MATERNITYEXAM 2REVIEW Nursing actions to non reassuring FHR patterns

Maternityexam 2review nursing actions to non

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MATERNITY—EXAM 2—REVIEW Nursing actions to non-reassuring FHR patterns Tachysystole hypertonic uterine activity with associated bradycardia Notice the frequency of uterine contraction with NO rest period Notice the effect on FHT
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MATERNITY—EXAM 2—REVIEW
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MATERNITY—EXAM 2—REVIEW VEAL CHOP Maternal VS (?ok) Maybe vaginal exam [prolapsed cord] 1. Identify the cause o 2. Stop pitocin if infusing o 3. Reposition mom to reduce cord compression o 4. Increase IV fluids o 5. O2 8-10 L/min ( increase maternal O2 saturation ) o 6. Consider internal monitors o 7. Notify primary provider o 8. Be aware potential need for c/s
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MATERNITY—EXAM 2—REVIEW Care 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 Points Monitoring of fetal well-being o Fetal well-being during labor is gauged by response of the FHR to UCs o Standardized definitions for common FHR patterns have been adopted by ACNM, ACOG, AWHONN o Five essential components include baseline FHR, variability, a o A ccelerations, decelerations, and changes in FHR over time o Emotional, informational, and comfort needs must be addressed when the mother and fetus are being monitored o Documentation is initiated and updated according to institutional protocol
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MATERNITY—EXAM 2—REVIEW Nurse must: Name of Prenatal Test What is Done? Why it is done? Screening/Diagnostic When is it Done? (Gestational age in weeks) Major Risks & benefits of the Test/Nursing D AFP Or MSAFP maternal serum AFP Maternal blood assay Screen and biochemical marker for NTD neural tube defects 80-85% detection rate Recommended for all women HIGH VALUE is associated with NTD LOW VALUE associated with DOWN’S SYNDROME 15-20 weeks Multiple Marker Screen 1.Triple Screen 2.QUAD screen Blood SCREEN measures MSAFP, HCG, estriol increases detection of trisomy 18.21 BLOOD screen Additional marker to triple screen( a placental hormone inhibin A) to increase accuracy of screening for Down’s in women less than 35 years old 16-18 weeks 16-18 weeks CVS Transcervical or transabdominal aspiration of amniotic fluid Continuous ultrasound guidance Lithotomy position Sterile catheter into Cervical os aspirate chorionic villi or thru abdominal wall KNOW NURSING INSTRUCTIONS FO DISCHARGING PT>R Diagnostic test and early diagnosis rapid results chemical marker Genetic testing 10-12 weeks More risk of fetal loss bleeding than amniocentesis Rh- mothers receive Rhogam after procedure because of risk of maternal fetal hemorrhage PUBS percutaneous umbilical blood sample For 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 isoimmunization 16 weeks Continuous fetal heart rate monitor before/during after procedure o FHR assessment o Uterine activity assessment
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