Intrapartum Fetal Surveillance: Sherpath

Question 1

Hypoxia

Answer 1

inadequate oxygen tension at the cellular level, characterized by tachycardia, hypertension, peripheral vasoconstriction, dizziness, and mental confusion. The tissues most sensitive to hypoxia are the brain, heart, pulmonary vessels, and liver.

Question 2

Four factors are necessary for adequate oxygenation of the fetus

Answer 2

Normal maternal blood flow and volume to the placenta
Normal oxygen saturation in maternal blood
Adequate exchange of O2 and CO2
Open circulatory path between the placenta and the fetus through vessels in the umbilical cord

Question 3

Fetal surveillance used during labor

Answer 3

Low-tech surveillance includes intermittent auscultation and palpation of the uterine activity.
High-tech surveillance includes external and internal electronic fetal monitoring.

Question 4

Fetoscope

Answer 4

a stethoscope for monitoring the fetal heartbeat through the mother’s abdomen.

Question 5

Doppler Ultrasound

Answer 5

Provides a method for the study of fetal heart rate (audible) and hemodynamics, including the uterine and umbilical arteries (which gives information on the perfusion of the placenta) and examining fetal organs to detect any hemodynamic rearrangements that can occur in response to fetal hypoxemia.

Question 6

Leopold’s Maneuver and Uterine Palpation

Answer 6

If the abdomen feels like a nose, then it is a soft, weak contraction.
If the abdomen feels like a chin, then it is a medium strength contraction.
If the abdomen feels like a forehead, then it is a very strong and productive contraction.

Question 7

Leopold’s Maneuver steps

Answer 7

1. palpitate the uterine fundus
2. palpitate for the fetal back
3. palpitate suprapubic area to confirm presentation
4. determine if the head is flexed or extended

Question 8

External electronic fetal monitoring (EFM)

Answer 8

considered high-technology, but it is not invasive. Equipment includes transducers that are attached to the patient and a bedside monitor unit with a screen to show a graphic display of the FHR and the uterine contractions.

Question 9

Tocodynamometer

Answer 9

he nurse should palpate the abdomen to identify where the contraction is strongest. This transducer measures the pressure changes of the abdomen contour to detect contractions. The uterine activity appears as a bell shape on the screen and lower grid of the strip.

Question 10

Fetal Scalp Electrode

Answer 10

used to assess the FHR. The nurse manually attaches the needle electrode to the fetal head through the vaginal canal and cervical opening. Because the nurse needs to get past the cervix, it must be dilated at least 2-3 cm and the membranes must be ruptured; otherwise, the nurse cannot insert the electrode.

Question 11

Uterine activity monitoring: (Pressure transducer at tip)

Answer 11

Solid catheter with transducer at tip.
Transducer physically in amniotic space, therefore measurements are typically higher.
Ability to perform amnioinfusion to dilute thickened meconium that has passed into the amniotic fluid and/or to relieve umbilical cord compression.

Question 12

Uterine activity monitoring: (Fluid Filled)

Answer 12

Hollow fluid-filled catheter.
Inserted through the dilated cervix into uterus to measure contractions and the uterine pressure.
Sensor is in the bedside monitor rather than at the tip (measurements are typically lower).

Question 13

Meconium

Answer 13

a material that collects in the intestines of a fetus and forms the first stools of a newborn. It is thick and sticky, usually greenish to black, and composed of secretions of the intestinal glands, some amniotic fluid, and intrauterine debris, such as bile pigments, fatty acids, epithelial cells, mucus, lanugo, and blood. The presence of meconium in the amniotic fluid during labor may indicate fetal distress and may lead to a lack of oxygen and developmental delays.

Question 14

Amnioinfusion

Answer 14

a nursing intervention from the Nursing Interventions Classification (NIC) defined as infusion of fluid into the uterus during labor to relieve umbilical cord compression or to dilute meconium-stained fluid.

Question 15

Which noninvasive tools may be used to evaluate the fetal heart rate?

Answer 15

Fetoscope: The fetoscope is one example of a noninvasive monitoring device to evaluate the fetal heart rate. It allows the nurse to listen to the opening and closing of the valves.

Doppler ultrasound: The Doppler ultrasound is a noninvasive tool used to evaluate the fetal heart rate. Doppler can make the fetal heart audible and automatically count the heart rate.

Question 16

The nurse sees that the patient is having a contraction, but the monitor is not detecting the contraction with the tocodynamometer. Which action would the nurse take?

Answer 16

Assess and reposition the tocodynamometer so it is secure.: The nurse would first assess the tocodynamometer to see if it is secure and placed correctly to monitor the contractions. To determine placement, the nurse should palpate the abdomen to identify the area where the contraction is strongest.

Question 17

The midwife has requested an amnioinfusion. Which internal uterine catheter should the nurse prepare?

Answer 17

An intrauterine pressure catheter: The nurse should prepare a solid intrauterine pressure catheter, which specifically has an extra lumen for amnioinfusion.

Question 18

advantages of Auscultation of Fetal Heart Rate (FHR) and Palpation of Uterine Activity

Answer 18

Mobility is a big advantage to this method, allowing the woman to freely move around and change position.
Allows for water methods of pain management (shower, whirlpool).
More natural atmosphere.

Question 19

Disadvantages of Auscultation of Fetal Heart Rate (FHR) and Palpation of Uterine Activity

Answer 19

The auscultation of the FHR is intermittent and may miss important changes for high-risk pregnancies. This results in a less accurate measurement.
Assesses FHR and uterine activity for only a small percentage of the total labor.
Some women find it distracting and uncomfortable.
Staff intensive.

Question 20

Advantages of External Electronic Fetal Monitoring (EFM)

Answer 20

Noninvasive and suitable for most women in labor.

Allows mobility if connected to a mobile telemetry unit.

Question 21

Disadvantages of External Electronic Fetal Monitoring (EFM)

Answer 21

Limits mobility if not a telemetry mobile unit.
The EFM can also be time consuming if it takes a while to obtain an accurate strip.
External devices are less accurate than the internal devices.

Question 22

Scalp Electrode: Advantages

Answer 22

Allows for more accuracy in the fetal heart rate patterns.

Continuous monitoring.

Question 23

Scalp Electrode: Disadvantages

Answer 23

ncreases the risk of infection.
Can cause injury to the scalp if the electrode is pulled off.
May be difficult to remove due to tangling in the fetal hair

Question 24

Intrauterine Pressure Catheters: Advantages

Answer 24

The fluid-filled catheter has higher accuracy than the external methods to measure contractions.

Question 25

Intrauterine Pressure Catheters: Disadvantages

Answer 25

Can cause an increased risk for infection

Question 26

Solid catheter (Intrauterine Pressure Catheter): Advantages

Answer 26

Not affected by height because the transducer is in the catheter.
Has higher accuracy than the external methods to measure contractions.
Has an extra lumen to facilitate amnioinfusion.

Question 27

Solid catheter (Intrauterine Pressure Catheter): Disadvantages

Answer 27

Maternal movement may dislodge the electrode.

Can cause an increased risk of infection.

Question 28

Fluid Filled Catheter (Intrauterine Pressure Catheter): Advantages

Answer 28

Has higher accuracy than the external methods to measure contractions with regard to intensity and resting tone.

Question 29

Fluid Filled Catheter (Intrauterine Pressure Catheter): Disadvantages

Answer 29

Does not have the extra lumen for amnioinfusion.
Can cause an increased risk of infection.
Affected by height because the electrode is located in the bedside monitoring equipment.

Question 30

A nurse is educating a patient about the difference between low-tech and high-tech fetal surveillance. How would the nurse describe the advantages of low-tech fetal surveillance methods, such as intermittent auscultation?

Answer 30

Allows patient movement: Intermittent auscultation of the FHR allows more mobility than high-tech methods.

Allows for a less medical atmosphere: Intermittent auscultation is intermittent, and the patient is not focused on watching the monitor and listening to beeping noises.

Appropriate for low-risk pregnant patients in labor: Intermittent auscultation is not the preferred method if the pregnancy is complicated or high risk. Continuous external or internal electronic fetal monitoring is preferred with high-risk pregnancies.

Offers patient more freedom in choosing pain management: Intermittent auscultation does allow the patient to use water-based methods, that is, whirlpool for pain management, because no equipment is attached continuously

Question 31

How would the nurse best respond to a laboring patient who is concerned that not enough monitoring is being performed

Answer 31

“Can you tell me why you feel this way?”: The nurse needs to validate the patient’s feelings and find out why she feels that way. Then explain the reasoning for the level of monitoring.

Question 32

Match the invasive fetal surveillance method to the correct advantage.

Answer 32

Fetal scalp electrode
**Accuracy of fetal heart rate
Solid intrauterine pressure catheter (IUPC)
**Accuracy of uterine contractions; also has an additional lumen for amnioinfusion
Fluid-filled catheter intrauterine pressure catheter (IUPC)
**Accuracy of uterine contractions, including intensity and resting tone

Question 33

The nurse is aware that which conditions must be met to apply a fetal scalp monitor?

Answer 33

The cervix should be at least 2 cm dilated.: The fetal scalp monitor can be used once the mother’s cervix has dilated to at least 2 cm.

The mother’s membranes must have ruptured.: The fetal scalp monitor can be used once the mother’s membranes have ruptured.

Question 34

The nurse is preparing for an amnioinfusion. The nurse knows that which situation may have caused the need for this intervention?

Answer 34

The fetus has experienced an intrauterine stress.: When stressed, the fetus can release meconium and risk aspiration. The amnioinfusion would infuse fluids to clear the meconium.

Question 35

A patient is worried about the amount of equipment being used to monitor the fetus. Which statement should the nurse make to decrease anxiety?

Answer 35

“I will explain each piece of equipment.”: By providing information about the equipment to the parents, the nurse should be able to decrease the anxiety and reassure them.

Question 36

Which intervention would the nurse use to decrease the patient’s anxiety or fear about electronic fetal monitoring?

Answer 36

Assess the parents’ present knowledge about electronic fetal monitoring.: To decrease a patient’s anxiety about electronic fetal monitoring, the nurse should first assess the parents’ present knowledge about electronic fetal monitoring, while building on existing knowledge.

Question 37

The patient is concerned by the use of the fetal scalp electrode and fears it will hurt the baby. Which is the best response by the nurse regarding the need for this assessment?

Answer 37

“The fetal scalp electrode will provide more accurate information.”: Explain to the parents how the fetal scalp electrode is more accurate than other fetal monitoring devices.