Directions: You are the admitting nurse in the labor and delivery suite. Annie J
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Directions: You are the admitting nurse in the labor and delivery suite. Annie Jackson es to PA g A your unit in early labor. Answer the following questions completely, thoroughly, and usin format. Thi s clinical preparation assignment is due to clinical instructor 72 hours after your last clinical day es 1. On arrival, Annic's has mild contractions that last 30 seconds and occur every 5 minut What three terms are used to describe contractions Annie is having? 2. Discuss performing Leopold's maneuvers and how Annie should be prepared. What is the purpose of using Leopold's maneuvers? 3. Annie notices that the monitor displays a heart rate of 134 and asks, "What should my baby's heart rate be?" What do you tell her? Define fetal baseline, fetal tachycardia, and fetal bradycardia. 4. You place Annie on an external electronic fetal monitor. When should the external electronic fetal monitor be used instead of the internal fetal monitor? 5. The monitor displays characteristics of a reassuring fetal heart rate pattern. What does that 6. Discuss fetal variability 7. What is the difference between early, late, and variable decelerations? mean 8. Annie feels a gush of fluid from her vagina. She immediately sits up and attempts to ambulate to the bathroom. What has occurred and what should be your next interventions? A sterile vaginal examination is to be performed on Annie. How should she be positioned? 10. What information will the vaginal examination provide? 11. During the vaginal exam, you can feel a firm surface against the cervix and a softer triangular shape in the upper right portion (between 12 and 3 on a clock). You also notice a small amount of blood. What is the presentation and position of the fetus and what causes the blood. 12, Annie's cervix has dilated to 5cm and she is 100% effaced. She asks what that means and how much longer she has to go. What do you tell her? 13. Annie complains of a dry mouth and wants a diet coke to drink. What nourishment is recommended for the laboring woman?Explanation / Answer
Q. 1: Here are the three types of contraction you are likely to encounter:
1. Practice Contraction: They may occur anytime during your pregnancy and not necessarily at the full term. In medical term, they are known as Braxton Hicks contractions. Practice contractions do not occur necessarily in every pregnancy.
2. False Contractions: (Braxton-Hicks contractions): They occur prior to your actual contractions, helping the cervix to get ready for delivery. They are intermittent and stop when your body position changes. Usually they don’t cause cervical effacement (dilation). False contractions may start well in advance or just prior to the actual contractions, it varies from case to case.
3. Actual Contractions: They are easily noticeable because the pain is persistent and intense. It doesn’t stop even if your body position changes. Frequency and intensity increase with time and may be accompanied by diarrhea or upset stomach. Cramps are also quite common. Actual contractions can be identified by pain in lower back, lower abdomen and upper thighs. It is followed by reddish discharge and rupture of the membrane (water break).
Q. 2.
Leopold's Maneuvers are a common and systematic way to determine the position of a fetus inside the woman's uterus; they are named after the gynecologist Christian Gerhard Leopold. They are also used to estimate term fetal weight.
The maneuvers consist of four distinct actions, each helping to determine the position of the fetus. The maneuvers are important because they help determine the position and presentation of the fetus, which in conjunction with correct assessment of the shape of the maternal pelvis can indicate whether the delivery is going to be complicated, or whether a Cesarean section is necessary.
First maneuver: Fundal Grip
While facing the woman, palpate the woman's upper abdomen with both hands. A professional can often determine the size, consistency, shape, and mobility of the form that is felt. The fetal head is hard, round, and moves independently of the trunk while the buttocks feel softer, are symmetric, and the shoulders and limbs have small bony processes; unlike the head, they move with the trunk.
Second maneuver: Umbilical Grip
After the upper abdomen has been palpated and the form that is found is identified, the individual performing the maneuver attempts to determine the location of the fetal back. Still facing the woman, the health care provider palpates the abdomen with gentle but also deep pressure using the palm of the hands. First the right hand remains steady on one side of the abdomen while the left hand explores the right side of the woman's uterus. This is then repeated using the opposite side and hands. The fetal back will feel firm and smooth while fetal extremities (arms, legs, etc.) should feel like small irregularities and protrusions. The fetal back, once determined, should connect with the form found in the upper abdomen and also a mass in the maternal inlet, lower abdomen.
Third maneuver: (1st pelvic grip)
In the third maneuver the health care provider attempts to determine what fetal part is lying above the inlet, or lower abdomen.[2] The individual performing the maneuver first grasps the lower portion of the abdomen just above the pubic symphysis with the thumb and fingers of the right hand. This maneuver should yield the opposite information and validate the findings of the first maneuver. If the woman enters labor, this is the part which will most likely come first in a vaginal birth. If it is the head and is not actively engaged in the birthing process, it may be gently pushed back and forth. The Pawlick's Grip, although still used by some obstetricians, is not recommended as it is more uncomfortable for the woman. Instead, a two-handed approach is favored by placing the fingers of both hands laterally on either side of the presenting part.
Fourth maneuver: (first Pelvic Grip)
The last maneuver requires that the health care provider face the woman's feet, as he or she will attempt to locate the fetus' brow. The fingers of both hands are moved gently down the sides of the uterus toward the pubis. The side where there is resistance to the descent of the fingers toward the pubis is greatest is where the brow is located. If the head of the fetus is well-flexed, it should be on the opposite side from the fetal back. If the fetal head is extended though, the occiput is instead felt and is located on the same side as the back.
Q. 4.
External Fetal Heart Rate Monitoring: There are two different ways to monitor your baby’s heartbeat externally:-
Auscultation: Fetal auscultation is done with a small, hand-sized device called a transducer. Wires connect the transducer to a fetal heart rate monitor. Your doctor will place the transducer on your abdomen so that the device will pick up your baby’s heartbeat. Your doctor will use the transducer to monitor your baby’s heartbeat at set times throughout your labor. This is considered routine for low-risk pregnancies.
Electronic Fetal Monitoring (EFM): Your doctor will also use EFM to monitor how your baby’s heart rate responds to your contractions. To do this, your doctor will wrap two belts around your abdomen. One of these belts will record your baby’s heart rate. The other belt measures the length of each contraction and the time between them.
Internal Fetal Heart Rate Monitoring: This method is used if your doctor is unable to get a good reading from EFM, or if your doctor wants to closely monitor your baby. Your baby’s heart rate can only be measured internally after your water has broken. Your doctor will attach an electrode to the part of your baby’s body that is closest to the cervical opening. This is usually your baby’s scalp. They may also insert a pressure catheter into your uterus to monitor your contractions.
Q. 6.
Baseline Fetal Heart Rate Variability
Baseline variability is defined as fluctuations in the fetal heart rate of more than 2 cycles per minute. No distinction is made between short-term variability (or beat-to-beat variability or R-R wave period differences in the electrocardiogram) and long-term variability.
Grades of fluctuation are based on amplitude range (peak to trough):
Absent variability = Amplitude range undetectable
Minimal = < 5 BPM
Moderate = 6 to 25 BPM
Marked = > 25 BPM
The tracing to the right shows an amplitude range of ~ 10 BPM (moderate variability).
A sinusoidal pattern has regular amplitude and frequency and is excluded in the definition of variability. A sinusoidal pattern has a smooth, undulating pattern, lasting at least 10 minutes with a fixed period of three to five cycles per minute and amplitude of 5-15 bpm. Short-term variability is usually absent.
Persistently minimal or absent FHR variability appears to be the most significant intrapartum sign of fetal compromise. On the other hand, the presence of good FHR variability may not always be predictive of a good outcome. Etiologies of decreased variability: Fetal metabolic acidosis, CNS depressants, fetal sleep cycles, congenital anomalies, prematurity, fetal tachycardia, preexisting neurologic abnormality, normal, betamethasone.
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