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NUR4445 High-Risk Pregnancy (Chapters 10-12, 15, and 17) Exam Study Guide
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NUR4445 High-Risk Pregnancy (Chapters 10-12, 15, and 17) Exam Study Guide...
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NUR4445 High-Risk Pregnancy(Chapters 10-12, 15, and 17) Exam
Study Guide
What are accelerations and decelerations in electronic fetal monitoring (EFM)? - Answer
- Accelerations: indicates fetal movement and shown above the baseline. They need to
be 15 beats above baseline AND lasting 15 seconds.
- Decelerations: decrease or slow down in the heart rate. (Think when you decelerate
your car goes slower)
What is a Non-Stress Test (NST)? What does it tell us about the fetus and how should a
fetus react with this test? - Answer - the tracing of the fetal heart rate
- it can tell us a lot about the status and well-being of the fetus-- tells us the variability of
oxygenation status
- Adequately oxygenated fetus with intact CNS demonstrates accelerated fetal heart
rate (FHR) in response to fetal movement!!
What are some advantages and disadvantages to NST? - Answer - Advantages: quick to
perform; permits easy interpretation; inexpensive; can be done in an office or clinic
setting and no known side effects.
- Disadvantages: sometimes difficult to obtain a suitable tracing; women must remain
relatively still for at least 20 minutes and there is a high false-positive rate
How should a pregnant woman be positioned during NST? - Answer - Positions during
NST include reclining chair or in bed; left-tilted; semi-fowler; side-lying position;
- AVOID supine position because it decreases fetal movement and increases maternal
back pain and SOB.
What outcome do we WANT with NST? - Answer - WE WANT A REACTIVE NST
- Reactive NST: 2 accelerations in 20 minutes!! (accelerations are 15 beats above the
baseline lasting at least 15 seconds so we want 2 in 20)
What are undesired outcomes for NST? When should a physician be notified for further
evaluation of fetal status? - Answer - Undesired outcome for NST: nonreactive and
unsatisfactory NST
- Nonreactive NST means these criteria were NOT met
,- If decelerations are noted, the physician/CNM should be notified for further evaluation
of fetal status.
At what gestation do providers usually recommend beginning fetal movement (FM
counts)? - Answer 28 gestational weeks, Do in a quiet place, give baby OJ or something
before so they are moving from the sugar
What is a contraction stress test (CST)? How does it work and what is it looking for? -
Answer - test evaluates the placental respiratory function (oxygen and carbon dioxide
exchange)
- can identify if fetus is at risk for intrauterine asphyxia. - Uterine contractions cause
stress and we want to see if the fetus can handle it.
- 15 minute baseline tracing of uterine activity and FHR is obtained to look for
spontaneous contractions. It evaluates the FHR tracing.
What outcome do you want with CST? - Answer - Negative: THIS IS WHAT YOU WANT
- Three good quality contractions, lasting 40 to 60 seconds in 10 minutes with no
evidence of late decelerations.
- This indicates normal placenta function and adequate fetal oxygenation. The fetus is
likely to withstand the stress of labor!
Equivocal result in CST - Answer - suspicious
- Inconsistent late decelerations or significant variable decelerations.
- Hyperstimulation shows contraction frequency of every 2 minutes with a late
deceleration or contractions lasting greater than 90 seconds with a late deceleration.
Positive result in CST - Answer - THIS IS BAD
- Repetitive persistent late decelerations with more than 50% of the contractions.
- This means that the fetus oxygenation is being compromised and the fetus will be
unlikely to withstand the stress of labor.
Who is CST contraindicated in (9)? - Answer - Third-trimester bleeding from placenta
previa,
- Marginal abruptio placentae or unexplained vaginal bleeding,
- Previous cesarean with classical incision (vertical incision in fundus of uterus)
- Premature rupture of the membranes,
- Cervical insufficiency (incompetent cervix),
- Cerclage in place,
, - Anomalies of the maternal reproductive organs,
- History of preterm labor (if being done before term),
- Multiple gestations
What is the nurse's role in CST (6)? - Answer - administer the CST
- interpret results
- report findings
- continue assessment
- education
- reassurance to the patient.
What is variability on EFM? - Answer - tells us how WELL the fetus is oxygenated
- It is the scratchiness of the FHR or how much it changes.
Absent variability - Answer - no changes or scratchiness detected
- THIS IS BAD!!
Minimal variability - Answer - the change in those small blocks is 2-5 beats above or
below your baseline
- maybe OK, maybe bad—could mean fetus is progressing to something bad, happens
when fetus is asleep
Moderate variability - Answer - the change in those small blocks is between 6-25 beats
above or below baseline
- this is what we want!!!
Marked variability - Answer - the changes in those small blocks is greater than 25 beats
above or below baseline
- THIS IS BAD
Early decelerations - Answer - MIRROR images of the contractions
- They start when the contractions start and end when the contractions end
- these are OK
Variable decelerations - Answer - abrupt drop >15bpm below baseline, lasting >15 secs
<2min with abrupt return to baseline.
- They may or may not occur with a contraction and are V or W shaped. (Remember V
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