By B. Holloway, et al.
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Extra resources for OB Peds Women's Health Notes
Terbutaline, albuterol) ■ BRADYCARDIA ■ FHR less than 110 BPM for 10 minutes ■ Possible cause: • Vagal stimulation • Hypoxia • Anesthetic agents ■ VARIABILITY ■ Fluctuations in FHR over time ■ Important indicator of fetal well-being ■ Sensitive to hypoxia and changes in Ph ■ Short-term variability (STV) • Beat-to-beat changes in FHR • Documented as present or absent • Most accurate with internal FHR monitoring ■ Long-term variability (LTV) • Pattern of fluctuations in FHR baseline (Expected pattern highlighted in blue) Long-Term Variability Absent (0–2 BPM) Minimal (3–5 BPM) Average (6–10 BPM) Moderate (11–25 BPM) Marked (Ͼ25 BPM) Possible Cause Maternal medication Fetal sleep Fetal hypoxia Adequate fetal oxygenation Early sign of mild fetal hypoxia Fetal stimulation 58 Page 58 03Holloway (F)-03 12/28/05 12:25 PM 59 Changes in Fetal Heart Rate ■ The nurse interprets changes to baseline FHR as reassuring or nonreassuring ■ The nurse must act on nonreassuring FHR patterns ■ ACCELERATIONS ■ Sudden increase of fetal heart rate over baseline ■ Indication of fetal well-being ■ Reassuring pattern ■ Possible cause: Fetal movement/stimulation Acceleration.
2003). Nursing Health Assessment: A Critical Thinking, Case Study Approach. A. 5 mg/dL Ͼ33% 150,000–400,000 mm3 5,000–12,000 mm3 Negative Negative 1:8 Immune AA, unaffected Negative Negative Normal cytology 02Holloway (F)-02 12/28/05 12:24 PM Page 27 27 Diagnostic Testing in Early Pregnancy Diagnostic Test Ultrasound Performed throughout pregnancy Clinical Applications: ■ Confirm and date pregnancy ■ Verify pregnancy location ■ Detect fetal cardiac activity ■ Measure fetal growth ■ Detect fetal anomalies ■ Measure amniotic fluid index ■ Determine fetal position ■ Determine placental position ■ Measure cervical length ■ Adjunct to invasive procedures Chorionic villi sampling (CVS) Performed at 10–12 weeks Clinical Application: ■ Chromosomal analysis Amniocentesis Performed throughout pregnancy Clinical Applications: ■ Chromosomal analysis is desired ■ Measure AFP ■ Measure bilirubin level ■ Determine lung maturity ■ Lecithin/Sphingomyelin Ratio (L/S Ratio) ■ Phosphatidylglycerol (PG) ■ L/S Ratio of 2:1 and positive PG indicative of fetal lung maturity Maternal Serum Triple Screen (tests maternal serum for AFP, hCG, and estriol) Nursing Considerations Position to avoid supine hypotension; folded towel under right hip if supine Review blood type, Rh and antibody status Administer Rh (D) immune globulin if indicated Monitor patient for postprocedure cramping or bleeding Monitor fetal heartbeat NOTE: This is a screening method only.
02Holloway (F)-02 12/28/05 12:24 PM Page 24 ANTEPARTUM Nursing Care with First Prenatal Visit ■ Determine EDD based on LNMP ■ Document current gestational age (gestational wheel is a tool for quick reference to current gestational age) ■ Document baseline vital signs ■ Document height, weight, and body mass index (BMI) ■ Obtain urine specimen and test for presence of: Substance Expected Finding Glucose Protein Negative/Trace Negative/Trace ■ Auscultate fetal heart tones ■ Measure fundal height in centimeters from symphysis pubis to the top of the fundus ■ Uterine size increases in pregnancy in a predictable pattern and is measured to gauge fetal growth ■ Fundal height that is lagging or greater than expected should be further investigated Weeks’ Gestation 12 16 20 21–36 Fundal Height Just above symphysis pubis Halfway between symphysis pubis and the umbilicus At the umbilicus Fundal height generally matches weeks gestation in centimeters EXAMPLE: Fundal height at 28 weeks should be approximately 28 cm.