NURS 351 Exam 1 Study Guide – Nevada State College

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NURS 351 Exam 1 Study Guide – Nevada State College Genetic testing (like Quadruple screening, AFP, Amniocentesis, Chorionic villi sampling, etc.) ⇒ FALSE: Genetic diagnosis is now available ... as early as the second trimester. ⇒ Fetal nuchal translucency testing: Intravaginal ultrasound to measure fluid in the fetus. ⇒ Administer RhoGAM IM at 28 weeks to patients who are Rh-negative. ⇒ To determine well-being of fetus during pregnancy. Quadruple screening (16-18 weeks gestation): A blood test that ascertains information about the likelihood of fetal birth defects. It does not diagnose the actual defect. It may be performed instead of the maternal serum alpha-fetoprotein yielding more reliable findings. Includes testing for: 1. Human chorionic gonadotropin (hCG): Hormone produced by placenta 2. Alpha-fetoprotein (AFP): Protein produced by fetus 3. Estriol: Protein produced by fetus and placenta 4. Inhibin-A: Protein produced by ovaries and placenta Biophysical profile: Non-reactive non-stress test. Uses a real-time ultrasound to visualize physical and physiological characteristics of the fetus and observe for fetal biophysical responses to stimuli. Variables included in test: • Fetal breathing movement • Fetal tone • Reactive FHR • Amniotic fluid volume < 4 = abnormal 4-6 = abnormal 8-10 = abnormal Contraction stress test: Nipple stimulated CTS consists of a woman lightly brushing her palm across her nipple for 2 min, which causes the pituitary gland to release endogenous oxytocin, and then stopping the nipple stimulation when a contraction begins. The same process is repeated after 5 min rest period. • Oxytocin (Pitocin) administration CST is used if nipple stimulation fails and consists of the IV administration of oxytocin to induce uterine contractions (Contractions started with oxytocin may be difficult to stop and can lead to preterm labor) Indications for this procedure: • Decreased fetal movement • Intrauterine growth restriction (IUGR) • Post maturity • Advanced maternal age AFP (A protein produced by the fetus): - Estriol: Protein produced by the fetus and placenta - Inhibin-A: Protein produced by the ovaries and placenta. • Elevations associated with neural tube defects and multifetal pregnancy; low level may be trisomy 21 (can be done b/w 16-18 weeks) and trophoblastic disease. • A blood test that ascertains information about the likelihood of fetal birth defects. It does not diagnose the actual defect. • Preferred at 16-18 weeks gestation. • Women at risk for giving birth to a neonate who has a genetic chromosomal abnormality. • Low levels of AFP may indicate a risk for down syndrome. • High levels of AFP may indicate a risk for neural tube defect. • Higher levels than the expected reference range of hCG and inhibin – A indicates risk for down syndrome. • Lower levels than the expected reference range of estriol may indicate a risk for down syndrome. Amniocentesis: the aspiration of amniotic fluid for analysis by insertion of a needle transabdominally into a client’s uterus and amniotic sac under direct ultrasound guidance locating the placenta and determining the position of the fetus. It may be performed after 14 weeks of gestation. • Removal of amniotic fluid sample from uterus after 14 weeks of gestation. ⇒ To determine fetal genetic diagnosis (2nd trimester), fetal maturity (last trimester), fetal well-being. ⇒ Usually takes 10 days to 2 weeks to develop cultured cell karyotype – could be well into 2nd trimester before diagnosis is made (making abortion more dangerous) • Genetic disorders • Karyotype: Determines down syndrome (trisomy 21) and sex-linked disorders. • Biochemical analysis: Metabolic disorders (Tay Sachs Disease) Fetal maturity: ⇒ L/S ratio (Lecithin/sphingomyelin): 2:1 ratio indicates fetal lung maturity unless mother is diabetic, has Rh disease, or fetus is septic (2:5:1 or 3:1 at 38 weeks) ⇒ Presence of Phosphatidylglycerol (PG): Most accurate determination of fetal maturity (usually after 35 weeks) absence of PG is associated with RDS. ⇒ Creatinine: Renal maturity indicator > 1.8 Fetal well-being: ⇒ Meconium in amniotic fluid may indicate fetal distress. Nursing responsibilities: ⇒ Baseline V/S and FHR ⇒ {Patient in supine position ⇒ Draw maternal blood sample for comparison with post-procedure blood sample to determine maternal bleeding ⇒ Provide emotional support, explain procedure, remain with client. ⇒ Monitor FHR x 1 hour after procedure and assess for uterine irritability. ⇒ Instruct PTL and SROM. • Administer RhO(D) immune globulin (RhOGAM) to the client if she is Rh-negative (standard practice after amniocentesis for all women who are Rh-negative to protect against Rh isoimmunication). Complications: ⇒ Spontaneous abortion ⇒ Fetal injury ⇒ Infection Remember: When done in early trimester, the bladder must be full to support the uterus for easy access. When done in late pregnancy, the bladder must be empty to avoid puncturing the bladder. Chorionic Villi Sampling (CVS): Ultrasound first, then test. Assessment of a portion of the developing placenta (chorionic villi), which is aspirated through a thin sterile catheter or syringe inserted through the abdominal wall or intravaginally through the cervix under ultrasound guidance and analyzed. • Done between 10-12 weeks, removal of small piece of villi under ultrasound guidance. • To determine genetic diagnosis early in first trimester. • Needs informed consent, placed woman in lithotomy position, may inflect a slight sharp upon catheter insertion. • Complications: Spontaneous abortion (5%), controversy regarding fetal anomalies. - CVS is a first-trimester alternative to amniocentesis with one of its advantages being an earlier diagnosis of any abnormalities. CVS can be performed at 10 to 12 weeks of gestation. Ultrasound: procedure lasting approximately 20 [Show More]

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