NR327_Exam_2_Study_Guide

M 13 maternal serumalphaGto protein UsedtodetectNeural TubeDefect AbnormalFindings referre dy quadmarkerscreening geneticcounseling ultrasound Amniocentesis INDICATIONS potential Diagnosis CONSIDERATIONS Allpregn ...

M 13 maternal serumalphaGto protein UsedtodetectNeural TubeDefect AbnormalFindings referre dy quadmarkerscreening geneticcounseling ultrasound Amniocentesis INDICATIONS potential Diagnosis CONSIDERATIONS Allpregnantclients11618Weeksofgestation Interpretatings DISCUSSITSTINGINlaient highlevelscanindicateneural tubedefect Draw Offer Blood Support Sample 1 EDUCATIONAS oropenabdominaldefect NEEDED 101Nlevels canindicateDownSyndrome AMNIOCENTESIS performed after 14wksofgestation insertion Aspiration of of aneedle amniotic trans fluid abdominally foranalysis intoby a CONSIDERATIONS Clientsuterus amnioticsacunderdirect Ultrasoundguidancelocatingtheplacenta PreProcedure ddeterminingpositionof fetus NURSINGACTIONS ExplainProcedure obtaininformedconsent INDICATIONS PatientEDUCATION instructpatienttoemptybladderprior Previousbirthwithchromosomalanomaly totheproceduretoreduceitssize reduce Aparentwhoisacarrierofchromosomalanomaly theriskofInadvertantpuncture Afamilyhxofneural tubeDefects intraprocedure prenatal DXof ageneticDisorderor congenitalAnomaly NursingActions Alphafetoprotein AFPlevelforabnormalities Baselinevitals EHRprior toprocedure lungmaturityassessment 3rdtrimester supinepositionplacewedge underahiptoDisplaceuterusoff venacava fetalhemolyticdisease place Drape overpatientexposingonlyherabdomen Meconiumintheamnioticfluid prepptforanultrasoundtolocateplacenta cleanseptabdomenwithanti septicsolution prior toadministrationoflocal anesthesiabyprovider INSTRUCTPTthatshe114111 feelslightpressureasthe needleisinsertedSheshouldcontinuebreathingbcholding herbreathwilllowerthediaphragmagainsttheuterus toshifttheIntrauterinecontentsNI NONStressTest MOSTWidelyusedtechniqueforanti partumevaluation of fetal Well beingperformedduring3rdtrimester NONINVASIVEProcedurethatmonitorsresponseofFHR toFetalmovement Patientpushesbuttonattachedtothemonitorwhenever shefeelsfetal movementwhichisthennotedontracing AllowsNursetoASSESStheFHRInrelationtofetal movement INDICATIONI DISADVANTAGESOFNSI Assessforintactfetal CNSduring Highrateoffalsenonreactiveresultswfetal movement the3rdTrimester responsebluntedbysleepcyclesofthefetusfetal Rulingouttheriskforfetaldeath immaturity maternalmedicationsenicotineuseDisorder 1hClientsWhohaveDMUsedtwiceaweekstarting at28Weeksto32Weeksofgestation PATIENTPresentation CONSIDERATIONS Decreased fetal movement patient Preparation intrauterinegrowthrestrictions seatpatientinarecliningchairor placeinasemi fowler'sleftlateral position Post maturity Apply CONDUCTIONgeltopatientsabdomen GestationalDM Applytwobeltstopatientsabdomen attach the Fitranduterinecontractionmonitors GestationalHTN MaternalChronicHypertension ONGOINGCARE Hxofprevious fetal demise INstructPTtopressthebutton AdvanceMaternal Age onhandheldeventeachtimeshe sicklecell Disease feelsthefetusmove 150 immunization IFthereareNofetal mumtfetussleeping vibroacousticstimulationsoundsourceusually laryngealstimulatorcanbeactivatedfor3 interpretationofFindings secondsonthematernal abdomenoverthe theMSTisinterpretedasreactiveifthe fetal headtoawakenthesleepingfetus Fitris anormal baselineratewith moderatevariabilityaccelerates least 151mm 101 minprior to32weeksFor least bseconds 10secondspriorto32weeks occurstwoormoretimesduringa20minperiod NonreactivelustisatestthatDoesnotDemonstrate leasttwoqualifyingaccelerationsina20min Window Ifthisisso afurtherassessmentsuch asacontractionstresstestCstorBPPisindicatedr BiophysicalProfite BPP INDICATIONI usesrealtimeultrasoundtoVISUALIZE potential Diagnosis physical physiologicalcharacteristics nonreactivestresstest ofthefetusEObserveforfetalbiophysical suspectedoligonydramniosorpolyhydramnios responsestostimuli ItcombinesFHR supectedFetalhypoxemiaorhypoxia monitoringnonstress test 5fetalultrasound clinical manifestations considerations prematureruptureofmembranes preparethepatientfollowingthe maternal infections samenursingmanagement Decreasedfetal movement Principles Asthoscusedforanultrasound intrauterinegrowthrestriction interpretations Variables Bppassesses fetal wellbeingbymeasuring Far gvariableswithascoreotzforeachnormalfindings reactiveinonstresstest z eOforeachabnormalfindinggoreachvariable nonreactive 0 Fetal breathingmovements Total ScoreFindings insomin atteastiepisodeotgrealerthanzosecauration 2 Absentorlessthanzosecauration 0 81010 Normallowriskofchronic arossbodymovements fetal asphyxia atleast totlexionm3ominez 3bodyorlimbextensions withreturn lessthan3episodes 0 4 6 tb suspect chronic Fetaltone fetalasphyxia atleast episode extension unthreturntoflexion2 lowexiensionistexiomlackofflexiomorabsentmovement a Qualitativeamniotic Fluid volume Less 4Ab stronglysuspect leastipocketoffiniathatmeasuresatieastuminzperpindicularplanes 2 chronicfetal asphyxia pockets absentorlessthanum0 CSI contrationStressTest INDICATIONST NippleStimulation lightlybrushpalmacrossnippleforzmin High postterm Risk pregnancy Pregnancy gestational Diabetes whichcausespituitaryglandstoreleaseendogenousoxytocinthen NONreactivestressTest stoppingnipple stimulationwhenacontractionbegins Sameprocess repealedaftera5minrest period OxytocinstimulatedcontractionTest AKAOxytocinChallengeTest OCT usedifnipplestimulationdoesntwork Nadministrationofoxytocintoinduceuterinecontractions contractionsstartedw oxytocinDifficulttostop contraindication placentapreviaVasapreviapretermlabormultiplegestationpreviousclassicalincisionfromcsection1 reducedcervical competencePatientPresentation Nursingconsiderations DecreasedFetalMovement obtainbaselinevitalsofEHRfetalmovement IUGR Post Maturity contractions10to20Min GestationalDM Explainproceduretopatient obtaininformedconsent Gestational HTN MaternalchronicHTN Complete anassessmentintoartificial stimulation if contractions HxofFetal Demise AdvanceMaternal Age ONGOINGCARE Sicklecell Disease initiatenipplestimulationifnocontractions rollanipplebetweenthumb fingers INTERVENTIONS monitor provideadequaterest periods forthepatienttoavoidhyperstimulation Initiate111Oxytocin oftheuterus ifhyper stimulationoftheuterus orpretermlaborsoccursDothefollowing Interpretations monitor forcontractionslastinglonger than90seeor occurringmorefrequentlyevery2mm NegativeCST1Normal findings AdministerToco's asprescribed IndicateIfwithina 10minperiod Maintainbedrest Duringprocedures IN13uterinecontractionsthereare observeptfor30mmafterwardtosee thatcontractions nolateDecelerationsoftheFHR haveceasedEpretermlabor doesnot begin PositiveCST abnormal findings consistent persistentlatedecelerations Huth501ormorecontractions tM8 suggestiveofuteroplacentalinsufficiency PotentialforDretermlabor VariableDcel cordcompression EarlyDcel FetalheadCompression Basedonthesefindingsthe provider Laboror may perform determine acesarian toinduce birthChromosomal Testing Pages34 35 ATIlookover Abruptioplacentaepremature separationofplacentafromtheuterus separationoccurswinksofgestation usually 3rdtrimester partial Detacment Leadingcauseofmaternal death1fetal mortality Complete Detachment Assessment ExpectedFindings MaternalHTNchronicorgestational sudden onset oflocalizeduterine pain BluntExternalAbdominalTrauma MVAmaternalbattering withDarkredvaginal Bleeding cocaineHasoconstriction areaofuterinetenderness canbelocalized Previousabrupt toplacental Ordiffusedover uterus boardlike CigaretteSmoking contractionswithhypertonicity prematureruptureofMembranes Fetal Distress Multifetalpregnancies ClinicalFindingsofhypovolemicShock Labs Diagnostic Procedure Hgb Hot Ultrasoundforfetal Wellbeing coagfactors eplacental assessment CLOTTINGFactorsInseminatedintravascular coagulation crossETypematchfor possiblebloodTransfusion Bpptoascertainfetalwellbeing KleihauerBetketstlusedtodetect fetal blood inmaternal circulation patientcenteredcare patientEducation palpate uterusfortenderness tone provideEmotional support AssessFHR forpatientandFamily immediatebirthismanagement AdministerNfluidsBPproductsEmedicationsasprescribed Administer028104minutafacemask monitorinalsobservingfordeclininghemodynamic status Continousfetalmonitoring Assessurinaryoutputomonitor fluidbalanceEItpwgnanc.ly 2ndmost frequentcauseofbleeding linearlypregnancya leadingcauseof Abnormalimplantationof a fertalkedovumoutsidetheuterinecavity Mtrtility Usually inthefallopiantube www.hcanresultmatubalrupture EIpectdFI.gs Causingfetalhemorrhage unilateral stabbingpainelenderness unthelowerabdominal quadrant Delayed11102Wks lighter thanusual Assessment riskfactory orirregularmenses Scant darkred.orbrownvaginal Anyfactors thatcompromisetubalpatencySTIsassisted spottingoccurs6108weeks reproductivetechnologiestubal surgery contraceptive afterlastnormal menses redvaginal intrauterineDevice IUD bleedingfrupturehasoccurred Referredshoulderpaindltbloodinthe Diagnostic ETherapeuticProcedures peritoneal orphrenunerveaftertubal cavityirrilatingtheacaphragm rupture Reportofindicationsofshock such faintness dizzinessrelatedto Transvaginalultrasoundshowsempty amountofbleedingmabdominal Uterus Cavity useCAUTIONIfllaginaldblmanual Clinicalfindingsofhemorrhage shock examinationareused hypotensiontachycardiapallor Rapidtreatment Medical Management ifrupturehasnotoccuredetubepreservationdesired Methotrexate inhibitscell divisionEembryoenlargementDissolvingthepregnancy Salpingotomyisotonetosalvagethefallopiantubeifnotruptured laparoscopicsalpingectomycremovalotthetube isperformedwhenthetubehasruptured PATIENT CENTERED Care PATIENTEDUCATION replacetiuideimaintainelectrobiebalance instructptwnoistaking methotrexate provideaeducationpsychological support toavoidalcoholconsumption vitaminscontaining folicaciatopreventatoxicresponsetothe adminmeasasprescribed medication Dreppttorsurgeryapostopnursingcare Advisetheclienttoprotect herself from providereterralforcuinttpartnertopregloss sunexposurephotosensitivity obtainserumncaanaprogesterone levels liver renal functionstudiescBc.anatypernPI Previn OccursWhentheplacentaabnormallyimplantsinthelower segment oftheuterusnear oroverthecervical OSinsteadofattachingtothefundus Theabnormalimplantationresultsinbleeding duringthethirdTrimesterofpregnancyasthe Arvinbeginstodilateandefface Assessment Bsuper completeortotal thecervicalOSiscompletelycovered previousplacentapremier bytheplacentalattachment IncompleteorpartialThecervicalosistheonly uterinescarringpreviouscesarian partiallycoveredbytheplacentalattachment birthcurettageendometritis Marginalorlowlying Theplacentaisattached maternal agegreater than35 in theloweruterinesegmentbutdoesnotwalkthe multifetalgestation cervical OS multiplegestationsorclosely spacedpregnancies ExpectedFindings snoring painlessBright redvaginalBleedingduringthesecondorthirdtrimester Uterussoftrelaxed nontenderwithnormal tone fundal height greater thanusuallyexpectedforgestational age Fetusinbreechobliqueortransverseposition ReasuringFAR L yTestN Vital signswithinnormallimits Hgb and Hot forbloodloss Assessm Decreaseurinaryoutputcanbebetter indicator cBc ofbloodloss BloodLupe and Rh coagulationprofile Kleihauer Betketest usedtodetectfetalblood in maternal circulationcontinuePlacentaPrevia PATIENTCENTEREDCARE DiagnosticProcedure Assessforbleedingleakageorcontractions Transabdominalontransraginalultrasoundfor placementoftheplacenta Assessfundalheight fetal monitoringforfetal wellbeingassessment PerformLeopoldManeyerslfetalpositione PATIENTEDUCATION Presentation BedRest refrainfromperformingvaginalExams Exacerbatebleeding NothingInsertedVaginally AdministerIVfluidsbloodproducts tomedications Asprescribed Corticosteriods betamethasone promotefetallungmaturationifearlydelivery isanticipatedIcesarianbirth Have02equipmentavailableincaseof fetal distress ThrombophlebitisEducation ThrombophlebitisPrevention walking Activity DontSmoke PromoteActivity Exercise CompressionSocks EngorgementRelief coldcabbageleauestforfeeding Displaced uterus full bladder empty Massagingfondue aftertheDeliveryofplacenta Babynotreceivingenoughmilk musthave atleat 6 8Mt diapers Funduslocation12hrumbilicus 14day_fullydescended rubellateaching NONimmune APGARscores NegativebeforeDK cantbecomePregnantfor4months LF Maynudtomin 1 5min Normallnfant 36.5 37.6 110 160 30 60 60 80 40 50Rooting helpsencouragefeeding Infantfeeding Q2hours SIDSteaching sleeponbacknoextrafirmmattress CONDUCTION AvoidContactWithColdSurfaces Circumcision Don'tremove1Touch yellowcrust Hyperbillrubinemia Poorfeeding Hypoglycemia Sls Jittery Respiratory difficultyPoorfeeding carseat rearfacing Anchoredtocar SKINTOSKIN Bonding CTX feeding Thermoregulation cord AHA 2arteries Nein postpartumhems Methergine prevents controlsPPH improvemuscletonestrengthofcontractions HighFiberfoodsoatmeallentils Asparagus Transcutaneous TENS gffmmugaay.no Drugfreepainrelief duringearlylabor Effleuragemassagetorelaxmusclesbetweencontractions Erythema Toxicumrashinnewborns 804 effaced 8cmdilated NeoNatalabstinencesyndrome withdrawseizureFussypoor feeding Thchomonal'SIS PretermriskAbdominaldiscomfort ACTIVElabor 1MitralValvestenosis pulmonaryEdemaAFBright sidedHF Tx DiureticBetablockerCalciumChannel blockersidelying AssistedDelivery Labs Bilirubin Platelet 15,000 350,000 Hgb1420 Glucose 4596 Hot 43631PreEclampsia swelling134 proteinuriaABDWeight gaintoutputabdominalpain Herpes Cytomegalovirus babyatriskforcongenitalanomalies CordProlapse kneestochestsidelying continousFAR Oxygen18lol perminute