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308- OB > intrapartum nursing assessment and fetal monitoring basics > Flashcards

intrapartum nursing assessment and fetal monitoring basics Flashcards

1
Q

psychosocial factors associated with a positive birth experience

A

choosing a physician/certified mid-wife who has similar philosophy of care - its important to be on the same page in case of emergency

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2
Q

maternal assessments during labor

A

monitor vs, be alert to preeclampsia, infection, hemorrhage; perform vaginal exam and assess labor status; labs urine, CBC, type and screen

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3
Q

maternal assessments during labor: vaginal exam /labor status

A
  • Cervical effacement, dilation, fetal station
  • Rupture of membranes (ROM) time and color if ruptured (nitrazine test, ferning)
  • UC pattern (palpate or use fetal monitor)
  • Fetal heart rate pattern
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4
Q

assessments during labor contd.

A

cultural- birth plan

psychosocial - attended CB classes, support during labor, evaluate womans response to labor/pain

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5
Q

latent phase

A
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6
Q

active phase

A
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7
Q

transitional phase

A
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8
Q

fetal presentation and position

A

inspection, palpation (leopolds maneuvers and vaginal exam) ultrasound

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9
Q

leopods maneuver determines

A

fetal position, presentation and lie

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10
Q

fetal heart rate

A

heart best through fetal back, find back using leopolds maneuver, doppler, electronic fetal monitoring (EFM)

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11
Q

leopolds maneuver first maneuver

A

palpate fundus of uterus with both hands - which part occupies the fundus?
am i feeling buttocks or head?

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12
Q

leopolds maneuver second

A

palpate one side of the uterus, then the other - where is the fetal back? where are the small parts or extremities?

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13
Q

electronic fetal monitoring (EFM)

A

can be continuous or intermittent, external and internal monitoring

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14
Q

EFM external monitoring

A
  • Ultrasound transducer measures FHTs (Fetal Heart Tones)

- Tocodynamometer “Toco” measures UC’s (Uterine Contractions)

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15
Q

EFM internal monitoring

A
  • Must have ruptured membranes
  • Internal electrode attached to baby’s scalp for FHTs- increased risk for infection (water has to be broken)
  • Intrauterine pressure catheter (IUPC) measures internal pressure of UCs- for contractions (water has to be broken before it’s placed)
  • Done when external monitoring not adequate
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16
Q

EFM advantages

A

noninvasive, membranes do no not have to be ruptured, performed by nurse

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17
Q

EFM disadvantages

A

contraction intensity not measured, movement required repositioning, quality affected by obesity and fetal position

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18
Q

indications for continuous EFM monitoring

A 
Multiple gestations
Oxytocin administration
Placenta previa or abruptio placentae
Maternal complications (hypertension, diabetes)
IUGR – intrauterine growth restriction
Meconium stained amniotic fluid
Fetal distress 
Premature/postdate
Abnormal NST/CST/BPP
any bleeding 
c-section ?
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19
Q

fetal heart rate patterns measured by assessing the

A

baseline rate, variability, periodic changes

20
Q

fetal HR patterns baseline rate

A

look at range of FHT over 10 min, normal is 110-160

21
Q

fetal HR patterns variability

A

change in HR over sec/min

22
Q

fetal HR patterns periodic changes

A

changes that occur over time/ with stress of activity

  • accelerations= transient rises in FHTs
  • decelerations= periodic decreases in FHTs
23
Q

normal FHR

A

110-160 bpm

24
Q

tachycardia

A

above 160 bpm for 10 min or more

25
Q

bradycardia

A

below 110 bpm for 10 or more

26
Q

fetal tachycardia most common causes

A

(baseline >160 bpm)

maternal fever, fetal infection, mild fetal hypoxia, neurologic immaturity/prematurity

27
Q

Fetal Tachycardia Nursing Interventions

A 
Assess maternal VS especially temp
Assess duration since ROM 
- >24 hours increases risk of infections
Intrauterine resuscitation:
- Change maternal position (left side)
- Increase IV rate 
- Oxygen therapy via mask at 8-10 l/min
- Turn off Pitocin (oxytocin) if running 
*Notify M.D./CNM immediately*
28
Q

fetal bradycardia most common causes

A

(baseline <110 bpm)

fetal hypoxia, postdates fetus, congenital fetal cardiac anomaly, may be maternal HR

29
Q

Fetal Bradycardia nursing interventions

A

Check maternal pulse to rule out monitoring mother’s heart rate instead of FHR
Check fetal gestational age (post maturity)
Intrauterine resuscitation:
-Change maternal position (left side)
-Increase IV rate
-Oxygen therapy via mask at 8-10 l/min
-Turn off Pitocin (oxytocin) if running

Notify M.D./CNM immediately
Prepare for immediate delivery, especially if FHR < 80 BPM

30
Q

FHR variability

A

Reflection of the “push-pull” effect between the sympathetic and parasympathetic nervous systems
Presence of FHR variability is an indicator of fetal well-being

31
Q

different amounts of FHR variability

A 
none= straight line -non-reassuring
minimal= (< 5/min) -watch closely 
moderate= 6-25/min- reassuring
32
Q

decrease in variability possible causes are

A

Anything that depresses the fetal CNS

  • Fetal sleep
  • Oxygen deficits/hypoxia
  • Prematurity
  • Cardiac or CNS anomalies
  • Narcotics or tranquilizers (drugs/medications
33
Q

Nursing Interventions for minimal or absent variability

A 
Note time, type of meds given 
-Is baby “drugged”? 
Check EDB
-is baby neurologically immature?
What to do...Intrauterine resuscitation:
-Change maternal position (left side)
-Increase IV rate 
-Oxygen therapy via mask at 8-10 l/min
-Turn off Pitocin (oxytocin) if running

Notify M.D./CNM immediately

34
Q

FHR periodic changes

A

accelerations (caused by fetal movmt/NST)

decelerations (early, late, variable)

35
Q

FHR Transient Changes Early Decelerations

A

Benign, seen in active labor
What do they look like?
-Typically uniform in shape (not irregular or spiky)
-Mirror the contraction (begin & end w/ UC)
-Rarely falls below 100-110 bpm
Probable cause is head compression

Interventions: NOTHING except monitor to ensure a more ominous pattern does not develop

36
Q

FHR Transient Changes:LATE Decelerations

A

An ominous sign!
What do they look like?
- Begins at or after peak of the contraction
- Have smooth uniform shape

Probable Cause: Uteroplacental insufficiency (UPI)
- Decreased blood flow with contractions, impedes fetal oxygen transfer….fetal causes hypoxemia with UCs

37
Q

early decelerations

A

Mirror each other - Peak of contraction mirrors the lowest point of FHR

38
Q

late decelerations

A

No mirroring- FHR starts to drop at peak, lowest part of FHR lines up/matches when contractions are over

39
Q

Interventions for Late Decelerations:

A

It’s all about intrauterine resuscitation!
Intrauterine resuscitation:
- Change maternal position (left side)
- Increase IV rate
- Oxygen therapy via mask at 8-10 l/min
- Turn off Pitocin (oxytocin) if running

  • Notify MD/CNM anticipate need for C/S*
  • *Keep patient and family informed**
40
Q

FHR Transient Changes:Variable Decelerations

A 
Variable Decelerations -Most variables are not serious 
What do they look like?
-Unpredictable drops in FHR
-Typically V, U or W ~ waveforms
-Sudden drop in FHR, with quick return

Probable Cause: cord compression - cord is pushed up against the baby

41
Q

Nursing Interventions for Variable Decelerations

A

Interventions:

  • Change position to decrease cord compression
  • May need O2, IV
  • Watch for severe or prolonged variables with late component and decreased variability
  • Rule out prolapsed cord– check cervix (if u feel it - stat c-section)

Emergency if prolapsed cord
- Give O2 mask, increase IV rate, Trendelenburg Position, push up presenting part, prepare for stat C/S!

42
Q

category I

A

FHR 110-160, moderate variability
Accelerations present or absent
Early decelerations possible
Variable or late decels absent

43
Q

category II

A 
Tachycardia or bradycardia
Minimal variability
Absent variability without decels
Marked variability
Decelerations – late or variable with variability
44
Q

category III

A

Absent variability with recurrent late or variable decels

Sinusoidal pattern- anemic, hypoxic (emergency)

45
Q

VEAL CHOP

A

variable- cord compression
early - head compression
accelerations- okay
late- placenta insufficiency

308- OB (4 decks)

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