OB NURS 306 REVIEW HARTMAN UPDATED.1. Non-Stress Test (non-induced)
a. Establish baseline (110-160 bpm) Bradycardia: < 110 bpm Tachycardia: > 160 bpm
b. Variability: well oxygenated, and CNS intact, normal cardiac response, fetus well oxygenated
i. If absent hypoxic and acidotic
1. Min...
ob nurs 306 review hartman updated 1 non stress test non induced a establish baseline 110 160 bpm bradycardia lt 110 bpm tachycardia gt 160 bpm b variability well oxygenated
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OB NURS 306 REVIEW HARTMAN UPDATED.
, Exam 1: Chapter 3, 4, 6, 8,
1. Non-Stress Test (non-induced)
a. Establish baseline (110-160 bpm) Bradycardia: < 110 bpm Tachycardia: > 160 bpm
b. Variability: well oxygenated, and CNS intact, normal cardiac response, fetus well
oxygenated
i. If absent hypoxic and acidotic
1. Minimal: < 6 bpm (Causes: hypoglycemia (give juice), hypoxia, placental perfusion
2. Moderate: 6-25 bpm NORMAL
3. Marked: > 25 bpm
c. Leave on for about 20 minutes minimally
d. Accelerations: from baseline 15 and lasts 15 seconds (REACTIVE 2+ acels)
e. NON-REACTIVE: no accel/ minimal variability
f. High risk preg: bi weekly NST from 32-34 weeks
• Q: What do you do if flat strip (no accel./ little variability) on NST?
• A: Give juice and jostle the baby
• Q: when would a charge nurse intervene with another nurse during a NST?
• A: when the RN is giving Pitocin b/c don’t give that with a NST, only CST
• Q: What does progesterone do?
• A: vascularity of uterine wall
• Q: when doing CST and stimulate mom what does results mean?
• A: If they can tolerate it, they most likely can have a natural birth
2. Contraction Stress Test (nipple stimulation and IV Pitocin: once more than 4 contractions in 10 min d/c IV)
a. + CST: abnormal finding, consistent and persistent late decels
b. – CST: normal finding no late deceleration
c. Decelerations are bad: b/c shows can’t tolerate labor (+ test)
i. Generally, goes right to a C-section
d. No late decelerations: negative (-) test
e. Early deceleration: not worried about it (sign of progress)
i. Rounded, start w/ contraction b/c getting head squeeze in canal
ii. Document but not worried about it
iii. Head compression: cerebral blood flow vagal response hr
f. Variable deceleration: caused by cord compression (independent from
contractions) lying flat on back bad
i. V, W, or U shaped, variable in size, shape, and timing to contraction
ii. Document, concerned about it
iii. Reposition mom and likely goes away (reposition to left RS pressure on vena cava)
iv. Oligohydramnios: not enough fluid, so causes cord compression (U-shaped,
sharpy)
• Q: What would you do w/ pt. who has decels b/f contraction?
, Exam 1: Chapter 3, 4, 6, 8,
• A: Check mom and baby, reposition
g. Late deceleration: placental insufficiency: not enough oxygen or blood going to the
baby (dunking head in swimming pool)
i. Rounded in shape
ii. Starts after contraction and ends after, baby runs out of air,
1. IV fluid, oxygen, reposition
h. If decels and baseline is normal, the CNS is still intact, and baby still okay
Variable Cord Compression
Early (shallow) Head Compression
Accelerations Okay
Late Perfusion
i. Intrauterine Fetal Resuscitation: Stop Pitocin 1) reposition first left lateral, O2,
fluid IV
• Q: What would be the minimum amount of time needed b/w contractions?
• A: 60 seconds, b/c 30 seconds is not good b/c run out of air
• Q: What do you do in intrauterine resuscitation?
• A: Change maternal position (left lateral), admin IV bolus fluid max intravascular volume and improve
utero-placental perfusion, Admin O2 10L/min via face mask to improve fetal oxygen status, amnio-
infusion (inject IV fluid (NS) in amniotic fluid (so no compression on baby) Control spontaneous decels…
** if contraction and doesn’t come down and next contraction happens tachycardia systole
3. WATCH FETAL MONITOR VIDEO FOR GOOD INFO ON FETAL MONITORING
4. Categories of Fetal Monitoring
a. Intensity: palpation mild (chin), moderate (nose), strong (forehead)
b. Leopold’s maneuvers: locate the fetal back
i. 1st stage: FH q 30 mins
ii. 2nd stage: FH q 5 mins
c. Category 1 fetal monitoring
i. Good baby: good variability, acceleration (no action required)
d. Category 2: equivocal, in between (decels with okay variability) evaluation/continued monitoring
e. Category 3: or absent variability, late decels (decels with no variability) prompt eval!! May
need intrauterine resuscitation should be initiated
5. Triple Marker (14 to 16 weeks)
a. HCG: make sure the placenta is working (1st trimester)
b. Estriol (estrogen breakdown product: tells if placenta working
c. (AFP) Alpha fetal-protein: blood test
i. If high: neuro tube defect (spina bifida, encephalomegaly)
1. Do ultrasound to alleviate fears (tells structural defect)
a. Tells fetal age (if age matches up w/ size of baby)
ii. If low: chromosome abnormality
1. Commonly Down Syndrome
2. Amniocentesis: have to wait 2 weeks (usually 18 to 20 weeks’ b/c
baby bigger and fluid with needle, baby not hit)
3. Teaching: signs of infection, fever, bleeding, contractions, any signs
of labor
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