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Top 5 Misunderstood OB Concepts

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***Previously Recorded***

Previa vs Abruptio? Eclampsia vs Preeclampsia? Are you just as confused as I am? Well stop on by as we drive home the top 5 OB misunderstood OB concepts!

Video Transcript

Oh, we are going to go through the if good morning everybody. Um, all this good ob content, this misunderstood things. I tried to come up with things that I was really confused on in school or just those common things that are kind of missed a lot. I’m an easily slipped up on. Um, so we’ll go through those. I am Miriam, for those of you that have not met me and I do the ob content on NRSNG and then do the awesome tutoring sessions. I’ve been an ob nurse for 10 years ish. Um, and did med search hospice before that. Um, so we will get started and go through this. I’m going to share my screen and go through a bunch of them just to kind of put down some different points. And then at the end I’m going to unshare and I have a couple of things to draw out that you guys can better visualize it. Alright, so let me share and we’ll get started.
Can I see that? Okay, perfect. Just want to make sure before we get started. Alright. So if you guys have questions as we’re going, go ahead and you can type them in and I’ll get to them at the end. Um, I promise I’ll get to all those questions, but I don’t want you to forget them either. Okay. So our first one is this placenta previa versus an abruption. So a Previa is going to be the location of the Placenta, um, and it can be in several different places so it can be covering the whole, the placenta could be implanted covering this whole cervix. Um, so obviously not exactly where we want it to be. We should be up on that anterior wall of the uterus. So this has to do with the location of the placenta and it is going to cause painless. Okay? So remember that your p and your p painless bleeding, that’ll be your big symptom for that.
Now this is commonly, um, put in questions with an abruption. So an abruption is where our placenta is going to come detached too early. Okay? So it just comes detached. Um, and this is going to cause painful, um, bleeding. Sometimes there won’t be any bleed, visual bleeding because as the placentas committee touched in that while the blood is building up behind the placenta, so you might not visually see it, but it will cause a lot of pain. I know it’s also going to cause a hard abdomen, just rigid board like so any of those terms in your questions? We’re talking about not bird-like board, like we are talking about an abruption. So where the Previa is the location, the placenta where it is implanted. So it’s just kind of implanted in the wrong place and it’s causing that pain. Um, painless bleeding to happen. All right, our next one is our pre e versus all our other hypertensive things.
So He’s our pre, okay. This is going to be, um, uh, where we have elevated blood pressure and that number is one 40 over 90 and we’re going to have, it’s not just like one check, right? We’re going to have this at least two times. Um, so one 40, over 90 and you have to have protein in the urine. So you can remember this for your p and your p also. Um, we have to have protein in the urine in order for you to be preeclamptic. Okay, so people get these confused with our other hypertensive. So let’s get into that. Any other hypertensive can be, some can turn into Preeclampsia, but Preeclampsia is only present when we have that protein in the urine. So that’s important. All right, so our gestational hypertension, so g, H, t, n, this is where someone has these elevated blood pressures and they might be that one 40 over 90 is our typical kind of range, but it is going to happen after 20 weeks of pregnancy.
So when that fetus is, um, 20 weeks or more in gestation, that is our gestational hypertension and we have no protein with this. Okay. Only in PE. So no protein spilling into the urine are chronic hypertensive. So these are people that just have an elevated blood pressure that’s happening. Um, prior to 20 weeks. There could is considered chronic if at any time either of these patients, someone has gestational or chronic, starts spilling protein in their urine, then they’re going to meet the criteria for our preeclamptic. Patient. ECLAMPSIA is where the patient sees it. Okay. So this is where we have an Apri e plate patient, which is preeclampsia. They become ECLAMPSIA. So they cease. So that is our m the difference between those, um, amber with someone with hypertension before pregnancy fall into? Yes. So they’re just a chronic hypertensive. So if they have any type of hypertensive before, then they are a chronic patient.
All right, so Eclampsia, we have seizures so that’s all it is. They were Preeclampsia, sick, they were still in protein and then they see all right down to our row GAM. So Rhogam this is an I am injection. Um, let’s, I am injection and this is given to a patient when they have a negative blood type, which is a rh status and negative blood type. So any negative, um, o negative, ab negative a or B negative, um, any of those. So negative blood type and they get it at 28 weeks gestation around there, give or take a week or two. So that’s kind of a goal. 28 weeks gestation, they get this, I am injection. Um, and then they are going to also be given it within a 72 hours of delivery. And this is only if the baby is a positive, but type. So the reason why is that this mom, if she’s got a negative blood type, she’s negative for antibody, she doesn’t have antibodies.
If the baby has po is positive. Um, and there’s any blood mixture that occurs in this pregnancy, then the mom could build antibodies against that blood type, which means it could harm a future pregnancy. So this, um, injection after delivery is to protect future pregnancies. She will also, she’s going to get it here within 72 hours of delivery. But also if at any time in the pregnancy, um, during pregnancy there is a risk that blood has mix. So when would that be? Um, that would be if there’s been a motor vehicle accident. So like that seatbelt hitting, there could be a mixture that could happen. Um, also if she has a miscarriage or stillbirth in the pregnancy, we’re going to go ahead and she’s going to get that Rhogam. It’s um, kind of rare that this blood mixture would happen. But because the effect of it can be so bad that she would attack a future pregnancy, we’re going to give it just in case so she could get it multiple times in her.
Um, pregnancy. Amber? Yes. So she gets at 28 weeks gestation. So that’s while she’s pregnant. And then post delivery, it’s within 72 hours of delivery. And then anytime during pregnancy if there’s a risk, that one is mixed. So motor vehicle accident or missed. Okay. Our next one here, I see this sub is questioned on our Facebook page a while ago. So I like to be clear on this. So postdates versus preterm, what are babies gonna look like on assessment? So for our postdates first we’ll talk about, so post dates just means that they have gone beyond, um, 40 weeks gestation. So we’re post dates. This baby has over cooked. Okay. So that’s kind of how I think of it. So when they have overcooked, they are going to have that dry peely skin. Think about, um, when you have been in the water too long and you get really pruny and all that, that’s kind of, that’s what’s happening.
They’ve been in that water miotic fluids so long. So they’ve dry peely skin. Um, they are going to be bigger, right? Cause I’ve had more time to grow and cook. Um, they are going to have more hair on the head. And that’s important to remember that it’s the head and I’ll explain why in just a second. Um, and then their nails might be longer. It should be longer because they just grown longer versus our preterm babies. So these kiddos have not cooked long. They’re undercooked so they are going to have me put undercooked. Um, so they’re going to have, I have some extra skin that they probably have not grown into. So just like a wrinkly that’s baggy hang in there cause they haven’t gotten that fat to fill it out. Um, so they’re typically going to be smaller obviously. And this isn’t always, but typically, um, their skin might be more clear.
It’s spinner, it’s clear. You can see the vascularity sometimes. And then, um, Vernix so that’s that white cheesy Steph that is on a baby. And this is a protective coating, um, that’s on the babies to help keep them warm and insulated and all that good stuff. So if they’re preterm, it’s awesome that they come out with this slips because they are going to me that extra barrier on them. So they have that Brian. And the other thing is about go and this is where I’m talking about with the hair. So they’ll, the new go. This is referring to the hair that’s covering the body and this is going to be more present, um, or prevalent on our preterm babies or babies born early. That body hair as a warm layer for them. Um, so a baby that is term, they have shed that hair so they don’t have, um, not always.
Of course certain cultures are gonna have more hairy babies. Um, but typically if we’re talking about a question as talking about posts versus our preterm, our post eight kids are going to have more hair on their head where our preterm babies are going to have more hair on the body. And that’s just to keep their undercooked body warm. Okay. Um, okay. Lee’s next two. I am going to answer my screen so I can kind of, um, share or draw this out for you. So I just want to make sure you guys have copied everything you need and then we’ll talk about our early versus late decelerations and our non-stress tests. So I’ll give you guys a second. I’m just screenshot or just make sure you’ve written everything that you wanted to write. Okay. Is everybody good or does anybody need it longer? Okay. Alright, awesome. And I’ll leave it in case we need to flip back to it. Alright. So,
okay, good. I see me. Okay. I’m going to try these out. So are the first one I want to talk about is our early versus late decelerations cause these are often [inaudible], um, compared, so first our early decelerations. So this is happened about on the fetal monitor strip and what the baby’s doing or what the heart rate’s doing. So at the bottom you have your contractions for the mom, um, and then the top, we have the baby’s heart rate. So for our early decelerations, yeah, heart rate going along. And then we have a debt. So bees, um, get some heart rate match up with the contractions. So key words that you will see are to identify our mirror image. And you have a contraction that’s r a m d cell that starts with contraction and recovers to baseline, um, and it recovers to baseline. So as you can see, it’s a mirror image.
They kind of line up, oh, sorry. It’s like I’m trying to move over, but it’s um, it’s like holding a mirror and you guys see it. So Mirror image and the desales start with the contraction at baseline, uh, or start with a contraction, then we’ll return to baseline. These are good contracts or desales. So the reason why it stood an early diesel means that we have, um, head compression happening. So head compression means that that baby’s getting closer to delivery, it’s closer into the vagina, and so it’s getting the head squeeze, so it’s getting compressed. Um, so this is just a sign that hey, you should probably check the patient and make sure, um, that she’s not about to have baby. So early decelerations. These are good. All right, let me, we’ll draw up our lady sales. So lengthy celebrations are not good. Let me show you what these are. Okay. So our late desales again, we’re going to have our contraction pattern.
Um, and then our heart rate is going to be chugging along here and then it’s going to dip and it might recover and if again, or it might not recover. Um, so these are not bad. This means we have placental insufficiency and I’ll move this up so you guys can see it in just a second. So placental insufficiency is just fancy for meaning. Uh, the placenta’s not getting blood and nutrients and oxygen to the baby the way it’s supposed to be. Um, the placenta is not working the way it’s supposed to. So, um, not good. What we’re going to do for this patient is we are going to turn her a, usually the left side is the best side, um, left lateral. Um, if she’s already on her left side, then we’re going to flip her again. Um, the other side just to see if that helps. Um, we are going to stop.
Yeah.
Pitocin, if she’s getting any. So the pitocin is that drug that’s helping that uterus to contract. And since the baby’s not tolerating the contractions, we want to try to stop those contractions. So we’ll stop the pitocin if we can, if she’s getting any to try to stop the contractions. And then we’ll also give oxygen. Now this is important. The oxygen, even if the mom’s oxygen level is the, um, is that 100%? So you would think she doesn’t need oxygen, right? Robbed. So the extra oxygen that the mom gets, we’ll go to the baby to help the baby’s heart rate. Um, so if the baby’s heart rate is ever not doing well, oxygen is what we need. So give oxygen. Sometimes you might give a fluid Bolus, but these are typically to be your big things that you’re going to do here. These three things. Uh, okay.
So I’ll put a little closer. You guys can see. So placental insufficiency. So Placenta isn’t, yes, the placenta is, um, even if the placenta isn’t working, right? Yes. So what do you mean? Even if the placenta, oxen, yes. So because what’s happening is, for instance, one of the ways that a placenta isn’t working and is insufficient is if that abruption, like we talked about, that placentas coming detached too early than whatever’s still attached is going to get the oxygen. If these things do not fix this, we will deliver this patient and go to the or. Um, we can’t let this baby keep tanking like this, right? So we’ve got to try to fix it or we deliver. Um, but of course, if we can deliver vaginally, that’s what we want to do. If we can get it fixed. Yes. So always give oxygens that extra, we’ll go.
So hopefully it’s not that the placenta’s fully detached, right? It’s still attached. It’s just not working as well. Um, so we can just flood that mom like 10 liters of oxygen and non re breather and get her all that extra oxygen. Okay. So those are late d cells. Now the next one on our little list is our non-stress tests. Let me find my erase. Okay. I have a mess over here. If only you all could see. Okay. So our non-stress tests, um, oh shoot, I just erased early B cells. Yes. Vicky, I’ll show you. Let me, um, okay. I’ll show you as soon as I do by non-stress test and Brunette, what fluid would you get? Just like m d 10 or normal sailing, whatever they’re getting, lactated ringers. Uh, whatever the doctors ordered for her to, usually they’re getting fluid anyways, but you would just start bolusing whatever fluid they’re assigned.
So that specifically is not as important. Um, if for late d cells, if they can’t fix or delivery vaginally emergency. Yes. So emergency c section will be what we need to do. Cause you don’t want to keep the baby in an environment where it’s placenta the way it should. So think of this, um, the placenta is the organ that the baby’s living off of, even if the baby has a heart and everything. If that placenta, the placenta, does oxygen exchange everything for that baby. So if that’s like the baby’s lifeline. So if our lifeline for us, our heart isn’t working, we have to fix it, right? So if the placenta, the baby’s lifeline is not working for it, then we have to fix it and that’s going to be delivery, um, by an emergency c section. If we need to, if she’s super close to delivering and we can just quickly have a baby then awesome.
Um, but if we still have a ways to go air, the baby’s really, I mean we’ve had them where baby’s heart rate suddenly is in the forties, which is Super Low, right? Cause our normal is like one 30 ish. Um, so you’re rushing into the o r you’re getting that baby delivered cause that’s what’s important as a safe and healthy baby. Alright, so let me do our non-stress test and then I’ll put up the early desales again for you. Okay. So our non-stress tests also known as NSA. He, so this one is going to be, um, a test that’s done to see how the baby’s tolerating living in the environment. So this is typically done on women that have, um, gone post-term so we’re like after 40 weeks gestation, so they’ll do them every week, um, just to check to make sure they still live in a good environment.
Um, it also will happen a lot for any of our high risk pregnancies. So for instance, a diabetic, um, it’s a high risk pregnancy, so they’re going to have non-stress tests done a lot to make sure that the baby is living in a good environment. So the mom’s going to be positioned comfortably, comfortably. She’s going to have her contraction monitor put on her and she may or may not be contracting. That’s not important for this, but they’ll put one on. Um, she’s also going to be given a clicker. So she will click this little button. Um, anytime she feels fetal movement occur. So a flip, a turn, a kick punch, whatever she feels it, she clicks the button. So what you end up getting is down at the bottom of the strip, you might have some little contractions happening, but what the nurses are looking for is these little click marks where she has clicked and felt fetal movement happening.
So what we want to see is that when the movement happens, our heart rate jumps up and goes back every time that they be news. What we want to see is a reactive strip. Okay? That is what you want reacted. And what does reactive mean? So it’ll mean 15 beats per minute, and I’ll explain this in a second, 15 seconds times 20 minutes. So you can remember this 15 by 15 times 20 so you want to see the baby’s heart rate has elevated from a space line by 15 beats per minute. So for example, at the baby’s baseline, heart rate was one 20, then we won’t want to see it jump up to about one 35 and you want it to stay up at that one 35 for about 15 seconds. And you want this to happen, um, three times and you have 20 minutes to get this to happen.
Okay. So three times in 20 minutes, two to three times. So 15 by 15 and you have 20 minutes. Now, sometimes in the first 10 minutes you’re going to get it and you’re good, but they have 20 minutes to get this, um, achieved. Okay. So 15 back, 50 times 20. So reactive. So think of it this way. I tell people, if you run up the steps, your heart rate should increase, right? Anytime you move around, your heart rate is going to jump up a little bit from where it was at baseline. So this is showing that the baby’s heart rate is reacting well to movement. So that means that if the baby’s well oxygenated getting what it needs to, so anytime the movie turns, news kicks, punches that heart rate to climb up a little bit. Um, it’s a lot of work in there moving around. So their heart rate should be showing you that. So she breaks 15 by 15 for 20 in a 20 minute 10 period. Okay, let me draw up your um, early desales again for Ya.
Sure.
And then I can pull up and show you guys. I think on this other strip too, we have a really awesome, um, in the fetal heart monitoring, there’s a, um, uh, test set around [inaudible], sorry, that shows you the different, um, on the monitoring strips. You can look and see on the early B cells, the little depths that happen. Um, Jenna who is the test use for getting, so the non-stress test is going to be used for any patient that has gone past their due date to make sure, cause that placenta’s really only meant to live for 40 weeks and work really well for 40 weeks and for going past 40 weeks. Then we want to make sure that that placenta is still working the way that it should be. Um, so for those and then any high risk pregnancy. So I just gave the example of diabetes. So any that’s a high risk pregnancy. Um, but any high risk or um, advanced maternal age, they’re more at risk so they’re going to have more non-stress tests done. Um, and that will just vary depending on the doctor, but they’ll just have them done more frequently. Yep. Heart disease. Exactly. We want to make sure that baby’s getting what they’re supposed to do. Alright, so here’s our contractions on the bottom. You have your fetal heart rate in a dip and a return.
So remember it’s a mirror image is kind of the key. And um, the country after the contraction we have, let’s see, the DSL starts
with the contraction and return to baseline. And that is key. Um, I tell people, if you’re getting these heart monitoring on there that you should draw it out. At least for me, I’m a very visual person. So if you draw it, then you can kind of visualize and see, okay, it’s starting. And then returning to baseline. Um, so those are your early decelerations. Yes. Brooklyn. I’m sure she did get it done a lot. I’m diabetic, so I had them that all the time. Um, non-stress tests a lot of times, but with ultrasounds, that was the good benefit. I had lots of ultrasounds done, but yes, a lot of sitting and clicking buttons.
Okay.
Um, Vicky, are you good now that you’ve seen or do you still need it up here?
Okay,
so, okay, perfect. So normal heart rate for a baby’s ass. So a normal heart rate for a baby is going to be one twentyish to one 60 ish. Um, that’s your normal heart rate. So on your monitorship ship. And then also right when they’re born, you might have time periods where they’re in a deep sleep and it might be a little bit lower, but that’s going to be your rule of thumb. You’re welcome.
Yeah.
Hmm. That’s an old wise tell amber about the heart rates being higher than boys. Um, I don’t know how true it is, but yes, they will say that. But, um, I think it’s an old wives tale. I am going to see, oh, perfect. I have this heart rate monitoring. Let me see if I can get it up and then I’ll share my screen so you guys can see. Yeah. Okay. Let me try to share here again and you guys can see this. So this is the cheat sheet I was mentioning that is in our, um, heart monitoring. Can you guys see it and then I can scroll. Okay.
Okay,
perfect. Let me try to, um, look.
So we’ll kind of go through this. So here is our variables, which means we have cord compression. Let me go down to our early versus late here. So here’s our early decelerations. So you see these contractions down here at the bottom right? And this bottom line here is the mom. Okay? So more of that right now. Um, you can see right here, this one, there was a dip, mere image dip, mirror image. This one was a little bit weird, but another mirror image dipping. And it always returned to baseline versus let’s go down here to our late.
So here are the moms heart rate and the babies kind of crisscross. But here’s our contractions. This one here is the baby. Okay? And you can see the dip happens right here where if you notice the contraction peak is here. So it’s happening after. And then again after. And this one does recover to baseline, but it is still happening after the start of the contraction. Down here is where we have a very sleepy, maybe you can see just that flat line kind of staying there. So just sleepy babies. So we would wake it up and here’s our acceleration. So this is a reactive strep. So if you were doing this as a non-stress test, you can see here we have the contractions happening and you have a baby that’s heart rate is moving up and staying up, which is a happy baby. Um, baby’s heart rate is seen.
Yes, always on the top. Um, Christmas. So the moms is the bile. You just have to watch some times cause think about it. A mom’s going to have a lower heart rate than the baby. So this is based off the number. Um, but like I said on that other one, they were kind of crisscrossing. So just make sure you’re following the right line to see. This is the baby one. Um, that mom must’ve been little stressed as her heart rate jumped up there. So that is an r, um, fetal heart rate monitoring on NRS and GV can pull up on the cheat sheet if you want to look at it more. Um, along with that pneumonic wheel chalk and it kind of explains it all for Ya. What other questions do you guys have?
If the baby’s heart rate drops less than one 20, is that concerning? So it’s gonna kind of depend, um, how low but yes. Um, we never want a baby’s heart rate to drop if the baby’s been like in the one fifties and suddenly is in the one tens, um, where one 10 might not be back concerning, but if we were starting in the one fifties, that’s going to be more of a concern versus a baby that started at one 20. Um, it could just be like we saw on that strip where that eighties kind of act and really sleepy and might just need to be woken up with some juice or this vibroacoustic stimulator like white tube that you stick on the mom’s belly and it Kinda jiggles everything awake, um, to wake. That may be. Yeah. Um, so yeah, you can do things like that or it depends what else is happening. If we’re having some decelerations that are going on, um, then we’ll want to obviously turn the patient, stop the Pitocin, that kind of thing. But yes, you’re welcome.
Um, no stress during labor. Exactly. We don’t want any ds and no late decelerations. Um, so Jenna typically questions, um, for late, early decelerations are going to be things like if the, um, you know, just comparing the two. So if, if a mom is having early decelerations, that things to know is that it’s from head compression. Um, so that’s our veal chop. Pneumonics you can go look that up. Um, but the early goes with the H, so it’s head compression. So that head is being squeezed because that’s closer to with delivery. So that just means the mom’s closer to delivering. So that’s fine. That’s a perfect sign. That baby still has a good heart rate. It’s returning to baseline. It’s all good, are late. Decelerations is going to be things that, how are you going to fix this? So we’re gonna fix it by giving oxygen.
We’re going to turn her on her left side, we’re going to stop the pitocin. Um, and we might need to emergently deliver. So those are the things for that, um, that you had kind of just need to understand with our, um, decelerations. Also things that would cause the late decelerations. So if you have non reassuring fetal heart status, we’re having these late decelerations. It could be anything that would cause a placenta duty insufficient. So things that would cause a placenta be insufficient. We talked about that a placenta coming detached. Um, if a placenta is coming detached, then it’s not working right? Cause at the centers attached that uterus wall and it’s pulling the nutrients from the mom through the placenta, through them, they’ll it to the baby. So if we start to come detached that part of it and then we can’t do that as well, if that makes sense.
Um, another thing could be a hyperstimulated uterus. So what does that mean? That means that our uterus is, um, so in a typical contraction, the uterus contract sounds, so think about squeezing kind of a water balloon. K So it contracts down. And then it gets to a resting state where it refills so that water pops back up it with black. Okay. So that’s the time that the placenta will then pull nutrients. If we are hyper-stimulated the uterus is just contracting, contracting, contracting, then we don’t have time for that and uterus to rest and get to a resting tone and fill the placenta with nutrients. So if we are hyper-stimulated, then it’s going to cause it insufficient placenta because the placenta cannot pull the nutrients that it needs. Um, does the placenta, usually you touched before, during, after delivery, you never want the placenta to detach before delivery because then the baby will die.
The baby loses its lifeline. Um, so that’s what the placenta abruption is. So you have your placenta attached to the uterus while an abruption could be slight where you just have a little bit and it might not, it might not look so good on a strip, but we’re not like emergent. Um, but then you also could have a full abruption where the placenta completely detaches. Um, so that would be a problem. Um, so yes, after the baby is the last thing to be delivered. Um, hyper-stimulated years again. Yes. So hyperstimulated uterus is where the uterus is over contracting. Um, so you can have, let me write this.
So contractions are measured in millimeters of mercury. OK? So sometimes they’ll have something in their, our eye UPC or it’s called an intrauterine pressure catheter. It’s literally a plastic tube that’s inserted in along the uterus wall through the vagina. Um, and it is going to measure the pressure of the contractions and things like blood pressure. So 20, this is our kind of our normal start, our 20, if it is over that it can be hyperstimulated if you are having, um, contractions that are happening, um, I think it’s more than five times in 20 minutes. So for having, these are 10 minutes, sorry, you’re just over contracting. So they’re happening like every one to two minutes. Contractions ever free. That’s not every, that’s more every one to two minutes. So what’s happening with this is that our uterus is being contracted. So if you think of a water balloon, it’s being squeezed. Okay. And that’s fine. That’s what’s supposed to happen. But then it’s supposed to get to that resting tone. I’m assist to get to a resting state. And in that resting state, it refills with blood and the placenta pulls the nutrients from that uterus wall. [inaudible]
okay. Uterus, Placenta. So it’s going to pull the nutrients across. Maybe it’s better if my job is, I’m not the best artists. So there’s our uterus and then our placenta is attached here. So during the resting time, it is pulling the nutrients from here into our little baby. Yeah.
If it doesn’t get a good resting time, it cannot refill with blood. So hyper-stimulated is just like an over contracting uterus, um, with high pressure, those strong contractions and we’re not getting rest in between. And a big sign of this is like a very hard abdomen, um, are very painful contractions. This is very painful because that years is, it’s like I’m having a Charlie horse in your uterus. I think what, I’ll try the course in your calf, that muscle stays contracted, right? If it’s contracted as not getting the blood flow. So think of it like that. Um, your, the uterus stays contracted. It’s like a Charlie horse, so that university is contracted. It can’t refill it blood and get the nutrients that it needs. So it’s overstimulated. Does that make sense? So this will cause the placenta to be insufficient because it cannot pull the nutrients across.
Perfect.
Um, how do you fix a hyperstimulated uterus? So if you have a hyperstimulated uterus, you’re going to stop anything that would be causing my contractions like participant oxytocin. Um, so we want to stop it. Um, if they are not getting that, then you might give something called a Toca lytic, which that’s a drug class took a lytics. So that’s things like, um, tribute saline. If you look, there’s a whole ob farm lesson in, um, it’s all of the lessons 12, module 12. So these Toca lytics will stop that muscle contraction if we need to. Um, so we’ll stop the pitocin. You’ll give oxygen, everything that you would do for a late deceleration. Um, try to turn the patient if you can. And then, um, if we need to, it might give a tokenistic to try to stop and slow down those contractions. Usually if they’re getting pitocin, then we can quickly, um, stop it and then it fixes this. Um, it just might mean that they don’t need so much pitocin, um, or their uteruses is hyper contracting to it. But a typical lytic, these are things that stop the contractions.
Um, Asia, I know that video on a man is coming like I think tomorrow, I don’t know that it’s up today. Um, I’ll have to check on that. If you put, um, contacted NRSNG and some of them an email and just ask about that to check when the video on demand. I know that they’re coming soon and you should hopefully be able to watch it. I just don’t know that it will come today. Um, but check with them and they’ll know the exact date for that. Um, is there an event that both late and early decelerations results? So yes, any, uh, you can have, so the monitor strip that I pulled up, um, where it showed on that cheat sheet, that was one patient that we had. Um, but I saved the Strip and she had all of those things happen throughout her course of labor.
So yes, you’re not going to typically have like a contraction that has an early days out and then the next contraction have a late decel. But you can have them all happen on one patient, but it won’t, shouldn’t be mixed within the monitor strip. Not saying that it can never happen, but typically like the lates are gonna keep happening until we fix the late decelerations. Okay. Um, overstimulated uterus, not good. [inaudible] not ready to deliver, but if they are ready to deliver, is it okay? So you never really want to hyperstimulate uterus because it means that you’re not getting good resting tone. The placenta’s not refueling, but if they’re super close to delivering and it’s p and she’s pushing and all that, then we’re not going to be, um, as concerned cause she’s delivering, right? She’s about to deliver. It’s all going to fix itself. We’re not going to give her tribute a lean or a Tocal leg or anything to stop it. We just want to have the baby. So yes, if she’s super close to having a baby, not that it’s okay, but, um, it’s not going to be as big of a concern. You’re welcome. Um, yeah, it’s coming. Don’t get too excited cause I’m not positive on when, but I know it’s coming.
So yes, just asked them. Um, and they might have that date impacted. I might be able to quick send a message and see. Let me ask for you all.
Okay.
Stay tuned. We’ll see if I get a response. I’ll thank you, amber. Yeah, lots of changes happening, but all really, really good things. I promise. Um, so many good things. The normal contraction you should see, not really a term for it. You just want to see a reactive strip. So you have, um, contractions. Sorry, my contractions are awful. They’re my little drawing. Um, so that’s why I’m not an artist. So reactive strip is, if you remember, that’s like with our non-stress test, you just see that a baby’s heart rate going up. Um, and as a happy, healthy baby. So this kind of thing, you just, no decelerations unless they’re early. You have a heart rate. That’s good and happy and healthy. Let me share my screen. Yes, with the acronym Field Cha, I’m about to show you this again. Um, give me one second here and I already had it up. Okay. Um, and I’ll show you. Okay. Can you see this? Here’s our veal chop. So, okay.
Okay. Accelerations. So this is our accelerations is our real chop. The Oh, it’s okay. So you don’t need any um, interventions for this. You see down here we have our contractions and then here you just have a happy good health, healthy heart rate when you don’t have any decelerations happening. Um, so this one is a good one to see that you want to see or are early. These are the two good ones. So with our earlier is if you remember that sat mute, um, up here, this is variability which goes with cord compression. If you see here, the first letter of each thing is our pneumonics. So this is r, B e a and then l is down here with late and then core compressions to c, h o and then r placental insufficiency down there. Um, so with variables equal cord compression. So this one we’re just gonna reposition or do whatever we can.
So you can see here the heart rate is kind of all over the place. Spiking Oliver, those are variables. Um, these can be okay but unless they’re like super crazy, which is one kind of is. Um, so we’re going to give her oxygen, turn her. All that core compression happens when that cool Austin baby decides that it’s going to pull on its bungee cord or squeeze it or maybe the head’s laying on it, anything that would be compressing the cord and remember our oxygen and nutrients are gonna come through that court. So if it’s being compressed too much, um, then it’s gonna cause some variables and we’re going to want to try to fix that. So repositioning the, the mom turning or giving oxygen will all help. And then our veal chop our lates down here with that placenta insufficiency. Hopefully that helped answer questions.
What other questions do you guys have? So Brooklyn go to um, that uh, cheat sheet on fetal heart monitoring in NRSNG and um, you can download it. You can open it, look at it and it will um, lay it all out for you where you can probably zoom in a little bit better for yourself and see and then look at the field shot, um, on that Austin cheat sheet. It also gives you the different things to do for each one or if it’s just a monitor thing and you don’t need to do anything, you’re welcome. I can see if I can try to pull it up. Last time I lost my people when I was in a session and tried to pull it up on inner synergy, but let me try. So hang on there, hang in there, he’ll lose me. Let’s see here. Fetal heart monitoring. And normally I give you guys the links to all the lessons, but I’ll tell you because at this one, um, being all of a misunderstood content, sometimes it
[inaudible].
Um, it’s just a lot of different lessons. So just search through, here we go. Here’s the link for the fetal monitoring that will pull that up. Are there any key words to look for on and clicks? What do you mean by that?
Maybe add a reference, the tutorial enter page for printing prayer. Yeah, that’s true. That’d be helpful. Um, the key word things are just that if you’re talking about what I think are going to be things like are, um, doing the whole like early decelerations are mirror images, those kind of pointers that I gave out a mat, I’m not sure about key words, um, for different things that are going on with the baby yet. They are probably, um, it’s going to be more so describing what a late deceleration is and then you’re going to have to know what to do to manage that care. Oh, amber, thank you. I hope, I hope your instructor does as well or you starting in the fall.
Awesome. Good luck. We’ll you are getting a head start. I love it. So utilized, um, the Ob course on NRS and g, obviously I’m a little biased but I go through everything and hopefully it helps make it super simple for you and just break it all down. Let me see if we got an answer about our video on demand. Nope, I got gotten no answer yet. Um, so just contact an interest in g about that. And I too, I didn’t have NRSNG either. Um, contact NRSNG and see, maybe they’ll be able to give you guys a date of video on demand coming. All right, guys. Well, if you don’t have any other questions, go out and be your best selves and happy nursing.

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