Care of Mother, Child, Family and

Population Group at Risk with Problems
High-risk Prenatal Client
A High Risk Pregnancy
• Is defined as one in which a concurrent disorder, pregnancy related complication or external factor
jeopardizes the health of the mother, fetus or both.
Identifying Clients AT RISK
Ways for identifying clients at risk ©
a. Physiological
b. Psychological
c. Social
RISK ASSESSMENT TOOL @_@... haha
Lol… (Didn’t copy)
Diagnostic Tests
1. Ultrasonography
A. Transvaginal Ultrasound
´ Uses a probe inserted into the vagina
´ Used to visualize the baby
´ Used for placental grading
´ Instruct client to VOID FIRST
B. Transabdominal Ultrasound
´ The transducer is moved across the woman’s abdomen
´ Instruct client to HAVE A FULL BLADDER
Nursing Responsibility~
- Inform~
- Provide COMFORT and PRIVACY
2. Alpha-Fetoprotein Testing (AFP) ÷ ARMED FORCES OF THE PHILIPPINES!! \m/
 Level of fetal protein in the pregnant woman’s serum or in a sample of amniotic fluid
 Done in 16 – 18 weeks (AFP mnemonic)
 Major protein produced by baby
´ Yolk – 1
st

´ Liver of the Fetus – 2
nd

+ Levels of Protein (GAS) + Levels of Protein (CDG)
- Spina bifida - Chromosome abnormalities
- Anencephaly
- Gestational Throphoblastic Disease
(Hydatidiform mole) H-Mole
- Gastroschisis - Down’s Syndrome
3 Chorionic Villi Sampling (CVS)
¬ Obtaining a small part of the developing placenta to analyze fetal cells at 10 – 12 weeks
of gestation
¬ Use: Chromosomal Abnormalities
´ BUT! Cannot detect SPINAL CORD ABNORMALITIES C (Nobody’s Perfect)
Transvaginal Ultrasound: Transabdominal Ultrasound:
EMPTY BLADDER FULL BLADDER
Nursing Responsibility~
- Rh(D) immune globulin (RhoGam) is given to the Rh negative woman
 RhoGam – Inhibits ANTIBODY production of the mother
against the Rh positive or negative of the baby © (galing tlga~)
- Assess!!!!
 Bleeding
 Spontaneous Abortions
 Rest! ( :
4 Amniocentesis
Done when in 15 – 17 weeks of gestation
Aspirates 20mL of fluid from the amnion of the mother
 Instruct mother to INCREASE oral fluid~ ©
Use of Amniocentesis
Early Pregnancy Late Pregnancy
1. Identifies chromosomal abnormalities 1. Identifies severity of maternal fetal
blood incompatibility and assesses fetal
lung maturity
2. Check color of amniotic fluid
- Yellow = Rh Incompatibility
Nursing Responsibility~
- Informed consent
- Provide comfort and privacy
- Aseptic technique
- Skin
- Assess – Infection, FHR, Fetal Movement, VS of mother
- RhoGam – Nag prick kasi
20 Weeks + 20 Weeks +
EMPTY BLADDER FULL BLADDER
5 Non-Stress Test (NST)
Measures the response of the Fetal HR to the Fetal Movement
´ After 1 or 2 movements, HR ^ 15 Bpm for 15 Secs within 10 – 20 minute period
Interpretation:
- Reactive (GOOD!! ©)
o At least 2 accelerations of FHR with fetal movement of 15 bpm
lasting 15 secs/more for over 20 mins
o 2 – 15beats – 15 secs – 20 mins
o Used to determine if the fetus is oxygen compromised
- Non-Reactive (BAD!! C)
o No acceleration after movement
o No movement
º If no movement, instruct client to
• Eat HIGH Carbohydrate foods like orange juice
(glucose~)
• Make NOISE! RAAAAAHH!!!!~~~
o Low Fetal HR variability
- Unsatisfactory Test – If the data cannot be interpreted or there was an
inadequate fetal activity
Non-reactive = Non-stress Test = NOT GOOD! C
Reactive = Non-stress Test = Really GOOD! ©
6 Contraction Test
 Means of evaluating the respiratory function of the placenta
 Use:
´ Identifies the fetus at risk for intrauterine asphyxia by observing the response
of the FHR to the stress of the uterine contractions (spontaneous or induced)
´ Perform Nipple Rolling
Interpretation:
A. Negative (GOOD!! ©)
 Shows 3 contraction of good quality lasting for 40 / more secs on 10 minutes
WITHOUT EVIDENCE OF FETAL HR DECELERATION
 Implication: Fetus can handle the hypoxic stress of uterine contractions
B. Positive (BAD!! C)
 Shows repetitive persistent late decelerations with more than 50°0 of the
contractions
 Implication: The hypoxic stress of the uterine contraction causes slowing of
the FHR… DONE in LATE PREGNANCY
C. Equivocal / Suspicious
 Shows non-persistent late deceleration or decelerations associated with
hyperstimulation
(Contraction frequency of every 2 mins or duration of
longer than 90 seconds)
Nursing Responsibility
- Explain!
- Semi-fowlers!
- Assess and monitor!
7 Percutaneous Umbilical Blood Sampling (PUBS)
° Obtaining a fetal blood sample from a placental vessel of from the umbilical cord
° May be used to give a blood transfusion to an anemic fetus :O!
° Use:
1. Identifies fetal conditions that can be diagnosed only with a blood sample
2. Blood transfusion for fetal anemia
8 Lecithin-to-Sphingomyelin (L/S) Ratio
I. Use:
4 Evaluate: Lungs ----- mature
4 22
nd
– 24
th
week of pregnancy: Production of SURFACTANT
- 2:1 Ratio (2L:1S)
¬ Amniocentesis
4 SHAKE!
- If there are bubbles, it means the lungs are mature
¬ For DM Clients
4 L/S is not ACCURATE!!
9 Biophysical Profile
I. FHR and Reactivity (NST)
II. Fetal Breathing, Movement
III. Fetal Body Movements
IV. Fetal Tone (Closure of the hand)
V. Volume of amniotic fluid (AFI)
- Biophysical profile is used to check the CNS function of the FETUS~
Use:
o Fetal oxygenation with poor placental function
o + Placental function is poor - + amniotic fluid
o Fetal hypoxia + ¬ FHR changes occur 1
st
followed by cessation of fetal breathing
movement, cross body movement and finally loss of fetal tone
Scoring the Biophysical Profile
Observation Normal (2 pts) Abnormal (0 pts)
1. Non-Stress Test Reactive Non-reactive
2. Fetal Breathing
Movement
During 30 minute observation period
One breathing period lasting at
least 60 seconds
Breathing period less than 60
seconds or no breathing observed
3. Fetal Body Movement
During 30 minute observation period
3 Discrete and definite
movements of the arms, legs or
body
Less than 3 discrete movements
of arms/legs or body
4. Fetal Muscle Tone
During 30 minute observation period
Arms and legs are usually flexed
with head on chest. One definite
extension and return to flexion
Arms and legs are usually flexed
with head on chest – No flexion
5. Amniotic Fluid Volume Largest pocket of fluid is greater
than 1 cm in vertical diameter
without containing loops of cord
Largest pocket is less than 1 cm
in vertical diameter without loops
of cord
Scoring:
• 8 – 10: Maximal score
• 0 – 4: Severe fetal compromise; delivery indicated
“It’s a new beginning ©….”

Identifies chromosomal abnormalities 2. Check color of amniotic fluid . VS of mother  RhoGam – Nag prick kasi 20 Weeks  EMPTY BLADDER 20 Weeks  FULL BLADDER Late Pregnancy 1.Yellow = Rh Incompatibility Nursing Responsibility~  Informed consent  Provide comfort and privacy  Aseptic technique  Skin  Assess – Infection. HR  15 Bpm for 15 Secs within 10 – 20 minute period Interpretation: - - Reactive (GOOD!! ) o At least 2 accelerations of FHR with fetal movement of 15 bpm lasting 15 secs/more for over 20 mins o 2 – 15beats – 15 secs – 20 mins o Used to determine if the fetus is oxygen compromised Non-Reactive (BAD!! ) o No acceleration after movement o No movement  If no movement. Fetal Movement. instruct client to • Eat HIGH Carbohydrate foods like orange juice (glucose~) • Make NOISE! RAAAAAHH!!!!~~~ o Low Fetal HR variability .Nursing Responsibility~  Rh(D) immune globulin (RhoGam) is given to the Rh negative woman  RhoGam – Inhibits ANTIBODY production of the mother against the Rh positive or negative of the baby  (galing tlga~)  Assess!!!!  Bleeding  Spontaneous Abortions  Rest! ( : 4 Amniocentesis  Done when in 15 – 17 weeks of gestation  Aspirates 20mL of fluid from the amnion of the mother  Instruct mother to INCREASE oral fluid~  Use of Amniocentesis Early Pregnancy 1. Identifies severity of maternal fetal blood incompatibility and assesses fetal lung maturity 5 Non-Stress Test (NST)  Measures the response of the Fetal HR to the Fetal Movement  After 1 or 2 movements. FHR.

- Unsatisfactory Test – If the data cannot be interpreted or there was an inadequate fetal activity Non-reactive = Non-stress Test= NOT GOOD  ! Reactive = Non-stress Test= Really GOOD!  .

6 Contraction Test  Means of evaluating the respiratory function of the placenta  Use:  Identifies the fetus at risk for intrauterine asphyxia by observing the response of the FHR to the stress of the uterine contractions (spontaneous or induced)  Perform Nipple Rolling Interpretation: A. Fetal Body Movements IV. Blood transfusion for fetal anemia Lecithin-to-Sphingomyelin (L/S) Ratio I. it means the lungs are mature  For DM Clients  L/S is not ACCURATE!! Biophysical Profile I. Equivocal / Suspicious  Shows non-persistent late deceleration or decelerations associated with hyperstimulation (Contraction frequency of every mins or duration of 2 longer than90 seconds ) Nursing Responsibility  Explain!  Semi-fowlers!  Assess and monitor! 7 Percutaneous Umbilical Blood Sampling (PUBS)  Obtaining a fetal blood sample from a placental vessel of from the umbilical cord  May be used to give a blood transfusion to an anemic fetus :O!  Use: 1. Use:  Evaluate: Lungs ----. Fetal Breathing. Identifies fetal conditions that can be diagnosed only with a blood sample 2. Fetal Tone (Closure of the hand) 8 9 . Negative (GOOD!! )  Shows 3 contraction of good quality lasting for 40 / more secs on 10 minutes WITHOUT EVIDENCE OF FETAL HR DECELERATION  Implication: Fetus can handle the hypoxic stress of uterine contractions B. FHR and Reactivity (NST) II.mature  22nd – 24th week of pregnancy: Production of SURFACTANT  2:1 Ratio (2L:1S)  Amniocentesis  SHAKE!  If there are bubbles. Positive (BAD!! )  Shows repetitive persistent late decelerations with more than 50°0 of the contractions  Implication: The hypoxic stress of the uterine contraction causes slowing of the FHR… DONE in LATE PREGNANCY C. Movement III.

V. Volume of amniotic fluid (AFI)  Biophysical profile is used to check the CNS function of the FETUS~ .

” . 4. 5. Fetal Body Movement During 30 minute observation period Fetal Muscle Tone During 30 minute observation period Amniotic Fluid Volume Scoring: • 8 – 10: Maximal score • 0 – 4: Severe fetal compromise. delivery indicated “It’s a new beginning …. legs or body Arms and legs are usually flexed with head on chest. amniotic fluid o Fetal hypoxia   FHR changes occur 1st followed by cessation of fetal breathing movement. Non-Stress Test 2.Use: o Fetal oxygenation with poor placental function o  Placental function is poor . One definite extension and return to flexion Largest pocket of fluid is greater than 1 cm in vertical diameter without containing loops of cord Abnormal (0 pts) Non-reactive Breathing period less than 60 seconds or no breathing observed Less than 3 discrete movements of arms/legs or body Arms and legs are usually flexed with head on chest – No flexion Largest pocket is less than 1 cm in vertical diameter without loops of cord 3. Fetal Breathing Movement During 30 minute observation period Scoring the Biophysical Profile Normal (2 pts) Reactive One breathing period lasting at least 60 seconds 3 Discrete and definite movements of the arms. cross body movement and finally loss of fetal tone Observation 1.

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