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1st Lecture High Risk Prenatal Client NCM102
1st Lecture High Risk Prenatal Client NCM102
Diagnostic Tests
1. Ultrasonography Transvaginal Ultrasound: Transabdominal Ultrasound:
A. Transvaginal Ultrasound EMPTY BLADDER FULL BLADDER
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 womans abdomen
Instruct client to HAVE A FULL BLADDER
Nursing Responsibility~
Inform~
Provide COMFORT and PRIVACY
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
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, 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
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!! )
Shows repetitive persistent late decelerations with more than 500 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
Nursing Responsibility
Explain!
Semi-fowlers!
Assess and monitor!
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 1st followed by cessation of fetal breathing
movement, cross body movement and finally loss of fetal tone
Scoring:
8 10: Maximal score
0 4: Severe fetal compromise; delivery indicated