NSG 222 - Family Nursing
Exam 2
Question:
Performing Leopold Maneuvers
Answer:
Leopold maneuvers are a method for determining the presentation, position, and lie of the fetus through the use of four specific steps. This method involves inspection and palpation of the maternal abdomen as a screening assessment for malpresentation. The flat palmar surfaces of the nurse's hands with the fingers together palpate the uterus A longitudinal lie is expected, and the presentation can be cephalic, breech, or shoulder. Each
maneuver answers a question:
· Maneuver 1: What fetal part (head or buttocks) is located in the fundus (top
of the uterus)?
· Maneuver 2: On which maternal side is the fetal back located? (Fetal heart
tones are best auscultated through the back of the fetus.)
· Maneuver 3: What is the presenting part?
· Maneuver 4: Is the fetal head flexed and engaged in the pelvis?
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Question:
Fetal Assessment During Labor and Birth
Answer:
A fetal assessment identifies well-being or signs that indicate compromise.The character of the amniotic fluid is assessed, but the fetal assessment focuses primarily on determining the FHR pattern. Umbilical cord blood analysis and fetal scalp stimulation are additional assessments performed as necessary in the case of questionable FHR patterns.
Question:
Analysis of Amniotic Fluid
Answer:
Amniotic fluid should be clear when the membranes rupture. Rupturing of membranes is either spontaneous or artificial by means of an amniotomy, during which a disposable plastic hook (an Amnihook) is used to perforate the amniotic sac. Cloudy or foul-smelling amniotic fluid indicates infection.Green fluid may indicate that the fetus has passed meconium secondary to transient hypoxia, prolonged pregnancy, cord compression, intrauterine growth restriction (IUGR), maternal hypertension, diabetes, or chorioamnionitis; however, it is considered a normal occurrence if the fetus is in a breech presentation. If it is determined that meconium- stained amniotic fluid is due to fetal hypoxia, the maternity and pediatric teams work together to prevent meconium aspiration syndrome, which can lead to respiratory distress. This would necessitate suctioning after the head is born before the infant takes a breath and perhaps direct tracheal suctioning after birth if the Apgar score is low. In some cases, an amnioinfusion (introduction of warmed, sterile normal saline or Ringer's lactate solution into the uterus) is used to dilute moderate to heavy meconium released in utero to assist in preventing meconium aspiration syndrome. 2 / 4
Question:
Analysis of Fetal Heart Rate
Answer:
Monitoring of the FHR throughout labor and birth is essential to assure fetal well-being to optimize neonatal outcomes. Analysis of the FHR is one of the primary evaluation tools used to determine fetal oxygen status indirectly.FHR assessment can be done intermittently using a fetoscope (a modified stethoscope attached to a headpiece) or a Doppler (ultrasound) device, or continuously with an electronic fetal monitor applied externally or internally
Question:
Category 1 Fetal Heart Rate
Answer:
Category 1 Normal:
Baseline 110-160 bpm Baseline variability moderate Present or absent accelerations Present or absent early decelerations No late or variable decelerations Can be monitored with intermittent auscultation during labor
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Question:
Category 2 Fetal Heart Rate
Answer:
Category 2 Indeterminate: Not predictive of abnormal fetal acid-base status,
but requires evaluation and continued surveillance Fetal tachycardia (over 160) Fetal bradycardia (less than 110) not accompanied by absent baseline variability Absent baseline variability not accompanied by recurrent decelerations Minimal or marked variability Recurrent late decelerations with moderate baseline variability Recurrent variable decelerations accompanied by minimal or moderate baseline variability, overshot, or shoulders Prolonged decelerations over 2 min but less than 10 min
Question:
Category 3 Fetal Heart Rate
Answer:
Category 3 Abnormal: Abnormal fetus acid-base status, requires intervention
Fetal bradycardia (less than 110) Recurrent late decelerations Recurrent variable decelerations (absent or declining) Sinusoidal Pattern (smooth, undulating baseline)
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