T4 - Assessment of High Risk Factors (Josh) Flashcards Preview

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Flashcards in T4 - Assessment of High Risk Factors (Josh) Deck (69):
1

What is a high risk pregnancy?

one in which the life or health of the mother or fetus is jeopardized by a disorder coincidental with or unique to the pregnancy

2

What risk factors are associated w/ Polyhydramnios?

Diabetes Milletus

Congenital Fetal Anomolies
***GI obstruction
***twin-twin transfusion

3

What risk factors are associated w/ Intrauterine Growth Restriction?

HTN
Diabetes
Chronic Renal Disease
Collagen Vascular Disease
Thrombophilia
Cyanotic Heart Disease
Poor Weight Gain
Smoking, ETOH, Drug Use
High Altitude

****pretty much anything that can affect perfusion of O2 and nutrients to fetus

4

What risk factors are associated w/ Oligohydramnios?

Renal Agenesis (Potter Syndrome)

Premature ROM

Prolonged Preg

Uteroplacental Insufficiency

Severe IUGR

Maternal HTN

5

What risk factors are associated w/ Chromosomal Abnormalities?

Advanced Maternal Age

Parental Chromosomal Rearrangements

Prev. Preg. w/ Autosomal Trisomy

Abnormal U/S Findings

6

Fetus should be --- if not asleep.

active (kicking)

7

How often will a high risk mother need to do a kick count?

What about a low risk?

High Risk = 2-3 times/day for 30 mins to 1 hr

Low Risk = 1-2 times/day for 30 mins to 1 hr

8

Within each 30min-1hr kick count time frame, how many fetal movements should be felt?

5-6

9

How long of an absence in fetal movement is a cause for concern?

12 hrs

***Call doc

10

How long to count fetal movement during each time period?

30 mins - 1 hr

***book says 1 hr, but if she gets 2-3 kicks in 30 mins, she would not need to continue counting

11

How many levels of U/S are there?

Three:
- Level One
- Level Two
- Level Three

12

What is Level One U/S checking for?

Fetal viability

Fetal presentation

Gest. Age

Placental Location

Fetal Amniotic Structures

AF vol.

13

What is Level Two U/S checking for?

Fetal Presentation during labor

FHT (when unable to obtain other ways)

14

What is Level Three U/S checking for?

anatomically or physiologically abnormal fetus

15

When would a Level Two U/S be called for?

a specific reason

16

When would a Level Three U/S be called for?

Detailed or Targeted inspection of fetus

17

When is the U/S more accurate?

the earlier it is taken

18

What are major uses for U/S during First Trimester?

Confirm Preg and Viability

Determine Gest. Age

Rule out Ectopic Preg

Detect Multips

Determine cause of Vag bleeding

Visualization during Chorionic Villis Sampling

Detect maternal abnormalities like bicornuate uterus, ovarian cysts, fibroids

19

What are major uses for U/S during Second Trimester?

Confirm EDC and Viability

Detect Poly- or Oligohydramnios

Detect Congenital Abnormalities

Detect IUGR

Assess Placental Location

Visualization during Amniocentesis

20

What are major uses for U/S during Third Trimester?

Confirm Gest. Age and Viability

Detect Macrosomia

Detect congenital abnormalities

Detect IUGR

Determine Fetal Position

Detect Placental Previa or Abruption

Visualization during Amniocentesis

Biophysical Profile

AF Vol. Assessment

Doppler Flow studies

Detect Placental Maturity

21

In order to perform an Abdominal U/S, what must we tell client?

bladder must be full (especially during first and third trimesters)

Sitting or reclining w/ wedge under hip

22

Which position would client be in to perform a Transvaginal U/S?

Lithotomy

23

When would the Transvaginal U/S be used?

frequently in early weeks of pregnancy and also to determine cervical length

24

How is gestational age and EDC determined via U/S during first trimester?

crown-rump length

25

How is gestational age and EDC determined via U/S during second trimester?

biparietal diameter of skull

femoral length

26

What Amniotic Fluid Index are we looking for?

between 10 - 25 cm

*** less than 5 cm is oligohydramnios

***more than 25 cm is polyhydramnios

27

What is oligohydramnios?

28

What is polyhydramnios?

> 25 cm of AF

***sign that baby's kidney's are overfunctioning

29

--- is associated with congenital anomalies (renal) and growth restrictions

--- is associated with neural tube defects, obstruction of GI tract, multips, and fetal hydrops.

Oligohydramnios ( 25 cm of AF)

30

How is Biophysical Profile measured and what is it measuring?

Abdominal U/S

Measures:
- Fetal Breathing Mvmts
- Gross Body Mvmt
- Fetal Tone
- Qualitative AF Vol.
- Reactive Non Stress Test (NST)

31

Biophysical Profile:

What fetal breathing movements are we looking for?

At least one episode of fetal breathing mvmts of at least 30 secs in a 20 min interval

***equals 2 points

32

Biophysical Profile:

What Gross Body Movements are we looking for?

At least three trunk/limb mvmts in 30 mins

***equals 2 points

33

Biophysical Profile:

What Fetal Tone are we looking for?

At least one episode o active extension w/ return to flexion of fetal limb or trunk;

Opening and closing of hand considered normal tone

***equals 2 points

34

Biophysical Profile:

What Amniotic Fluid Index are we looking for?

AFI > 5 cm or at least one pocket > 2 cm

***equals 2 points

35

Biophysical Profile:

What NST are we looking for?

Reactive

***equals 2 points

36

Biophysical Profile:

What scores do each of the five measures receive?

Normal = 2 points

Abnormal = 0 points

***Looking for 10:10 ratio

37

What Biophysical Profile scores are considered a low risk for chronic asphyxia?

8 - 10

38

What Biophysical Profile scores would make you suspect chronic asphyxia?

4 - 6

39

What Biophysical Profile scores would make you STRONGLY suspect chronic asphyxia?

0 - 2

40

When would an Amniocentesis be done?

after 14 wks gestation when uterus rises above symphysis pubis and fluid amounts are adequate to sample

*** take to lab in brown bag (kept out of light)

41

--- is used as a screening tool for Neural Tube Defects.

Amniocentesis (Alpha-Fetoprotein)

42

How can Amniocentesis determine lung maturity?

shows L/S ratio to determine lung maturity

43

Why would we do an Amniocentesis in early pregnancy?

What about late pregnancy?

Early = detect chromosomal abnormalities

Late = determine fetal lung maturity (L/S ratio)

44

What L/S ratio indicates lung maturity?

2:1

45

What are some complications from Amniocentesis?

Infection

Fetal injury

AF leakage

Pregnancy loss (spontaneous abortion)

Maternal Hemorrhage

Rh Isoimmunization

AF Embolism

***1 out of every 450 babies can die

46

Nursing Responsibilities for Amniocentesis?

Have mom empty bladder

Monitor Fetus before procedure and at least 1 hour afterwards

Observe for Vaginal bleeding, leakage of AF, severe cramping, or fever

Mild physical discomfort (mom will be scared)

47

When would Chorionic Villus Sampling be performed?

10-13 wks of preg

***diagnoses chromosomal and genetic defects

48

What are the two ways that the Chorionic Villus sample can be taken?

Vaginally

Abdominally

49

Why is a Chorionic Villus Sample a good representation of baby's genetic makeup?

cells from villi have same genetic makeup as the cells from embryo

50

Why has Chorionic Villus Sampling declined?

Triple and Quad Screenings have replaced it

51

What are the advantages of Chorionic Villus Sampling?

Can be done early (10-13 wks)

Sample gives ACTUAL genetic makeup of baby

52

What are the disadvantages of Chorionic Villus Sampling?

Bleeding

ROM

Intrauterine Infection

Spontaneous Abortion

Limb Anomalies (if done before 10 wks)

53

Which procedure gives direct access to fetal blood circulation and requires a 1-4mL blood draw from umbilical cord?

Percutaneous Umbilical Blood Sampling (PUBS)

***aka Cordocentesis

54

What important test requires a PUBS sample?

Kleihauer-Betke Test

***determines maternal/fetal cross contamination of blood

55

What is treatment for a positive Kleihauer-Betke Test?

transfuse the anemic or thrombocytopenic fetus in utero

56

What are complications of PUBS?

Bleeding from puncture site

Cord laceration

Thromobembolism

Preterm Labor

Premature ROM

Infection

57

What are nursing responsibilites regarding PUBS?

Continuous Fetal Monitoring for 1-2 hrs after procedure

Repeat U/S if bleeding or hematoma formation

Have mom do kick counts at home

58

Elevated levels of --- are associated with open neural tube and abdominal wall defects.

Maternal Serum Alpha Fetoprotein (MSAFP)

***AFP is produced in the FETAL gestational tract & liver and increasing levels are detectable in the maternal serum from 14-34 weeks.

59

When would a Maternal Serum Alpha Fetoprotein screen be performed?

b/t 15-20 wks

60

What tests are done in Triple Screening?

Quad Screening?

Triple:
- MSAFP
- Unconjugated Esteriol
- hCG

Quad:
- MSAFP
- Unconjugated Esteriol
- hCG
- Inhibin A

61

Triple Screen:

What will it look like if Trisomy 18?

What will it look like if Trisomy 21?

Trisomy 18 = all will be low

Trisomy 21 =
- MSAFP will be low
- Esteriol will be low
- hCG will be high

62

With Quad Screen, what would happen if Inhibin A is high?

extra screening would be down for women less than 35 for Down Sydrome

63

Trisomy -- babies are usually stillborn (or have many major problems if they live).

18

***will never meet developmental milestones

64

What is a Non-Stress Test (NST)?

fetal monitoring for 20-30 mins with vibroacoustic stimulation

65

What is a Reacgtive NST?

normal FHR baseline w/ accels

***nonreactive will require additional testing (BPP)

66

What type of Contraction Stress Test do you want?

negative (for bad outcomes)

***CST provides an earlier warning of fetal compromise than NST

67

What does a Contraction Stress Test look for?

see if baby gets stress by contractions

***aka Oxytocin Challenge Test

68

How is a Contraction Stress Test performed?

FHR baseline for 10-20 mins

Contractions Started
- 3 in 10 mins

Report findings
- Negative
- Positive
- Equivocal
- Suspicous
- Unsatisfactory

69

How are contractions started w/ Contraction Stress Test?

Nipple Stimulation

IV Pitocin