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NRSG 344 > Fetal Monitoring > Flashcards

Fetal Monitoring Flashcards

1
Q

hypoxemia

A

low oxygen in blood

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2
Q

hypoxia

A

low oxygen in tissues

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3
Q

acidemia

A

high hydrogen ions in blood

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4
Q

acidosis

A

high hydrogen ions in tissues

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5
Q

asphyxia

A

hypoxia and metabolic acidosis

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6
Q

contraction frequency

A

time between beginning of each contraction/peak of each contraction

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7
Q

contraction duration

A

length of contraction

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8
Q

contraction intensity

A

strength of contraction (palpate) - mild, moderate, strong

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9
Q

resting tone

A

tone of uterus between contractions (palpate)

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10
Q

relaxation time

A

time between the end of one contraction and the start of the next

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11
Q

placental circulation - veins and arteries

A

one umbilical VEIN carries oxygenated blood to FETUS

two umbilical ARTERIES carry deoxygenated blood to PLACENTA (fetal lung)

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12
Q

fetal circulation is a _____ system pumped by ______

A

closed, fetal heart

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13
Q

where and how does oxygen exchange occur with baby?

A

intervillous space/placental lake in chorion; CO2 diffuses into placenta, O2 diffuses into baby

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14
Q

factors impacting placental perfusion

A
  • tachysystole, hypertonus
  • maternal: HoTN, HTN, DM, fever, stress
  • placental: calcification, small size, infection, implant, abruption
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15
Q

during uterine contractions, which is compressed first/opens first, vein or arteries?

A

vein 1st compressed, then arteries
fetal reserve used
vein opens first, then arteries

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16
Q

what is electronic fetal monitoring?

A

continuous visual record of FHR and uterine activity

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17
Q

external fetal monitoring

A
  • tocotransducer (measures uterine contractions, but cannot measure strength)
  • ultrasound transducer (measures FHR)
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18
Q

internal fetal monitoring

A

spiral electrode – attached to fetal scalp
intrauterine pressure catheter – measures actual strength of contractions, but you must still palpate the fundus

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19
Q

normal vs tachysystole

A

normal: 5 or less contractions in 10 minutes, over an average of 30 minutes

tachysystole: more than 5 contractions in 10 mins (avg 30 min)

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20
Q

interventions for tachysystole

A

turn patient, turn off Oxytocin/Pitocin, palpate uterus for placental abruption, watch for BP drop and HR increase (hemorrhage!)

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21
Q

What are the four vital assessments of FHR?

A
  1. baseline rate
  2. variability
  3. accelerations
  4. decelerations
22
Q

BASELINE RATE - normal

A

110-160 bpm (2 min minimum over 10 mins)
- estimate - round to 5s
- absence of contractions!
- increase is expected with fetal movement

23
Q

BASELINE RATE - tachycardia + causes

A

> 160 bpm

causes: fetal hypoxemia, anemia, sepsis, prematurity, cardiac issues, maternal fever, dehydration, sepsis, anxiety, thyroid issues, and drug interactions

24
Q

BASELINE RATE - bradycardia + causes

A

< 110 bpm

causes: maternal positioned on back, HoTN, rxn to pain meds, hypoglycemia

25
Q

variability + ranges

A

normal changes in FHR over time

moderate: 6-25 bpm
minimal: <=5
absent: 0 (EMERGENT)
marked: >25 bpm

26
Q

causes of minimal variability

A

hypoxia/acidosis, fetal sleeping, drug fx, fetal tachycardia, fetal anomalies/prematurity

27
Q

intervention for absent variability

A

Intrauterine Resuscitation and stat C-section

28
Q

causes of marked variability

A

increased fetal movement, vaginal exam/fetal stimulation, pushing, possible r/o hypoxia?

29
Q

accelerations

A

sudden increases in FHR; very common

increase in 15 bpm for 15s to 2 mins (32+wks)
increase in 10 bpm for 10s to 2 mins (<32 wks)

REASSURING SIGN

30
Q

decelerations

A

15 bpm x 15 s
triggered by baroreceptors and chemoreceptors

31
Q

periodic decels

A

occur with contractions

32
Q

episodic decels

A

occur with or without contractions

33
Q

recurrent decels

A

must occur in over 50% of contractions in 20 mins

34
Q

early decels

A

nadir of decel at the same time as the peak of contraction
periodic, gradual, <=2 mins
BENIGN - usually due to pressure on the fetal fontanel
usually begins at about 4 cm dilation; may be a sign of progression

35
Q

variable decels

A

episodic, abrupt, 15x15, <2 mins

BARORECEPTORS - pressure on CORD –> increased BP and decreased HR

CONCERNING - may be s/s of nuchal cord or knot in cord

36
Q

variable decels intervention

A

Intrauterine Resuscitation
- change maternal position
- increase IV fluids, O2 at 10L/min (for 20-30 mins)

37
Q

late decels

A

episodic, gradual, nadir AFTER contraction peak, <2 min
indicative of chronic deoxygenation, uteroplacental insufficiency
may be seen in epidural d/t mom’s BP dropping but should stop soon

38
Q

what happens as late decels occur over time

A

decreasing variability occurs over time, leading to hypoxemia and hypoxia

39
Q

late decel interventions

A

Intrauterine REsuscitation - 10 L/min O2, reposition, increase IV fluids
stop oxytocin STAT
notify provider to come STAT
begin C-section if no improvement

40
Q

Prolonged decels

A

lasts 2-10 minutes

41
Q

prolonged decel causes

A

prolapsed cord, placental abruption, precipitous delivery

42
Q

prolonged decel interventions

A

reposition, elevate presenting part (life fetal head up off the cord), prep for delivery STAT

43
Q

sinusoidal pattern

A

very serious – sine-wave 3-5/min for 20+ mins

44
Q

sinusoidal pattern causes

A

Rh isoimmunization, severe fetal anemia, fetal acidosis, placental abruption, hemorrhage

45
Q

sinusoidal pattern intervention

A

STAT c-section, notify NICU

46
Q

Three-tiered FHR system each category meaning

A

Cat I: Normal acid-base status
Cat II: indeterminate
Cat III: abnormal acid-base status

47
Q

category I FHR

A

110-160 bpm w/ moderate variability; may have accels or early decels

48
Q

category III FHR

A

absent variability with: bradycardia OR recurrent late/variable decels
sinusoidal pattern

49
Q

category II FHR

A

anything NOT in cat I/III

moderate var w recurrent late/var decels OR bradycardia
minimal var w/ recurrent var decels
absent var w/o recurrent decels
prolonged decels

50
Q

Cat III responses

A

intrauterine resuscitation

51
Q

Cat II responses

A

stop oxytocin, cervical exam, reposition, monitor BP for HoTN, evaluate contraction frquency/duration for uterine hyperstimulation

52
Q

overall responses to nonreassuring FHR

A

MAXIMIZE OXYGENATION

positioning, IV fluids, oxygenate, breathing, stop oxytocin

NRSG 344 (8 decks)

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