Electronic Fetal Monitoring Flashcards
What some nursing interventions for EFHM? (4)
Have pt empty bladder
Palpate the fundus- put toco on fundus
Preform Leopolds- place ultrasound on PMI
Monitor VS
What are the two parts of IFM
Fetal scalp electrodes (FSE)- Cervical dilation needs to be 2-3
Intrauterine pressure catheter (IUPC)
Where do you palpate to determine intensity of Contractions
The fundus
When do you palpate during the contraction to determine intensity
During the peak (ACME)
How would you document these finding of intensity’s of contractions
Cannot indent uterus
Can slight indent
Easily indent
3+ (Forehead)
2+ (Chin)
1+ (Nose)
What is the normal contraction ratio
5 or less contractions in 10 mintues
What is normal resting tone ?
10 mm of Hg
What is a normal FHR?
110-160 bpm
How long do you need to wait to find a baseline?
2 minutes
What are some periodic FHR patterns
FHR changes in relations to a uterine contraction
What are some episodic FHR Patterns
FHR Changes unrelated to contractions
FHR Accelerations :
Term
Preterm
What does it mean
What nursing intervention is required
15x15
10x10
A reactive, healthy fetus
No intervention is required
Early Decelerations
Define:
What is happening
Nursing intervention?
FHR slowly decelerates as the ctx begins and returns to baseline as Ctx ends
Response to fetal head compression
No interventions needed
What are the four types of baseline variability
Absent- 0-1 changes in bpm
Minimal- 1-5 changes in bpm
Moderate- 6-25 changes in bpm
Marked- >25 changes in bpm
What three things needs to be considered when looking at baseline
Gestational age
Fetal sleep cycles
Changes from last baseline
What are some causes for decreases in variabilty
Medication- narcotics, CNS depressant, mag sulfate, anesthesia
Hypoxiap- (Turn patient)
Variable decelerations
Define:
Causes
Nursing intervention
A decrease in FHR that is varied in shape, size, and timing
Slow return to baseline
Issue with the o2 pathway, cord compression
Intrauterine resuscitation nursing interventions
Late Decelerations
Define
Causes
Nursing Interventions
Gradual decrease in FHR that begins after the ctx and returns after the ctx is over
Uteroplacental insufficiency- preeclampsia, post dates, diabetes, placenta abruption
Intrauterine resuscitation is needed
Prolonged decelerations
Define
Cause
Nursing Intervention
Decrease in FHR lasting 2 or more minutes
Interruption of uteroplacental perfusion, umbilical blood flow
Intrauterine resuscitation is needed
What is the 5 steps for Intrauterine Resuscitation (IUR)
Turn Patient - left lateral
Turn oxytocin off
Turn up IV fluids- IV bolus
Turn 02 up-10L w/ NR mask
Notify physician
What is VEAL CHOP
FHR. Cause. Intervention
Variable Cord Compression. Move pt
Early Head Compression. Not needed
Acceleration. OK. Nothing
Late. Placenta Insufficiency Emergency
What is category I for FHR
Variability
Baseline FHR
Accelerations:
Decelerations:
Nursing Intervention
Moderate variability
110-160
Accelerations: present or absent
Decelerations: NO late or variable
No action is needed
Category III FHR
Requirements
Nursing interventions
Absent variability and any of the following
Recurrent late or variable deceleration
Bradycardia
Sinusoidal pattern
IUR
What are some nursing interventions for abnormal FHR patterns
Assess VS
Assess hydrations
Assess UA
Assess maternal pain and anxiety
Perform vaginal exam to R/O prolapsed cord
IUR
What are the ABCD for management FHR issues
Assess the o2 pathway
Begin corrective measures
Clear obstacle to rapid delivery
Delivery plan
