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24 Cards in this Set

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Why is the assessment of fetal movement an important indicator of well-being?
Clinicians generally agree that vigorous fetal activity provides reassurance of fetal well-being and that marked decrease in activity or cessation of movements may indicate possible fetal compromise.
When is the fetus most active?
Movements are directly related to the infant's sleep-wake cycles. The typical active fetal period lasts 40 minutes and peaks between 9pm and 1am in response to maternal hypoglycemia.
Name some external stimuli of fetal activity:
Sound, cigarette smoking and drugs, as well as juice, maternal movement and maternal hypoglycemia.
What can be done to promote fetal movement?
Talking, singing, music, rubbing her tummy can all be done to promote fetal movement.
How can clients be taught to monitor/document fetal movement?
Beginning at about 27 weeks gestation, keep a daily record of fetal movement. Try to begin counting at about the same time each day about an hour after a meal if possible. Lie quietly in a side-lying position. Using the Cardiff card, place an X for each fetal movement until she has recorded 10. Using the DFMR have the woman count three times a day for 20-30 minutes.
When should a mother contact the care provider regarding fetal movement?
If there are fewer than 10 movements in 3 hours, if overall the fetus's movements are slowing, and it takes much longer each day to note 10, if there are no movements in the morning, and if there are fewer than 3 movements in 8 hours.
For what client is documentation of fetal movement particularly important?
Maternal history of spontaneous abortion, unexplained fetal death, post dates, diabetes, HTN/preeclampsia and HIV+.
Name some fetal indications for ultrasound:
Suspected growth restriction, prolonged pregnancy, fetal lung maturity, detection of death, birth weight in relation to gestational diabetes, position, amniocentesis placement.
Name some maternal indications for ultrasound:
(Benefits of ultrasound)Early detection of pregnancy, observation of fetal heartbeat and fetal breathing movements, identification of more than one embryo or fetus, clinical estimations of birth weight, detection of anomalies, examinatin of nuchal translucency in the first trimester to assess for down syndrome, fetal cardiac structures, identification of amniotic fluid index,location of placenta, placental grading, fetal position and presentation.
What fetal anomalies can be detected by ultrasound?
Hydrocephalus, anencephaly, myelomeningocoele, achondroplasia and other dwarfism, spina bifida, exomphalos, Gastroschisis, duodenal atresia and fetal hydrops, trisomy, cleft lips/ palate and congenital cardiac abnormalities.
What other testing is facilitated by ultrasound?
Ultrasound can also assist in other diagnostic procedures in prenatal diagnosis such as amniocentesis, chorionic villus sampling, cordocentesis (percutaneous umbilical blood sampling) and in fetal therapy.
Describe a nonstress test:
NST is a widely used method of evaluating fetal status, may be used alone or as part of a more comprehensive diagnostic assessment called a biophysical profile. The nonstress test is based on the knowledge that when the fetus has adequate oxygenation and an intact CNS, there are accelerations of the FHR with fetal movement.
What is a reactive test?
A reactive NST shows at least two accelerations of FHR with fetal movements of 15 beats per minute lasting 15 seconds or more over 20 minutes. THIS IS THE DESIRED RESULT.
What is a nonreactive test?
In a nonreactive test, the reactive criteria are not met. For example, the accelerations are not as much as 15 beats per minute or do not last 15 seconds.
What is unsatisfactory test?
An NST is unsatisfactory if the data cannot be interpreted or there was inadequate fetal activity.
What nursing responsibilities are asspciated with a NST?
The nurse evaluates the woman's understanding of the NST and the possible results. The reasons for the NST and the procedure are reviewed before beginning the test. The nurse administers the NST, interprets the results and reports the findings to the certified nursing midwife or physician and the expectant woman.
Describe Contraction Stress Testing (CST):
This is a means of evaluating the respiratory function (oxygen and carbon dioxide exchange) of the placenta. The critical component of the CST is the presence of uterine contractions. An electronic fetal monitor is used to provide continuous data. After a 15 minute baseline recording of uterine activity and FHR, the tracing is evaluated for evidence of spontaneous contractions. If the placental reserve is insufficient, fetal hypoxia, depression of the myocardium, and a decrease in FHR occur.
Describe a Biophysical Profile (BPP):
5 variables:
Fetal breathing movement, fetal movements of body or limbs, fetal tone(extension and flexion of extremities), amniotic fluid volume and reactive FHR with activity (or reactive NST).
Describe Doppler Velocimetry:
Measures blood flow changes that occur in maternal and fetal circulation in order to assess placental function. The signal is reflected off the red blood cells moving withion the vessels and creates a "picture" that looks like a series of waves. The highest wave represents systole and the lowest is diastole.The normal ratio is below 2.6 and below 3 at term. Elevations above 3 and above are considered abnormal. Doppler blood flow studies are helpful in assessing and managing pregnancies with suspected uteroplacental insufficiency before asphyxia occurs.
Describe Amniocentesis:
Used to obtain amniotic fluid for testing. The physician scans the uterus using ultrasound to identify the fetal and placental positions and to identify adequate pockets of amniotic fluid. The skin is cleaned w/betadine, the use of a local anesthetic at insertion site is optional, a 22 gauge needle is inserted and amniotic fluid is withdrawn.
When is amniocentesis performed?
Women who have an increased risk for certain birth defects (such as Down Syndrome, Tay-Sachs,PKU) or malformations in the fetus.
What tests can be done on amniotic fluid?
The triple test assesses for appropriate levels of AFP, hCG and UE3. The triple test is the most widely used test to screen for Down Syndrome(trisomy21), Trisomy 18, and NEURAL TUBE DEFECTS. L/S ratio, Phosphatidylglycerol (PG) - a reliable indicator in predicting lung maturity, and Lamellar body counts each of these determine lung maturity.
What is Chorionic Villus Sampling (CVS)?
Involves obtaining a small sample of chorionic villi from the developing placenta. CVS is performed at times for first trimester diagnosis of genetic, metabolic and DNA studies.
What are the advantages/disadvantages of Chorionic Villus Sampling (CVS)?
The advantages are early diagnosis and short waiting times for results. It is performed between 10 and 12 weeks rather than at 16 weeks for amniocentesis. Risks include failure to obtain tissue, rupture of membranes, leakage of amniotic fluid, bleeding, intrauterine infection, maternal tissue contamination of the specimen and Rh alloimmunization. CVS testing also has a higher rate of spontaneous abortion than amniocentesis. Other complications include fetal limb defects and abnormalities of the fetal face and jaw. IT CANNOT DETECT NEURAL TUBE DEFECTS.