Intrapartum Nursing Care and Fetal Monitoring

Question 1

What are the 8 labs to be done for L&D admission?

Answer 1

Blood type/Rh factor CBC G/C status GBS status Hepatitis status HIV status Rubella status VDRL/RPR status

Question 2

What type of IV fluid is typical for L&D?

Answer 2

lactated ringers

Question 3

Which arm is the IV access placed?

Answer 3

non-dominant

Question 4

What is our nursing care for newly admitted L&D patients?

Answer 4

Monitor VS Establish IV access Monitor contractions; maternal/fetal tolerance Monitor ROM Monitor perineum, activity and pt position Monitor fluid intake Pain management Pt comfort/support

Question 5

What is important to keep in mind regarding angiocatheter size and blood products.

Answer 5

Need a larger Cath size due to blood viscosity

Question 6

What is the purpose of fetal monitoring?

Answer 6

Determine fetal status Identify the fetal hypoxic stress

Question 7

The umbilical vein carries what to where?

Answer 7

Oxygenated blood to the fetus

Question 8

Umbilical arteries carry what to where?

Answer 8

Deoxygenated blood to placenta

Question 9

True or False The CNS has no affect on the FHR.

Answer 9

False. It plays a significant role in the regulation of the FHR

Question 10

How does a contraction effect blood flow to the mother and fetus?

Answer 10

Increases blood volume to mother, decrease flow to fetus

Question 11

Fetal bradycardia/tachycardia diminish

Answer 11

Oxygenation

Question 12

How do we assess the intensity of contractions when we compare them to our own bodies?

Answer 12

Mild = Nose Moderate = Chin Strong = Forehead

Question 13

Why are Leopold’s maneuvers performed regarding fetal monitoring.

Answer 13

To establish position of fetus to know where to position monitoring equipment

Question 14

What devices are used for monitoring the FHR? Indicate if they are internal or external.

Answer 14

Ultrasound transducer: external Spiral electrode: internal

Question 15

What devices are used for monitoring uterine activity? Indicate if they are internal or external.

Answer 15

Tocotransducer: external Intrauterine pressure catheter (IUPC): internal

Question 16

Name the advantages of both internal and external fetal monitoring

Answer 16

External: non-invasive, low risk Internal: more detailed data

Question 17

On a FHR strip, each box indicates…

Answer 17

10sec of time

Question 18

Each section between bold vertical lines indicates…

Answer 18

1min of time

Question 19

What do the upper and lower sections of the strip represent?

Answer 19

Upper = FHR Lower = Contractions/uterine activity

Question 20

Define the baseline FHR on the strip

Answer 20

FHR average over 10mins

Question 21

What do accelerations indicate and is it bad?

Answer 21

Normal HR increases with fetal movement. It is ok.

Question 22

What are decelerations?

Answer 22

Drops in heart rate.

Question 23

What are the three types of decelerations and what do they indicate?

Answer 23

Early = drop in heart rate is due to head compression Late = drop in rate is due to uteroplacental exchange issues Variable = drop in rate is due to cord compression

Question 24

What are the nursing interventions for early decels?

Answer 24

These are typical. Monitor and document

Question 25

What are the nursing interventions for late decels?

Answer 25

Reposition mother, monitor and document

Question 26

What are the nursing interventions for variable decels?

Answer 26

Reposition, O2 administration @ 8-10L/min w/ non-rebreather mask

Question 27

A FHR reading is either _____ or _____.

Answer 27

Reassuring or non-reassuring

Question 28

During the second stage of labor, fetal heart tones are documented…

Answer 28

every 5 to 15 minutes.

Question 29

During the early phase of labor, fetal heart tones only need to be documented every

Answer 29

30 minutes

Question 30

During the latent phase of labor, fetal heart tones only need to be documented every

Answer 30

30 minutes

Question 31

Regarding Cesareans, The guidelines for decision to incision are

Answer 31

30 minutes.