MODULE 2: 1 ST, 2 ND, AND 3 RD TRIMESTER NURSING CARE By Professor A. Portzline 8/2010.
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Transcript of MODULE 2: 1 ST, 2 ND, AND 3 RD TRIMESTER NURSING CARE By Professor A. Portzline 8/2010.
IN THIS MODULE WE WILL :
Discuss things that occur during prenatal appointments, up until labor begins
Introduce you to electronic fetal monitoring
Please note- this Module only covers the normal course of pregnancy. We will discuss abnormal aspects in Module 4.
A woman calls her OB’s office and says she took a pregnancy test, and it was positive. She’s very excited!
SO WHAT HAPPENS NOW?
Usually the first prenatal appointment occurs between
8-10 weeks gestation.
The earliest a woman can discover she’s pregnant is 5
days before her menses is due. This is different for
each woman, but typical menstrual cycles are
considered 28 days.
THE 1ST TRIMESTER= WEEKS 1 TO 13
During the first OB appointment, the woman
is interviewed by the nurse, who completes a
health history called the Hollister form
(named after the man who created the form).
Prenatal labs are drawn at this time.
A med check is done
to ensure the woman is
taking a prenatal
vitamin and that none
of her meds are
contraindicated in
pregnancy.
A transvaginal
ultrasound may be
done to measure
length and auscultate
the fetal heartbeat.
Many things occur during the 2nd
trimester:
1. If her blood is Rh negative, she receives
Rhogam between 24- 28 weeks.
2. Optional amniocentesis and/or genetic
testing to determine the risk of syndromes.
3. 1 hour glucola test ~28 weeks.
4. Fetal monitoring occurs at OB appointments,
starting ~24 weeks.
AM
NIO
CE
NT
ES
IS
Under the
guidance of
ultrasound, a
needle enters
the amniotic
sack through the
woman’s
abdomen and
draws a sample
of amniotic fluid.
This is tested
for various
genetic
syndromes, like
Downs (aka
Trisomy 21).
THE GLUCOLA TEST
Checks for gestational diabetes mellitus.
A fasting blood glucose level is drawn, then the patient
drinks a glucose solution.
A 1 hour blood glucose level is drawn to check her
metabolism of the glucose solution. Any value
> 130mg/dL is considered abnormal.
This will be discussed at length in Module 4.
Explore this website for details if you’re curious:
Gestational Diabetes
INTRODUCTION TO FETAL MONITORING
View this patient educational video first: http://www.youtube.com/watch?v=DvcDXvlCXAE
Fetal monitoring can be:
external, using a tocodynamometer or toco and an electronic fetal monitor disc or EFM.
internal, using an intrauterine pressure catheter or IUPC and a fetal scalp electrode or FSE. These can only be used once the amniotic sack is ruptured.
or a combination of the above.
Please read this fetal monitoring article
Intro to fetal heart rate monitoring
Please read an overview about fetal heart rate monitoring here: http://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/electronic_fetal_heart_monitoring.htm#Variable%20decelerations
You are responsible to know: tachycardia, bradycardia, baseline heart rate, accelerations, variability (long-term only), contraction pattern, early, late and variable decels.
Please contact me with any questions. I’m here to help you!
Don’t be overwhelmed by all this new info. You will come to understand it.
Module 3 will continue with info about electronic fetal monitoring.
Thank you for viewing this presentation.
REFERENCES
Edwards Hospital. (2010). Fetal monitoring. Retrieved from http://www.youtube.com/watch?v=DvcDXvlCXAE
Medline Plus. (2010). Fetal heart monitoring. Retrieved from http://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/electronic_fetal_heart_monitoring.htm#Variable%20decelerations
Norman, J. (2010). Diagnosing diabetes. Retrieved from http://www.endocrineweb.com/diabetes/diagnosis.html
The Brookside Associates Medical Education Division. (2009). Electronic fetal heart monitoring. Retrieved from http://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/electronic_fetal_heart_monitoring.htm#Variable%20decelerations