AMNIOCENTESIS: (Bukola) page 33-34
Obtain FHR PRIOR to procedure.
● Amniocentesis is a prenatal test. Is the sampling of amniotic fluid using a hollow
... [Show More] needle inserted into the uterus, to screen for developmental abnormalities in a fetus.
● Prescribed for a pt. who is at increased risk of having a baby with a birth defect or genetic condition.
● An ultrasound transducer is used to show a baby's position in the uterus on a monitor prior to procedure.
● It may be performed after 14 weeks of gestation. Patient Education
● Instruct client to empty her bladder prior to procedure
● During procedure slight pressure will be felt, keep breathing.
○ The diaphragm is lowered when pt holds the breathe.
Nursing Interventions
● With Rh negative will be given Rho(D) immune globulin, to protect against Rh isoimmunization.
● Monitor FHR after the procedure for 30mins
● Notify provider for leakage, bleeding on site, pressure, contraction
ULTRASOUND EDUCATION: (Joseph) page 29
● instruct patient to have full bladder. “Drink 1 quart of water prior to the procedure”er
● put the Wedge UNDER the right buttuck to prevent supine hypotention.
NONSTRESS TEST: NURSING INTERVENTIONS: (Joseph) page 31
● “What are you looking at while you monitor my baby?”
○ “This test monitors the response of your baby’s FHR to fetal movement.”
● Which trimester can this noninvasive test be performed? 3rd, 32 weeks
● Let's look at 2 strips to determine reactive vs. non reactive.
○ Let’s go over the reactive definition AGAIN!
○ Nonreactive, baby is sleeping, Opioid and nicotine(smoking) can cause baby to relax which can cause a false nonreactive NST
● Why do we ALSO need to connect the client to the Toco transducer during this test?
○ If an acceleration occurs at the same time as a contraction it does not count
● Best Maternal Position during this exam?
○ High fowler’s or left side
○ Supine with wedge under hip
● What is the ‘normal’ range for the FHR? (page 86)
○ 110 -160 bpm
○ After birth: 100 - 160 bpmdip
NONSTRESS TEST: RESULTS: (Destinee)-third trimester
Done twice a week at 28-32 weeks gestation, IF HIGH RISK PREGNANCY (PAGE 31, BOTTOM LEFT under Client Presentation.)
● Reactive (good): FHR normal baseline with moderate variability. Accelerates at least 15 beats for 15 sec and it occurs twice during 20 mins
● Remember, it’s not counted as an acceleration IF it occurs DURING a contraction!!!
● Non-reactive: no demonstration of 2 qualifying accelerations in 20 mins
● Some medications, like Opioids & Nicotine can cause non-reactive results.
○ Stimulate baby for 3 sec, give food or drink OJ
○ Reffered to get BPP or CST
● False non-reactive NST when baby is asleep (sleep periods 20-30 mins), if Pt is on opioids (dilaudid) or is a smoker (page 31)
● Moderate variability with a minimum of 2 accelerations
● What is the definition of a acceleration?
○ 15 bpm above the fetal baseline and lasts for 15 seconds during a 20 minute period. (I say, “it’s a 15 by 15”)
○ Less than 32 weeks = 10 bpm, lasts 10 seconds
Identification of Prolonged Decelerations: (Crystal)
● Decrease in FHR is 15 beats/min or more BELOW THE BASELINE and lasts for at least 2 min but less than 10 if sustained for 10 min its a baseline change.
Nursing interventions for Prolonged Decelerations: (Crystal)
● Notify provider
● Stay with patient’
● Reposition pt. (Turn on side)--always least invasive action first!!!
● Maternal Oxygen--facemask at 8-10L/min
● IV fluid bolus
Assessing Fetal Lung maturity (prior to birth): (Destinee)--PAGE 34
● Preterm baby lungs are not mature no surfactant.
● Amnio for L/S RATIO AND PG presence. --page 34
○ L/S Ratio- 2:1 ratio indicates fetal lung maturity (2.5:1 or 3:1 for a client with diabetes) Its ration should be higher than standard.
○ Absence of PG (phosphatidylglycerol) = respiratory distress : WANT PG for lung maturity
● Mom at risk will receive 2 doses of betamethasone (corticosteroid)
○ Enhance fetal lung maturity
○ Doses 24 hrs apart
○ Prolong labor if you can to give both doses
Expected Lab findings: (Karla)
● BUN [Show Less]