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Complex Care > Week 12 TUES > Flashcards

Week 12 TUES Flashcards

maternal/ fetal assessment

1
Q
  • transducer emits high frequency sound waves, placed on mothers abdomen and moved to see the fetus
  • standard component of prenatal care
A

ultrasonography

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2
Q

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

A

doppler ultrasonography

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3
Q

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

A

Alpha-fetoprotein analysis

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4
Q

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

A

Nuchal translucency screening

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5
Q

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

A

Amniocentesis

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6
Q

indirect measurement of uteroplacental function

A

nonstress test

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7
Q

What does a nonstress test measure for the fetus

A

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

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8
Q

NST procedure

A
  • 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
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9
Q

NST nursing management

A
  • 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
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10
Q

Biophysical profile (BPP)

A

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

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11
Q

What is the scoring system for BPP

A

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.

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12
Q

What is primary powers

A
  • The primary stimulus powering labor is contractions
  • cause complete dilation and effacement of the cervix during first stage of labor
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13
Q

What is secondary powers

A
  • use of intrabdominal pressure (voluntary muscle contracted) exerted by the woman as she pushes and bears down during 2nd stage of labor
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14
Q

uterine contractions

A

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

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15
Q

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

A

effacement

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16
Q

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

A

dilation

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17
Q

Early labor dilation and contractions

A

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

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18
Q

Active labor dilation

A

4-7 cm dilation

19
Q

Transition stage

A

8-10cm dilation

20
Q

3 phases of contraction

A
  • increment
  • acme
  • decrement
21
Q

increment

A

build-up of contraction

22
Q

acme

A

peak

23
Q

decrement

A

descent/ relaxation of uterine muscle fibers

24
Q

Maternal Physiologic responses to labor

A
  • 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
25
Q

Fetal physiologic responses to labor

A
  • 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)
26
Q

What is the purpose of FHR monitoring

A
  • determine rate and rhythm of fetal HR
  • normal 11-160
27
Q

What is the purpose of continuous electronic fetal monitoring

A

detect fetal FHR changes EARLY!

28
Q

Indications for continuous electronic fetal monitoring

A
  • 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
29
Q

Clinical goal with continuous electronic fetal monitoring

A
  • identify fetuses w/ increased risk of hypoxia injury to that intervention can avoid adverse outcome
  • early detection> early interventions> save lives
30
Q

Category I FHR

A
  • normal FHR
  • baseline rate 110-160
  • strongly predictive of normal
  • no late decels/ variables
  • early decels fine
31
Q

Category II FHR

A
  • tracing not assigned to cat I or cat III
  • not predictive of abnormal fetus status
32
Q

Category III FHR

A
  • 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
33
Q

fetal bradycardia

A

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

34
Q

Fetal tachycardia

A

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

35
Q

4 categories of variability

A

absent, minimal, moderate, marked

36
Q

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

A

variability

37
Q

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

A

Accelerations

38
Q

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

A

deceleration

39
Q

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

A

early decel

40
Q

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

A

late decel

41
Q

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

A

variable

42
Q

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

A

Sinusoidal pattern
- super rare!

43
Q

Nursing role in cat III FHR

A
  • 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

Complex Care (26 decks)

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