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OB Nursing > Fetal Monitoring > Flashcards

Fetal Monitoring Flashcards

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1
Q

Monitor Strip Paper

A

o Each dark line = 1 minute of time
o Each small red box or unbolded line represents 10 seconds (bpm)
o Each line going up and down horizontally represents a 5-mmHg change

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2
Q

ultrasound transducer

A

 Detects FHR baseline, variability, accelerations, and decelerations
 Picks up ultrasound wave that is bounced back off the fetal heart and counts the FHR by the change in ultrasound wave frequency that occurs when the waveform is reflected of the moving heart

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3
Q

tocodynamometer

A

 Measures the frequency and duration of the uterine contractions (UC)
 Palpation of contractions = measure the pressure and intensity of UC

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4
Q

placement of ultrasound transducer

A

 Use Leopold’s maneuver to determine the placement
 Placed on the woman’s abdomen at the location of the fetus’s back and move the transducer until clear signal and FHR is heard. Secure it with monitor belt

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5
Q

placement of tocodynamometer

A

Place the TOCO on the fundus of the uterus where the contraction feels the strongest to palpate. Secure with monitor belt

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6
Q

Internal Electronic Fetal Monitoring

A

o Intrauterine Pressure Catheter
o Fetal scalp electrode (FSE) or internal scalp electrode (ISE)
o Applied to the presenting part of the fetus to directly monitor FHR
o Accurately measures the frequency, duration, intensity, resting tone, and Montevideo units

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7
Q

Documentation of Uterine Activity

A

Frequency
Duration
Intensity
Resting tone

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8
Q

Uterine Contraction Frequency

A

Measurement of the onset of one contraction to the onset of the next contraction

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9
Q

Uterine Contraction Duration

A

Length of a contraction from onset to then end

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10
Q

Uterine Contraction Intensity - external

A

 Strength of contraction measured by palpation
 Should be able to document the strength and when they change
 Mild - feel tip of the nose
 Moderate - feel the chin
 Strong - feel the forehead

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11
Q

Uterine Contraction Intensity -internal

A

 Strength of the contraction measured in the amniotic fluid
• Exact quantitative measurement
 mmHg – can be reported in the chart
 Montevideo units (MVU)

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12
Q

Resting Tone

A

Uterus muscle should be completely relaxed b/w contractions
 Important for the blood flow to be restored to the fetus
o Normal range: 20 – 25 mmHg; relaxed or not by palpation

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13
Q

Tachysystole

A

Contraction frequency of more than 5 contractions in 10 minutes which may or may not include signs of nonreassuring FHR measurements averaged over 30 minutes

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14
Q

Documentation of FHR Data

A

Baseline
Variability
Periodic or Episodic Changes
Reoccurrence of patterns

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15
Q

FHR Baseline

A

o Mean FHR rounded to increments of 5 bpm during a 10-minute segment
 Excluding periodic or episodic changes and periods of marked variability
o Baseline duration must be for a minimum of 2 minutes otherwise baseline is indeterminate
o Normal FHR range: 110 – 160 bpm

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16
Q

Tachycardia

A

> 160 bpm ≥ 10 minutes

causes: fetal anemia, hypoxemia, prematurity, maternal infection

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17
Q

Tachycardia Nursing Interventions

A
  • If maternal fever exists; administer prescribe antipyretics
  • Administer oxygen (8 – 10 L/min via nonrebreather mask)
  • Monitor the administration of bolus IV fluids
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18
Q

Bradycardia

A

< 110 bpm ≥ 10 minutes
causes: hypoxemia, hypothermia, vagal stimulation, uterine rupture, prolasped cord, cardiac anomalies, placental abruption

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19
Q

Bradycardia Nursing Interventions

A
  • D/C Pitocin if infused
  • Reposition client in a side-laying position
  • Administer oxygen (8 – 10 L/min via nonrebreather mask)
  • Start an IV if not already in place
  • Monitor the administration of a prescribed tocolytic medication
  • Notify the provider
20
Q

FHR Variability

A

o Presence of moderate variability reflects adequate oxygenation in the fetus at that moment
o Fluctuations in the FHR baseline that are two cycles per minute or more and that are irregular in amplitude
o BEAT TO BEAT CHANGE IN HEART RATE
o Determined by the autonomic nervous system

21
Q

Moderate Variability

A

6 - 25 bpm

22
Q

Minimal variability

A

less than 5 bpms
o Some fluctuation is present
o If the heart beats to fast; myocardial oxygenation decreases leads to decelerations, decreased perfusion, blood flow will be backed up
o Fetal Tachycardia

23
Q

Minimal Variability Nursing Interventions

A

 Fluid replacements
 If hemorrhaging find where she is bleeding from to stop the bleeding
 If emergency C-section:
• Interdisciplinary team, Start IV lines, Fluid bolus, Foley Catheter
 If mother is HTN: not enough blood flow to the uterus causing increase FHR and minimal variability
• Anything over BP 140/90 is concerning
• BP 160/90 requires immediate treatment

24
Q

Marked Variability

A

o Fetal stress (stress increases HR which increases SV)

o Should only see this when mother is pushing

25
Q

Marked Variability Nursing Interventions

A

 Reposition the mother to relieve pressure off the cord
 Increase oxygen to the fetus (oxygen supplementation via non-rebreather mask)
 Fluids (increase volume = increased blood flow)

26
Q

Absent Variability

A

no fluctuations present (flat line)
o Cardiac or brain anomalies
 Encephaly (no fetal brain)
o Mother is admitted:
 Reposition onto mother’s side
 IV line to see if can be corrected
 Fluid IV bolus
 If on Pitocin and causes absent variability STOP, the infusion b/c the fetus is not responding to the contractions well
o Fentanyl (anything that decreases maternal respirations)
o Maternal stress affects blood flow and oxygenation to the fetus

27
Q

Periodic Changes

A
  • occurs with contractions
  • any change (up/down)
  • placental abruption (increases contraction and blood is being affected)
28
Q

Episodic Changes

A
  • occurs without contractions
  • “nonperiodic changes”
  • Depends on when they occur, if deceleration occurs after contraction stops or acceleration occurs after contraction starts
29
Q

Variable Decelerations

A

o Visually apparent abrupt decrease in the FHR which may or may not be associated with a contraction
o Cause - CORD COMPRESSION
o Decrease is > 15 bpm and lasts > 15 seconds but less than 2 minutes from onset to returning to baseline

30
Q

Variable deceleration causes:

A

o Causes: medications that depress the CNS
o Periodic:
 Fetus laying on the cord
 Contractions apply pressure to the cord
 Cord is wrapped around the baby
 Baby can grab and clench the cord in utero

31
Q

Variable Deceleration Nursing Interventions

A

 Reposition mother
 Prolapse cord assessment (SVE)
 Fluids – increase blood flow

32
Q

Early Decelerations

A
  • Visually apparent usually symmetrical with a gradual decrease and return of the FHR associated with a contraction
  • Cause: HEAD COMPRESSION
    (vagal stimulation)
  • more than 30 seconds
33
Q

Late Decelerations

A
  • Visually apparent symmetrical gradual decrease of the FHR associated with contractions
  • Cause: UTEROPLACENTAL INSUFFICIENCY
  • > 30 seconds
  • Delayed in timing where deceleration starts at the peak of the contraction and recovers after the contraction ends
  • VERY CONCERNING!
34
Q

Prolonged Decelerations

A
  • Visually apparent abrupt decrease in the FHR below baseline that is > 15 bpm lasting for ≥ 2 minutes
  • Periodic and episodic
  • warrants immediate attention
  • stop Pitocin
35
Q

Prolonged Deceleration caused from:

A
  • Cord compression (prolapsed cord)
  • Maternal hypotension
  • Excessive uterine activity (tachysystole)
  • Vagal stimulation
  • Uterine rupture
  • Maternal seizures or respiratory/cardiac arrest
36
Q

Recurrent Decelerations

A
  • Decelerations and Acceleration are defined recurrent if they occur with greater than 50% of the contractions in 20 minutes
  • More concerned about recurrent deceleration than acceleration
37
Q

Accelerations

A
  • Visually abrupt increases in FHR above baseline
  • Onset to peak is > 30 seconds
  • 15 beat change and less than 15 seconds
  • associated with fetal movement
  • Indicates the absence of fetal acidosis and presence of central oxygenation
38
Q

Acceleration baseline

A
  • 28 – 32 weeks: 10 beats from baseline lasting for 10 seconds
  • After 32 weeks: 15 beats from baseline lasting for 15 seconds
39
Q

Sinusoidal FHR Pattern

A
  • Indication of fetal anemia (rare)
  • Smooth underlying pattern requires immediate attention
  • Interventions: give blood in utero, percutaneous umbilical (pubs)
  • No variability – heart is not pumping effectively
40
Q

Sinusoidal pattern caused from:

A

ABO incompatibility
maternal hemorrhaging
twin transfusion syndrome
CNS depressant medications (narcotics)

41
Q

Category I

Normal - Interpretation

A

Tracings in this category are strongly predicted of normal acid/base status (presence of oxygenation and moderate variability) at the time of observation.

42
Q

Category I

Normal - Features

A
  • Baseline rate: 110 – 160 bpm
  • Baseline variability: moderate
  • Late or variable decelerations absent
  • Early decelerations present or absent
43
Q

Category II

Indeterminate - Interpretation

A

Tracings in this category are not predictive of abnormal acid/base status, however there are insufficient data to classify them as either category I or category III

44
Q

Category II

Indeterminate - Features

A
  • Minimal variability
  • Absent variability without recurrent decelerations
  • Marked variability
  • Absence of induced accelerations after fetal stimulation
  • Recurrent variable decelerations with minimal or moderate variability
  • Prolonged deceleration
  • Recurrent late decelerations with moderate variability
  • Variable decelerations with “slow return to baseline,” “overshoots,” or “shoulders
45
Q

Category III

Abnormal - Interpretation

A

Tracings in this category are predictive of abnormal acid/base status at the time of observation.

46
Q

Category III

Abnormal - Features

A 
Sinusoidal Pattern
Absent variability and any of the following:
• Recurrent late decelerations
• Recurrent variable decelerations
• Bradycardia

OB Nursing (4 decks)

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