NURB 331: Assessment For Risk factors
NURB 331: Assessment For Risk factors NURB 331
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This 6 page Class Notes was uploaded by Kelsey Forbeck on Friday September 30, 2016. The Class Notes belongs to NURB 331 at University of Indianapolis taught by Professor Rairdon in Fall 2016. Since its upload, it has received 2 views. For similar materials see Lifespan 1 in NURSING at University of Indianapolis.
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Date Created: 09/30/16
NURB 331: Lifespan 1 Exam 2 Assessment for Risk Factors Assessment of Fetal Movements o Daily fetal movement count (DFMC) is a valuable method of evaluating conditions of fetus A.K.A “kick count” Vigorous movement is good It is bad if there is no fetal movement in 12 hours The fetus may have periods of rest which are about an hour or so with no movement or minimal movement Biophysical Assessment o Ultrasound Use of intermittent high-frequency sound waves to create image of fetus Looks at the well-being of the baby Clinical Applications Early identification of pregnancy FHR and respirations See if there are multiples Measure the baby’s heads and legs to see how they are growing Estimate birth weight Detection of anomalies Exam baby heart Amniotic fluid index Location of the placenta Placenta grading. Measure degree of calcification (from drugs and alcohol) Detects if there was fetal death Determine the fetal position and presentation Amniocentesis Assess for Downs in first trimester o 2nd Trimester Ultrasound Measurements Fetal parietal diameter Femur length Abdominal and head circumference to make sure it can get out of mom and to measure gestational age o Amniotic Fluid Assessment The amount of the fluid is an indicator of the fetuses well being Technique is known as amniotic fluid volume and index Amniotic Fluid Volume Used to find pockets of amniotic fluid Amniotic Fluid Index Pockets of fluid measured in four quadrants Largest pocket is identified and measured AFI that is greater than 20 cm indicates hydraminos AFI less than 5 cm indicates oligohydramnios o Biophysical Profile (BPP) Assessment of 5 fetal biophysical variables Breathing movements Body movements Tone Amniotic fluid volume FHR reactivity Helps identify compromised fetus and confirm healthy fetus Best score you can have is ten Scoring 10- They are normal and safe 8- As long as they can move and have fluid 6- Depends on what is going on 4- and less they need to come out of there Assessment Using Electronic Fetal Monitoring o Nonstress Test Noninvasive that measures their heart rate according to their movement Position mom in semi-fowlers with wedge under hips NST STARTS BETWEEN 30-32 WEEKS AND CONTINUED TO BIRTH You start by finding the best fetal heart sound by using Leopolds Recordings for 20-40 Patient record fetal movement by pressing a button Reactive: Show 2 or more accelerations of 15 bpm or more within 20 min These are the good ones Non-Reactive: Accelerations are less than 2 Less than 15 bpm No accelerations o Contraction Stress Test (CST) Purpose: To identify by fetus is stable during rest then compromised during stress Figuring out how baby will handle labor This provides earlier warning of fetal compromise then NST More time consuming 2 methods of performing 1. Nipple stimulation contraction test (dads stimulate nipples causing release of oxytocin the love drug and causes contractions) 2. Oxytocin-stimulated contractions Late decelerations mean baby cannot handle labor Biochemical Assessment o Amniocentesis Aspiration of amniotic fluid from pregnant uterus for examination Done 14-16 weeks of pregnancy You only need 1 ml of fluid Indications: Genetic concerns Fetal maturity Fetal hemolytic disease Meconium (due to baby stress from hypoxia) o Antepartal o Intrapartal Complications: Maternal: o Hemorrhage o Fetomaternal Hemorrhage (break between mom and baby) o Infection o Labor o Abruptio placentae (placenta breaks loose before it is supposed to) o Damage to intestines or bladder o Amniotic fluid embolism Fetal: o Death o Hemorrhage o Infection (amnionitis) o Injury from needle o Miscarriage or preterm labor o Leakage of amniotic fluid Procedure: o Empty bladder o Supine position/ folded towel under right hip o Attach FHR and contraction monitor o Explain local anesthesia o Warm patient about the feeling of pressure o Tell her to NOT hold her breath (this will lower diaphragm against uterus and shift intrauterine contents) o After inserting needle, attach syringe o Remove fluid o Women needs to rest quietly for 30 mins o Assess FHR and uterine contractions to make sure there aren’t any complications o Women may be given Rhogam if they are rh negative to prevent isoimmmunization Color o Color of water o Slightly yellow in late pregnancy o Strong yellow suggests blood o Green color suggests meconium (fetal distress) o L/S ratio Tells how developed babies lungs are based on surfactant found in amniocentesis Surfactant keeps alveoli open Alveoli form 22-24 weeks Infants with diabetes may have a false mature reading o Bilirubin Product of RBC breakdown Presence of bilirubin in amniotic fluid may indicate blood incompatibility Specimen must be blood free or there might be false positives o Chromosome Analysis Few fetal skin cells are always present in amniotic fluid These cells may be cultured and stain for karyotyping Detects chromosome disorders o Inborn errors Inborn errors in metabolism can be detected in amniocentesis Done Prior to Amniocentesis o Alpha-fetoprotein (AFP) Produced by the fetal liver and is detectable in increasing amounts in the pregnant women from 14-34 weeks Used to screen for neural tube defects Usually done 15-22 weeks Recommended for all pregnant women Abnormal findings mean they need to come back for a follow up procedures and counseling and possibly an amniocentesis If it comes back abnormal then it is not a positive indication of anything it just means, there is a possibility things are incorrect Decreased levels occur with chromosomal defects like down syndrome o Quadruple Marker Test (called this because there are four tests) Consists of MSAFF, unconjugated esteriol, hcg, and inhibin A o Chorionic Villi Sampling (CVS) Biopsy and analysis of chorionic villi for chromosome analysis nd 2 trimester amniocentesis is safer Watch with ultrasound to follow where needle is going then go to get a sample that way Early diagnosis Removal of a small piece of placenta (reflects genetic makeup of fetus) Complications: Vaginal spotting Bleeding Miscarriage Rupture of membranes Chorioamnioitis (infection in chorion) o Percutaneous Umbilical Blood Sampling (PUBS) Performed under local anesthesia Go in and get blood sampling from umbilical cord Most used method of fetal sampling Indications: Diagnose blood disorder Karyotyping of malformed fetus Detect fetal infection Determine acid-base status of fetus with IUGR Assessment and treatment of isoimmunization and thrombocytopenia (low amount of platelets) Complications: Leakage of blood form puncture site Cord laceration Thromboembolism Preterm labor Premature rupture of membranes Infection