1st lecture nscm 102 wahaha

8/3/2019 1st Lecture Nscm 102 Wahaha

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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 – 1st

Liver of the Fetus – 2nd

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 (Nobody’s Perfect)

Transvaginal Ultrasound : Transabdominal Ultrasound :EMPTY BLADDER FULL BLADDER




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

0 Done when in 15 – 17 weeks of gestation

0 Aspirates 20mL of fluid from the amnion of the mother

0 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 maturity2. Check color of amniotic fluid

- Yellow = Rh Incompatibility


Informed consent

Provide comfort and privacy

Aseptic technique

Skin

Assess – Infection, FHR, Fetal Movement, VS of mother

RhoGam – Nag prick kasi

20 Weeks 20 WeeksEMPTY 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!! )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

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. 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 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 o f every2 mins or duration o

longer than90 secon ds)

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 sample2. Blood transfusion for fetal anemia

8 Lecithin-to-Sphingomyelin (L/S) Ratio

I. Use:

Evaluate: Lungs ----- mature

22nd – 24th week of pregnancy: Production of SURFACTANT

2:1 Ratio (2L:1S)

Amniocentesis

SHAKE!

If there are bubbles, it means the lungs are mature

For DM Clients

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 1st followed by cessation of fetal breathing

movement, cross body movement and finally loss of fetal tone

Scoring the Biophysical ProfileObservation Normal (2 pts) Abnormal (0 pts)

1. Non-Stress Test Reactive Non-reactive

2. Fetal Breathing

MovementDuring 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 MovementDuring 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 ToneDuring 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 loopsof cord

Scoring:

• 8 – 10: Maximal score

• 0 – 4: Severe fetal compromise; delivery indicated

“It’s a new beginning ….”

1st lecture nscm 102 wahaha

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