Fetal Monitoring Flashcards
purpose of fetal monitoring
assess fetal response to stress of labor
monitoring techniques
intermittent auscultation
electronic
intermittent auscultation advantage/disadvantages
freedom of movement, inexpensive
cant assess FHR variability (no perm. record), not recommended for high risk
types of intermittent auscultation
hand held Doppler
fetoscope
electronic monitoring types
toco transducer
ultrasound transducer
iupc(intrauterine pressure cath)
fse(fetal scalp electrode)
advantage/disadvantage of electronic monitoring
monitor FHR(perm. record) increased risk of operative interventions, internal monitoring can cause rupture, restricts movement
intermittent auscultation guidelines
q30-60 - first stage
q15-30 - second stage
monitor during/after (30 sec) contraction
electronic monitoring guidelines
preg w/o comp. q30/q15 (first/second stage)
preg w/comp. q15/5
use of oxytocin q15/q5
baseline fetal HR characteristics
baseline fetal hr baseline variability accelerations decelerations changes over time contraction pattern
baseline fetal HR
110-160 (norm)
avg rate during 10min segment (excluding changes) rate is rounded to 5bpm
baseline variability
irregular fluctuations in baseline FHR assessed over 10min
each 10 sec fetal heart beats 18-26 times
baseline variability classifications
absent - undetectable
minimal - >undectable25 bpm
sinusoidal patterns
assoc w/severe fetal anemia
pseudo-sinusoidal
assoc w/maternal narcotics
fxr affecting fhr variability
sleep, congenital heart conditions, diabetes, hyper/hypo tension
fetal tachycardia
HR above 160bpm for >10min
early sign of fetal hypoxemia
nursing interventions for fetal tachy
o2 - 8-10L
reduce fever
fetal bradycardia
HR below 110bpm for >10min
late sign of fetal hypoxemia
nursing interventions for fetal brady
O2
IV hydration
position change
periodic changes occur
in response to uterine contractions
episodic changes occur
intermittently, isolated events, not in the presence of uterine activity
types of changes
accelerations
decelerations
accelerations are
abrupt increase in fhr above baseline >=15bpm lasting >=15sec
decelerations are
decelerations in fhr by dominance of parasympathetic response
benign or non-reassuring
3 types of decelerations
early
late
variable
early decelerations are
gradual decrease in fhr starting w/contraction ending with return to baseline
cause of early decelerations
fetal head compression (vagal response)
no intervention needed
late decelerations are
gradual decrease in fhr beginning after contraction ends after contaction
late decelerations are caused by
placental insufficiency
ominous when repeated or not resolved w/interventions
nursing interventions for late decelerations
position change
02-10L
increase IV fluids
stop Pitocin
variable decelerations are
abrupt decrease in fhr
vary in shape, depth, timing
cause of variable decelerations
cord compression
nursing interventions for variable decelerations
position change
02 -8-10L
discontinue pitocin
veal chop acronym
variable - cord
early - head
acceleration - OK
late - placenta
cat 1 fhr tracing
normal - fetal well being
cat 2 fhr tracing
indeterminant - not predicitive of abnormality
cat 3 fhr tracing
abnormal - require prompt intervention
cat 3 characteristics
absent variability AND
late/variable decelerations
brady or sinusoidal pattern
uterine activity assessed and monitored for
frequency - start of one to the next contraction
duration - start to the end of a contraction
intensity is documented as
external - mild, moderate, strong (+1.2.3)
internal - mmHg via IUPC (intrauterine pressure cath)
EFM is not useful in reducing what
cerebral palsy
abnormal uterine activity
contractions occuring 90sec. (tetanic contractions)
unusually high resting tone (hypertonus)
norm uterine activity
contractions q2-5 min
lasting =30sec
5 or less contractions in a 10min period, over 30min
