Maternal/ Newborn Intrapartum/ Labor & Delivery HESI Review_Latest Update 2022 with all the chapters covered

Daily kick counts • Fetal movement is a good sign of fetal well-being. • Clients do not always feel the fetus movement; however, they should be able to feel at least 10 movements in any given 2-hour period. • Client teaching should be done by the third trimester and needs to include instructions on how to count movement and to notify the provider if they have no fetal movement for a period (like 12 hours). • If fetal movement does not reach 10 movements in one hour, the client is instructed to drink a few ounces of orange juice and monitor for another hour (total 2 hours). • Remember, anything that depresses the mom’s CNS will also depress the fetal CNS. Ultrasound • Ultrasound is a non-invasive procedure that is safe throughout the pregnancy. The test checks different things in each of the 3 trimesters. Remember: 1st trimester is 1 through 13 weeks; 2nd trimester is 14 through 26 weeks; and 3rd trimester is 27 through 40 weeks. Review your HESI manual on page 251 to see what is assessed during each of the trimesters! • One of the most common reasons for doing an ultrasound in the 2nd trimester (14-26 weeks) is to assess if fetal growth matches the gestational age. Remember that all normal fetus grows the same up to 20 weeks because organs are being formed. Individual growth and weight vary after 20 weeks. • Nursing consideration for an ultrasound: full bladder until 22 weeks, then after that, they should have an empty bladder. • An ultrasound is an ideal test if the pregnant client is unsure of the date of her last menstrual period. Biophysical Profile (BPP) • BPP is an accurate indicator of fetal well-being. Higher the score the better. • There are five assessments done do determine a BPP score. Four ultrasound data includes fetal breathing, movement, heart rate, amniotic fluid index, and then the result of a non-stress test. Amniocentesis • An amniocentesis may be done for several reasons. It is an invasive procedure so there needs to be a medical indication for one. The risk may be minimized by using ultrasound during the procedure. If a client complains of low back pain with pelvic cramping following the procedure, it is imperative that they are assessed for complications from the procedure. • RhoGam should be given following the procedure if the client is RH negative. • If done for genetic concerns, remember that a high alphafetalprotein (AFP) may indicate a neural tubal defect; low may indicate trisomy 21 • Nursing consideration for an ultrasound: full bladder until 22 weeks, then after that, they should have an empty bladder. • Also used for assessing fetal lung maturity - L/S & S/A ratios 2:1 (see table 10-4) 1