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Womens Health Exam 2 > Fetal Monitoring > Flashcards

Fetal Monitoring Flashcards

1
Q

What are some external monitors?

A

U/S (ultrasound) for FHR

Toco- to detect contractions

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2
Q

What are some internal monitors?

A

FSE- fetal scalp electrode which monitors FHR

IUPC- intrauterine pressure catheter which monitors contractions

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3
Q

How is the baseline fetal heart rate determined?

A

By approximating the mean (average) FHR during a 10 minute period, rounding to increments of 5 bpm like 125,130 etc

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4
Q

What is normal, bradycardia, and tachycardia heart rate for fetus?

A

Normal- 110-160

Bradycardia- <110 for at least 10 min

Tachycardia- > 160 for at least 10 minutes

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5
Q

What is baseline variability?

A

A reliable indicator of fetal cardiac and neurologic function and well-being and is defined as fluctuations in the baseline FHR, that are irregular in amplitude, and with a frequency of over two cycles per minute

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6
Q

How is variability classified

A

Absent FHR variability

Minimal FHR

Moderate FHR

Marked FHR variability

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7
Q

What is absent FHR variability

A

Amplitude range undetected

0-2 beats- looks like a flatline, non reassuring

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8
Q

What is minimal FHR variability

A

Amplitude range detectable, but 5 bpm or less

3-5 bpm

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9
Q

What is moderate FHR variability

A

Normal

Amplitude range of 6 to 25 bpm

Indicates absence of hypoxia, even if decelerations are present, demonstrating the fetus can utilize available oxygen

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10
Q

What is marked FHR variability

A

Amplitude range greater than 25 bpm

Excessive variability and uncommon. May indicate early hypoxia

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11
Q

What is an acceleration?

A

Abrupt increase in the baseline FHR with an onset to peak of less than 30 seconds and lasting less than 2 minutes

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12
Q

What is classified as an acceleration?

A

The peak must be 15 bpm or more, and the acceleration must last 15 seconds or more when the fetus is equal to, or greater than 32 weeks

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13
Q

What are accelerations for less than 32 weeks of gestation

A

A peak of 10 bpm or more and a duration of 10 seconds or more

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14
Q

Why are accelerations usually benign?

A

Because they are associated with an intact fetal nervous system, lack of fetal hypoxia, and acidosis

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15
Q

What are decelerations

A

Often referred to as decels

Generally defined as decreases in the FHR below the baseline

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16
Q

When does acceleration occur?

A

Fetal movement or stimulation

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17
Q

What is a reactive strip?

A

15 by 15

Abrupt increase by at least 15 beats above baseline for at least 15 seconds

In other words, increased by 1.5 boxes and across 1.5 boxes

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18
Q

What are the categories for decelerations?

A

Early

Variable

Late

Prolonged

19
Q

Which category for deceleration is reassuring?

A

Early, meaning, no nursing intervention is needed

20
Q

What are early decelerations and what causes them?

A

Occurs early with the onset of the contraction

Mirrors the shape and timing of the contraction

Appearance is shallow and cuplike

It is reassuring, caused by vagal stimulation that occurs with pressure on the babies head

21
Q

What are variable decelerations?

A

Can occur with or without a contraction

Often abrupt onset with a U, V, or W shape.

Non reassuring, especially if deep and prolonged

22
Q

What is a variable deceleration the result of

A

Compression of the umbilical cord

23
Q

Interventions for variable decelerations

A

IV open

Pit off

Position change

02 on

May perform vaginal exam

24
Q

What are late decelerations?

A

Occurs late, or after the onset of the contraction

Non reassuring, especially if seen with absent or minimal variability

25
Q

What is late decelerations caused by?

A

Result of uteroplacental insufficiency (fetus not getting enough oxygen)

26
Q

Why is the baby not getting enough oxygen during late decelerations?

A

When you have a contraction, no matter what, during that contraction the placenta is compressed, and during that time period there is no blood flow and therefore no oxygen going to the baby.

Now the problem with lates is that the baby is not tolerating that contraction, so having a late decel is kind of the baby kicking itself while it’s already down because it’s lost oxygen during the time of the contraction, and then furthermore is continuing to not be able to access oxygen during the time.

27
Q

What is a prolonged deceleration?

A

A “long late”

A 15 beat drop below baseline lasting more than two minutes, but less than 10 minutes

Non reassuring

28
Q

What happens if a prolonged deceleration is longer than 10 minutes

A

You have a new fetal heart rate baseline

29
Q

What is VEAL CHOP

A

V- variable deceleration
E- early deceleration
A- acceleration
L- late deceleration

C- cord compression
H- head compression
O- OK
P- placental insufficiency

30
Q

What is category one?

A

Reassuring

FHR 110-160 baseline, moderate variability, no variable or late decelerations

31
Q

What is category II?

A

Indeterminate, warrants continual assessment

Those that are not either reassuring, or non-reassuring

32
Q

What is category III?

A

Non-reassuring, warrants immediate intervention

Absent variability, with recurrent late or variable decelerations and/or bradycardia or sinusoidal patterns

33
Q

How does changing laboring mothers position help the fetus?

A

Improves blood flow to baby and relieves possible cord compression

34
Q

Why does opening an IV help with decelerations?

A

Increases rate of IV fluids which could be either normal saline or lactated ringers to maintain blood pressure and hydration

35
Q

How much oxygen would be administer?

A

10 L/ min via face mask

36
Q

Why would we do a vaginal exam for decelerations?

A

It’s to evaluate labor progress, and rule out cord prolapse

37
Q

What does Pitocin do?

A

Makes the contractions stronger and longer

Which is why we shut it off

38
Q

When do we call the doctor?

A

After we’ve done our nursing interventions

39
Q

What do we look at when observing contractions?

A

Frequency

Duration

Intensity

Resting tone

40
Q

What is the frequency of a contraction?

A

Measured in minutes

Beginning of one contraction to beginning of the next contraction

41
Q

What is the duration of a contraction?

A

Measured in seconds

Beginning to end of each contraction

42
Q

How do you measure the intensity of a contraction?

A

External monitor (toco): palpation: mild, moderate, or strong

Internal monitor (IUPC): subtracting resting tone from strongest (tallest contraction) and weakest (shortest) for a range in mmHg

43
Q

What is resting tone

A

Pressure of the uterus at rest/between contractions

External: by palpation (we want the fundus soft)

Internal: in mmHg (we want it less than 35)

44
Q

Example of an intensity with internal monitor?

A

Resting tone is 20
Weakest UC is 75
Strongest UC is 95

75-20= 55
95-20= 75

UC intensity is 55-75 mmHg

Womens Health Exam 2 (9 decks)

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