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TEST 2 > Fetal Monitorign > Flashcards

Fetal Monitorign Flashcards

1
Q

Fetal Assessment

A
  • primarily focuses on FHR pattern.
  • characteristics of amniotic fluid
  • Fetal cord blood sampling
  • fetal scalp stimulation
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2
Q

SROM

A

SPONTANEOUS RUPTURE OF MEMBRANES

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3
Q

AROM

A

ARTIFICIAL RUPTURE OF MEMBRANES
(amnihook)

done by HCP

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4
Q

Green fluid in amniotic fluid

A

Meconium staining
Normal if breeched

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5
Q
  • cause of respiratory failure in Term & post-term infants
A

MAS
(meconium aspiration syndrome)

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6
Q

What causes MAS (meconium aspiration syndrome)?

A
  • occurs when newborns inhale particulate MECONIUM mixd with amniotic fluid INTO THE LUNGS while still in utero or on the FIRST breath after birth.
  • INTRAUTERINE DISTRESS CAUSES PASSAGE OF MECONIUM INTO AMNIOTIC FLUID
  • CAUSES RESPIRATORY DISTRESS
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7
Q

how to prevent MAS (meconium aspiration syndrome)

A
  • Suctioning AFTER head is born BEFORE baby takes first breath
  • direct tracheal suctioning AFTER birth
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8
Q

When MODERATE-HEAVY meconium is present in placenta, what is done?

A
  • Amnioinfusion: intro of warmed, sterile normal saline (NS) or RINGERS LACTATE solution in uterus
  • Assists in preventing MAS
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9
Q

What is used to monitor FETAL HEART RATE (FHR)?

A
  1. electronic fetal monitor
  2. fetoscope modified stethoscope
  3. doppler US
  4. Fetal Scalp electrode
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10
Q

Intermittent FHR monitoring involves

A
  • using doppler or fetoscope for periodic assessment of FHR.
  • listen for short periods of time at REGULAR INTERVALS.
  • does not provide a complete picture of fetal well being.
  • 1 full min AFTER a contraction
  • listen for 30 sec x 2
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11
Q

does Intermittent FHR monitoring limit mobility?

A

no. MOM IS. MOBILE

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12
Q

What type of pts are candidates for intermittent FHR monitoring?

A
  • Acceptable option for LOW-RISK laboring women.
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13
Q

When is the BEST time to listen FHR monitoring during ‘Intermittent FHR monitoring’

A

listen at the end of a contraction (NOT AFTER one) so late decelerations could be detected

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14
Q

Where is FHR best heard?

A

fetals BACK

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15
Q

What is CEPHALIC

A

cephalic means head in anatomy

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16
Q

IF fetus is in cephalic position, FHR is in

A

mothers lower quadrants (R or L)

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17
Q

IF fetus is in BREECH position, FHR is in

A

above level of maternal umbilicus

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18
Q

To ensure that Maternal HR is not confused with Fetal HR

A

Palpate the maternal radial pulse simultaneously while auscultating FHR

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19
Q

Guidelines for assessing FHR

A
  • Initial 10 to 20 min continously. FHR upon entry in L&D
  • Completion of a prenatal & labor risk assessment
  • Intermittent auscultation during active labor
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20
Q

Intermittent auscultation DURING LABOR for lOW-RISK moms is every

A

Q 30 min

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21
Q

Intermittent auscultation DURING LABOR for HIGH-RISK moms is every

A

Q 15 min

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22
Q

Intermittent auscultation DURING 2ND STAGE for lOW-RISK moms is every

A

Q 15 MIN

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23
Q

Intermittent auscultation DURING 2ND STAGE for HIGH-RISK moms is every

A

Q 5 MIN AND DURING PUSHING STAGE

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24
Q
  • CONTINUOUS tracing of the FHR
    sound is produced with each heartbeat
  • provides information about fetal oxygenation
  • prevent fetal injury resulting from impaired fetal oxygenation during labor.
A

Continuous electronic fetal monitoring (EFM)

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25
Q

Disadvantages of EFM (continuous electronic fetal monitoring)

A
  • limits mobility
  • needs supine position
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26
Q

Continuous EFM is used on MOMS that are

A
  • Oxytocin infusion
  • Epidural analgesia
  • Compromised health – mom & baby
  • Moderate hypertension >150/100
  • Confirmed delay in 1st or 2nd stage of labor
  • Prolonged ROM
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27
Q
  • ____________ is demonstrated in a heart rate pattern change and is by far the MOST common etiology of fetal injury & death
  • can be prevented WITH optimal fetal surveillance during labor & early intervention.
A

FETAL HYPOXIA
(low levels of O2)

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28
Q

continuous External monitoring is used when

A
  • ROM intact or not.
  • no cervical dialation
  • dialated cervix
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29
Q
  • involves placement of a spiral electrode INTO fetal presenting part (usually parietal bone on head) to ASSESS FHR
  • Pressure transducer placed internally within the uterus to record uterine contractions
A

CONTINUOUS INTERNAL MONITORING

30
Q

Candidates for cont. internal monitoring

A
  • high risk
  • decreased fetal mvmnt
  • abnormal FHR on auscultation
  • High HR, DM
31
Q

BAseline FHR is measured by

A
  • occurs during 10-min segment
  • done when no contractions
  • fetus NOT experiencing episodic FHR changes.
32
Q

Baseline HR should be

A

110-160 BPM
higher than an adult.

(adult is 60-100)

33
Q

fetal bradycardia

A
  • < 110

(lasting > 10 min)

34
Q

fetal tachycardia

A
  • > 160
    (lasting > 10 min)

`

35
Q

FHR falls into 3 categories.

A
  • Category 1= normal (no intervention needed)
  • CAtegory 2= indeterminate
  • category 3 = abnormal INTERVENTION NEEDED
36
Q

type of category for FHR:

  • NOT predictive of abnormal fetal acid–base
A

CATEGORY II

37
Q

TYPE OF CATEGORY:

  • ABNORMAL FETAL ACID-BASE
  • REQ. PROMPT EVAL AND Rx
  • Requires action on mothers side
A

CATEGORY III

38
Q
  • EARLY RESPONSE TO ASPHYXIA (suffocation)
  • Fetal infection
  • maternal fever

CAUSES:

A

TACHYCHARDIA
HIGH HR.

39
Q
  • Prolonged maternal low BS
  • Maternal or fetal low Temp.
  • Fetal acidosis
  • MOM LOW BP

CAUSES:

A

BRADYCARDIA
LOW HR

40
Q
  • IRREGULAR fluctuations in the baseline HR (110-160)
  • measured amplitude of PEAK TO TROUGH in beats per min.
  • push & play Nervous system
A

baseline variability

41
Q

VARIABILITY is ONE OF THE MOST IMPORTANT characteristics for

A

FHR

42
Q

Variability FHR has 4 categories.
Name them:

A

4

  • absent: undetectable
  • minimal: < 5 bpm
  • moderate: 6-25 bpm
  • marked: >25 bpm
43
Q

Absent (0 fluctuation= undetectable)
to
Minimal <5 bpm

indicates:

A
  • mom low bp
  • fetal problems
    poor outcome
44
Q

interventions for Absent-minimal bpm

A
  • improve MATERNAL blood flow & perfusion
  • notify HCP
  • prepare for CS if no improvements
45
Q

Moderate category of 6-25 bpm indicates

A
  • ANS & CNS developed and oxygenated
  • fetal well-being

continue to monitor

46
Q

Marked category of >25 bpm interventions

A
  • not good sign
  • determine cause
  • increase iv fluid rate
  • O2 admin
  • notify HCP
47
Q

Absent fluctuations is

A

0 fluctuations
(undetectable)

48
Q

Minimal fluctuations is

A

fewer 5 bpm

49
Q

Moderate fluctuations is

A

6-25 bpm

50
Q

Marked fluctuations is

A

more thabn 25 bpm

51
Q
  • transitory abrupt increases in the FHR above the baseline
  • associated with sympathetic nervous stimulation
  • considered reassuring and require no interventions
A

FETAL ACCELERATIONS

52
Q

What is fetal accelerations considered

A

reassuring
This is good if in the 15x15 rule

53
Q

Associated with SYMPATHETIC nervous stimulation
(fight-or-flight response)

A

Fetal Accelerations

54
Q

FETAL ACCELERATION last

A

Last < 30 sec from Onset to Peak

55
Q

Acceleration 15 x 15 rule
What is this rule

A

Increase of 15 bpm every 15 seconds but less than 2 mins.

56
Q

What does fetal acceleration mean?
Is this good or bad?

A

Fetal movement
Fetal well-being

requires no interventions

57
Q

A transient fall in FHR caused by stimulation of Parasympathetic NS

A

Fetal Decelerations

58
Q

Decelerations are described by

A

thier shape
association to uterine contraction

59
Q

3 types of Fetal Decelerations

A
  1. early deceleration
  2. variable deceleration
  3. late deceleration
60
Q

Mirror contractions
Rarely below 100 bpm

A

Early deceleration

61
Q
  • Nadir (lowest point) occurs AFTER contractions
  • gradual & shallow drops
A

late deceleration

62
Q
  • Vary in shape, depth, & time
  • Abrupt decrease in FHR= QUICK DROPS
  • 15 bpm x 15 sec <2 Min.
  • Accels. at onset & at end of cont. ( “shoulders”)
  • U, V, W shapped - jagged lines
  • Not 1 looks like the other
  • No apparent association with contractions
A

Variable decelerations

63
Q

causes for prolonged deceleration

A
  • Prolonged cord compression
  • Supine maternal position
  • Fetal blood sampling
  • Maternal seizures
  • Regional anesthesia
63
Q
  • Abrupt FHR declines
  • at least 15 bpm last >2 mins BUT <10 mins
  • drops to <90 bpm
A

Prolonged deceleration

64
Q

RX for prolonged deceleration

A

id underlying cause and correct it.

65
Q
  • Visually apparent
  • Smooth, wavelike undulating pattern
  • Severe hypoxia R/T fetal anemia & hypovolemia
A

Sinusoidal Pattern

66
Q

Sinusoidal pattern is considered a category

A

always category III

67
Q

RX for sinusoidal pattern

A

fetal intrauterine infusion

68
Q

which categories require further analysis

A

Category II and Category III

69
Q

What are Other Fetal Assessment Methods

A
  • umbilical cord blood analysis (done at birth- evaluates newborns condition)
  • Fetal scalp (vibroacoustic) stimulation (promotes fetal mvmnt to accelerate FHR)

TEST 2 (6 decks)

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