - variety of problems related to compromise in fetal/ maternal health - moderate htn, delay in 1st/ 2nd stage of labor - presence of meconium

Question 29

Clinical goal with continuous electronic fetal monitoring

Answer 29

- identify fetuses w/ increased risk of hypoxia injury to that intervention can avoid adverse outcome - early detection> early interventions> save lives

Question 30

Category I FHR

Answer 30

- normal FHR - baseline rate 110-160 - strongly predictive of normal - no late decels/ variables - early decels fine

Question 31

Category II FHR

Answer 31

- tracing not assigned to cat I or cat III - not predictive of abnormal fetus status

Question 32

Category III FHR

Answer 32

- predictive of abnormal fetal acid base status at the time of observation - sinusoidal pattern for at least 20 mins - absent variability - recurrent late decels, bradycardia, and variables

Question 33

fetal bradycardia

Answer 33

FHR < 11bpm and lasts 10 mins - caused by fetal hypoxia, fetal acidosis, hypoglycemia, cord compression

Question 34

Fetal tachycardia

Answer 34

FHR >160bpm - early compensatory response to asphyxia, hypoxia, maternal fever, fetal anemia & infection, maternal dehydration

Question 35

4 categories of variability

Answer 35

absent, minimal, moderate, marked

Question 36

irregular fluctuations in baseline FHR which is measured as the amplitude of the peak to trough in bpm

Answer 36

variability

Question 37

transitory abrupt increases in FHR above the baseline that last less than 30 secs from onset to peak

Answer 37

Accelerations

Question 38

tranisent fall in FHR caused by stimulation of the parasympathetic nervous system

Answer 38

deceleration

Question 39

visually apparent, usually symmetrical, characterized by gradual decrease in FHR in which the nadir (lowest point) occurs at the peak of contraction

Answer 39

early decel

Question 40

visually apparent, symetrical, transitory decrease in FHR that occurs after the peak of contraction

Answer 40

late decel

Question 41

visually apparent abrupt decreases in FHR below baseline and have unpredictable shape on the FHR baseline, possible demonstrate no relationship with contractions

Answer 41

variable

Question 42

visually apparent smooth, sinewave like undulating pattern in the FHR baseline with cycle frequency of 3-5bpm that persists for >20 minutes

Answer 42

Sinusoidal pattern - super rare!

Question 43

Nursing role in cat III FHR

Answer 43

- Notify the health care provider about the pattern and obtain further orders, document all interventions and their effects on FHR pattern - Discontinue oxytocin or other uterotonic agent as dictated by the facilities protocol if being administered - Turn client on L or R lateral, knee-chest or hands and knees to increase placental perfusion and relieve cord compression - Administer O2 via nonrebreathing face mask to increase fetal oxygenation - Increase IV fluid rate to improve intravascular volume and correct maternal hypotension - Assess the client for any underlying contributing causes - Provide reassurance that interventions are to effect pattern change - Modify pushing in the 2nd stage of labor to improve fetal oxygenation - Document any and all interventions and changes in FHR patterns - Prepare for surgical birth if pattern not corrected in 30 minutes