Antepartum Testing Case Study (45 min)
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Outline
A 38-year-old female is 27 weeks pregnant and hasn’t felt the baby move as she has been. The vital signs are as follows:
HR 110 bpm
RR 20 bpm
BP 98/55 mmHg
Temp 97.6°F
Fetal HR 133
The doctor has ordered a non-stress test due to the mothers age and the decrease of fetal movements. The nurse explains the procedure to the patient and prepares her to begin testing.
How many transducers does the nurse need?
- Two. One for mother and one for baby.
What instructions does the nurse need to give the patient?
- Anytime she feels fetal movements to push the button.
The testing is underway and the patient presses the button. The nurse notes the fetal heart rate has stayed at 130 bpm and has not changed. This happens 2 more times with the same results.
What do these results this mean? What are the implications?
- The test results are “non-reactive”
- A non-reactive stress test indicates the baby may not be okay. Further testing is warranted!
The doctor decides to further testing by performing a contraction stress test. The nurse knows that she needs to prepare the patient for this by explaining the medication and how it will feel.
What medication is given during a contraction stress test? How would you explain this procedure and medication to the patient?
- Oxytocin (Pitocin)
- This medication is given to initiate uterine contractions to see how your baby will respond to that stress. We will do the same procedure as before and see how the baby’s heart rate reacts when a contraction occurs.
Does the nurse need to get any additional equipment to perform this test?
- The nurse needs to start an IV line to administer the Oxytocin, if one is not already available, but the rest of the monitoring equipment is the same.
The patient is prepared and the Pitocin is administered. The patient presses the button and the nurse notes on the fetal heart monitor that the heart rate has risen to 150 bpm. This result is confirmed 2 more times.
What does this test result mean?
- The test result is “reactive” and that baby is ok.
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