OB Mod 6 FHR Monitoring/Assessment
When do fetal movements become minute? - 36 weeks, which is normal.
Why is an ultrasound used in the 1st
... [Show More] trimester? (3) - -To determine date of confinement. (dating)
- Dx of inconsistencies in development
- After bleeding
What is a NST? - Non Stress Test
-Apply fetal heart rate monitor and assess for accelerations
What is an acceleration? - Increases in HR of at least 15 bpm for at least 15 seconds
What is a reactive NST? - Acceleration at least 2 times in 20 minutes. This is reassuring
Whats does a non reactive NST mean? - When accelerations don't hit the reactive status. It's indeterminate -- so not good or bad, but rather a reason to investigate further
What is a CST? - Contraction Stress Test
-When FHR monitoring is done and assessment is made for decels during contraction.
What are the requirements for a successful contraction stress test? How is this achieved? - 3 contractions within 20 minutes.
-contractions can be natural, or stimulated with nipple stim
What are the possible results/significants of a CST? - Negative is normal (no decels)
Positive is worrisome (late decels)
What is a biophysical profile? - an assessment of the fetus' health using 5 components that are scored either 0 or 2.
What scores are significant? - -8+ is ok.
- 6-8 is kinda iffy... keep an eye on the little bugger.
- <6 means that baby needs to come out
10 is a perfect score
What are the 5 components of a biophysical profile exam? - NST
Breathing
Movement
Tone
Amniotic Fluid Volume
NST scoring - 2 pt for Reactive
0 pt for Non-Reactive
Breathing scoring - 2 pts: 30 sec of sustained fetal breathing activity during a 30 minute observation
0 pts: <30 sec of breathing activity is 30 min
Movement scoring - 2 pts: 2+ discrete gross limb movement in 30 min
0 Pts: <2 gross limb mvmts in 30 min
Tone Scoring - 2 pts : One incidence of demonstrating tone by moving a limb, and it returning to its flexed state quickly in 30 min
0 pts: no return of limb to flexed state, or absence of movement
Amniotic Fluid Volume scoring - 2 pts: At lease 1 pocket of fluid that measures at least 2 cm in 2 perpendicular planes
0 pts: Largest pocket of fluid is < 2 cm
When assess amniotic fluid volume, what fetal system are you assessing? - Circulatory system and UOP. Amniotic fluid is baby pee!
When would you not perform a CST? - On a pregnant woman when labor is contra indicated, like with placenta previa or prematurity.
(NEED MORE HERE)
Why is chain of command so crucial in L&D? - because it's not an exact science.
How long after birth can a parent submit a claim against a hospital? And for the child? - parent: 18 yrs
child/self: 21 yrs
What is auscultation in L&D? - Listening only with no electronic or paper record produced
What is intermittent monitoring in L&D? - Anytime there is monitoring that produces an electronic or paper record.
What is continuous monitoring - Continous monitoring.
How does FHR monitoring play into EBP? - It's not EBP actually. No conclusive evidence, yet it is the standard of care.
ACOG indication for continuous monitoring: Maternal - -Pre-existing or Gestational diabetes
-Hypertension
-Hemorrhage
-Medical Disease: cardiac, renal, anemia, hyperthyroidism, vascular disease [Show Less]