HESI PN MATERNAL NEWBORN PROCTORED EXAM
VERSION 5
● Amniocentesis is a prenatal test. Is the sampling of amniotic fluid using a hollow needle inserted into the uterus, to screen for developmental abnormalities in a fetus.● Prescribed for a pt. who is at increased risk of having a baby with a birth defect or genetic condition.● An ultrasound transducer is used to show a baby's position in the uterus on a monitor prior to procedure.● It may be performed after 14 weeks of gestation.Patient Education ● Instruct client to empty her bladder prior to procedure ● During procedure slight pressure will be felt, keep breathing.○ The diaphragm is lowered when pt holds the breath.Nursing Interventions
● With Rh negative will be given Rho(D) immune globulin, to protect against Rh isoimmunization.● Monitor FHR after the procedure for 30mins ● Notify provider for leakage, bleeding on site, pressure, contraction
ULTRASOUND EDUCATION: () page 29
● instruct patient to have full bladder. “Drink 1 quart of water prior to the procedure ● put the Wedge UNDER the right buttuck to prevent supine hypotention.
NONSTRESS TEST: NURSING INTERVENTIONS: page 31
● “What are you looking at while you monitor my baby?” ○ “This test monitors the response of your baby’s FHR to fetal movement.” ● Which trimester can this noninvasive test be performed? 3rd, 32 weeks ● Let's look at 2 strips to determine reactive vs. non reactive.○ Let’s go over the reactive definition AGAIN!○ Nonreactive, baby is sleeping, Opioid and nicotine(smoking) can cause baby to relax which can cause a false nonreactive NST ● Why do we ALSO need to connect the client to the Toco transducer during this test?○ If an acceleration occurs at the same time as a contraction it does not count ● Best Maternal Position during this exam?○ High fowler’s or left side 1 / 4
○ Supine with wedge under hip ● What is the ‘normal’ range for the FHR? (page 86) ○ 110 -160 bpm
○ After birth: 100 - 160 bpm
NONSTRESS TEST: RESULTS:)-third trimester
Done twice a week at 28-32 weeks gestation, IF HIGH RISK PREGNANCY (PAGE 31, BOTTOM LEFT under Client Presentation.) ● Reactive (good): FHR normal baseline with moderate variability. Accelerates at least 15 beats for 15 sec and it occurs twice during 20 mins ● Remember, it’s not counted as an acceleration IF it occurs DURING a contraction!!!
● Non-reactive: no demonstration of 2 qualifying accelerations in 20 mins
● Some medications, like Opioids & Nicotine can cause non-reactive results.○ Stimulate baby for 3 sec, give food or drink OJ ○ Reffered to get BPP or CST ● False non-reactive NST when baby is asleep (sleep periods 20-30 mins), if Pt is on opioids (dilaudid) or is a smoker (page 31) ● Moderate variability with a minimum of 2 accelerations ● What is the definition of a acceleration?○ 15 bpm above the fetal baseline and lasts for 15 seconds during a 20 minute period. (I say, “it’s a 15 by 15”) ○ Less than 32 weeks = 10 bpm, lasts 10 seconds
Identification of Prolonged Decelerations:
● Decrease in FHR is 15 beats/min or more BELOW THE BASELINE and lasts for at least
- min but less than 10 if sustained for 10 min its a baseline change.
Nursing interventions for Prolonged Decelerations: )
● Notify provider ● Stay with patient’ ● Reposition pt. (Turn on side)--always least invasive action first!!!● Maternal Oxygen--facemask at 8-10L/min ● IV fluid bolus
Assessing Fetal Lung maturity (prior to birth): )--PAGE 34
● Preterm baby lungs are not mature no surfactant.● Amnio for L/S RATIO AND PG presence. --page 34 2 / 4
○ L/S Ratio- 2:1 ratio indicates fetal lung maturity (2.5:1 or 3:1 for a client with diabetes) Its ration should be higher than standard.
○ Absence of PG (phosphatidylglycerol) = respiratory distress : WANT PG for
lung maturity ○ Obtained via amniocentesis ● Mom at risk of preterm delivery will receive 2 doses of betamethasone (corticosteroid) ○ Enhance fetal lung maturity ○ Doses 24 hrs apart ○ Prolong labor so you can to give both doses
Expected Lab findings:
● BUN
○ First trimester: 7-12mg/dL
○ Second trimester: 3-13 mg/dL
○ Third trimester: 3-11 mg/dL
● Hematocrit: 30-40 %
● Hemoglobin: 11-15 g/dL
● Platelets: 150,000-400,000
● Liver enzymes (ALT 8-20 and AST 5-40) ● Protein is NEVER normal in urine
Describe fetal Late deceleration:
★ Fetal heart rate slows after contraction has started and returns to baseline well after contraction has ended.Causes of late decel.
● Uteroplacental insufficiency causing inadequate fetal oxygenation.Interventions ● Side lying position first action ● Increase rate of IV fluid ● Discontinue oxytocin ● Administer oxygen 8-10 L via nonrebreather face mask ● Elevate legs ● Prepare for assisted vaginal birth or cesarean
Pitocin (Oxytocin) 3 / 4
● No more than 5 contractions in 10 minutes ● No more than 7 contractions in 15 minutes ● Contraction longer than 90 seconds is hyper-contraction and leads to fetal distress ○ D/c or lower the dose ○ A prolonged contraction duration (greater than 90 seconds) or too frequent contractions (more than five in a 10-min period) without sufficient time for uterine relaxation (less than 30 seconds) in between can reduce blood flow to the placenta. This can result in fetal hypoxia and decreased FHR
GBBS: patient education regarding screening:
● screen at 35 weeks to 37 weeks, and if it has positive, antibiotic treatment will be given during labor/after SROM
HOW DO YOU EXPLAIN THIS TO YOUR CLIENT
● Natural bacteria, sometimes leaks out and baby can be exposed during vaginal birth.○ Can cause neurological issues (cerebral palsy) ○ Give antibiotic q4hrs IV while in labor; stop antibiotics once baby is born.○ Client does NOT need antibiotics if she’s going to have a c-section.
Teach client about hysterosalpingography:
● outpatient radiological procedure in which dye is used to assess the patency of fallopian tubes for imaging.● Assess for history of iodine and seafood allergies prior to procedure (because of the contrast dye) ● If allergic to shellfish and needs procedure done, pt will premedicated with Diphenhydramine(Benadryl)
Evaluating lab values for a client with Preeclampsia: pg 60
UA= protein 1-2 is mild, +3 is chronic At risk for HELLP
Hemolysis: results in anemia and jaundice
Elevated Liver enzymes
Low Platelets : less than 100,000 results in bleeding
Labs:
1. albumin : 3.5-5
2. Ammonia: 15-45
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