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>Variable or late decelerations: Absent, Category II from three-tier system FHR monitoring, Category II tracings include all FHR tracings not categorized as category I or III. >Following expulsion of an enema nursing considerations for internal fetal monitoring ati Check out our blog for articles and information all about nursing school, passing the NCLEX and finding the perfect job. >Post-date gestation It is manifested by regular contractions and thinning and opening of the cervix to name a few. This can happen at any gestational age, even full term. Fetal heart rate monitoring measures the heart rate and rhythm of the fetus. Sale ends in: 6 days 10 hours 42 mins 1 sec. Fetal Heart Rate Monitoring and VEAL CHOP MINE in Nursing This maneuver validate the presenting part. Najee Harris Parents Nationality, During fetal development, AFP levels in serum and amniotic fluid rise; because this problem crosses the placenta, it appears in maternal serum. And it records baseline FHR, long-term variability, accelerations, and decelerations. >Bradycardia is a FHR less than 110/min for 1 minute or longer, Continuous electronic fetal monitoring Advantages, >Noninvasive and reduces risk for infection 8. learn more Page Link Facebook Question of the Week. Juni 2022 . [4] This situation prevents a safe vaginal delivery and requires the delivery of the neonate to be via cesarean delivery. TEAS Tuesday: Answers to your most frequently asked ATI TEAS, Version 7 questions May 25, 2022 / by Kari Porter Tips for Coping with Stress During Nursing School REVIEW ATI NURSING ACTIONS COMPLICATIONS pg 150-151 25 Changes in FHR patterns are categorized as episodic or periodic changes. It is manifested by regular contractions and thinning and opening of the cervix to name a few. >Maternal use of cocaine or methamphetamines It can also be done before labor and delivery, as part of routine screening at the very end. I think it is so neat that technology has advanced in such a way that we can monitor mother's . It could even restrict placental blood flow, resulting in abnormal fetal heart rate patterns. Perinatal nurses are most often the primary health care professionals responsible for FHM. >Recurrent late decelerations Therefore, special nursing intervention is not required. Picmonic. Accelerations, fetal bradycardia, fetal tachycardia, decrease or loss of FHR variability, early decelerations of FHR, late decelerations of FHR, variable decelerations of FHR, Variable transitory increase in the FHR above baseline. External Fetal. The plan has resulted in the installation of more than 30,000 systems statewide since its inception in 1996. The H/H levels are monitored, and external electronic fetal heart rate monitoring is initiated. This lets your healthcare provider see how your baby is doing. In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of antepartal, intrapartal, postpartum, and newborn care in order to: Assess client's psychosocial response to pregnancy (e.g., support systems, perception of pregnancy, coping mechanisms) In late stages of pregnancy, AFP levels in fetal and maternal serum . Assess FHR for 60 seconds before and immediately following a uterine contraction. External User Login - Lippincott Advisor for Education. In this video the procedure, complications, and nursing care for an external cephalic version. It assists the fetal ability to cope with the contraction of high-risk pregnancy and the stress of labor. The following are 3 different methods of fetal monitoring: Now that we know how to monitor the fetal heart rate, lets look into what this information will clue us into. Fetal Assessment: Leopold Maneuvers, Fetal Heart Rate - LevelUpRN >Ensure electronic fetal monitoring equipment is functioning properly What Happened To Tadd Fujikawa. The machine have two transducers. Can measure the frequency, duration, and intensity of UCs, The average rate during a 10 minute segment that excludes periodic or episodic changes, periods of marked variability and segments of baseline that differ by more than 25 beats/minute, Absent - straight line simplify Topics you are currently struggling With. Late decelerations can be defined as temporary decreases in FHR that occur after a contraction begins. 2023 nurseship.com. An example of data being processed may be a unique identifier stored in a cookie. The consent submitted will only be used for data processing originating from this website. What are some complications of Continuous internal fetal monitoring? A slow heart rate, or bradycardia, may indicate the baby is not getting enough oxygen delivery to the brain. Background. >Compression of the fetal head resulting from uterine contraction Keywords Electronic fetal monitoring, Nursing instructions, Maternity nurses 1. -Discontinue oxytocin if being administered. Variable declerations Cord compression, Late decelerations-Placental insufficiency. >Umbilical cord compression The population was women in labor with uneventful singleton pregnancies at term. >Maternal hypotension, placenta previa, abruptio placentae, uterine hyperstimulation with oxytocin These should subside within 2 minutes. Fetal Heart Tone Monitoring of Decelerations For Nursing Students and Nurses. Step 3. A transducer is placed over the point of maximal impulse (PMI), the location on the patient's abdomen where fetal heart tones can be heard best. >Intrauterine growth restriction The most common way to monitor the fetal heart rate is using an ultrasound transducer, a non-invasive procedure. >Active labor PDF Proctored Ati Test Maternity Answers Pdf , Mariann Harding Full PDF The baseline intrauterine pressure is 25-30 mmHg. with a belt. >Congenital abnormalities. Posted on June 11, 2015. b. notify the physician so that a fetal scalp blood sample can be obtained. Nursing considerations. CUSTOM ART FOR CUSTOM NEEDS >Membranes do not have to be ruptured Pitocin may be used alone or with other medications. securing it with a belt. >Fetal cardiac dysrhythmias Additionally, types of labor induction (cervical ripening, amniotomy, and oxytocin) and nursing care for all. We're going to monitor maternal vital signs, fetal heart rate, diagnostic tests, administer medications, promote rest, and prepare the patient for delivery. I think it is so neat that technology has advanced in such a way that we can monitor mother's . Amniotomy may be contraindicated in the following situations: Known or suspected vasa previa. Labor is the process by which the pregnant body prepares for the delivery of the fetus. Electronic fetal heart monitoring is not a substitute for appropriate professional nursing care and support of women in labor. Also, be sure to check out these otherMaternal (OB) Nursing study guides (downloadable PDF cheat sheets also available): During labor, both the mother and fetus will be monitored closely. In nursing, the acronym VEAL CHOP can be used to remember the types of fetal heart rate patterns and the causative factors associated with them. Repeat hourly x's 3 for vaginal doses and x's 1 for oral doses . >Maternal complications (gestational diabetes mellitus, gestational hypertension, kidney disease) Internal fetal monitoring involves inserting an electrode through the dilated cervix and attaching the electrode to . This lets your healthcare provider see how your baby is doing. Describe three (3) important nursing considerations when caring for a client with internal fetal monitoring. An experienced labor and delivery nurse without a patient care assignment was designated to continuously assess all active fetal monitoring tracings, via an electronic display away from the main nurses' station, as an adjunct to the care and assessment of the nurse with primary responsibility for the patient. What are some nursing interventions of variable decelerations of FHR? Additionally, types of labor induction (cervical ripening, amniotomy, and oxytocin) and nursing care for all. Describe three (3) important nursing considerations when caring for a client with internal fetal monitoring. >Viral infection Introduction Electronic fetal monitoring is processa method of assessing fetal status both before fetaland during labor. External Fetal Monitoring (EFM) is the most commonly used method, which also assesses uterine activity.-Discontinue oxytocin if being administered -Assist mother to a side-lying position -Administer oxygen via facemask 8 - 10 L -Give bolus of isotonic IV fluids -Notify . [1][2][3] It is a major risk factor for postpartum hemorrhage and can lead to morbidity and mortality of the mother and neonate. Outline the nurse's role in fetal assessment. Degree of descent of the presenting part into the pelvis >Maternal diabetes mellitus. REVIEW ATI NURSING ACTIONS COMPLICATIONS pg 150-151 25 Changes in FHR patterns are categorized as episodic or periodic changes. >Late or post-term pregnancy Fetal Heart Rate Monitoring - Freeman 2012 "Fetal heart rate monitoring is widely used by almost every obstetrician as a way to document the case and to help decrease health care costs. During fetal development, AFP levels in serum and amniotic fluid rise; because this problem crosses the placenta, it appears in maternal serum. >Administer oxygen by mask 1t 8 to 10 L/min via nonrebreather face mask >Accurate measurement of uterine contraction intensity This can happen at any gestational age, even full term. Its described as cycles per minute and the frequency of cycles is 3 to 6 per minute. -Maternal complications It assists the fetal ability to cope with the contraction of high-risk pregnancy and the stress of labor. [1]. >Prolonged FHR deceleration equal or greater than 2 minutes but less than 10 minutes Aspiring nurses can learn about the different types of nurses, education requirements, and nurse salary statistics.Nursing students can access care plan examples, nursing school study tips, NCLEX review lectures and quizzes, nursing skills, and more. Maternity Nursing and Newborn Nursing Test Bank. External fetal monitoring is crucial in evaluating the fetus that is at risk for severe hypoxia. New nurses can access job resources such as interview tips, nursing job resumes, and job search tools. >Notify the provider Ultrasound (US) is acoustic energy that interacts with human tissues, thus, producing bioeffects that may be hazardous, especially in sensitive organs (i.e., brain, eye, heart, lung, and digestive tract) and embryos/fetuses. Fetal Heart Tone Monitoring of Decelerations For Nursing Students and Nurses. o 1:1 nursing should be employed when auscultation is used . >Place client in side-lying position We and our partners use data for Personalised ads and content, ad and content measurement, audience insights and product development. Use code: MD22 at checkout. >Prior to and following administration of or a change in medication analgesia nursing considerations for internal fetal monitoring ati Early decelerations are not indicative of fetal distress. The variability is Reassuring, if it is between5 25 bpm. The average fetal heart rate is between 110 and 160 beats per minute. 5. and nursing literature have explored these com-munication barriers, especially between nurses and physicians. It records uterine contractions. Periprocedure. Your doctor may choose to perform fetal monitoring during pregnancy or labor if any of the following occurs: You have anemia. In 2011, one in three women who gave birth in the United States did so by cesarean delivery 1.Even though the rates of primary and total cesarean delivery have plateaued recently, there was a rapid increase in cesarean rates from 1996 to 2011 Figure 1.Although cesarean delivery can be life-saving for the fetus, the mother, or both in certain cases, the rapid increase in the rate of . nursing considerations for internal fetal monitoring ati nursing considerations for internal fetal monitoring ati. It is an important clinical indicator that is predictive of fetal acid-base balance and cerebral tissue perfusion. Teach patients to: Follow our Facebook Page for the NCLEX-Style Question of the Week as well as relevant posts and live events to help you on your road to becoming a . can disconnect the monitor temporarily. proper placement of transducer. Risks of internal monitoring include, but are not limited to, infection and bruising of the fetal scalp or other body part. Slide 3: Electronic Fetal Monitoring. -Fetal distress, Copyright 2023 StudeerSnel B.V., Keizersgracht 424, 1016 GC Amsterdam, KVK: 56829787, BTW: NL852321363B01, Fetal heart rate monitoring measures the heart rate and rhythm of the fetus. Copyright 2017 Enlightened Objects LLC - All Rights Reserved. It truly is a beautiful process from conception to birth and thereafter. Patient may then ambulate for 30 minutes and then monitor FHR and UA x's 30 minutes if no evidence of non-reassuring FHR or tachysystole. Med-Surg. It uses a stethoscope or Doppler transducer . These various technologies assist in supporting interventions for a nonreassuring fetal heart rate pattern when necessary. Association of Women's Health . . Fetal bradycardia is defined as a baseline fetal heart rate of less than 110 bpm and lasts longer than 10 minutes. Methods: This was a prospective observational study in a labor ward of a tertiary care university hospital. >Fetal sleep cycle (Minimal variability sleep cycles usually do not last longer than 30 minutes) On occasion, internal fetal monitoring is needed to provide a more accurate reading of the fetal heart rate. Prematurity: variability is reduced at earlier gestation (<28 weeks), variability is less than 5 bpm for between 30-50 minutes, or, variability less than 5 bpm for more than 50 minutes, more than 25 bpm for more than 25 minutes, or, visually apparent with elevations of FHR of at least 15 bpm above the baseline, usually, last longer than 15 seconds but not for longer than 2 minutes, prolonged acceleration is when it lasts longer than 2 minutes but less than 10 minutes, if acceleration lasts more than 10 minutes, it is considered a change in baseline, informing the primary healthcare provider about pattern change, persists at that level for at least 60 seconds. Explain the various comfort-promotion and pain-relief strategies used during labor and birth. moderate variability. The onset of early deceleration to nadir (lowest point) is usuallymore than or equal to 30 seconds. Support. 211 Comments All rights reserved. Absent baseline variability not accomplished by recurrent decelerations Additional nursing interventions include: Variable deceleration is defined as an abrupt decrease of FHR from the onset of the deceleration to the beginning of the FHR nadir of <30 seconds. FHR Variabilityis a normal reflex that occurs as a result of the interaction between the parasympathetic and sympatheticnervoussystems. Observe for any change in maternal condition, such as ruptured membranes or the onset of bleeding. Delayed timing of the deceleration occurs with the nadir of the uterine contraction. Place client in left-lateral position, Slowing of FHR with start of contraction with return of FHR to baseline at end of contraction. nursing considerations for internal fetal monitoring ati Invasive EMF is done by applying a spiral pointed scalp electrode to the fetal scalp after rupturing the membranes. Kaplan Diagnostic Exam with rationales.docx - Kaplan Published by at 29, 2022. Ensure that the patient is not taking concomitant ACEi or ARB therapy. Nursing intervention? Identify descent of presenting part into pelvis Determine the part that is presenting over the true pelvis inlet by gently grasping the lower segment of the uterus between the thumb and fingers. Special Considerations In cases of multiple gestation, a monitor capable of simultaneously recording more than one fetal . Intermittent auscultation of the FHR is a low-technology method that can be performed during labor using a hand-held Doppler ultrasound device, an ultrasound stethoscope, or fetoscope to assess FHR. >Fetal congenital heart block L&D/Maternal Fetal Monitoring/Quick Notes L&D/Fetal Monitoring/Fhr Internal L&D/Fetal Monitoring Strips Desired Outcome: The patient will re-establish . During the assessment, you'll observe the fetal heart rate, rhythm, and intensity. In this video the procedure, complications, and nursing care for an external cephalic version. Internal fetal monitoring involves inserting a transducer through your cervical opening and placing it on your baby's scalp. To identify these problems, thoroughly assess the patient before tube feeding begins . They are identified visually on a fetal monitor tracing by when they occur in the contraction cycle either the onset or at the end . Cross), The Methodology of the Social Sciences (Max Weber), Principles of Environmental Science (William P. Cunningham; Mary Ann Cunningham), Civilization and its Discontents (Sigmund Freud), Educational Research: Competencies for Analysis and Applications (Gay L. R.; Mills Geoffrey E.; Airasian Peter W.), Biological Science (Freeman Scott; Quillin Kim; Allison Lizabeth), Give Me Liberty! During the assessment, youll observe the fetal heart rate, rhythm, and intensity. Fetal movements/kick counts to ascertain fetal well being- count and record fetal movement- One method: Mothers should count fetal activity two or three times a day for 2 hr after meals or bedtime. It also gives you a clue as to what the correlating nursing interventions should be for each pattern. Alaska Commercial Fishing Boats For Sale, To identify these problems, thoroughly assess the patient before tube feeding begins and monitor closely during feedings . Slide 3: Electronic Fetal Monitoring. Invasive EMF is used for high risk mothers or fetuses. The catheter measures the pressure within the amniotic space during contractions and allows physicians to evaluate the strength, frequency . Intermittent fetal heart rate monitoring involves periodic auscultation of FHR using an ordinary stethoscope or a fetoscope or a hand-held Doppler. This applies to all medical and nursing personnel. Labor is the process by which the pregnant body prepares for the delivery of the fetus. Dec 11, 2017. Electronic fetal monitoring, Nursing instructions, Maternity nurses >Preeclampsia -Give bolus of isotonic IV fluids Once deceleration starts, it takes about 20 to 30 seconds to reach its lowest point. It also checks the duration of the contractions of your uterus. This Electronic Fetal Monitoring (EFM) is called Cardiotocography (CTG). Use PSpice to input the circuit of the given figure. The average pressure is usually 50 to 85 mm Hg. Objective: To compare fetal heart rate (FHR) signals acquired simultaneously by an external ultrasound probe and a scalp electrode during the second stage of labor. Pitocin (Oxytocin Injection): Uses, Dosage, Side Effects - RxList The method that is used depends on the policy of your ob-gyn or hospital, your . Thebaselinefetal heart ratecan be defined as theaverageheartrateof thefetuswithina10-minute period. Purpose: The population was women in labor with uneventful singleton pregnancies at term. Follow our Facebook Page for the NCLEX-Style Question of the Week as well as relevant posts and live events to help you on your road to becoming a . A spike on the fetal heart tracing in response to the cough indicates proper positioning of the catheter. Your health provider will check your baby's heart rate either continuously with an electronic fetal monitor, or periodically (this is called intermittent auscultation). Market-Research - A market research for Lemon Juice and Shake. Interpretations of findings for continuous electronic fetal monitoring. and nursing literature have explored these com-munication barriers, especially between nurses and physicians. >Rupture of membranes, spontaneously or artificially If you have a high-risk pregnancy or are having your labor induced . The catheter measures the pressure within the amniotic space during contractions and allows physicians to evaluate the strength, frequency . Intermittent fetal heart rate monitoring involves periodic auscultation of FHR using an ordinary stethoscope or a fetoscope or a hand-held Doppler. -You can move with the monitor in place. Identify ways to apply key safety elements to your unit policies, procedures, and practices related to electronic fetal monitoring. Continuous electronic fetal monitoring may be indicated due maternal or fetal conditions. Amniotomy may be contraindicated in the following situations: Known or suspected vasa previa. Purpose: To outline the nursing management of antepartum and intrapartum patients during external and internal fetal monitoring, intermittent fetal heart rate (FHR) auscultation, as well as nursing management for when . Monitor lab results and report abnormalities to the healthcare provider (HCP), including serum potassium and creatinine levels and blood urea nitrogen. kennan institute internship; nascar heat 5 challenge rewards Visually you can see the presence or absence of short-term variability. Every 5-15 minutes during the second stage for low risk women, Is indicated when abnormalities occur with intermittent auscultation and for use in high-risk patients, Continuous Electronic fetal monitoring- indirect or external, Continuous external fetal monitoring is accomplished by securing an ultrasound transducer over the clients abdomen, which records the FHR pattern, and a tocotransducer on the fundus that records uterine contractions, Attachment of a small spiral electrode to the presenting part. Solar power systems to generate electricity are, as yet, not cost-effective on Hawaii. We've made a significant effort to provide you with the most informative rationale, so please read them. >Early decelerations: Present or absent It is most commonly measured via electronic fetal monitor. Your bag of waters (amniotic fluid) must be broken and your cervix must be partially dilated to use internal monitoring. nursing considerations for internal fetal monitoring ati. One of the coolest things about the labor process is the monitoring of fetal heart tones. ATI Nursing Blog. Additionally, Meris reviews types of labor induction (cervical ripening, amniotomy, and oxytocin) and nursing care for all. Baseline fetal heart rate can be interpret as reassuring,non-reassuringorominous signs. She also discusses the components and scoring of the Bishop Score. >A provider, nurse practitioner/midwife or specially trained registered nurse must perform this procedure. 2. without opening a boring textbook or powerpoint. Fetal monitoring is a large part of the labor process that labor and delivery nurses must be knowledgeable about. What is the VEAL Chop Method for Nursing? -Non-reassuring FHR patterns (bradycardia, minimal/absent variability, late/variable, -If you need to walk or use the bathroom, we. -Non-reassuring FHR patterns (bradycardia, If you're pregnant, your doctor will want to make sure your baby is healthy and growing. What are some considerations for preparation of the client for intermittent fetal monitoring and uterine contraction palpitations? Most cases are diagnosed early on in . Memorial Day Sale. Let the circuit sweep through frequencies of 100Hz100 \mathrm{~Hz}100Hz to 1MHz1 \mathrm{~MHz}1MHz. >Variable decelerations. Methods: This was a prospective observational study in a labor ward of a tertiary care university hospital. internal fetal monitoring, including the appropriate use for each. If you would like to change your settings or withdraw consent at any time, the link to do so is in our privacy policy accessible from our home page.. Leopold Maneuvers: determine the part that is presenting over the true pelvis inlet, Gently grasping the lower segment of the uterus between the thumb and fingers. >prepare for an assisted vaginal birth or cesarean birth, >Transitory, abrupt slowing of FHR less than 110/min, variable in duration, intensity, and timing in relation to uterine contraction. Manage Settings nursing considerations for internal fetal monitoring ati. wrong with your baby. 6. -Oxytocin infusion (augmentation or induction of labor) As a result, thermal and mechanical indexes have been . Overview Purpose: determine fetal well being by measuring FHR, fetal response to contractions. nursing considerations for internal fetal monitoring ati Contraction Stress Test (CST) By Nursing Lecture. Rambutan Leaves Turning Brown, >Prolonged umbilical cord compression Accelerations are common and are associated typically with any direct or indirect fetal movement. Minimal - detectable up to 5 bpm Intrauterine pressure transducer is introduced into the uterine cavity. a. BUN 25 mg/dL b. serum creatinine 0.8 mg/dL c. urine output of 280 mL w/ 8 hr d. urine negative for ketones A nurse is providing teaching about family planning to a client who . >Abruptio placentae: Suspected or actual In late stages of pregnancy, AFP levels in fetal and maternal serum . >Maternal infection, chorioamnionitis learn more Page Link Virtual-ATI. Doctors can use internal or external tools to measure the fetal heart rate (1). Some of our partners may process your data as a part of their legitimate business interest without asking for consent. Interventions of the nurse with intermittent fetal monitoring and uterine contraction palpitations? The decline of the contraction intensity as the contraction is ending. Preterm labor, also known as premature labor, occurs when the body starts the process of delivery of the fetus before the 37th week of pregnancy. >Bradycardia. Secondly, the word CHOP represents the cause for these pattern variations. >Accelerations: Present or absent DC Duttas textbook of obstetrics (8th ed). By using any content on this website, you agree never to hold us legally liable for damages, harm, loss, or misinformation. Fetal movements of less than 3 per hr or movements that cease entirely for 12 hr indicate a need for further evaluation Diagnostic testing for fetal . Perinatal nurses are most often the primary health care professionals responsible for FHM. The nadir occurs at the same time as the peak of the contraction. that depress the CNS, such as narcotics, barbiturates, tranquilizers, or general anesthetics Check out our blog for articles and information all about nursing school, passing the NCLEX and finding the perfect job. >Short cord Presumptive Signs of Pregnancy Changes that are experienced by the woman that make her think that she may be pregnant. It traces both the fetal heart rate, fetal movement, and uterine contractions on a graph paper. Sinusoidal pattern Electronic fetal monitoring that is, constantly monitoring a baby's heartbeat is often used during labor to make sure babies don't lack of oxygen during labor and suffer resulting brain damage. >Following vaginal examination L&D/Maternal Fetal Monitoring/Quick Notes L&D/Fetal Monitoring/Fhr Internal L&D/Fetal Monitoring Strips Care for a high-risk pregnant patient necessitates more than a basic understanding of pregnancy, labor, and delivery. Preterm labor, also known as premature labor, occurs when the body starts the process of delivery of the fetus before the 37th week of pregnancy. If the head is presenting and not engaged, determine whether the head is flexed or extended. It gives an indirect indication of the oxygen status of the fetus. nursing considerations for internal fetal monitoring atipositive and negative effects of nanotechnology on the environment. >Monitor maternal vital signs, and obtain maternal temperature every 1 to 2 hours However, we aim to publish precise and current information. >Fetal heart rate baseline variability is described as fluctuations in the FHR baseline that are irregular in frequency and amplitude. >Auscultate FHR before, during and after a contraction to determine FHR in response to the contractions. Since the fetus is inside the mothers uterus, physical assessment is not a viable option. SKILL NAME ____________________________________________________________________________ REVIEW MODULE CHAPTER ___________. My Blog nursing considerations for internal fetal monitoring ati .
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We got our robust technical support team. Members of this team are well experienced and knowledgeable. In addition we conduct virtual meetings with our BCs to update the development in the banking and the new initiatives taken by Bank and convey desires and expectation of Banks from BCs. In these meetings Officials from the Regional Offices of Bank of Baroda also take part. These are very effective during recent lock down period due to COVID 19.
Information and Communication Technology (ICT) is one of the Models used by Bank of Baroda for implementation of Financial Inclusion. ICT based models are (i) POS, (ii) Kiosk. POS is based on Application Service Provider (ASP) model with smart cards based technology for financial inclusion under the model, BCs are appointed by banks and CBCs These BCs are provided with point-of-service(POS) devices, using which they carry out transaction for the smart card holders at their doorsteps. The customers can operate their account using their smart cards through biometric authentication. In this system all transactions processed by the BC are online real time basis in core banking of bank. PoS devices deployed in the field are capable to process the transaction on the basis of Smart Card, Account number (card less), Aadhar number (AEPS) transactions.