NUR 221 EXAM 2 LATEST UPDATE
GRADED A+
Absent FHR variability
amplitude range undetected
Minimal FHR variability
1-5 bpm
Moderate FHR variability
6-25 bpm what we want
Marked FHR variability
>25 bpm
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NUR 221 Exam 2: Fetal Monitoring and Maternal Complications in Pregnancy, Exams of Nursing
A comprehensive overview of fetal monitoring techniques and maternal complications during pregnancy, particularly focusing on fetal heart rate patterns, contractions, and preeclampsia. It includes explanations of various monitoring methods, such as leopolds maneuver, non-stress test (nst), and biophysical profile (bpp), along with detailed descriptions of common complications like preeclampsia, hellp syndrome, and gestational hypertension. The document also outlines interventions and management strategies for these conditions, emphasizing the importance of fetal well-being and maternal safety.
Typology: Exams
2024/2025
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NUR 221 EXAM 2 LATEST UPDATE
GRADED A+
Absent FHR variability
amplitude range undetected
Minimal FHR variability
1 - 5 bpm
Moderate FHR variability
6 - 25 bpm what we want
Marked FHR variability
25 bpm
What is Leopolds maneuver?
Purpose: to determine presentation and position of fetus and aid in knowing where to position FHR monitor Method: explain procedure to pt, have woman empty bladder, wash hands, stand beside, facing woman's head 4 maneuvers
What is normal FHR?
110 - 160 bpm newborn is the same
bradycardia FHR and causes
<110 bpm due to perfusion issues, body is in distress
Tachycardia FHR and causes
Intensity of contractions
strength of contraction at its peak (mild, moderate, strong)
How can you tell the intensity of a contraction by feeling?
cheek= resting nose= mild chin= moderate forehead= strong
What is TOCO?
For uterine activity palpate uterus for contraction Apply over fundus- make sure there is contact GOES ON TOP tells frequency and duration of contractions
Accelerations in FHR
an apparent, abrupt increase in the FHR above baseline.
- Greater than or equal to 32 weeks gestation
- The increase from onset to peak in <30 seconds
- The peak must be at least 15 bpm and last at least 15 seconds
-If <32 weeks gestation at least 10 bpm for 10 seconds
This is a normal good finding... Just document and continue to monitor.
Early Decelerations - Fetal Heart Rate
have a shape that is symmetrical, with a gradual decrease and return of FHR to baseline in association with a contraction -Means Head compression-normal labor process **gradual decrease **mirror image of contraction JUST OBSERVE-prepare for delivery, document normal labor
nadir
the lowest point after the onset of an early/late deceleration and variable
Late decelerations - Fetal Heart Rate
have a shape that is symmetrical. with a gradual decrease and return of FHR to baseline in association with a contraction
Intervention- Deliver fetus
POISON stands for
P- position change (to left side) O- oxytocin off I- increase IV rate (give extra fluids) S- sterile vaginal exam O- oxygen (10 L nonrebreather) N- notify MD or CNM
Baseline FHR
Average FHR in 10 minute window. Does not include accelerations or decelerations and it must be in between contractions. There must be at least 2 minutes of identifiable baseline.
Prolonged deceleration- Fetal heart rate
greater than 15 bpm and lasts 2-10 minutes from onset to return to baseline -a prolonged decel that lasts >10 minutes is considered a change in baseline
Kick counts (fetal movement counting)
How many kicks in a 1 hour period of time should be the same time each day should be after eating don't do it when the baby is sleeping
- notify dr. if less than 10 kicks in 1 hour period
Non-stress test (NST)
-ultra sound record movement, doppler measures fetal HR, assess fetal well being -Reactive if 2 or more acceleration with 15bpm lasting 15 seconds for 20 min with return to baseline -if less than 32 weeks 10 bpm lasting 10 seconds
-if the test is nonreactive the patient should have a biophysical profile (BPP)
Biophysical Profile (BPP)
uses a real-time ultrasound for visualization of physical and physiological characteristics of a fetus. 5 variables assessed
- Fetal breathing -Score 2- at least one episode of fetal breathing movements of at least 30 second duration in a 30 minute observation -Score 0- Absent fetal breathing or less than 30 seconds in 30 minutes
- Fetal movements
-Rate of preterm birth 70%, 15% before 28 weeks
S/S: usually develops antepartum period most women report hx of malaise, flu-like symptoms, epigastric RUQ pain, headache, change is loc, vision changessymptoms worse at night and improve during the daytime.
Dx: abnormal lab levels AST -10- ALT -10- Platelets 150-400k
Dx for HELLP increases risk for DIC, placental abruption, liver hemorrhage or failure, ARDS, sepsis, stroke
Preeclampsia risk factors
-Nulliparity -Age >40 or < -interpregnancy interval >7 yrs -family history of preeclampsia -woman born small for gestational age -obesity/gestational DM -preeclampsia in previous pregnancy -poor outcome in previous pregnancy -preexisting medical conditions
-chronic htn -renal disease -type 1 DM -factor V leiden mutation -mulitfetal pregnancy -African American
preeclampsia S/S & Tx
a complication of pregnancy characterized by hypertension >140/90, edema, and proteinuria
-after 20 weeks gestation
Severe htn > 160/
S/S: edema above the waist, hyperactive deep tendon reflexes 3/4+, clonus present, proteinuria, HTN
-Risk for seizures: assess for mental status changes, vision changes, worsening headache
Labs: >300 mg protein in 24 hour urine specimen
Protein/creatinine ratio > 0.
+1 on urine dipstick
Random urine must have 2 samples at least 6 hours apart >30 mg/dL of protein in both samples
CBC, BUN, creatinine, AST, ALT
Biophysical profile needs to be done once or twice weekly to determine fetal wellbeing deliver fetus around 37 weeks
-Calcium Gluconate Emergency birth pack easily accessible
chronic hypertension
A blood pressure that is equal to or greater than 140/90 mm Hg, which exists prior to pregnancy, occurs before the 20th week of pregnancy, or continues to persist postpartum.
Risk factors: African American Obese Primary HTN
High Risk For: superimposed preeclampsia, stroke, acute kidney injury, heart failure, placental abruption, and death
Fetal Risks: IUGR, death, preterm birth
Tx: Antihypertensive drugs, Labetelol, nifedipine, methydopa, and thiazide diuretics
**Methyldopa and Labetelol are the drug of choice for breastfeeding moms
Gestational hypertension
onset of hypertension without proteinuria or other systemic findings after 20 week gestation. BP
140/90. --Has to be recorded on 2 occasions at least 4 hours apart after 20 weeks gestation with a previously normal blood pressure. -About 25-50% of women with gestational Htn go on to develop preeclampsia
Tx: Antihypertensive medications -Usually resolves first week postpartum
Magnesium Sulfate
Anticonvulsant Given with preeclampsia to prevent seizures and also helps to slow everything down and lower BP. Helps neurologically with the fetus and can help prevent cerebral palsy or other defects. -Given IV, give a loading dose 4-6 grams in 100mL IV fluid over 15-20 mins and then a maintenance amount of 40 Gms in 1000 mL with LR IV 2 grams per hour -Maintain serum Mg level of 4- -Antidote: calcium gluconate
Assess for: Respirations < Maternal Oximeter reading <95% Hyporeflexia or DTR (Patella) Urinary Output <30 mL/hr Toxic serum level >8 mg/dL
premature separation of the placenta from the wall of the uterus, can be partial or complete detachment
Risk Factors: cocaine use HTN smoking PROM multifetal pregnancy Trauma Hx of abruption anything that affects perfusion
Dx: Transvaginal US (about 50%) others are diagnosed by clots found in the placenta
S/S: Pain at site of detachment painful dark red vaginal bleeding boardlike abdomen can have blue discoloration uterine tenderness
Maternal complications:
DIC
hypovolemic shock renal failure
Fetal complications: IUGR preterm birth neurological defects
MGMT: depends on degree of detachment if stable: monitor, assess fetus regularly (NST, BPP), betamethasone, serial labs (to check for hemorrhage), urine output, if stable VAGINAL DELIVERY if unstable or complete abruption: emergency C-SECTION, monitor vitals
VEAL CHOP MINE
Mnemonic for decelerations
Variable Decels Cord Compression Move Mom
Early Decels Head Compression Identify labor progress
Accelerations Okay No action
Late Decels Placental insufficiency Emergency POISON
Category 1 FHR tracing
variable decels
TX: DELIVERY
Maternal cardiac disease
Impaired cardiac function usually results from a congential defect or history of rheumatic heart disease with valve prolapse or stenosis; dangerous because of plasma volume increase that accompanies pregnancy. Can happen up to 5 months postpartum.
Risk Factors: Have prior heart disease
40 yo Have preeclampsia or HTN African American obese
S/S: Extreme swelling or weight gain Extreme fatigue Fainting Persistent cough chest pain or fast heart beat severe SOB crackles orthopnea
rapid respirations cyanosis moist, frequent cough
Tx: Antepartum- decrease stress on heart intrapartum- watch O2, pulmonary artery cath, ECG, fetal HR, elevate head & shoulders, side lying position, epidural, prefer vaginal birth Don't deliver flat in stirrups/ No Valsalva maneuver
Hydralazine
Vasodilator; Antihypertensive
S/E: HA, flushing tachycardia, palpitations, N/V, decrease in uteroplacental blood flow
Fetal S/E: tachycardia, late decels
Contraindicated in maternal tachycardia
Can take while breastfeeding
Labetalol (Trandate)
beta-blocker, antihypertensive
S/E: lethargy fatigue, sleep disturbance, orthostatic hypotension
Contraindicated in women with asthma, heart disease, and CHF
Methyldopa (Aldomet)