Fetal Heart Monitoring Like A Pro

Aren't monitoring. So we're going to go through just the basics of the different monitoring for the fetus and um, what you're seeing and what it means, what is happening. So there's a little helpful pneumonic and it's called veal chop. So
if you guys write it like this on your paper, if you're taking notes, it'll help Seville chop and then I'll go through each one. So the first one, R v is going to be variables and that matches up with our C, right? And the C is going to be cord compression. So the left side letters are going to be what is happening on the Strip and why it is happening is going to be the right side. So variability, let's look at what that's going to look like. Okay. So, um, if you have your contraction monitor paper, you have contractions. Um, I'm not the best artist, so bear with me. Um, even though these are the squiggly lines, so we have contractions and with core compressions having lead variability, so you have a fetal heart rate is going to be on this top, right? So with variability, your heart rate is just kind of all over the place.
So there can be good variability happening. Matches means the baby's awake, the baby's moving around. And that would just be kind of like a steady good movement in the heart rate. Um, with some little clines versus kind of like this little flat line would be no variability. So when this is talking about when we have variability seen that is documented for um, fetal monitoring strip, our heart rates kind of all over the place and this means cord compression is happening. So core compression is going to be, um, like the, either the head is leaning on the cord, baby snuggling up to that thing and it's getting compressed against the uterus or it could be that he or she is pulling on, it's a little bungee cord. Um, whatever it's doing, squeezing it, um, the baby's squeezing it is just causing compression to that cord. So this is not a good thing. Um, but we can easily hopefully fix it. So we can do things like turn the mom side to side to help get that baby off the cord. Um, and stop getting that cord compressed. So that is going to be kind of our, um, big thing we'll do for variability. So that is variability. So core compression ratio. Our next one we're going to talk about is the earliest.
So this is early, the celebrations, so desales for short, so early desales and this is going to go with head compression. So that's what's happening with this. Um, this one is a good thing. So the head's being compressed. That means we're closer to delivery. The head is being compressed usually by um, cause it's getting closer into the vagina, into the pelvis where it's a little bit narrower. So it just means that the head's getting closer to delivery. So what does that look like? We have our contractions,
yes.
And then we are going to have early decelerations. So early these cells means our heart rate is good and then it takes a dip and then it recovers and then it takes another dip with a contraction. Are Your big signs that you will see on a test when you were asked this, and if I was you, when you are given an explanation on a test of a fetal heart monitoring, I would draw. So draw what it is saying so that you can visualize. At least that's how I learn is by looking at it. So with this, it is a mirror image. So that's kind of a key word that's using questions a lot. So it's a mirror image to the contraction. The other key that you'll see is that we have the heart rate. We'll return to baseline, so it will return to its baseline. It's normal, it's average heart rate by the time the contraction ends traction. So those are going to be our early, so it's a mirror image and we have the dip in heart rate or deceleration in heart rate. That happens with the contraction, but it recovers to baseline at the end of the contraction. So those are our earliest. Again, this one is good,
so it just means that head's being compressed. It's getting closer to delivery. All right. Our next one r a is gonna be acceleration or accels. And this one happens because we are okay or the baby's well oxygenated is another one. Um, but typically, okay, so that is our a and r o. So this one you have your contractions and you are going to see the fetal heart rate XL. So you have your heart rate going and we have a jump in heart rate and usually it's like it jumps 15 seconds by 15 beats. So if it was um, the heart rates average was one 30, it would jump up 15 more to one 45 and lasts for about 15 seconds. We call that 15 by 15. Um, so those are good accelerations, just needs the baby's happy and healthy movie. Think about it, when you go run up the steps, right, your heart rate jumps up or it should, your heart rates not gonna stay at like 60, 70.
When you go up the stairs, it's going to jump up, especially if you climb a bunch of stairs. So the same thing, it's the baby's moving. It's having movements within the heart rate is going to jump up. Um, and that's a good thing, right? You don't want a baby that's kind of floating around in there and not having a heart rate go up. You want good, healthy, reactive heart rates that are happening. So that's our acceleration. So that one is good as well. And our last one is that, and it is called late decelerations or late decels and it is going to go with the reason is placental insufficiency. So that is never a good thing for our placenta to be insufficient. Right? So with this one, and this is where this relates and the early decelerations get confusing. And that's why I say if you draw it out, it just helps because you can visualize it.
And if that doesn't work for you, then cool. If on what works for you. But I just know that helps me, right? So we have our contractions again at the bottom and then we're going to have late decelerations. So your heart rates kind of Tikkun Olam, um, the fetal heart rate, and then it's going to dip and it might recover or it might continue to drop. Um, we have our heart rate. And so with this one are key things to remember before that hurry. You can probably see open little movement there with our heart rate. So with our late decelerations, you will see on your questions number how I said with earlier, you're going to have that mirror image thing happening. So with our Lacey celebration, the dip in heart rate happens after. That's your key after the start of the contraction. So after, um, it might recover or it might not. So when this happens, it means placental insufficiency. So this could be things like an abruption, that placenta as coming detached from the uterus, um, before it should. So when it comes detached, blood flow isn't getting to that baby the way that it should. Um, whatever it is, blood flow, oxygen is not getting to the baby the way that it should. So what are we going to do?
These patients or anytime we have a not good, um, tracing on the monitor we will turn the mom. So turn the patient left is the best side. If she's already on the left, we're going to turn her to her. Right? You're just going to kind of readjust that patient. Flip-Flopper Turner where you're going to give oxygen. She's a mom. And the reason is because if you, even if the mom's oxygen saturation, you might see us in questions too cause it gets tricky. If a mom's oxygen saturation is 99%, you would think, oh I don't need to give her oxygen but any extra is going to go to that fetus. So that's why you give her oxygen. So I don't care if her oxygen saturation's 100%, if she's having late decelerations or poor fetal heart rate tracing, you're going to give them an oxygen. That extra oxygen will go to the baby and that will help the heart rate of the baby.
Okay, so turn, give oxygen. Um, if she is getting pitocin or oxytocin for delivery, we are going to stop it. Okay. Cause her body, that fetuses and not tolerating the contractions. So we want to stop them if we can. If she is contracting too much, too fast and she's not getting pitocin, then we might give her something like tribute saline or something that can stop the contractions. But our big things are training the patient giving oxygen stop. That might even give our fluid Bolus, whatever it may be. But you're going to, these are the key things that you'll be asked about on tests and CLECs are going to be the turn patient, give action stat pitocin and hopefully that will correct it. If we don't correct it. Um, we are willing to deliver. So if we aren't 10 centimeters dilated, then we are going to go to the R, um, because we need to keep that fetus happy and healthy and get the baby out because it's showing us good.
Okay. I'm gonna give you guys a chance to type in any questions that you have about this. And while you're doing that, I just am going to write on here CLC again. So, um, variables, cord compression, these are not good but easily fixed. Hopefully by turning the patient early, these cells are had compression. This is good check and it means that we are close to delivery. So usually we can look on the monitor and see that a mom is close to delivery, probably closer to 10 centimeters without even checking her cervix because we can look and see that the um, we're having early decelerations. Okay. Accels or accelerations is our, okay. So this one is also good. It means we have a happy moving baby in there that has a heart rate that is, um, going up with it's movement and then late d cells. And this is our placental.
Yeah.
Insufficiency. Sorry. Hopefully you guys can read this. Um, and this one is not good. So remember we're going to turn the patient, we're going to give oxygen. Um, whatever it is that we can do to fix that. Um, okay. Variables with moderate early decelerations. What is the first thing to do? Okay, well that's, it's a question. Um, or like a test question. Honestly, it's going to depend on your choices. Um, you know, in nursing we have a lot of things that you do all at once, but if we're having just variability, the first thing you're probably going to do is try to turn the patient and see if we can get a quick, easy fix. Um, that would be my choice. So yeah, turn the patient, see what we can do.
Especially because early decelerations aren't typically a bad thing. But you know, in nursing you might be doing one thing while somebody else is calling the provider. But of course your questions, it's all you all own. What other questions do you guys have about this or anything ob I'm happy to answer if you've seen something crazy in clinical or in practice that you want to know more about while you guys are doing that. And then put our links in. Um, this first one is to the fetal monitoring lesson right there in NRS NRSNG. G that has some helpful, I think there's some helpful images, pneumonic things and um, they'll obviously the lesson. And then this other one is that Google doc that you've probably seen a thousand times just to fill out to help us make sure we're doing the best we can for you all and get you the information that she needs.
Um, if a mom is dehydrated, what would you see in a fetal hurry? Okay. So with dehydration you would usually see some variability happening. Um, like not good variability. So it could be that it also is going to depend if she's contracting at all. But if it's just pure as she's dehydrated, um, and we're not contracting, you're just going to kind of see the heart rate being, um, a little bit flat and having those variable decelerations or just kind of up and down and all over the place. Usually though, if she's dehydrated, she probably, her body's irritated by that and is going to contract some. Um, so really our big thing to fix there is going to be to hydrate moms. He'll give her a bolis. Um, give her, you know, a bag of fluids, um, or po hydrate depending on how bad it is to see if that can help fix it.
So that would be the first thing you'd want to do for those women too, is just to hydrate, especially if they're preterm. So with these, um, when you guys are typing more questions, I'll tell you a little story. So these late decelerations, um, you want to quickly get the baby out so you'll have where all the sudden you are going to the o r and I know in our hospital we have, it's called just splash and dash. So, um, you don't do the whole prep, you just quickly throw some Beta dyne on. They cut and get the baby out because you're talking about like a matter of minutes that you have to get that baby out. And we say from decision to incision, um, we have 20 minutes to get the baby out. And usually it's way less than that, but that's the goal, right? So those late decelerations, if you're having late decelerations and we're super close to delivering, we're at 10 centimeters and we think she can push that baby out quicker, then we can go to the Orr then awesome. But if not, then it's gotta happen because we've got to save the fetus.
And so that's our placental insufficiency. So typically the biggest thing there is going to be your placental abruption patients. So that placentas coming detached or you have women that are over stimulate. Their uterus is overstimulated. So it's contracting, contracting, contracting. And when it does that, it does. The uterus doesn't have, um, fill back up and get back to a resting state in between. So I mean, think about it. If you just think about like a normal muscle, if you have a muscle that is constantly in contraction mode, it's not getting good blood flow. Um, and it hurts, right? So that's what's happening for these patients is they're contracting, contract and detracting. Cause the uterus is a muscle. So it's doing that. It doesn't get back to its resting tone. Can't rest. It can't fill back with blood, which means the fetus cannot get what it needs either. So that, so then those with this hyperstimulated uterus, you're going to have those late decelerations. Probably because the placenta is not functioning properly. It's not able to, it's not able to fill back with blood.
I know that these, um, fetal heart monitoring can be really confusing and you probably only get like one or two questions on a test. But having that veal chop pneumonic I think is really helpful. And just write it out. Um, draw whatever the image is that they're painting in your mind, that picture so that you can have a good idea of what the question's asking. Remember that with your early decelerations, the keyword that you will probably see in a question is going to be that mirror image. And I always in an early deceleration, the heart rate recovers to baseline. Um, in late decelerations, it may or may not recover and that one is not a mirror image. The lates are going to be, um, that the contraction or that contraction starts. So we're at the peak and in the fetal heart rate dips. So it happens after the fact. Hopefully you could tell that from my work shrines.
Okay.
What other questions do you guys have? [inaudible] okay. No, there's like lots of things that can kind of happen and look crazy with these. So with our m accelerations, remember that that is okay. The baby's getting good oxygen. So just think of it as like when you run up the steps, your heart rate increases. So when the baby turns and moves and flips, that heart rate is going to go up and you're going to see those accelerations. And what we want to see is 15 by 15 so we, the heart rate of the fetus goes up 15 beats per minute and it lasts for 15 seconds. So that acceleration lasts for 15 seconds.
Okay.
Either way they're axles, but that's like a really good strip. That looks really good when the heart rate does that.
What else do you guys don't have any questions? Things you've seen that look weird or questionable? Oh, here we go. So yeah, and she's a placenta previa. Um, yes. So with Placenta Previa guys, I got my uterus pillow for my last session, so is helpful. Okay. So with Placenta Previa, that just means that the placenta is in the wrong place. So different than the abruption, right? The abruption is, are painful. That placenta is coming detached with a previa. It's how it's implants. So the implants incorrectly, so you can have different levels of this. You can have a complete where we are the placenta implants and it's completely covering the cervix, right? Our placenta supposed to be like up here somewhere. Um, but in a Previa, it's down here at the bottom. Um, and so a woman might see some spotting during her pregnancy. So it can either be like that.
It can also be marginal where it's just on the edge. Um, so that's what a Previa is. It just has to do with where the placenta implants. So, okay. And what do you do? What does the heart rate strip look like? Okay. So for this, a baby should still look good on a monitor and less than mom is bleeding. So some women will have bleeding occur from their previous, like they're not in labor, but the Starbucks is counting, you know, softening up or whatever. And a placenta is right there, so it might bleed them. So when that is happening, the mom is being, um, or the fetus is being monitored through the mom, right? So you might see heart rate and you might see some late decelerations with this because of where the, um, that we're having some bleeding happening. So it's not being sufficient.
Typically, if we see any of that, we monitor maybe for a little bit longer, but we're going to deliver. So delivery happens early with these women. Um, it has to be a c-section, um, and less, it is like just right on the edge. But if we are completely covering the cervix, we have to have a c-section because you, if you let the cervix styley their placenta is going to deliver first and we don't want to listen to, to deliver before the fetus. Right? It's, it's lifeline. It's like the heart coming out of us before we're ready. It's not gonna work. So,
um,
the fetal monitoring strip might show some lady salaries just that they're not going to lie, lasts that long, if that makes sense. He will deliver these patients by c-section and we will monitor their blood loss. So these women, if they start to have spotting and bleeding, we'll put them in the hospital, we'll monitor the blood loss, they'll do pad counts and weights to get a quantified blood loss to know how much she's losing. There'll be watching frequent labs on the mom, um, to make sure her h and atrial Cain, everything's looking okay. And of course that baby will be monitoring. If we can get her stable to where she stops bleeding, then um, call we can send her home and she's going to come back for more monitoring or her more frequent ob checks probably. Um, if she continues to bleed too much, then we're going to go ahead and deliver. So that is kind of in a nutshell for previous. So previa has to do with the placenta being implanted in the wrong ways. Does that help you? I hope. And like I said, there's different levels. And let me see, I think there's a lesson on PBL. Let me pull that up for you and I'll give you the link right into it.
Okay. Bear with me one second. Okay.
Yeah. Yup.
Okay. This goes right into the placenta previa lesson, um, with a client, be it increase. Yes. So if she's at an increased risk for a hemorrhage actually during pregnancy, so not even posting and after, but yes, anytime anything is not implanted correctly, doesn't go correctly. They're at an increased risk, typically for hemorrhage. Um, she is going to have already lost the good amount of blood probably through her cervix if she has a previa. So it already kind of puts her in a spot where she's already lost some blood and now we might, we're going to lose some more. Um, so it might not be one of those like rapid hemorrhages where we're losing blood, losing blood, and it's all right. They're happening at the same time. It's going to be something over time and that's why they're going to be counting the blood loss. Um, and now most facilities are getting into the quantification of blood loss so that we get an actual good number of how much blood is lost.
So the way that's done is they weigh the pads, the bloody pads, the chucks pads, whatever it's on. Um, and it's a one to one ratio when you're doing your math math. So one milliliter of blood equals one gram. So it's w r yes. So we are, sorry, I said that wrong. We have um, yeah, one-to-one. So if you are lost 500 ccs of blood, then that's five, um, 500 grains. Sorry I was, I'll replace that one to one. So 500 can use a blood clot that weighs 500 grams. Um, then we've lost 500 CCS of blood, which is a lot. So, and that's a hemorrhage, especially for a vaginal delivery. So that's how they're going to quantify it to make sure.
Yes. So typically we used to just like, I mean two months ago we used to just look at blood loss and say, oh it looks like two 50 or the doctors would, and then it was kind of bound as it was weighed out that they always underestimated their blood loss, which I get. It's not easy to do that. So now they weigh out everything. Um, so it's always good if you're getting report on a patient as coming upstairs after delivery, you want to know what was the blood loss during delivery so that you know, um, as you're taking care of the patient, if they lose that much again we might be a problem cause we're adding it all together. Hopefully that helped him. Wasn't too much information. I don't want to confuse you guys.
Okay.
You know, I could talk the all day.
Okay.
What other questions do you guys have? Anything else you've seen or just isn't quite clear? I was it in my last session. I feel like a lot of you are probably on summer breaks. That's awesome that you're getting into your ob stuff and getting a head start. Let me put the other links in again for ya.
So I had put in that preview one. I know our numbers kind of changed, so I just want to make sure everyone in here has it. But this is the one right into the lesson. Um, yes. So we have pulled 20, where that's another good one that we could have a tutoring session on. I'm always trying to come up with other ideas. Um, okay. So let me try to do it with best and see if we can do it. So everyone's gonna kind of do their own way, but typically you're going to feel at the top of the uterus, the Fundus and the provider, whoever is going to feel nervous. Um, so if you feel a hard structure that is the head a hard slash soft structure is going to be the button. Um, so typically they start at the top, but they will make the question, should have some type of term for soft, um, to lead you to buy.
If it's a hard structure, that's all is described as the head. So they start at the top. Um, they always are gonna have a hand on the bottom so that they can feel kind of what's there. Um, and then they are going to feel around and they always want to kind of keep tight hands as they're going around so that they can feel everything right. And you got all that extra water in there. So we're trying to actually just feel the baby. If you, they'll say you just feel, um, like small little bumps are going to be your hands or your feet. So it's typically how you're feeling bighead and how, where you're feeling the butt and then where the back is and then you can tell like, okay, the hands in the feet. So the back is going to be a Laurel long firm structure.
Cause think about it. You have let me draw. It's not going to be good probably, but so we want our head down to the bottom right. So we'll say that that's her head and you're going to have this long structure. So you'll feel this firm structure as you go up being the bat and then our butt. Um, and then he has a feet. So this is gonna be a little bit softer. The button is, the head is going to be harder, which makes sense, right? Um, you know, your head is all bone, so it's feeling that harder structure. So typically they're gonna start at the Fundus and then work their way around, um, and feel the different structures. So that is how they will do the, um, Leopold's maneuver. So the long firm's surface is the back and um, the head is hard and the butt is a softer surface. And then our hands and our feet are going to be just kind of little bumps that are felt. And I'm going to pull up cause I think Leopold's is in here on some, um, in a lesson too. So let me see if I can find that.
Okay.
Might be um, not called Leopold's though. Of course it's not. Okay. Let's see if I can find it. When you guys think of any other questions that you have.
Okay. [inaudible]
see where it is. Sorry guys, just bear with me while I try to find this for you.
[inaudible]
oh, here it is. It is Leopold. I must have spelled it wrong. Okay. Here is our Leopold's lesson. So we'll have a little video in the outline and kind of explain what those specific structures I'll feel like for you and hopefully that will help you. Nope. Nope. That was fetal circulation. Ignore that. I clicked on the wrong one.
You don't want that. Go back to, here we go. Any appointments
was patient and didn't let it load. Okay. Here's Leopold's. Do you have tricks from every that positions of the fetus in the uterus? Um, do you mean like the station
or um,
Stacy, let me know if you mean like the station of the fetus, like the, that positioning if that's what you're referring to or, or if you mean the Leopold stuff. And I'll answer the other question while I'm waiting for you to answer that question. Once or twice asked to determine where to find the fees as heart rate and the position the fetus was in. Yes. So we always want to put the heart monitor. The best place is going to be on the fetal back because if the baby's in fetal position like this, right, you can't really put it on its heart, it's all bent over and there's going to be a lot of water in Yak fluid in the way. So the back is going to be the best spot cause that's gonna be, um, where there's not space between it. You're putting it right on the fetal back. So that's going to be the best spot. So you need to feel around for Leopold in New York to find that back. So it's going to be that long from structure is the back
okay.
Usually long will be a key word in there. Um, and again with those draw it out because you can picture where the baby is, even if it's as bad as my little drawing that I did for you. Um, cause we would want to put the fetal monitor here, which should be on our left side, mom's right side. So make sure that you're looking at that in the question too.
Okay.
That's okay. That it's not easy to remember everything. So hopefully that'll help you remember that. Um, Stacy, oh, vertex. The Phallic. Okay. I don't have any like key pneumonic things or um, fun little sentences or anything to help remember. But we obviously at vertex and the Phallic, so, so phallic is head down. Um, I just think of like Cephalgia like that is brain, that's head. Um, if you look at some like the med terminology courses and stuff like that will kind of help maybe with that. But so the SEF bla, um, Cephalhematoma all that stuff is all heads is the phallic is going to be our head down. Um, vertex is also his head down, so those kind of go hand in hand. Um, you will have breach. So breach can be abut breach, it could be foot breach. So footling breach. So it's just breach means we're faced the wrong way. Okay, so the head is at the top. Um, and then trans and verse, I just think of transverse for Whale Cross, um, Trans Siberian railroad. I don't know if these help remember. So we're going across it. That is where the baby is laying horizontal. So here would be our vertex or suffer phallic.
Yeah.
If this is the mom.
Yeah,
well she's got a big torso. Um, okay. So that is our head down our, our sip valic or vertex. If we were transverse then the baby would be laying like this. So just across the belly, I think that's just something I've kind of memorized. But also I took a good med term class that kind of helped me with that. So just the Phallic, his head, um, or vertex change verse. And then breach is just going to be where our head, yes. Up here it's up at the top of the uterus, um, at the fundus. And so with these cases, we either need to flip the baby or we need to have a c section. Oh, you're right. She may be wondering about that. Those are confusing.
Okay.
So we had had a um, tutoring session on that again, and I'll do one soon since you guys are asking, cause that is a good one. So I'll go into that. Um, c thing, keys, that is what you're talking about. So that first letter that l like if we're talking Lop, r o p Oops, it's the first letters gonna be left or right.
So
we are talking about the presenting part. So what is on its way out? Hopefully Stacy, sorry. Okay, I'm with you now. So let me, I'll go through it for you. You probably thought I was crazy. Um, okay, so left or right. So which way is the head facing? Um,
and we're talking about the mom's left or right. Okay. So again, these are drawn out kind of a situation because they are really confusing. I agree. Um, the middle letter is going to be what's coming out. So our o which is typically what it is, is the asa put, right? So that's the back part of the head. The reason why that is because the art, hopefully our baby has its chin to its chest, right? So the asa put the back of the head, it's going to be what's coming out. So it's which way that also is facing. Is it facing the mom's left or the right? It is not the way that the face of the baby is facing. So don't get confused that. So, um, oh shoot. I don't race my little baby I had drawn. So let's, I'm gonna Redraw it real quick so we can use that. Okay. So here's the asa put right right here. If this is the mom,
well we have the asa put facing her right side. Okay. So that's why I say to draw it out. I think it's just helpful. And then posts carrier anterior. So, um, is it towards the front or towards the back? And that's going to be typically they'll say either anterior posts to your hair. So this is the presenting part. So let's talk about that. Also puts the big one, right? That's what typically the questions are gonna ask you. Cause we certainly hope before delivering badge finally that it's the head coming out first. Right? So that's our asa play. Um, it could be a mentum, which would be, let me write this. So that's labeled. Oh, [inaudible] momentum is labeled m um, that's the chin. It could be a scapular. Never get things right. We see these things as presenting parts, we're going to go to that or cause we don't want this stuff to come out versus especially a Chin because that head will snap that.
So our Scapula is se labeled. So just draw it out however they are asking you. And remember it's the way that that asa put his face or whatever the presenting part is. If it's the mentum it's the, it's which way it's facing. Is it facing the mom's left or the mom's right. And then is it posterior anterior was at, towards the front or towards the back. Hopefully that helps. Stacy did that help a little bit cleared out? I think the big thing that people always get messed up on is the left and the right positions. Um, but yeah, I say draw it out. That's what when I was teaching in class. Good. Yeah, you do good. I'm glad that that helped. Um, it is, it's very confusing. In fact, it took me a long time to kind of catch onto that and figure it out myself. Do you guys have any other questions when your numbers change and it's gonna put in our Google doc form one more time for you guys. Make sure you fill that out and um, it'll just help us make sure we're getting you the best that we can you guys another second in case any questions pop up.
Okay.
Nope. Alright, well go out and be your best house today. And as always, happy nursing. Oh, you have question. Any suggestions on what you're really brushed up on before the end? CLECs regarding ob. Um, I would go through and watch the videos and even if you just wanna Watch, you know, I time is a big constraint when you're studying for the boards. Um, but watch the last couple of minutes of each of the videos because it is going to get the key points of what I talked about in the lessons. So, um, if you don't remember something, you were like, oh, I need more on that, then go back and watch it. Read the video guide and look at the outline. Um, if you say I got it, then move on. By all means do not stay on something that you already know in wasted time. Um, I know it helps us feel better about ourselves when we feel like we know it and can keep reviewing it.
It's important to review what you don't. So do that. Um, and you can set up MPQ questions just for ob related. Ob is obviously not going to be a heavy concentrated topic, um, on boards. I wouldn't think you're going to be asked far more other stuff in the specialty, but I would go through, look at each of the videos and that won't take you too long. I know there's a bunch of lessons, but if you're just looking at the last couple minutes, um, and then read over those video guides and just do some practice questions, do practice questions in the areas that you're struggling in. Um, and I think that,
yeah,
good luck. Are you taking them soon? The big questions for ob is gonna be, um, oh, next month. Okay. You got a little time. It'll fly by though. Um, your ob questions though, are not going to be probably going until like super minor details, but review the medications because medications is a big thing on the boards. So review those. So at least still have that clear and that's, I think all of less than 12 are module 12 on NRSNG. So look at that. Um, especially in, make sure you understand the use of each of the medications and what it's for. Perfect. Good luck. All right. Go out and be your best self. Say and as always, happy nursing.