Contraction Stress Test

DESCRIPTION
Assesses placental oxygenation and function
Determines fetal ability to tolerate labor and determines fetal well being
Fetus is exposed to the stressor of contraction to assess the adequacy of placental perfusion under simulated labor
conditions
Performed if nonstress test is abnormal

IMPLEMENTATION
The external fetal monitor is applied to the mother, and a 20 to 30 minute baseline strip is recorded.
The uterus is stimulated is stimulated to contact either by the administration of a dilute dose of oxytocin (Pitocin) or
by having the mother use nipple stimulation until 3 palpable contractions with a duration of 40 seconds or more in a
10 minute period have been achieved.
Frequent maternal BP readings are done, and the client is monitored closely while increasing doses of oxytocin are
given.

RESULTS
Negative Contraction Stress Test
Represented by no late or variable deceleration of the fetal heart rate

Positive Contraction Stress Test

(Abnormal)
Represented by no late variable deceleration with 50% or more of the contractions in the absence of hyperstimulation
of the uterus

Equivocal
Contains decelerations but with less than 50% of the contractions, or the uterine activity shows a hyperstimulated
uterus

Unsatisfactory
Adequate uterine contractions cannot be achieved, of the FHR tracing is not of sufficient quality for adequate
interpretation

Heimlich Maneuver
Stand behind the victim
Place arms around the victim’s waist
Make a fist
Place the thumb side of the fist just above the umbilicus (belly button) and well below the xiphoid process
Perform five quick in and up thrusts (between the umbilicus and xiphoid process)
Use chest thrusts for the markedly obese or for advanced pregnancy victim

Nonstress Test (NST)

DESCRIPTION
Performed to assess placental function and oxygenation
Determines fetal well-being
Evaluates fetal heart rate (FHR) in response to fetal movement

IMPLEMENTATION
External ultrasound transducer and the tocodynamometer (toco) are applied to the mother, and a tracing of at least 20
minutes duration is obtained so that the FHR and the uterine activity can be observed
Obtain baseline blood pressure and monitor BP frequently
Position mother in the left lateral position to avoid vena cava compression
Ask mother to press a button every time she feels fetal movement
The monitor records a mark at each occurrence of fetal movement, which is used as a reference point to assess FHR
response

RESULTS
Reactive Nonstress Test (Normal/Negative)
Indicates a healthy fetus
Two or more fetal heart rate accelerations of at least 15 beats per minute, lasting at least 15 seconds from the
beginning of the acceleration to the end, in association with fetal movement, during a 20 minute period

Nonreactive Nonstress Test (Abnormal)

No accelerations or accelerations of less than 15 beats per minute or lasting less than 15 seconds in duration during a
40-minute observation
Unsatisfactory
Cannot be interpreted because of the poor quality of the FHR

Pyramid Points
Do not interrupt CPR for more than 5 seconds
STOP CPR ONLY IF:
Pulse and respiration return
Emergency Medical System arrives
The rescuer becomes exhausted
A physician declares the victim dead

Client teaching
LEG AND HIP EXERCISES
Instruct the client to press the back of the knees against the bed, and then to relax the knee
This contracts and relaxes the thigh and calf muscles to prevent thrombus formation
Instruct the client to rotate each foot in a circle at least ten minutes an hour
Have the client flex the knee and thigh, straighten the leg up in the air, and hold for 5 seconds before lowering,
performing the exercise ten times per day

COUGHING AND DEEP-BREATHING EXERCISES

Instruct the client that a sitting position gives the best lung expansion for coughing and deep-breathing exercises
Instruct t the client to breathe deeply three times, inhaling through the nostrils and exhaling through the mouth
Instruct the client that the third breath should be held for 3 seconds, then the client should forcefully cough out three
times
The client should perform this exercise every 2 hours

SPLINTING INCISION
If the surgical incision is abdominal or thoracic, instruct client to place a pillow, or one hand with the other hand on
the top, over the incisional area
During deep breathing and coughing, the client presses gently against the incisional area to splint or support it

INCENTIVE SPIROMETRY
Instruct client to assume a sitting position
Instruct client that lips need to cover the mouthpiece completely
Instruct client to inhale slowly and maintain a constant flow through the unit
When maximal inspiration is reached, client should hold the breath for 2 to 3 seconds and then exhale slowly
Instruct client that the number of breaths should not exceed 12 breaths per minute

KICK TEST (Fetal Movement Counting)

1. Mother lies down on the left side for 1 hour after meals and counts fetal kicks for 30 minutes
2. Instruct client to notify physician or health care provider if there are fewer than 5 kicks in 1 hour

TORCH Syndrome

Infection Characteristics
Toxoplasmosis - Protozoan infection
- Produces no serious effects in the mother
- Can be transmitted to the fetus
- Can result in severe physical and developmental abnormalities
- Common carriers include cat feces and raw beef

Other Infections - Such as syphilis

Rubella - Systemic viral infection

- Causes congenital rubella syndrome, which include congenital heart
disease, cataracts, growth retardation, and pneumonia if the mother becomes
infected within the first trimester
- Deafness and some learning disabilities can occur if the mother
becomes infected during the first trimester
Cytomegalovirus - A viral infection that persists in the body indefinitely, with periods
of reactivation without symptoms
- Can infect the fetus or infant during delivery or after birth through
breast milk, blood transfusions, or contact with infected secretions

Herpes simplex - Sexually transmitted disease caused by a virus

- Periods of reactivation
- Neonate is commonly infected during delivery by direct contact with
lesions in the genital tract
- Can cause neurological impairment or death

BOX 65-5 Glasgow Coma Scale

MOTOR RESPONSE POINTS
Obeys a simple response = 6
Localizes painful stimuli = 5
Normal flexion (withdrawal) = 4
Abnormal flexion (decorticate posturing) = 3
Extensor response (decerebrate posturing) = 2
No motor response to pain = 1

VERBAL RESPONSE POINTS

Oriented = 5
Confused conversation = 4
Inappropriate words = 3
Responds with incomprehensible sounds = 2
No verbal response = 1

EYE OPENING POINTS

Spontaneous = 4
In response to sound = 3
In response to pain = 2
No response even painful stimuli = 1

Fern Test
1. A microscopic slide test to determine the presence of amniotic fluid leakage
2. Specimen is obtained from the external os of the cervix and vaginal pool
3. Fluid is examined on a slide under a microscope
4. A fernlike pattern occurring from the salts of amniotic fluid indicates the presence of amniotic fluid
5. Implementation
a. Position client in the dorsal lithotomy position
b. Instruct the client to cough to cause the fluid to leak from the uterus if the membranes are ruptured

The Addicted Newborn

A. Description: Newborn who has become passively addicted to drugs that have passed through the placenta
B. Addicting Drugs
1. Heroin
a. Newborn may appear normal at birth with a low birth weight
b. Withdrawal occurs within 12 to 24 hours and may last 5 to 7 days
2. Methadone
a. Withdrawal occurs within 1 to 2 days to one week or more, is most evident at 48 to 72 hours weeks,
and may last 6 days to 8 weeks
b. Newborn appears very ill
c. May develop jaundice due to prematurity
3. Cocaine
a. Causes decreased interactive behavior
b. Feeding problems are present
c. Irregular sleep patterns and diarrhea
d. Major deformities will occur, especially in the renal system
Medications That Can Affect the Surgical Client
ANTIBIOTICS
Potentiate the action of anesthetic agents
If taken for 2 weeks before surgery, aminoglycosides such as gentamicin (Garamycin), tobramycin (Nebcin), and
neomycin (Mycifradin) may cause mild respiratory depression from depressed neuromuscular transmission

ANTIDYSRHYTHMICS
Reduce cardiac contractility and impair cardiac conduction during anesthesia

ANTICOAGULANTS
Alter normal clotting factors and increase the risk of hemorrhaging
Aspirin (acetylsalicylic acid [ASA]) and ibuprofen (Motrin, Advil) are commonly used medications that can alter
clotting mechanism
They should be discontinued at least 48 hours before surgery

ANTICONVILSANTS
Long-term use of certain anticonvulsants can alter the metabolism of anesthetic agents

ANTIHYPERTENSIVE
Can interact with anesthetic agents and cause bradycardia, hypotension, and impaired circulation

CORTICOSTERIODS
Cause adrenal atrophy and reduce the body’s ability to withstand stress
Before and during surgery, dosages may be temporarily increased

INSULIN
The need for insulin after surgery in a diabetic may be reduced, because the client’s nutritional intake is decreased
Stress response and IV administration of glucose solutions can increase insulin dosage requirements after surgery

DUIRETICS
Potentiate electrolyte imbalances after surgery

ANTIDEPRESSANTS
May lower the blood pressure during anesthesia

ANTICHOLINERGICS
Medications with anticholinergic effects increase the potential for confusion