Test 4 High Risk Factors Flashcards Preview

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Flashcards in Test 4 High Risk Factors Deck (72):
1

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

High risk pregnancy

2

What are the purposes of antenatal testing?

- determine fetal well-being
- estimate growth and weeks gestation
- predict outcome of pregnancy

3

Ways that we can observe fetal well-being on the monitor:

Variability
FHR
Accels

4

Polyhydraminos

too much amniotic fluid...b/c baby is peeing a lot

5

Oligohydraminos

not enough amniotic fluid...b/c baby isn't peeing enough

6

Smoking causes vasoconstriction. What can this cause for the fetus?

May not get enough nourishment from the placenta, so there could be a growth constriction

7

What 5 things does the nurse need to know about each test?

1) Indication for the test
2) Timing of the tests
3) How the test is done
4) Interpretation of test results
5) Nursing care with each test

8

Fetuses should be active unless _____.

asleep

9

How often should a high-risk mother check for fetal movements?

2-3 x day for 30 min to 1 hr

10

How often should a low risk mother check for fetal movements?

1-2 x day for 30 min to 1 hr

11

Should feel ____ fetal movements within each kick count.

5-6

12

We will be concerned if there is no fetal movement in ____ hrs. What test would be ordered?

12
Ultrasound

13

When should the mother call the doctor regarding fetal movement?

No movement in 12 hrs.
Consistent decrease in movement.

14

What are the 3 levels of ultrasound?

1) Standard (Basic or Level 1)
2) Limited (Specific Reason or Level 2)
3) Specialized (Detailed/Targeted or Level 3)

15

What does a Level 1 US check?

- fetal viability
- presentation
- gestational age
- placental location
- fetal anatomic structures for malformation & amniotic fluid volume

16

What does a Level 2 US check?

- fetal presentation during labor
- FHT when not able to obtain in other ways (ie obese mom)

17

What does a Level 3 US check?

- anatomically or physiologically abnormal fetus (ie heart probs in utero)

18

Which US is more accurate - early or late?

Early

19

Bladder full or empty for:
1st Trimester
2nd Trimester
3rd Trimester

1st: Full bladder
2nd: Full bladder
3rd: Empty bladder

20

How can the gestational age and EDC (due date) be determined by US?

1st trimester: crown-rump length
2nd trimester: biparietal diameter of fetal skull

21

What are the classifications of amniotic fluid index (AFI)?

Oligohydraminous: 25cm

22

What is a biophysical profile (BPP) and what does it measure?

An abdominal US
Measures:
- fetal breathing movements
- gross body movement
- fetal tone
- qualitative amniotic fluid volume
- reactive non stress test

23

What do we look for with fetal tone?

Is the fetus really moving extremities or just body.

24

What are the scores of the BPP?

Normal = 2
Abnormal = 0
Looking for a 10:10 ratio

25

What does an amniocentesis check for?

genetic abnormalities

26

How do we send the amniocentesis specimen to the lab, why?

In a brown paper sack, b/c it can be negatively effected by light

27

When can an amniocentesis be performed?

after 14 weeks b/c uterus rises above the symphysis pubis and fluid amounts are adequate for sample

28

What does the amniotic fluid show?

- Lecithin/syhingomyelin (L/S ratio) or shake test --> checks for fetal lung maturity
- Alpha-fetoprotein --> used as screening tool for neural tube defects
- Desquamated fetal cells --> allows for genetic testing

29

Why would an amniocentesis be done in early pregnancy?

detect chromosomal abnormalities

30

Why would an amniocentesis be done in late pregnancy?

most often to determine fetal lung maturity with L/S ratio to detect the amount of surfactant production in fetal lungs

31

What does the L/S ratio of 2:1 indicate?

Lung maturity

32

What is surfactant?

substance that reduces the surface tension of pulmonary fluids to allow gas exchange in the alveoli.

33

What are potential complications of amniocentesis?

- infection
- injury to fetus
- leakage of AF
- pregnancy loss
- maternal hemorrhage
- Rh isoimmunization
- amniotic fluid embolism
- fetal death

34

What are the nursing responsibilities for amniocentesis?

- mother empty bladder
- monitor fetus before procedure and at least 1 hr post-procedure using EFM
- observe for vaginal bleeding, leakage of amniotic fluid, severe cramping, or fever
- mild physical discomfort; most women fear procedure

35

What does chorionic villus sampling check?

Diagnoses chromosomal and genetic defects

36

When is a CVS checked?

10-13 weeks

37

Where is the sample of blood and tissue taken from with a CVS?

edge of placenta

38

Can the placenta be accessed vaginally or abdominally for CVS?

Both

39

Cells from the villi have the same genetic make-up as the cells from the ____.

embryo

40

Is CVS a safe or risky procedure for baby?

risky!

41

What tests have helped decrease the need for CVS?

triple & quad screens

42

What are the advantages of CVS?

- can be done early in pregnancy, 10-13 wks
- sample gives genetic makeup data

43

What are the disadvantages of CVS?

- bleeding
- rupture of amniotic membranes
- intrauterine infection
- spontaneous abortion
- performed prior to 10 wks gestation, has been associated with limb anomalies

44

What is a percutaneous umbilical blood sampling (PUBS)?

Test for genetic information, fetal infection, assessment & treatment of isoimmunized and thrombocytopenic fetus

45

How is PUBS performed?

US guided withdrawal of blood (1-4ml) from a fetal umbilical blood vessel near its insertion into the placenta

46

What does the PUBS Kleihauer-Betke test check for?

checks for maternal-fetal cross contamination

47

What are potential complications of PUBS?

- bleeding from puncture site
- cord laceration
- thromboembolism
- preterm labor
- premature ROM
- infection

48

What follow-up is needed after PUBS?

- continuous fetal monitoring for 1-2 hours after procedure and repeat US for bleeding or hematoma formation
- teach mom fetal kick counts for at home monitoring

49

What does maternal serum alpha fetoprotein (MSAFP) check for?

neural tube and abdominal wall defects

50

When is MSAFP performed?

between 15-20 weeks

51

What test is ordered if MSAFP shows elevated levels indicative of neural tube or abdominal defects?

Ultrasound to rule out fetal abnormalities or multiple gestation

52

Alpha-fetoprotein is produced in the fetal ____ ____ & ____.

gestational tract
liver

53

What weeks is AFP detectable in maternal serum?

14-34 weeks

54

What are the multiple marker screen tests?

triple & quad screens

55

What does the triple screen test?

- MSAFP
- unconjugated esteriol
- hCG

56

What does the quad screen test?

- MSAFP
- unconjugated esteriol
- hCG
- Inhibin A

57

Trisomy 21 is called:

Down's Syndrome

58

Trisomy 18 is called:

Edward's Syndrome

59

What does non stress test (NST) check for?

fetal movement ???

60

How long is the fetus monitored in a NST?

20-30 min

61

What is a REACTIVE finding of NST?

normal FHR baseline with fetal movement (accelerations = fetal movement)

62

What is a NONREACTIVE finding of NST?

Additional testing needed
(will require a BPP to be done)

63

What is vibroacoustic stimulation?

Sound & vibration used to elicit a fetal response

64

Contraction Stress Test (CST) or Oxytocin Challenge Test (OCT)...monitor FHR for:

10-20 min for baseline

65

CST or OCT...contractions started by:

- nipple stimulation
- IV pitocin/oxytocin

66

CST or OCT...we want ___ contractions in ___ min.

3 contractions in 10 min

67

CST/OCT...findings are classified as:

- negative
- positive
- equivocal
- suspicious
- unsatisfactory

68

What constitutes a NEGATIVE CST/OCT?

NO decels
(Negative means good)

69

What constitutes a POSITIVE CST/OCT?

Late decels with 50% or more contractions
(Positive means bad)

70

What constitutes an EQUIVOCAL/SUSPICIOUS CST/OCT?

Late decels or prolonged variable with 50% of contractions

71

What constitutes an EQUIVOCAL HYPERSTIMULATORY CST/OCT?

Decels with contractions every 2 min or lasting longer than 90 secs
*not enough time to reoxygenate

72

What constitutes an UNSATISFACTORY CST/OCT?

No contraction in 10 min or unable to determine FHR