Assess fetus or mother first?

[WantAccel.BSN, BSN, RN]

Let's say you have a pregnant woman who come into the ED with vomiting, fever, etc., and reports she has been unable to keep anything down for 2 days. She has a hx of methadone use and possible continued use of intravenous drugs. How do you proceed with this assessment? I'm thinking you would assess the fetus first via a NST, but I'm not sure if that's right. Thoughts? Thanks in advance!

[Fyreflie]

If I was unable to plop the monitor on while taking her history (that would be my first choice) I would auscultate at the first possible opportunity. It really also depends on the gestation. Under 23-24 weeks it's debatable whether you should or can have an NST that tells you much and we usually just auscultate.

Really, your first priority is Mom but if course you want to know how baby is tolerating things as soon as you're able.

[FLOBRN]

Alway the mom first. If the mom is not stable, it changes the plan.

I agree with putting the monitor on while you are doing the assessment.

[Elvish, BSN, DNP, RN, NP]

I always assess Mom first. Ideally, like another poster said, you try to throw her on the monitor while checking her out, but if you can't, Mom comes first.

Something else to think about - I'm not saying this is what Mom had, but her constellation of symptoms can also be part of withdrawal, which CAN negatively affect the fetus, depending on the drug and severity of withdrawal.