What is the 3rd trimester goal?
to determine whether the intrauterine environment continues to be supportive to the fetus.
What is a NST?
Performed easily & quickly in an outpatient setting.
Test is usually completed within 20-30 minutes, but may be required if fetus needs to be awakened
What is the most common cause for a nonreactive test?
common absence of FHR accelerations is the quiet fetal sleep state.
What can the nurse do to stimulate fetal movements?
suggest that a woman drinks OJ to increase her blood sugar level
What test is performed after a nonreactive NST?
The test is often extended an additional 20 minutes, and if it does not meet the criteria after 40 min a CST & BPP is usually performed
What is a reacitive result of a NST?
Two accelerations in a 20 min period each lasting 15 sec and peaking at least 15 breat/min above baseline
what is a nonreactive test for NST show?
a test that does not produce 2 or more qualifying accelerations in a 20 min period
What does vibroacoustic stimulation do?
often used to stimulate fetal activity if the initial NST results are nonreactive
How long does a vibroacoustic stimulation test take to complete?
takes approx 15 min to complete with fetus monitor for 5-10 before stilulation to obtain baseline FHR.
If baseline pattern is non-reactive the sound source is then activated for 3 sex on maternal abdomen over fetal head.
Monitoring contiues for 5 min
Can a vibroacoustic test be repeated?
Yes @ 1 min intervals up to 3x when there is no responce.
If results is non reactive in vibro and NST what else do you do?
BPP and CST
What is a CST?
Contraction Stress Test
Identifies the jeoparidized fetus who is stable @ rest but shows evidence when exposed to stress of UC.
What is the cons of CST?
- 1. More time consuming
- 2. More expensive
In CST, what does late decels show?
What is the procedure of a CST?
- 1. semi-fowler position
- 2. monitored electronically by fetal ultrasound & toco
- 3. Observered for 10-20 min for baseline, variability & occure of contractions
What are the 2 types of CST?
- 1. Nipple Stimulation Contraction Test
- 2. Oxytocin Stimulation contraction test
How do you do the Nipple stimulation contraction test?
- 1. apply warm H2O w/washcloth to both breasts for several min
- 2. massage 1 nipple for 10 min through clothes for 2 min
- 2. Rest for 5 min, repeat cycles & rest as necessary to achieve uterine activity
What is an adequate contraction for CST nipple stimulation test?
UC lasting more than 90 sec ir 5 or moe contractions in 10 min
What is an oxytocin stimulated contraction test?
IV of oxytocin to stimulate UC.
How is the oxytocin hung in the CST?
piggyback & delivered by pump
What rate do you hang the oxytocin for CST?
begin at 0.5 milliunits/min double the dose every 20 min until 3 UC of good quality lasting 40-60 sec observed within 10 min period.
When performing a CST, using a oxytocin stimulator, what dose is usually enough to get adeqaute UC?
When performing a CST, what is a major SE that you need to monitor?
When you have results of CST, what does a negative indicate?
no late decels observed, repeat in 1 week
When you have results of a CST, what does POSITIVE indicate and what are its associations??
- 1. Intrauterine fetal death
- 2. late fetal decels in labor
- 3. IUGR
- 4. meconium stained amniotic fluid
When would you hospitalize a patient for CST & why?
Positive results to watch for close observation, or delivery or both
When performing a CST, what do you WANT?
3 contractions lasting 60-90 sec in 10 min
True or False:
When performing a CST, increase in FHR is good.
When performing a CST, and you have a decrease in FHR then rebound what type of heart rate is that?
Early decelerations: okay
When performing a CST, and you have a late decelerations what does that indicate and what do you do?
hypoxia and you stop delivering oxytocin
When women are dx with a high risk pregnancy, her & her family will likely experience what?
stress r/t dx
When dx with a high risk pregancy women experience many emotions, what are some normal psychological responses?
- low self esteem/guilt
- inability to function