OB_Fetal_Assessment

OB_Fetal_Assessment - Fetal Assessment Introduction Fetal...

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Fetal Assessment    Introduction Fetal monitoring is the term used to describe the assessment of uterine activity and fetal response . Uterine contractions (UC) are stressful to the fetus because they intermittently decrease the oxygen supply from the placenta to the fetus.- give pain med at the beginning of a contraction Fetal Reserve- about 90 seconds A term used to define the concept that the fetus is provided with Additionally, it refers to the degree of hypoxemia the fetus can tolerate before tissue hypoxia and acidosis will occur. Organizations related to OB/Neonatal/Women’s Health AWHONN (Association of Women’s Health, Obstetric, and Neonatal Nursing) ACOG ( American College of Obstetricians and Gynecologists) AAP (American Academy of Pediatrics) FHR Monitoring Fetal heart rate (FHR) should always be monitored : Before and after AROM (artificial rupture of membranes)- cord could leak out fluid; make sure the cord is not ruptured. After SROM (spontaneous rupture of membranes) Before and after meds of any type After periods of ambulation After expulsion of an enema Standards of Care Low risk clients - auscultate FHR : 1st stage of labor Latent phase: q 60 minutes Active phase: q 30 minutes 2nd stage of labor: q 15 minutes   Standards of Care High risk clients - auscultate FHR : 1st stage of labor: 1
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Latent phase: q 30 minutes 0-3 cm dilated Active phase: q 15 minutes 4-7 cm dilated 2nd stage of labor: q 5 minutes -pushing until the birth of the baby Low risk vs. High risk Low risk: Ages 18-35 Para 0 to 3 37-42 wks gestation One fetus Prenatal care No OB/med problems No drug/alcohol abuse High risk: Basically, anyone not covered by the list on the left is high risk!! External Fetal Monitoring (EFM) Also called indirect monitoring Involves use of an ultrasound transducer to monitor the FHR and a tocotransducer to monitor UC. - Toco is placed highest on the abdomen- has a button and when uterus/muscles contracts it his the button   Advantages/Disadvantages of External Monitoring Advantages: Non-invasive Disadvantages: Has to be readjusted with maternal and fetal movement Cumbersome Does not provide in-depth assessment data ********** Internal Monitoring PG 315 Also called direct monitoring Involves the use of a fetal scalp electrode (FSE ) for the FHR and an intrauterine pressure catheter (IUPC) for the UC. Can be applied only after ROM, adequate cervical dilatation (2-3 cm), and easy access to presenting part of fetus. ****** 2
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    Advantages/Disadvantages of Internal Monitoring Advantages: More accurate (UC readings are in mmHg) Helpful with obese client Provides variability readings Allows for greater mobility in bed Disadvantages: Invasive Increased risk of infection/perforation
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This note was uploaded on 05/04/2008 for the course NURS 230 taught by Professor Knobloch during the Spring '08 term at Lady of the Lake.

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OB_Fetal_Assessment - Fetal Assessment Introduction Fetal...

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