Exam 1 (Fetal Assessment During Labor) Flashcards
1
Q
Fetoscope & stethoscope
A
Allow a clear fetal heart auscultation.
2
Q
What does FHR stand for?
A
Fetal Heart Rate
3
Q
What is an Electronic Fetal Monitor (EFM)?
A
An EFM is a useful tool for visualizing FHR patterns on a monitor screen or printed tracing.
4
Q
What are the Goals of Fetal Monitoring?
A
To differentiate reassuring from nonreassuring fetal patterns.
5
Q
What is FHR a direct link to?
A
FHR is direct result of fetal oxygenation & wellbeing.
6
Q
FHR Accelerations
A
-Increase FHR -Defined as an increase of 15 bpm or greater above baseline lasting at least 15 seconds but less than 2 minutes.
7
Q
FHR Decelerations
A
-Decrease FHR -May be benign or non-reassuring.
8
Q
FHR Baseline
A
Average FHR
9
Q
FHR Variability
A
Variations in FHR
10
Q
Name 4 ways O2 deprivation occurs by.
A
- Reduction of blood flow to fetus through maternal vessels (Maternal hypertension, hypotension, hemorrhage) 2. Reduced oxygen in maternal blood (Maternal hemorrhage or anemia) 3. Alterations in fetal circulation (umbilical cord compression, placental separation, head compression) 4. Decreased blood flow to placenta (hypertonic contractions)
11
Q
What is Normal Uterine Activity (Contractions)?
A
Contractions q 2-5 minutes.
12
Q
What is Normal Uterine Activity (Duration)?
A
Duration - < 90 seconds.
13
Q
What is Normal Uterine Activity (Intensity)?
A
Intensity - < 100mmHg by IUPC.
14
Q
What is Normal Uterine Activity (Resting Time)?
A
Resting time - 30 seconds or more between contractions.
15
Q
What is Normal Uterine Activity?
A
5 or fewer contractions in 10 minutes averaged over 30 min.
16
Q
What is Tachysystole? [Note: is this the right definition? Please verify!]
A
5 or more contractions in 10 minutes averaged over a 30 min.
17
Q
What is a normal Baseline FHR?
A
110-160 beats/minute
18
Q
When does acceleration usually occur?
A
During fetal movement.
19
Q
How can the mother help recored Fetal monitoring?
A
The mother records when the fetus moves.
20
Q
What is nonreasuring FHR Patterns associated with?
A
Associated with fetal hypoxemia
21
Q
What does fetal hypoxemia include?
A
-Baseline FHR < 110 or > 160 bpm -Absent or persistently minimal variability -Recurrent late or variable decelerations -Bradycardia
22
Q
Do you want variation in FHR?
A
YES!
23
Q
What is fetal bradycardia mean?
A
(baseline FHR < 110 bpm x 10 minutes or longer) Occurs rarely & unrelated to fetal oxygenation. Most often occurs due to fetal cardiac problems, viral infections, maternal hypothermia, maternal hypoglycemia. Bradycardia is a late sign!
24
Q
Is fetus tachycardia an early or late sign of fetus stress?
A
Early! Bradycardia is a late and bad sign.
25
What is the appropriate resting time between contractions?
At least 30 seconds.
26
What is intermittent auscultation (IA)?
It involves listening to fetal heart sounds at periodic intervals to assess FHR.
27
What is intermittent auscultation technique?
1. Listen over point of maximal intensity, PMI. 2. Palpate abdomen for contractions while listening. Listen during and between contractions to identify variations in FHR with and without contractions. Identify baseline FHR between contractions. Document intensity, duration, & frequency.
28
What are some advantages of intermittent auscultation?
Ease of maternal movement
29
What are some disadvantages of intermittent auscultation?
Difficult in obese women. Can’t monitor periodic changes.
30
Is decreased variability reassuring or non-reassuring?
Non-reassuring!
31
What is the purpose of Electronic Fetal Monitoring?
Purpose is ongoing assessment of fetal oxygenation.
32
What are the goals of Electronic Fetal Monitoring?
Goal is to detect fetal hypoxia and intervene in a timely manner to avoid bad outcomes.
33
What are the two methods of Electronic Fetal Monitoring?
External fetal monitoring Internal fetal monitoring
34
External Fetal Monitoring parts?
1) FHR Monitor 2) Uterine Activity (UA) Monitoring
35
External Fetal Monitoring (FHR Monitor)?
Reflects sound waves off fetal heart valves. Ultrasound transducer applied using gel to maternal abdomen over PMI.
36
External Fetal Monitoring (Uterine Activity (UA) Monitoring)?
-Tocotransducer applied to abdomen over uterine fundus. -The toco can measure frequency, regularity, duration of contractions, not intensity. -Confines a woman to bed. -Less accurate than internal monitoring.
37
What can a Tocotransducer measure?
The toco can measure frequency, regularity, duration of contractions, not intensity.
38
Internal Fetal Monitoring?
More accurate than external monitoring. Should utilize if there is an uncertain or difficult EFM tracing.
39
How is Internal Fetal Monitoring obtained?
Internal spiral electrode (intrauterine pressure catheter – IUPC) attached to fetal presenting part.
40
What is a requirement for IUPC?
Membranes must be ruptured and cervix opened at least 2-3 cm.
41
What can the IUPC measure?
Can measure frequency, regularity, duration, intensity and resting tone. Documented continuously on monitor paper.
42
What is the most important difference between external and internal monitoring?
Internal monitoring can measure intensity. External CANNOT!
43
Variability (Absent)?
no change in heart rate
44
Minimal variability?
1-5 beats/min
45
Moderate variability?
6-25 beats/min
46
Marked variability?
\>25 beats/min
47
What can diminished variability be the result of?
Fetal hypoxemia & acidosis, certain drugs received by the mother, or sleeping infant.
48
Bening variability?
usually lasts 30 min or less
49
Ominous variability?
extends beyond 30 min.
50
Tachycardia FHR Baseline mean?
(\>160 bpm x 10 minutes or longer) - early sign of fetal hypoxemia.
51
What can Fetal Tachycardia result from?
Can result from maternal infections (PROM with amnionitis), maternal hyperthyroidism, fetal anemia, certain maternal drugs.
52
FHR periodic changes?
Ones that occur with uterine contractions.
53
FHR Episodic changes?
Not associated with uterine contractions.
54
Is acceleration a reassuring or non-reasuring fetal pattern?
Reassuring! Can be spontaneous or due to fetal movement or elicited by fetal scalp stimulation.
55
Early Decelerations?
Caused from fetal head compression. Is normal & benign. Starts before contraction & returns to baseline at the same time as UC.
56
What can cause early decelerations?
May be caused by UC’s, vaginal exams, & placement of internal fetal monitors.
57
When do early decelerations occur?
Usually occurs during 1st stage of labor.
58
Are intervention usually needed for early decelerations?
Intervention usually not necessary.
59
What causes Late Decelerations?
Caused by uteroplacental insufficiency (uterus and placenta aren’t getting enough O2)
60
What is Uteroplacental insufficiency?
uterus and placenta aren’t getting enough O2
61
What are interventions for late decelerations?
-Lateral position (vena cava) -Elevate legs -Increase IV fluids -Palpate uterus for tachysystole -D/C oxytocin (Pitocin) if using -O2 at 8-10 L via face mask -Obtain internal monitoring if not already in use -Assist with birth (cesarean or vaginal assisted) if pattern can’t be corrected
62
What is Variable Decelerations?
A visual abrupt decrease in FHR below baseline of 15 bpm or more x 15 seconds to 2 minutes. Occur any time during UC’s. Have a “U”, “V”, or “W” shape.
63
What causes variable decelerations?
Are caused by umbilical cord compression. If occasional, these have little clinical significance.
64
When do variable decelerations occur?
2nd stage when pushing
65
What are some intervention for variable deceleration?
-Maternal position changes (side-to-side, knee chest) -D/C oxytocin (Pitocin) -O2 at 8-10 LPM via face mask -Assist with vaginal or speculum exam to assess for cord -prolapse -Assist with amnioinfusion if ordered -Alter pushing technique (open glottis, shorter pushes) -Assist with birth (vaginal assisted or cesarean) if pattern unable to be corrected
66
What is Valsalva maneuver?
Mother holding breath and pushing.
67
What are prolonged decelerations defined as?
A visual decrease in FHR below baseline 15 bpm or more lasting from 2-10 minutes Deceleration \> 10 minutes is considered a baseline change
68
What are the 5 components a nurse must evaluate to determine whether intervention or imminent birth is necessary?
1) Baseline rate 2) Baseline variability 3)Accelerations 4) Decelerations 4) Changes or trends in FHR pattern over time
69
What is Intrauterine resuscitation?
Interventions initiated when nonreassuring FHR pattern is noted.
70
What is the goal of Intrauterine resuscitation?
Aimed at improving O2 to fetus.
71
What are the 3 priorities of Intrauterine resuscitation?
#1 Open the maternal & fetal vascular system. #2 Increase blood volume. #3 Optimize oxygenation of circulating blood volume.
72
What are Intrauterine resuscitation interventions for EVERY patient?
Place on R or L side or Trendelenburg – not supine – improves uteroplacental blood flow. Increase IV rate to increases maternal blood volume. O2 via facemask @ 8-10 LPM.
73
Interventions for Maternal Hypotension?
-Increase primary IV rate -Change to lateral or Trendelenburg position -Administer ephedrine or phenylephrine to raise BP
74
Interventions for Uterine tachysystole?
-Reduce or d/c uterine stimulants (oxytocin) -Administer a uterine relaxant (tocolytic) (Brethine)
75
What does the drug Tocolytic do?
Is a drug that stops contractions.
76
Interventions for Nonreassuring FHR tracing during 2nd stage labor?
Open glottis pushing Fewer pushing efforts during each contraction Make pushing efforts shorter Push only with every 2nd or 3rd contraction Push only with a perceived urge to push
77
What is priority for a client with late decelerations?
Turn her to her side
78
What is the benefit of scalp stimulation?
-FHR should increase in response to stimulation of fetal scalp on manual exam (15 bpm x 15 seconds). -Checks fetal wellbeing after decelerations or diminished variability.
79
Amnioinfusion
Supplements amniotic fluid to help with cord compression or oligohydramnios (scant fluids) or anhydramnios (no fluids).
80
Does amnioinfusion alter IUPC readings?
Alters IUPC readings unless flow of solution stopped momentarily and a reading obtained.
81
Amnioinfusion requirements?
-Membranes must be ruptured. -NS or LR must be warmed to room temp before infusion or warmer for preterm or small babies.
82
Tocolytic Therapy?
-Administration of drugs that inhibit UC’s. -Improves placental blood flow by inhibiting UC’s. -If FHR improves woman may be allowed to continue to labor. -Doctor must order
83
Umbilical Cord Acid-Base Determination?
-Cord blood taken from umbilical cord after birth. -Test for pH, Pco2, Po2 -Reflects fetal condition
84
What could a nurse do to test fetal oxygenation in the presence of deceleration?
Scalp stimulation
85
Main pt teachings?
1) Encourage pt not to lie on her back - prevent hypotensive syndrome r/t vena cava compression and late decelerations. 2)Discourage Valsalva maneuver when pushing. 3)Open glottis pushing.
86
Documentation.
Fetal monitoring strips and Fetal electronic charting should correspond!
87
What does this graph represent?
Acclerations
88
What does this graph represent?
Bradycardia
89
What does this graph represent?
Early Decelerations
90
What does this graph represent?
Late decelerations
91
What does this graph represent?
Tachycardia
