L&D PP

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Anonymous
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248587
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L&D PP
Updated:
2013-11-22 23:59:18
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Nursing Childbearing
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Nutrition and AP Testing
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  1. Your client is 10 weeks pregnant and there is 
    a family history of Tay-Sachs disease.  
    She would like prenatal testing to determine 
    if her child has this genetic condition.
     At this point in her pregnancy, the client is 
    a candidate to have which prenatal genetic
     test?  
    Students' responses:   Chorionic villus sampling, Done at 10-12 wks.
  2. Your client is 35  6/7 weeks gestation and is
     having amniocentesis.  Identify a test that
     would be performed at this time during her
     pregnancy on the amniotic fluid sample.  
     
    • Students' responses:  Client is in third trimester:  Lung maturity, L/S ratio (>2:1= mature) and presence of PG= mature.
    • Key Point:  Genetic testing, alpha-feto protein levels are usually performed in 
    • first trimester.   
  3. Your client is 17 weeks gestation and is 
    having amniocentesis after having an 
    abnormal Quadruple Screen.  Identify 
    what test could be performed on the 
    amniotic fluid sample. 
    Students' responses:  Patient is 17 wks gestation, in this case we could do alpha-feto protein levels or genetic testing.  Key Point: We would not do fetal lung maturity since fetus is only 17 weeks gestation and also is not viable (viability is 20 weeks gestation).  These two tests are done in the third trimester when determining if fetus is delivered preterm would the fetus experience respiratory distress syndrome (RDS)
  4. Your client is 35 weeks gestation and her 
    non-stress test was non-reactive.  
    You anticipate that what test would be 
    ordered at this time? 
    • Students' Answers:   BPP or CST 
    • (if not contraindicated)
  5. You are to initiate a Contraction Stress Test
     (CST) on a client who is 36 weeks gestation.
      The client has just had a non-reactive 
    Non-stress test (NST).  Identify what 
    contraindications to having a CST you
     should look for in the client’s history 
    before starting the CST.   
    Students' answers:  HIstory of preterm labor and PROM, vaginal bleeding, previous cesarean birth with classic incision, incompetent cervix
  6. Contraction Stress Test (CST), which 
    interpretation (result) is reassuring, 
    indicating there is no uteroplacental 
    insufficiency.  
    Student's responses: Negative CST indicates no uteroplacental insufficiency. Baby's heart rate does not decelerate and stay low after contractions, no late decelerations.
  7. When during the pregnancy, is the Fetal 
    Nuchal Scan performed, why and how it 
    is performed?  
    Students' responses: Fetal Nuchal Translucency is performed 11-13 weeks, it is an ultrasound used to help identify excess fluid on back of fetus' neck that can indicate Trisomies 13, 18, and 21.
  8. With a Contraction stress test, you are 
    looking for what fetal heart rate change
     occurring in response to  
    Students' answers: contractions. Looking for  late decelerations occurring with contractions (uteroplalcental insufficiency)
  9. With a Non-stress test, you are looking 
    for what fetal heart rate change occurring 
    in response to:  
     
    Students' answers: Looking for acceleration of FHR occurring with fetal movement. Need 2 instances within 20 minutes. (tests fetal well-being)
  10. Which client has Physiologic anemia of 
    pregnancy and which client has pathologic 
    anemia:  
    a)  HCT/Hb   34/12  
     b)  HCT/Hb   30/10  
    • a)  HCT/Hb   34/12  Physiologic anemia of pregnancy (normal change with pregnancy)
    • b)  HCT/Hb   30/10  Pathologic anemia (This patient was anemic before pregnancy & takes iron during pregnancy
  11.  Briefly give a case where a NST would be
     performed and a case where a CST would
     be performed. 
    • NST:  Diabetes, HTN, IUGR, a woman experiences <3 fetal movements in one hour ("kick count").  
    • CST: If NST was non-reassuring and mother did not have contra-indications for having a CST
  12. Your client is 32 weeks gestation and her pregnancy has been progressing without complications. She presents to the prenatal clinic reporting that she has not been feeling much fetal movement this morning. What non-invasive test may be performed on the client at this time?
    • NST or BPP (this test includes an ultrasound)
    • Key point: contraction stress test (CST) in more invasive since it requires starting an Iv

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