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NST vs CST vs BPP by Mind Map: NST vs CST vs BPP

1. Non-stress test

1.1. “Not stressful for mom or fetus”

1.2. Non-invasive, may even be done at a private OB office

1.3. May be given to patients the last month of pregnancy on a routine basis

1.4. This is an assessment of fetal well-being

1.5. Looking for “accelerations” in response to fetal movement, this means the fetal heart rate should increase every time the fetus moves

1.6. External fetal monitoring is applied to the patient

1.7. The patient is given a button, and presses it every time she feels the baby move

1.8. If there is no movement within the first 15 minutes the baby may be sleeping. The nurse can give the patient juice/crackers, or vibroacoustic stimulation to wake the baby up.

1.8.1. The fetus may or may not be in distress, we don't have enough data yet, so continue to maintain the client on EFM, and continue to monitor the client

1.9. For a reactive/reassuring result the fetal monitoring strip must show 2 accelerations of 15 bpm, for 15 seconds within the 20-minute time frame.

1.9.1. A non-reactive/non-reassuring result the strip must show that the criteria was not met within a 40-minute time frame, the nurse should notify the provider.

2. Contraction stress test

2.1. “Very stressful on mom and the fetus”

2.2. Very invasive

2.3. Cannot be done in a private OB office as a trained L&D nurse is required for monitoring

2.4. Involves administration of Oxytocin by Infusion

2.5. Not given to every patient on a routine basis

2.6. Oxytocin will induce contractions, so this may be given to see if the patient and the fetus can withstand labor may be commonly called “trail of labor”

2.7. Once Oxytocin is introduced to the body, it may be hard to stop labor, even if you stop the Oxytocin.

2.8. Many contraindications exist please make sure you are aware of them. They are provided in your texts, 2 different PP slides, and are listed in the category "contraindications to CST" below

2.9. On the fetal monitoring strip, the nurse is observing for late decelerations.

2.10. If she passes the test the result will be “negative” (as she was negative for late decelerations)

2.11. If she fails the test, the results will be “positive”, as she is positive for late decelerations)

2.12. If she fails(positive) implement your interventions for late decelerations

2.12.1. Stop the oxytocin

2.12.2. Lay on side/change position

2.12.3. Increase the IV fluid

2.12.4. Oxygen, mask 10-12 Liters

2.12.5. Notify provider

2.13. Additionally, you might want to place the patient NPO as they may be going for a surgical birth.

3. Contraindications to CST

3.1. History of previous C/S, preterm labor Cephalopelvic disproportion, HX of uterine SX, Fibroids, malpresentation of fetus, above zero station, acute maternal distress, acute fetal distress

3.1.1. It not just about remembering them as a checklist. Critically think which client would you not want to administer oxytocin to. Example- a client that is preterm: if you give then oxytocin they will deliver a preterm baby Example-a malpresentation: if there is no possibility that we think the baby will fit though the birth canal(passage) we will not give oxytocin to this client, as we would cause the baby to get stuck, such as a shoulder dystocia, on its way out

4. Biophysical profile

4.1. Involves performing a non-stress test by the nurse, and an ultrasound by the ultrasound technician

4.2. Looking for 5 markers of fetal well-being

4.2.1. Fetal heart rate (NST)

4.2.2. Breathing movements

4.2.3. Gross body movements

4.2.4. Fetal tone

4.2.5. Amount of amniotic fluid

4.3. Each marker gets 2 points

4.4. The nurse gets the ultrasound score from the ultrasound technician

4.5. The nurse is responsible for acting upon the score

4.6. 8-10 is normal

4.7. 6 or below suggests hypoxia

4.7.1. Notify the provider

4.7.2. Keep patient NPO a surgical birth may be required