Category Archives: Maternal/Child Health (OB)

Maternal/Child Health (OB): Fetal and Maternal Assessment Techniques

I. ULTRASOUND (US)

  • used during first trimester to assess: # of fetuses, gestational age, uterine abnormalities, fetal cardiac movement and rhythm
  • used during second and third trimester to assess: size-date discrepancies, amniotic fluid volume, uterine anomalies, amniocentesis results, gestational age, fetal viability, placenta location and maturity
  • nursing implications: patient may need to maintain a full bladder prior to US if in the first or second trimester for the uterus to be observable (not needed for transvaginal US)
  • no known complications

II. CHORIONIC VILLI SAMPLING (CVS)

  • at 8 to 12 weeks gestation, a small piece of villi is removed guided under an US
  • determines genetic diagnosis in the first trimester
  • nursing implications: lithotomy position, patient may feel sharp pain when catheter inserted
  • complications: spontaneous abortion

III. AMNIOCENTESIS

  • at 14-16 weeks, amniotic fluid sample removed from uterus
  • used to assess: genetic diagnosis, fetal lung maturity, fetal well-being
    genetic disorders: trisomies, metabolic disorders, neural tube defects
    fetal lung maturity: L:S ratio (2:1) and presence of prostaglandins (PG) after 35 weeks is most accurate determination
    fetal well-being: bilirubin delta optical density, meconium may indicate fetal distress
  • nursing implications: supine position, use of Betadine to sterilize site, label samples, monitor FHR 1 hour after procedure; ***if amniocentesis is done in early pregnancy, bladder must be FULL; it done in late pregnancy, bladder must be EMPTY to prevent puncture
  • complications: spontaneous abortion, fetal injury, infection

IV. ELECTRONIC FETAL MONITORING (EFM)

  • variables of EFM:
    – contractions – duration, frequency, intensity
    – baseline fetal heart rate (FHR) – 110-160, measured over 10 minutes
  • variability: absent, minimal (< 5 bpm) , moderate (6-25 bpm), marked (>25 bpm)
  • VEAL CHOP
  • warning signs: absent or minimal FHR, bradycardia (< 110), tachycardia (>160), variable decelrations
  • emergent signs: severe variable decelrations (FHR <70, lasting > 30-60s), late decelerations

V. NONSTRESS TEST (NST)

  • assesses fetal response to movement which can determine fetal well-being in high-risk pregnancies
  • healthy “reactive” sign: fetus responds to movement by a fetal heart rate (FHR) acceleration of 15 beats, lasting 15 seconds after movement, occuring twice in a 20 minute period
  • nursing implications: apply fetal monitor, give handheld event marker to mother and instruct her to push button whenever she heels movement, it may also be recorded on FHR strip, *if there is not fetal movement, assume that the fetus is sleeping and stimulate it through sound or palpation or have mother move it and begin test again

VI. CONTRACTION STRESS TEST (CST) or OXYTOCIN CHALLENGE TEST (OCT)

  • assesses fetal response to low oxygen supply during induction of contractions (through nipple stimulation or Oxytocin)
  • nonreassuring “bad” sign: late decelerations = placental insufficiency!
  • contraindications: rupture of membranes (ROM), prematurity, hydramnios, multiple gestation, placenta previa, previous uterine classical scar
  • nursing implications: place external monitors of abdomen (ultrasound and tocodynanometer); record a 20 second baseline strip to determine reactivity (fetal well being) and presence/absence of contractions; for nipple stimulation, have patient use warm wet washcloths to roll nipple of one breast for 10 minutes and rol both if contractions don’t start within 10 minutes; oxytocin infused if no contractions after nipple stimulation
  • complications: hyperstimulation or tetany (contractions over 90 seconds OR contractions with less than 30 seconds in between) R/T overstimulating nipples
  • REMEMBER: a NEGATIVE test = GOOD (fetal well being)

VII. BIOPHYSICAL PROFILE (BPP)

  • ultrasound used to evaluated fetal health by assessing:
    1.) fetal breathing movements (FBM)
    2.) gross body movements (GBM)
    3.) fetal tone (FT)
    4.) reactive fetal heart rate (nonstress test)
    5.) qualitative amniotic fluid volume (AFV)
  • each variable = 2 points for a normal response; 0 points for an abnormal (either 2 OR 0)
  • nursing implications: prepare, inform, provide support; teach patient that a LOW score = fetal compromise and needs to be assessed further
  • a score of 8-10 = fetal well-being

VIII. FETAL PH BLOOD SAMPLING

  • determiens true acidosis when nonreassuring fetal heart rate is noted (tachycardia not related to maternal variables, decreased variability not related to nonasphyxial causes, severe variable decels unresponsive to treatment, late decels)
  • only performed in intrapartum period
  • sample taken from the presenting part (breech or scalp) when membranes have ruptured and cervix dilated to 2-3cm
Image Source: #1, #2, #3, #4, #5, #6, #7,
Content derived from HESI Comprehensive Review for the NCLEX-RN Examination.
Advertisements

Maternal/Child Health (OB): Fetal Heart Tones Acronym

VEAL CHOP

Variable decelerations…..Cord compression
Early decelerations………Head compression
Accelerations…………….OK, may need Oxygen
Late decelerations……….Placental Insufficiency

INTERVENTIONS

Variable decels → reposition mother to knee-chest position to get baby’s head off the cord OR use two fingers to lift the baby’s head off the cord until further interventions required
Early decels → 
sign that baby is descending into the pelvis, monitor as needed
Accelerations → 
reassuring (normal) sign; last for 15+ seconds and peaks 15+ beats/min
Late decels →
worrisome sign; reposition mother, administer IV fluids and anticipate discontinuing/decreasing Oxytocin or administering a tocolytic to decrease contractions

Image Source.

Maternal/Child Health (OB): The Basics

There is a lot of newly introduced vocabulary alongside a different conceptual view in the care of both the pregnant woman and the unborn child or newborn.

The content is organized into 3 main phases of peripartum care:
Antepartum (before the pregnancy)
Intrapartum (during pregnancy)
Postpartum (after pregnancy) 

Below is an abbreviated outline of the content typically covered in this course:

  • Fetal conception and development
    – Phases of the menstrual cycle
    – Process of fertilization
    – Fetal and Maternal changes
  • Risk factor and fetal assessment
    – Maternal and paternal psychosocial responses to pregnancy
    – Prenatal care: GTPAL, office visits, labs
    – Fundal height assessment
    – Anticipatory guidance for the first, second and third trimesters,
    – Fetal and maternal assessment methods: ultrasound, chorionic villi sampling (CVS), amniocentesis, electronic fetal monitoring, nonstress test (NST), contraction stress test (CST), biophysical profile (BPP), fetal pH blood sampling
  • Labor and Delivery
    – Leopold maneuvers – helps to determine fetal presentation, fetal position, fetal lie and fetal engagement
    – True vs False labor
    – The four stages of labor
    – The 3 phases of the first stage of labor: latent, active, transition
    – Analgesia and anesthesia – local, regional, peridural, intradural blocks
  • High risk pregnancies
    – Miscarriage/spontenous abortion – emergency!
    – Hydatiform Mole – developmental anomaly, “grape-like” clusters
    – Abruptio placentae – premature complete or partial detachment of the placenta from the uterine wall
    – Placenta previa – abnormal implantation of the placenta
    – Anemia
    – Ectopic pregnancy – abnormal implantation of fertilized egg outside of the uterus
    – Infection – TORCH (Toxoplasmosis, Other [HIV, Varicella, Parvo, Syphillis, Coxsackievirua], Rubella, Cytomegalovirus, Herpes simplex)
    – Preterm labor
    – Dystocia – difficult birthing
    – Preeclampsia, eclampsia
    – Hyperemesis gravidarum
    – Gestational diabetes
  • Postpartum
    – Normal postpartum changes of the uterus, cervix, breasts, CV, hematologic, integumentary, musculoskeletal system
    – Normal postpartum vital signs: high temp, low pulse, normal BP, rare changes in RR
    – Measuring fundal height – height decreases 1 cm per day
    – Assessing lochia (postpartum discharge) – rubra → serosa → alba
    – Assessing perineal area and episiotomies (incision of the posterior vaginal wall)
    – Examine breasts for tenderness, engorgement, breastfeeding techniques
    – Assist with mother-baby bonding
    – Assess urinary, bowel movements
    – Determine needs for RhoGAM, rubella vaccine, medications
  • Newborn care
    – APGAR assessment
    – The 5 symptoms of respiratory distress: retractions, tachypnea ( > 60), dusky color, expiratory grunt, flaring nares
    – Newborn prophylactic eye care with erythromycin ointment
    – Physical assessment: vitals, measurements, head-to-toe, reflexes
    – Primary concerns of: aspiration, infection, hypothermia, hypoglycemia, hemorrhagic disorders, hyperbilirubinemia
    – Assess elimination and feeding patterns
    – Screen for genetic disorders such as phenylketonuria (PKU) after breast milk/formula ingestion
    – Provide teaching about newborn care concerning bathing, diapering, crying and comfort

Under each area of content, familiarize yourself with the associated vocabulary, consider the type of care the mother and/or child should receive at this stage in pregnancy and what the nurse should be aware for in terms of possible complications.

Image source.
Content derived from HESI Comprehensive Review for NCLEX-RN Examination.

“Reviews & Rationales”

Photobucket Photobucket

These supplemental reads were recommended by a nurse graduate YouTuber. She expressed how beneficial these books where in reviewing & emphasizing the material of the corresponding topics. They come in a variety of topics that cover from Pre-Nursing to Senior II. According to reviews on Amazon.com, many buyers recommend these reads as it has helped them during their courses.

I just ordered the Medical-Surgical & Mental Health R&R books to try them out. It couldn’t hurt to consider them if you’d want to spend a little extra. I personally have found them to be great as additional abbreviated material alongside the textbook material from the theory class. Below are the estimated, minimum, used prices.

Pre-Nursing:
Prentice Hall Nursing Reviews & Rationales: Anatomy & Physiology: Amazon ($14)
Prentice Hall Nursing Reviews & Rationales: Pharmacology: Amazon ($20)
Prentice Hall Nursing Reviews & Rationales: Pathophysiology: Amazon ($20)

Junior I:
Prentice Hall Nursing Reviews & Rationales: Nursing Fundamentals: Amazon ($15)
Prentice Hall Nursing Reviews & Rationales: Health Assessment: Amazon ($20)
Prentice Hall Nursing Reviews & Rationales: Fluid, Electrolyte, Acid-Base Balance: Amazon ($20)

Junior II:
Prentice Hall Nursing Reviews & Rationales: Medical-Surgical Nursing: Amazon ($20)
Prentice Hall Nursing Reviews & Rationales: Mental Health Nursing: Amazon ($18)

Senior I:
Prentice Hall Nursing Reviews & Rationales: Child Health Nursing: Amazon ($17)
Prentice Hall Nursing Reviews & Rationales: Maternal-Newborn Nursing: Amazon ($20)

Senior II:
Prentice Hall Nursing Reviews & Rationales: Nursing Leadership & Management: Amazon ($12)

Images from amazon.com