L&D II Flashcards
Exam 2
What is category I?
Normal fetal heart rate patterns
What is variability
Variability is defined as fluctuations in the BL rate
What does marked variability look like?
> 25 bpm
What does moderate variability look like?
6-25 bpm
What does minimal variability look like?
<6 bpm
What do absent variability look like?
straight line
What is a tachycardic FHR?
> 160
What is a bradycardic FHR?
<110
What is a normal FHT?
110-160
What are the purposes of fetal surveillance?
To assess how the fetus is tolerating labor and to monitor oxygenation status.
What are the two approaches to intrapartum fetal monitoring?
Intermittent auscultation with palpation of uterine activity (low tech) and electronic fetal monitoring (high tech).
How would a nurse do intermittent auscultation and palpation?
Doppler for 15-60 seconds or longer between ctx
Simultaneously palpate maternal pulse
Listen after ctx 15-30 seconds for increases or decreases
Palpate ctx
What are the limitation of intermittent auscultation and palpation?
- 1-1 nursing care
- Not always ideal
- Can’t assess patterns of FHR variability, periodic or non-periodic changes
- No permanent, documented visual record of FHR or UA
What are the advantages of intermittent auscultation and palpation?
- Mobility
- Position changes and ambulation
- Least invasive
- Natural atmosphere
Who is 1 to 1 nursing care appropriate for when doing intermittent auscultation?
Low-risk mothers without complications.
Why should contractions be felt in the forehead?
To indicate strong and effective contractions.
What are the limitations to external electronic fetal monitoring?
- Reduced mobility is the major limitation.
- Frequent repositioning of transducers
- May double-count a slow FHR or half-count a fast FHR
- Maternal HR may be recorded rather than FHR
- Obese and preterm clients may be difficult to monitor
What are the advantages of external electronic fetal monitoring?
- Noninvasive
- Does not require rupture or membranes
- Supplies more data about the fetus and ctx
- Continuous recording and permanent record
- Gradual trends in FHR and uterine activity are apparent.
What is external electronic fetal monitoring?
Monitoring the baby’s heart rate and uterine contractions during labor
Why is external electronic fetal monitoring important?
To assess the well-being of the baby during labor
What is a con of external fetal monitoring
Less accurate than internal devices but are noninvasive and suitable for most women in labor
What is external fetal monitoring?
Noninvasive monitoring of the baby’s heart rate and uterine activity
What is remote surveillance in external fetal monitoring?
Surveillance of the baby’s heart rate and uterine activity from a distance
What is an ultrasound transducer used for in external fetal monitoring?
To monitor the baby’s heart rate
What is a toco transducer used for in external fetal monitoring?
A pressure-sensitive area detects changes and abdominal contour to measure uterine activity
Where does a toco transducer go on the mother’s abdomen?
On the fundus of the uterus
What is a transducer?
A device that converts one form of energy into another
What are the limitations of internal fetal monitoring?
- Requires rupture of membranes
- Cervix must be dilated
- Improper insertion can cause trauma (vaginal lacerations, uterine perforation, placental abruption)
- Presenting part must be identifiable
- Increased risk of infection
What are the advantages in internal fetal monitoring?
- Accurate FHR
- Maternal position changes does not effect quality of tracing
- Possibility of displaying ECG
- Only true measurement of ctx
- Allows for amnioinfusion
When should the cervix be dilated and ruptured?
In obese patients
When is internal fetal monitoring helpful?
In obese patients
What is the main advantage of using internal devices for fetal monitoring?
Accuracy
What are the requirements for using internal devices for fetal monitoring?
Ruptured membranes and about 2 cm of cervical dilation
What is the slightly increased risk associated with internal fetal monitoring?
Infection
What does an FSE detect?
Electrical signals from the fetal heart
What is the baseline fetal heart rate?
Determined in a 10-minute period
What is variability?
Measure of how spread out or dispersed a set of data values are
How is variability measured?
Using statistics such as range, variance, and standard deviation
What a s/s of a compromised fetus?
severe fetal anemia, twin-twin transfusion, intracranial hemorrhage, infection, hypoxia, gastroschisis, cardiac anomalies
What is a sinusoidal pattern?
Sinusoidal pattern is a regular pattern with 3-5 cycles per minute over at least 20 minutes.
Does a sinusoidal pattern have any accelerations or fetal movement?
No, a sinusoidal pattern does not have accelerations or fetal movement with or without stimulation
When does a sinusoidal pattern require immediate attention?
A sinusoidal pattern requires immediate attention when there is a compromised fetus.
What can cause a sinusoidal appearing pattern?
Opioid administration can cause a sinusoidal appearing pattern.
What are the two type of fetal heart rate pattern?
Periodic and Episodic
What type of fetal heart rate pattern is associated with uterine contractions
periodic fetal heart rate patterns
What type of fetal heart rate pattern is associated without uterine contractions
Episodic fetal heart rate patterns
What are accelerations?
Temporary increase in FHR
At what gestational age do accelerations occur at the rate of 15 x 15?
> 32 weeks gestation
At what gestational age do accelerations occur at the rate of 10 x 10?
< 32 weeks gestation
What are accelerations associated with?
Fetal movement
When else may accelerations occur?
During a vaginal examination, during uterine contractions, mild cord compression, breech presentation
What is considered a prolonged acceleration?
> 2 minutes
When does a prolonged acceleration become a baseline change?
> 10 minutes
What are early decelerations?
Fetal head compression; Deceleration onset, nadir, and recovery coincide with, or mirror, the beginning, peak, and ending of a contraction.
What is the onset to nadir for early decelerations?
30 seconds or more and are periodic
Are early decelerations indicative of fetal compromise?
No
Do position changes usually have an effect on early decelerations?
No
What is the onest of nadir for late deceleration?
Onset to nadir is 30 seconds or more
What are late decelerations?
Impaired oxygen exchange; In most cases, the onset, nadir, and recovery of the deceleration occur after the beginning, peak, and end of a uterine contraction.
When do late decelerations begin and end?
Begin after peak of contraction, return to baseline after contraction ends
What is a concerning pattern for late decelerations?
Recurrence of 50% or more contractions in 20 minutes
What nursing intervention is required for late decelerations?
Improve placental blood flow and fetal oxygen supply
What falls below the baseline rate in variable deceleration?
Shape, duration, and degree of fall below baseline rate are variable.
What are variable decelerations?
Reduced flow through umbilical cord
How long does it take for the onset to nadir of variable decelerations?
< 30 seconds
What is the minimum frequency of variable decelerations?
At least 15x15
What may cause variable decelerations?
Cord compression
Do variable decelerations require nursing intervention?
Yes
What is prolonged deceleration?
Periodic or episodic deceleration lasting 2-10 minutes.
When does prolonged deceleration occur?
2-10 minutes from onset to return to baseline.
Is nursing intervention necessary for prolonged deceleration?
Yes.
What does category III consist of?
- Tracings include absent variability AND any of the following:
- Recurrent late decels
- Recurrent variable decels
- Bradycardia
- Sinusoidal pattern
- IS indicative of an abnormal fetal acid-base status and poor fetal well-being.
- Requires prompt intervention
What is category III?
abnormal fetal heart rate patterns
What are the components of category II
- Includes ANY tracing that isn’t Category I or III
- Is not enough evidence to be category I or III
- Not predictive of abnormal fetal acid-base status
- Requires nursing intervention, close monitoring and re-evaluation
What is category II?
Indeterminate and you want to see if the fetal heart rate patterns falls closer to I or III
What consists of category I
Includes ALL of the following
- FHR Baseline 110-160 bpm
- Moderate variability
- Accels present OR absent
- Early decels present OR absent
- Late and variable decels absent
- Indicative of normal fetal acid-base
- No necessary interventions r/t tracing
What is intensity of contraction?
how they fell mild moderate or strong
What is duration?
period from the beginning of a uterine contraction to the end of the same contraction
What is frequency?
time elapsed between the beginning of one contraction and the beginning of the next
What are the four components of the assessment of uterine activity?
Frequency, Duration, Intensity, Resting tone
What should you know in terms of decls
It’s okay to be EARLY for dinner, but don’t be LATE!!
What does MINE stand for
Move patient
Identify labor progress
No action needed
Execute immediately
What does CHOP stand for?
Cord compression
Head compression
Okay
Placental insufficiency
What does VEAL stand for?
Variable
Early
Acceleration
Late
What are some common corrective measures for Cat. II or III readings?
- Maternal repositioning
- Oxytocin off
- Withhold misoprostol
- Oxygen
- IV fluid bolus
- SVE
- Amnioinfusion
- Notify physician
- Modify pushing efforts
- Administer terbutaline
- Prepare for C/S
How is a sample of cord blood obtained?
From umbilical artery (unoxygenated) and umbilical vein (oxygenated)
What is the time frame to send the samples to the lab after collection?
Within 60 minutes
What parameters are analyzed in cord blood to determine the presence of fetal acidosis?
pH, partial pressure of carbon dioxide, bicarbonate, and base deficits or excess
How is fetal acidosis distinguished if detected?
Respiratory, metabolic, or mixed
What should nurses do to increase fetal oxygenation?
Take corrective action to increase fetal oxygenation and promote adequate fetal oxygenation
Who should nurses report changes in patterns to?
Report changes in patterns to the physician or nurse midwife
What should nurses do to support the woman and her partner?
Support the woman and her partner and provide education
What should nurses do after assessment and care?
Document assessment and care
What factors should be considered when making the decision to go to a birth facility?
Distance, transportation, child care needs
What information is important to know about previous labors?
Number, duration
What are the signs that indicate it’s time to go to the hospital/birth center?
Contractions that are regular, 5 mins apart, last 1 min for 1 hour, ruptured membranes A gush or trickle of fluid from the vagina, with or without contractions, bright red bleeding, decreased fetal mvmt
What are the nursing responsibilities during admission to a birth facility?
Establish therapeutic relationship, assessment
What does the assessment during admission include?
Medical, surgical, psychosocial, and obstetric history; head-to-toe physical examination/assessment; labor plan; maternal-fetal status
What is considered a normal fetal heart rate (FHR)?
FHR 110 to 160 bpm
What should be assessed in the fetal heart rate?
Regular rhythm: Presence of acceleration; absence of deceleration
What vital signs should the nurse identify signs of?
Hypertension and infection
What are some signs of impending birth?
Grunting sounds, bearing down, urgency to push, screaming, rocking
What is Aminisure?
A test to determine the pH level
What is Srom?
A term related to the rupture of the membranes
What is Arom?
A term related to artificial rupture of the membranes
What indicates labor?
Actual changes occurring in the cervix
What nursing responsibilities are involved during admission to a birth facility?
Focused assessment, Basic information, Physical exam, reflexes, Labor status, Contraction pattern, SVE unless preterm (<37 weeks) or bleeding, Establish if rupture of membranes, Amniosure, nitrizine ph test, AROM vs SROM, Clear with vernix particles, Determine true or false labor
What should the nursing staff determine during admission regarding the patient’s labor status?
Whether the patient is in true or false labor
What are some methods used by the nursing staff to determine if there has been a rupture of membranes?
Amniosure, nitrizine ph test
Which patients should not have a sterile vaginal examination (SVE) performed during admission?
Preterm patients (<37 weeks) or those experiencing bleeding
What color is amniotic fluid when presenting with meconium?
Brown
What color does amniotic fluid turn in the presence of chorioamnionitis infection?
Yellow or cloudy
What are nursing responsibilities during admission to a birth facility?
Notify provider, give report, obtain orders, admit or discharge
What assessments should be done during admission to a birth facility?
UA, UDS
What should be done to reassess labor status?
Observe for 1-2 hours
What is an important aspect of managing false or early labor?
Identification of patient problems
What is the ultimate goal for a patient experiencing false or early labor?
Discharge
What are some important aspects of true labor?
Admit to unit, Consent forms, Pain management
What are some common interventions during labor?
Epidurals, C-section, Induction
What laboratory tests are typically performed during labor?
CBC, UA, UDS, Type & Screen
What is the recommended size for IV access during labor?
18g
What kind of maternal assessment do you perform for true labor?
- Labor progress
- Contractions
- Intake and output
- Response to labor/signs of coping
During ongoing assessment what kind of fetal assessment do you perform?
- FHR
- Fetal membranes and amniotic fluid
What are conditions associated with fetal compromise?
- FHR outside normal limits (110-160 bpm) and loss of variability
- Meconium-stained amniotic fluid
- Cloudy, yellowish, foul-smelling amniotic fluid
- Excessive frequency or duration of contractions
- Incomplete uterine relaxation
- Maternal hypotension or hypertension
- Maternal fever
What are some strategies for promoting labor progress?
Positioning and movement, teaching, comfort measures
Is pain relief during labor realistic?
No
What is the goal during the second stage of labor?
Pushing efforts 3 times every contraction to fully dilate and have the baby low
What is laboring down?
Allowing the woman to rest and let the baby descend during the second stage of labor
What are some positions that can be used during labor?
Various positions to aid in comfort and progress
Why are varied positions important for labor?
Promote comfort and optimal fetal positioning
What is induction of labor?
Artificial methods to stimulate uterine contractions
what is induction associated with?
high cesarean rate
When are elective induction allowed?
After 39 weeks
What are the indications for induction and augmentation of labor?
SROM, Post term pregnancy, Chorioamnionitis, Hypertension, Abruptio placentae, Maternal medical conditions, GDM, Fetal demise
What are the contraindications for induction and augmentation of labor?
Placenta previa, Vasa previa, Umbilical cord prolapse, Abnormal fetal presentation, Active genital herpes, Previous uterine surgery, Breech presentation, Overdistended uterus, Severe maternal conditions
Who is done by amniotomy fluid?
physical or nurse midwife and they do it by snagging the amnio hook snags membrane
What is the risk of amniotomy?
- prolapse umbilical cord
- infection
- abruption placenta
What is amniotomy?
Artificial rupture of membrane
What are some nursing considerations for amniotomy?
Baseline information, fetal heart rate 20 to 30 min before procedure
What should be done to assist with the amniotomy procedure?
Place absorbent pads, provide necessary equipment
What should be done after the amniotomy procedure?
Provide post-procedure care and identify complications
What is the purpose of induction and augmentation of labor?
To start or speed up the labor process
What is the Bishop score used for?
Assessing cervical readiness for induction
What is a pharmacologic method for induction?
Misoprostol (Cytotec)
What is a mechanical method for induction?
- Transcervical balloon catheter
- membrane stripping
- separate sack from uterus
- hydroscopic inserts
What is the most common technique for inducing and augmenting labor?
Oxytocin administration
What is the recommended starting rate for oxytocin administration?
0.5-2 milliunits/min
How often should the dose of oxytocin be increased?
Every 15-40 minutes
What should be monitored frequently during oxytocin administration?
Uterine activity, FHR, and fetal heart patterns
What are some responsibilities during birth?
Preparing delivery table, perineal cleansing, supporting woman during pushing, initial care of newborn, administering medications
What is the purpose of administering medications during birth?
To contract the uterus and control blood loss
