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OB Exam > Fetal Heart Rate Assessment (Ch.9) > Flashcards

Fetal Heart Rate Assessment (Ch.9) Flashcards

1
Q

What does assessing a fetal heart rate (FHR) tell the nurse?

A

-Fetal oxygenation

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2
Q

What does acceleration mean?

A

Increase in FHR above baseline (>15 bpm over baseline for 15 seconds for 2 minutes)

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3
Q

What does deceleration mean?

A

Decrease from baseline

Can be periodic or intermittent

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4
Q

What is a late deceleration?

A

Gradual decrease of FHR taking more than 30 seconds

  • Lowest point is at the peak of contraction
  • Always periodic
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5
Q

What is prolonged deceleration?

A

Decrease FHR that is >15 bpm lasting > 2minutes but < 10 minutes
-Can be periodic or intermittent

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6
Q

What is a normal heart rate?

A

110-160

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7
Q

FHR tachycardia

A

> 160 lasting 10 minutes or longer

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8
Q

FHR bradycardia

A

<110 bpm lasting 10 minutes or longer

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9
Q

What is contraindicated with internal fetal monitoring on quiz

A
  • Active genital herpes
  • Positive group B streptococcus
  • Placenta previa
  • Undiagnosed vaginal bleeding
  • Chorioamnionitis
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10
Q

How does internal electronic uterine monitor work?

A

Catheter is placed in the uterine cavity to directly measure uterine contractions
-Membranes must be ruptured

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11
Q

What is a tocodynamometer?

A

External electronic devices for monitoring and recording uterine contractions during labor
-Cannot measure intensity

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12
Q

What are some reasons you would use internal monitoring versus external?

A
  1. Maternal Obesity
  2. Lack of progress in labor
  3. Treat a worsening Category 2 tracing via amnioinfusion
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13
Q

How do you know if the strength of the uterine contraction is good?

A

At least 200 MVUs every 10 minutes for 2 hours

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14
Q

What does the top grid of monitor paper tell you?

A

FHR

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15
Q

What does the lower grid of monitor paper tell you?

A

Uterine contraction

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16
Q

What is an issue with external monitoring?

A

It can pick up the maternal HR instead of the fetus and will show a low HR

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17
Q

How does the parasympathetic nervous system effect the baby?

A

Slows FHR and helps maintain variability

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18
Q

What does the FHR look like if they have a little hypoxia and are able to deal with it?

A

Variable decelerations

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19
Q

What hormonal regulations occur when the fetus is hypoxic?

A

Release of epinephrine and nor-epinephrine that increase FHR and BP

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20
Q

What are the three types of fetal responses that?

A

No hypoxia = Accelerations
Compensating = Variable deceleration
Decompensation = Late deceleration

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21
Q

What is a category 3 predictive of?

A

Abnormal fetal acid base balance and require promote evaluation

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22
Q 
Which of the following FHR patterns indicated a normal FHR? 
A. Category 1
B. Category 2
C. Category 3 
D. None of the above
A

A. Category 1

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23
Q

Intrauterine Resuscitation Interventions if goal is to Promote Fetal Oxygenation

A

~Administer oxygen at 10 L/min via nonrebreather face mask (DC ASAP based on fetal response)
~Lateral positioning (L or R side)
~IV Fluid bolus of ≤ 500 mL LR solution
~DC oxytocin, remove dinoprostone insert, or withhold next dose of misoprostol
~Alter pushing to every other contraction or temporarily stop pushing (during second stage of labor)

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24
Q

Intrauterine Resuscitation Interventions if goal is to Reduce Uterine Activity

A

~DC oxytocin, remove dinoprostone insert, or withhold next dose of misoprostol
~IV Fluid bolus of ≤ 500 mL LR solution
~Lateral positioning (L or R side)
~If no response, consider administration of 0.25 mg SQ terbutaline

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25
Q

Intrauterine Resuscitation Interventions if goal is to Alleviate Umbilical Cord Compression

A

~Repositioning
~Amnioinfusion (during first-stage labor)
~Alter pushing to every other contraction or temporarily stop pushing (during second stage of labor)
~Umbilical cord prolapse, elevate the presenting fetal part while preparations are made for an expected birth

26
Q

Intrauterine Resuscitation Interventions if goal is to Correct Maternal Hypotension

A

~Lateral positioning (L or R side)
~IV Fluid bolus of ≤ 500 mL LR solution
~If no response, consider ephedrine 5-10 mg IV push

27
Q

What can Fetal tachycardia be a sign of?

A

Early fetal hypoxemia especially with decreased variability and deceleration

28
Q

What are some maternal causes of fetal tachycardia?

A 
~Fever
~Infection (check allergies)
~Dehydration 
~Epinephrine, Terbutaline 
~Cocaine
29
Q

What heart rate can cause fetal demise if it persists?

A

200-220

30
Q

Nursing actions to fix fetal tachycardia

A

Treat underlying cause of tachycardia such as antibiotics for infection, antipyretics for fever, and fluids for dehydration
~Assess maternal VS (temp)
~Assess hydration by checking skin turgor, mucous membranes, urine specific gravity, I/O
~Decrease or DC Oxytocin

31
Q

When is fetal bradycardia considered an emgergency?

A

Sudden profound bradycardia (less than 80 bpm)

32
Q

Is fetal bradycardia of >80 with variability (fluctuations) considered good, okay, bad?

A

Okay needs to be monitored but not horrible

33
Q

What type of fetal bradycardia is associated with current or impending fetal hypoxia?

A

Bradycardia with loss of variability or late deceleration

34
Q

What are some maternal causes to fetal bradycardia?

A

~Supine position
~Dehydration
~Hypotension
~Placental abruption

35
Q

What are some fetal causes to fetal bradycardia?

A

~Fetal response to hypoxia
~Baby is laying on umbilical cord
~Fetal head is compressed

36
Q

If using external monitoring and the FHR indicates bradycardia, what do you need to check?

A

Check the mother’s radial pulse because the EFM may be picking up the mother’s heart rate

37
Q

Nursing actions to fix fetal bradycardia

A

~Sterile vaginal exam to see fetal response to touching the head
~Vaginal exam for prolapsed cord
~Intrauterine Resuscitation Interventions

38
Q

What is the most important predictor of adequate fetal oxygenation and fetal reserve during labor

A

Baseline variability

39
Q

What is the gold standard for variability (fluctuations)?

A

Moderate (6-25 bpm) shows well-oxygenated fetus with normal acid-base balance

40
Q

What are the different types of variability (fluctuations) ?

A

Absent: looks like flatline
Minimal: undetectable below 5 bpm
Moderate: Amplitude from 6-25 bpm
Marked: Greater than 25 bpm

41
Q

Maternal causes of minimal or absent variability (fluctuations)

A

~Supine hypotension
~Cord Compression
~Uterine tachysystole
~Drugs (illicit drugs, alcohol)

42
Q

How do you confirm minimal or absent variability (fluctuations)?

A

Artificial rupture of membranes and more invasive internal monitoring with fetal spiral electrode

43
Q

Nursing actions for minimal or absent variability (fluctuations)

A

Intrauterine Resuscitation Interventions

44
Q

What are the four types of deceleration?

A
  1. Early
  2. Variable
  3. Late
  4. Prolonged
45
Q

What are episodic changes?

A

Accelerations and deceleration patterns not associated with contraction
Most common is accelerations

46
Q

What are FHR accelerations predictive of?

A

Adequate oxygenation and require no interventions

47
Q

What does early decelerations indicate?

A

Occur with contractions and is a normal response and require no intervention
-Fetal head compression

48
Q

What is the most common deceleration seen in labor?

A

Variable deceleration

-caused by umbilical cord compression

49
Q

Characteristics of normal variable decelerations

A
  1. Duration of less than 60 seconds
  2. Rapid return to baseline
  3. Normal baseline and variability
50
Q

Define an “overshoot”

A

Accelerations at the beginning and end of decelerations

51
Q

Treatment for abnormal variable decelerations

A

Intrauterine Resuscitation Interventions

52
Q

What are late decelerations a sign of for the fetus?

A

Fetal intolerance to labor

-uteroplacental insufficiency

53
Q

What is usually the problem with late decelerations?

A

Placenta

54
Q

What three things do you look at for uterine activity?

A
  1. Frequency (beginning of one to start of next)
  2. Intensity (strength)
  3. Duration (beginning to end of same contraction)
55
Q

What is the normal amount of contractions in a 10 minutes averaged over 30 minute period?

A

5 or fewer

56
Q

What is a big concern if the uterus is in tachysystole?

A

the uterus could rupture

57
Q

Characteristics of tachysystole of the uterus

A

~More than 5 UC in 10 minutes

58
Q

How do you treat tachysystole of the uterus?

A

DC medication that caused it and Intrauterine Resuscitation Interventions

59
Q

What does magnesium sulfate do for preterm labor?

A

Decreases FHR variability and acceleration amplitude in preterm infants

60
Q

What is the normal type of deceleration?

A

Early decelerations (FHR is responding to UC)

OB Exam (5 decks)

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