Chapter 14: Fetal Monitoring Flashcards

1
Q

What do the invervals between the dark lines respresent on a FHR tracing?

A

1 minute

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2
Q

what is displaying on the tracing paper?

A
  • upper: FHR in response to contractions
  • lower: uterine activity
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3
Q

what are 2 ways we can assess FHR?

A
  • intermittent auscultation (IA)
    • 1 min before contraction starts, during contraction, and 2 min after
    • mobility, more natural, less costly
    • only assessing a small % of labor, maternal obesity/large amniotic fluid V may make it difficult to use
  • EFM
    • has more data and can help a woman through a contraction
    • reduced mobility, may require frequent adjustment
    • best identifies a well oxygenated fetus but does not reliably identify a compromised fetus
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4
Q

What is external fetal monitoring?

A
  • non invasive
  • perform Leopold’s maneuvers to determine where to put transduccers
  • apply the tocotransducer for contractions and ultrasonic transducer (for FHR)
  • position client in comfortable position (but avoid supine)
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5
Q

what types of thing affect the tocotransducer?

A
  • fetal size
  • abdominal fat thickness
  • maternal position
  • fetal position
  • location of transducer
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6
Q

how often and how long to chart external contraction monitoring?

A

depends on whether the mom is low risk or high risk and what stage of labor they are in

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7
Q

Where do you place the tocotransducer and ultrasonic transducer?

A
  • tocotransducer: over the fundus
  • ultrasonic transducer: over the fetal back
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8
Q

how do we determine where to put the transducers for EFM?

A
  • Leopold’s Maneuvers:
    • assesses fetal presentation, position, and lie
    • Steps:
      • face woman, palpate upper abdomen with both hands, and note shape, consistency, and mobility of part
        • fetal head is firm, round, and moves independently of trunk
        • fetal buttocks is softer and moves with trunk
      • move hands on pelvis and palpate abdomen with deep pressure
        • you should feel the fetal back (smooth) on one side and fetal extremities on the other (knobby)
      • then, place one hand just above symphysis and note whether palpated part feels like fetal head or buttocks, and whether it is engaged
      • face woman’s feet and place both hands on lower abdomen and move hands down the sides of the uterus toward pubis
        • note cephalic prominence or brow
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9
Q

what is involved with internal fetal monitoring?

what does it require?

A
  • Invasive:
    • fetal scalp electrode (FSE): placed on fetal scalp or buttocks (not face, genitals, or fontanels)
    • intrauterine pressure catheter (IUPC)
  • Requires:
    • ROM
    • 2-3 cm dilation
    • engaged presenting part
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10
Q

What does the intrauterine pressure catheter (IUPC) look at?

A
  • uterine activity:
    • contraction intensity
    • resting tone of the uterus
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11
Q

Internal Contraction Monitoring

A
  • IUPC: will tell you intensity and resting tone
  • more objective, but not perfect
    • position in uterus matters
    • meconium and vernix can disrupt reading
  • chart depending on stage of labor and whether high or low risk
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12
Q

how to count contraction frequency?

duration?

A
  • frequency: start of one contraction to another
  • duration: length of one contraction from increment to decrement
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13
Q

what to evaluate on an EFM strip?

A
  • FHR baseline
  • variability
  • periodic changes (decels)
  • clinical context
  • maternal contractions:
    • frequency and duration (if external monitor)
    • intensity and resting tone (if internal monitor)
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14
Q

what is baseline FHR?

A
  • should be between 110-160
  • evaluate on a 10 min strip
  • round to nearest 10 bpm
  • assess between contractions
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15
Q

what is variability in FHR?

A
  • change in baseline FHR
  • it is the difference b/w the lowest and highest beat to beat over 1 minute
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16
Q

how to interpret variability?

A
  • absent: 0-2 bpm
  • minimal: 3-5 bpm
  • moderate: 6-25 bpm
  • marked: >25 bpm
17
Q

what are the causes of decreased variability?

A
  • fetal sleep wake states
  • medication: narcs, sedatives
  • hypoxia/acidosis
  • fetal anomalies
18
Q

why is variability so important?

A
  • Adequate oxygenation promotes normal function of ANS and helps fetus adapt to labor
  • Variability evaluates the fetal ANS, esp the parasympathetic branch
19
Q

what is fetal bradycardia?

why does it occur?

A
  • <110 bpm
  • why?
    • late fetal asphixia
    • maternal hypoTN
    • prolonged cord compression/prolapse
20
Q

fetal bradycardia: interventions

A
  • notify physician
  • perform vaginal exam (check for cord)
  • initiate intrauterine resuscitation:
    • change maternal position & palpate uterus
    • oxygenate: 8-10 L/min
    • hydrate w/ inc IV fluids
    • assess maternal BP and medicate as needed
    • turn Pitocin off (if infusing)
  • prepare for possible C/S
21
Q

what is fetal tachycardia?

why does it occur?

A
  • >160 bpm
  • why?
    • maternal fever
    • fetal infection
    • dehydration
    • fetal anemia
    • congenital heart condition
    • medications: terbutaline (tocolytic)
22
Q

fetal tachycardia: interventions

A
  • change maternal position
  • O2 at 8-10 L/min
  • notify physician
  • evaluate whole monitoring strip, because could be prolonged accelerations
23
Q

what is acceleration?

A
  • visual, apparent, abrupt inc in FHR (15 beats and <15 seconds)
  • occurs with fetal movement
  • may or may not be related to uterine contractions
  • interpretation: sign of fetal well-being
24
Q

what is deceleration?

A
  • transient dec in FHR
  • occurrence is r/t pathophysiology
25
Q

What are early decels?

A
  • gradual decrease in FHR
  • mirrors uterine contraction
    • starts and ends with contraction
26
Q

what is the interpretation of early decels?

A
  • can be benign
  • may indicate head compression
27
Q

nursing care w/ early decels

A
  • continue to monitor
  • vaginal exam
28
Q

mechanism of early decel

A
  • pressure on fetal head–>
    • inc intracranial pressure–>
      • alteration in cerebral blood flow–>
        • vagal N stimulation–>
          • FHR deceleration
29
Q

what is a variable decel?

A
  • abrupt decrease
    • dec in FHR is at least 15 bpm and lasts 15 sec but less than 2 min
  • vary in occurrence, waveform, and onset
    • not uniform in appearance
  • V, W, or U shaped
30
Q

why does variable decels occur?

A
  • cord compression: the HR rises and falls abruptly (w/in 20 sec) w/ the onset and relief of cord compression
    • nuchal cord
    • cord prolapse (rarely)
31
Q

mechanism of variable decels

A
  • umbilical cord compression–>drop in fetal systemic BP and HR
32
Q

nursing care for variable decels

A
  • change position
  • d/c oxytocin
  • administer O2
  • inc fluids
  • vaginal exam
  • notify healthcare provider
  • amnioinfusion
33
Q

what are late decels?

A
  • gradual decrease
  • decrease after acme (peak) and recovers after contraction ends
    • shifted to the right: often begin after peak in contraction
  • nonreassuring
34
Q

why do late decels occur?

A
  • uteroplacental insufficiency
  • maternal hypoTN
  • chronic HTN and GDM
35
Q

nursing care for late decels

A
  • change position
  • d/c oxytocin
  • administer O2
  • inc fluids
  • notify health care provider
36
Q

VEAL CHOP

A
  • Variable Decels–>Cord Compression
  • Early Decels–>Head compression
  • Accelerations–>Oxygenation
  • Late Decels–>Placental Insufficiency
37
Q

FHR Indicators: Reassuring

A
  • indicates adequate fetal oxygenation
  • accelerations in FHR
  • moderate variability
38
Q

FHR Indicators: Non-Reassuring

A
  • indicates deficient fetal oxygenation
  • repetitive decels in FHR
  • minimal variability w/ no accelerations
  • bradycardia