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IM 6 Test 1 > Electronic Fetal Monitoring > Flashcards

Electronic Fetal Monitoring Flashcards

1
Q

what type of FHM allows ambulation/voiding

A

external FHM

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2
Q

what type of FHM makes women use a bedpan

A

Internal

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3
Q

how often should you monitor VS after membranes rupture

A

q 2 hours

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4
Q

vertex PMI

A

R or L lower quadrant

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5
Q

Breech PMI

A

R or L upper quadrant

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6
Q

when should you listen to FHR in intermittent auscultation during contractions

A

before, during and after a contraction

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7
Q

guidelines for intermittent auscultation X6

A 
active labor
immediately after membrane rupture
preceding and following ambulation
prior to and following pain medication
following vaginal exam, enema and cath
event of abnormal/excessive uterine contractions
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8
Q

what does the fetal heart monitor look at

A

FHR in r/t uterine contractions

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9
Q

Baseline FHR is measured when

A

measured between uterine contractions and don’t involve acels or decels

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10
Q

maternal indications for continuous EFM X7

A 
gestational diabetes
HTN
kidney disease
placenta previa
placenta abruption
induction/augmentation
abnormal FHM testing
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11
Q

Fetal indications for continuous EFM X5

A

multiple gestations, postdate gestations, intrauterine growth restriction, meconium stained fluid, fetal bradycardia

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12
Q

what is intrauterine growth restriction

A

baby growth restricted d/t some external reason

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13
Q

EFM ultrasound placed

A

over fetal back to record heart rate

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14
Q

EFM tocodynamometer placed on

A

fundus to record uterine contraction

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15
Q

Toco records what in contractions

A

frequency – NOT strength

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16
Q

what does FSE require X2

A

requires ruptured membranes and cervical dilatoin of 2-3 cm

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17
Q

where does FSE attach

A

presenting aprt

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18
Q

FHR baseline is measured from a X minute long strip and needs X minutes. round to increments of X

A

measured from a 10 minute long strip and needs 2 minutes of uninterrupted measurement. round in increments of 5

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19
Q

most important indicators of fetal CNS health

A

baseline and variability

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20
Q

fetal baseline normal

A

110-160

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21
Q

fetal bradycardia

A

<110 or >90 with variability

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22
Q

when is bradycardia an OB emergency

A

<80 BPM

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23
Q

Fetal Causes of bradycarda X3

A

late manifestatoin of fetal hypoxia, O2 pathyway interruption or congenital cardiac defects

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24
Q

Maternal causes of bradycardia X4

A

hypotension, narcotics, magnesium sulfate, anesthesia

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25
Q

what is magnesium sulfate used for

A

suppressing labor in HTN moms

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26
Q

fetal tachycardia

A

> 160

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27
Q

when could fetal demise occur in tachycardia

A

200-220

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28
Q

fetal causes of tachycardia X2

A

early sign of hypoxia, fetal anemia

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29
Q

maternal causes of tachycardia X6

A

anemia, dehydration, fever/infection, hyperthyroidism, medication, illicit drugs

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30
Q

what drugs can cause tachycardia in baby X5

A

atropine, terbutaline, hydroxyzine, cocaine, meth

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31
Q

IUR consists of X5

A

left lateral maternal positioning, O2 at 10 L/min via non-rebreather, bolus of 500 mL NS/LR, stop oxytocin, notify MD

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32
Q

absent variability

A

non-reassuring, 0-1

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33
Q

minimal variability

A

fetal sleep cycle, <5

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34
Q

moderate variability

A

reassuring, 6-25

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35
Q

marked variability

A

could be good or bad may indicate need for IUR, >25

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36
Q

how long is the fetal sleep cycle

A

<30 minutes

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37
Q

what is the #1 cause of decreased variability

A

sleep cycle

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38
Q

persistant variability over 60 mins despite intervention indicates X3

A

hypoxia, hypoxemia, acidosis

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39
Q

maternal causes of FHR variability X4

A

narcotics, CNS depressants, mag sulfate, anesthesia

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40
Q

what protects umbilical cord vessel

A

wharton’s jelly

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41
Q

what are the 5 factors for adequate fetal oxygenation

A

maternal: normal maternal O2, adequate exchange of O2 and CO2, sufficient blood flow
fetal: placental circulation via cord, normal circulatory and O2 carrying function

42
Q

what do the umbilical arteries transport

A

return deoxygenated blood back to the mom

43
Q

periodic FHR changes are

A

FHR changes r/t a uterine contraction

44
Q

episodic FHR changes are

A

unrelated to a uterine contraction

45
Q

what is a FHR acceleration

A

increase of FHR of 15 bpm above baseline for 15+ seconds

preemie: 10 bpm in 10 seconds

46
Q

when can accelerations occur

A

contractions, vaginal exams or breech presentions

47
Q

what does an acceleration show

A

reassuring - shows a non-acidotic, reactive and healthy fetus

48
Q

nursing interventions for accelerations

A

no nursing interventions required

49
Q

what is an early decel

A

gradual decrease of FHR below baseline as contraction begins and returns to baseline as contraction ends

50
Q

what can an early decel indicate

A

baby descending down pelvis

51
Q

nursing interventions for early decels

A

no interventions needed - consider vag exam to check labor progress

52
Q

late decelerations are

A

a gradual decrease in FHR below basline that begins after contraction

53
Q

what does a late decel reflect

A

ominous, non-reassuring pattern showing placental insufficiency

54
Q

nursing interventions for late decelerations

A

IUR done immediately

55
Q

maternal causes of late decels X6

A

hypotension, placental previa or abruption, HTN, diabetes, placental changes, uterine hyperstimulation or tachysystole

56
Q

tachysystole

A

too many contractions at one time

57
Q

Variable decelerations

A

abrupt decrease in FHR that is vairable in shape and duration

58
Q

cause of variable decelerations

A

restricted blood flow in the cord

59
Q

nursing interventions for variable decels

A

IUR done immediately

60
Q

prolonged deceleratinos

A

decrase in FHR below baseline lasting 2-10 minutes

61
Q

what does a prolonged deceleration under 2 minutes indicate

A

baseline change

62
Q

what causes prolonged decels

A

interruption of uteroplacental perfusion/umbilical blood flow

63
Q

nursing interventions for prolonged decelerations

A

IUR done immediately

64
Q

VEAL CHOP variable

A

variable - cord compression - move patient

65
Q

VEAL CHOP early

A

early - head compression - initiate c-section measures

66
Q

VEAL CHOP acceleration

A

acceleration - OK - nothing

67
Q

VEAL CHOP late

A

late - placental insufficiency - emergency delivery

68
Q

duration

A

length of contraction from beginning to end

69
Q

frequency

A

beginning of one contraction to beginning of the next

70
Q

relaxation time

A

end of one contraction to the beginning of the next

71
Q

what is adequate relaxation time

A

> 60 seconds to allow for uterine flow

72
Q

IUPC normal resting tone

A

5-15

73
Q

IUPC hypertonus resting tone

A

20-25

74
Q

mild intensity or 1+ feels like

A

your nose

75
Q

moderate intensity or 2+ feels like

A

chin

76
Q

strong intensity or 3+ feels like

A

forehead

77
Q

IUPC mild contraction pressure

A

30 mmHg

78
Q

IUPC strong contraction pressure

A

70 mmHg

79
Q

labor average IUPC pressure

A

50-75 mmHg up to 110 when pushing

80
Q

normal contraction rate

A

5 or fewer contractions in a 10 minute window averaged over 30 minutes

81
Q

how long should normal contractions last

A

45-90

82
Q

tachysystole

A

5+ contractions in a 10 minute period averaged over 30 minutes

83
Q

what is hypertonic uterine activity

A

resting tone between contraction is high reducing uterine blood flow and decreasing fetal O@ supply

84
Q

what does hypertonic uterine activity contribute to X4

A

hypoxemia, hypoxia, metabolic acidosis, metabolic acidemia

85
Q

tocolytic drug

A

terbutaline

86
Q

maternal position to reduce uterine activity and why

A

left lateral - improves blood flow

87
Q

how many tiers are in the FHR interpretation system

A

3

88
Q

category I FHR is

A

normal

89
Q

what qualifies a category I FHR

A

moderate variability, baseline of 110-160.

potentially accelerations and early decels

90
Q

what must be absent in a category I FHR

A

late and varied decels

91
Q

nursing interventions for Category I FHR

A

no action required

92
Q

category II FHR is

A

indeterminate - fetal acid/base status is uncertain

93
Q

what qualifies a category II FHR

A

tracings not categorized as I or III

94
Q

nursing interventions for category II FHR

A

requires continued intervention, evaluation and reevaluation

95
Q

category III FHR is

A

abnormal and shows a problem in the fetal acid/base balance

96
Q

what qualifies a category III FHR

A

absent variability, and/or recurring late decels, recurring varied decels, bradycardia, sinusoidal pattern

97
Q

nursing interventions for a category III FHR

A

initiate IUR and prompt provider evaluation and delivery

98
Q

what does IUR consist of

A

“The 4 turns”

Turn patient - left lateral
Turn IV fluid up - 500 mL NS/LR
Turn O2 on - 10 L/min via non-rebreather
Turn oxytocin off

notify MD ASAP

99
Q

during IUR, consider X3

A

correcting maternal hypotension, performing amnioinfusion, modifying second stage pushing efforts

100
Q

when should you do an amnioinfusion

A

variable deceleration

101
Q

what does modifying second stage pushing efforts mean

A

push every 2nd or 3rd contraction to allow for refill

102
Q

preemie monitoring considerations

A

higher baseline w/n normal range, accels may have lower amplitude and variability may be decreased

IM 6 Test 1 (5 decks)

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