ATI Capstone Maternal Newborn Assessment Updated 2023

ATI Capstone Maternal Newborn Assessment Updated 2023 leopold maneuvers - - performing external palpations of the maternal uterus through the abdominal wall to determine the number of fetuses, the presenting part, fetal lie, fetal attitude, degree of descent of the presenting part into the pelvis, and the location of the fetus's back to assess the fetal heart tones vertex presentation - Fetal heart tones should be assessed below the mother's umbilicus in either the right or left lower quadrant of the abdomen breech presentation - Fetal heart tones should be assessed above the mother's umbilicus in either the right- or left-upper quadrant of the abdomen. considerations - - ask the client to empty the bladder before beginning the assessment - place client in supine position with a pillow under the head, and have both knees flexed - place a small , rolled towel under the client's right or left hip to displace the uterus off the major blood vessels to prevent supine hypotensive syndrome intermittently auscultate during the latent phase - - every 30-60 minutes intermittently auscultate during the active phase - - every 15-30 minutes intermittently auscultate during the second stage - - every 5-15 minutes indications for leopold maneuvers - - determine active labor - rupture of membranes spontaneously or artificially - preceding and subsequent to ambulation - prior to following administration of or a change in medication analgesia - at peak action of anesthesia - following vaginal examination - following expulsion of an enema - after urinary catheterization - abnormal or excessive uterine contractions normal FHR - 110-160 w/ increases and decreases from baseline continuous electronic fetal monitoring - - accomplished by securing an ultrasound transducer over the clients abdomen, which records the FHR pattern and a tocotransducer on the fundus that records the uterine contraindications indications for electronic fetal monitoring - - multiple gestations - oxytocin infusion - placenta previa - fetal bradycardia - maternal complications - intrauterine growth restriction - post-date gestation - active labor - meconium stained amniotic fluid - abruptio placentae - abnormal nonstress test or contraction stress test - abnormal uterine contractions - fetal distress Three Tier System - - fetal monitoring system with FHR interpretation system - category 1 - - baseline FHR of 110-160 /min - baseline FHR variability: moderate - accelerations present or absent - early decelerations: present or absent - variable/late decelerations: absent Category 2 - - tracings include all FHR tracings not categorized as category 1 or 3. - baseline rate (tachycardia, bradycardia not accompanied by absent baseline variability) - baseline FHR variability (minimal baseline variability, absent baseline variability not accompanied by recurrent decelerations, marked baseline variability) - episodic or periodic decelerations ( prolonged FHR decel equal or greater than 2 min but less than 10 min, recurrent late decelerations w/ moderate baseline variability, recurrent variable decels w/ minimal or moderate baseline variability - variable decels w/ additional characteristics including overshoots, shoulders, or slow return to baseline FHR category 3 - - FHR tracings include either sinusoidal pattern, absent baseline FHR variability (recurrent late/variable decels, bradycardia) - increment, acme, decrement increment uterine contractions - - beginning of the contraction as intensity is increasing adme uterine contractions - - peak intensity of the contraction - decrement uterine contractions - - the decline of the contraction intensity as contraction is ending accelerations - - Variable transitory increase in the FHR above baseline causes of accelerations - - healthy fetal/placental exchange - vaginal exam - fundal pressure - intact CNS response to fetal movement - uterine contractions - fetal scalp stimulation nursing interventions for accelerations - - be reassuring - no interventions required - indicate reactive nonstress test fetal bradycardia - - FHR less than 110/min for 10 min or more causes of fetal bradycardia - - uteroplacental insufficiency - umbilical cord prolapse - materanl hypotension - prolonged umbilical cord compression - anesthetic medications - fetal congenital heart block - viral infections - maternal hypoglycemia - fetal heart failure - maternal hypothermia nursing interventions for fetal bradycardia - - discontinue oxytocin if being administered - assist the client to a side-lying position - administer oxygen by mask at 10 L/min via non-rebreather face mask - insert IV catheter if one is not in place and administer maintenance IV fluids