100%(1)1 out of 1 people found this document helpful
This preview shows page 47 - 52 out of 133 pages.
MATERNITY—EXAM 2—REVIEWNursing actions to non-reassuring FHR patterns Tachysystole hypertonic uterine activity with associated bradycardiaNotice the frequency of uterine contraction with NO rest period Notice the effect on FHT
MATERNITY—EXAM 2—REVIEW•VEAL CHOP•Maternal VS (?ok)•Maybe vaginal exam [prolapsed cord]1. Identify the cause o2. Stop pitocin if infusingo3. Reposition mom to reduce cord compressiono4. Increase IV fluidso5. O2 8-10 L/min ( increase maternal O2 saturation )o6. Consider internal monitorso7. Notify primary providero8. Be aware potential need for c/s
MATERNITY—EXAM 2—REVIEWCare Management Other methods of assessment and interventions•FHR response to stimulation ( fetal scalp stim )•Fetal oxygen pulse oximetry ( via scalp electrode )•Amnioinfusion ( cushion the cord with intrauterine fluid via infusion)•Tocolytic therapy ( relax the uterus activity)•Umbilical cord acid-base determination ( cord pH )REMEMBER!Key PointsMonitoring of fetal well-beingoFetal well-being during labor is gauged by response of the FHR to UCsoStandardized definitions for common FHR patterns have been adopted by ACNM, ACOG, AWHONNoFive essential components include baseline FHR, variability, aoAccelerations, decelerations, and changes in FHR over timeoEmotional, informational, and comfort needs must be addressed when the mother and fetus are being monitoredoDocumentation is initiated and updated according to institutional protocol
MATERNITY—EXAM 2—REVIEWNurse must:•Name of Prenatal TestWhat is Done?Why it is done?Screening/DiagnosticWhen is it Done? (Gestational age in weeks)Major Risks & benefits of the Test/Nursing DAFPOr MSAFP maternal serum AFPMaternal blood assayScreenand biochemical marker for NTD neural tube defects 80-85% detection rateRecommended for all womenHIGH VALUE is associated with NTDLOW VALUE associated with DOWN’S SYNDROME15-20 weeksMultiple Marker Screen 1.Triple Screen2.QUAD screenBlood SCREEN measures MSAFP, HCG, estriol increases detection of trisomy 18.21BLOOD screenAdditional marker to triple screen( a placental hormone inhibin A) to increase accuracy of screening for Down’s in women less than 35 years old16-18 weeks16-18 weeksCVSTranscervical or transabdominal aspiration of amniotic fluidContinuous ultrasound guidance Lithotomy positionSterile catheter intoCervical os aspirate chorionic villi or thruabdominal wall KNOW NURSING INSTRUCTIONS FODISCHARGING PT>RDiagnostic test and early diagnosis rapid results chemical markerGenetic testing10-12 weeksMore risk of fetal lossbleeding than amniocentesisRh- mothers receive Rhogam after procedure because of risk of maternal fetal hemorrhagePUBS percutaneous umbilical blood sampleFor fetal blood sampling or direct fetal blood transfusion- direct access to fetal Diagnostic test and biochemical marker commonly use to diagnose inherited blood disorders or treatment of RH isoimmunization16 weeksContinuous fetal heart rate monitor before/during after procedureoFHR assessmentoUterine activity assessment