Nursing Care of Child Bearing Families Session: 4

I this is the fourth session of the class and we discussed some of the changes that a woman will face during the pregnancy, and started talking about the fetal heart monitor and how to read it. The next post for this class will be a review guide of the information that may be on the next text. Happy studying.

-Peter

Session 4

Normal phys changes in pregnancy

  • hematologic
    • increase in plasma and RBC
      • blood is diluted
      • Hbg goes down as well as Hct
      • fetus is storing iron so there may not be as much going to make RBC
    • immunocompromise
      • increased WBC
  • MSK
    • loose joints and tendons from relaxin
  • Vena Cava syndrome
    • lean to her left side so there is decreased pressure on the vena cava

Fetal assessment

All women should be offered genetic testing

Amniocentesis

  • .5% chance of loss

CVS – chorionic villi sampling

  • does not detect neural tube defects
  • 1% chance of loss

electronic fetal monitoring

  • know how to read these will
  • the purpose is to prevent fetal hypoxic ischemic injury
  • vocabulary
    • common language so that there are fewer miscommunications
    • frequency – the start of one contraction to the start of another
      • dark vertical lines are a minute on the EFM
    • duration
      • length of time of the contraction
    • Intensity: of contractions
      • cannot tell the intensity from an external monitor
      • must palpate, and get subjective data to get contractions
      • IUPC – intrauterine pressure catheter measures the intensity as well
    • Category 1
    • Category 2
    • Category 3
    • Montevideo units -MVU total intensity of each contraction (from baseline)added up in a 10 min period. 200 MVU is the pressure needed for 90% of labors to move forward.  
    • normal fetal HR is 110-160
      • make sure you compare this to the mother’s pulse to be sure that you are not reading the mother’s pulse as the baby’s
      • listen to FHR during the contraction through doppler and for 30 seconds after contraction
    • US transducer
      • placed in area of max intensity of FHR
      • use gel when applying
    • Tocotransducer
      • has a button on the bottom
    • Fetal scalp electrode
      • fetal ECG from a spiral electrode hooking gently into baby’s skin
    • Intrauterine Pressure catheter
      • measures frequency, duration and STRENGTH of contractions.
    • Meconium fluid is baby poop
    • autonomic nervous system
    • Vagus stimulation will slow down HR and increase peristalsis to cause meconium
    • Placenta produces estrogen, progesterone, hPl, and hCG
    • tachysystole is rapid contractions with small rest periods
    • FHR baseline to the nearest 5 BPM
    • variability
      • absent – flat line
        • associated with sleep
      • minimal – less than or equal to 5 bpm of variance from baseline
      • Moderate – best rhythm(best parasympathetic/sympathetic teeter-totter), 6-25 bpm variance from baseline
      • Marked variability – more than 25 bpm from base, usually does not last long
      • Accelerations are always good
        • greater than 15 seconds and shorter than 2 min
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