Mod 3 part 2 Flashcards
Primary goal of fetal surveillance
To enable clinicians to assess adequacy of fetal oxygenation during labor.
Adequate fetal oxygenation requires:
1) Sufficient maternal blood flow and volume to the placenta
Variability
Most critical predictor of adequate fetal oxygenation
Chemoreceptors
Increase the fetal heartrate
Baroreceptors
Get us to baseline heartrate
Know mom’s heart rate before you start reading the fetal strip
So you know it’s separate from the baby’s heart rate
Intermittent auscultation vital sign monitoring schedule
Latent phase: Every 30 minutes
minimal variability
> undetectable but <5/min
moderate variability
amplitude range 6-25 bpm
Marked variability
Greater than 25/min
sinusoidal variability
ominous sign on fetal monitoring strip. Smooth, wavelike pattern. Category 3.
Normal baseline FHR
110-160 bpm
Early decelerations
Decelerations which begin prior to peak of the contraction and end by the end of it. they are caused by head compression. no need for intervention if variability is within normal range (6-10) and the FHR is within normal range. safe
Late decelerations
Bad (placental insufficiency)
Variable decelerations
Decelerations which show an abrupt decrease of FHR less than 15 bpm, lasting 15 seconds to 2 minutes; caused by umbilical cord compression
Recurrent decelerations
Decelerations which occur in more than 50% of uterine contractions in a 20-minute period.
Category 1
Baseline 110-160
Category 2
Bradycardia
Category 3
Absent baseline variability AND
Ketorolac (Toradol)
class: nonsteroidal anti-inflammatory agents, nonopioid analgesics
Mag Sulfate
Anticonvulsant commonly given in OB
methergen
Medication given to contract uterus to remove clots
Hemabate
Medication given for active hemorrhaging
Oxytocin (Pitocin)
Stimulates uterine contractions for the purpose of induction or augmentation of labor. Uses: antepartum for contraction stress test (CST), intrapartum for induction or augmentation of labor, postpartum to promote uterine involution. Precautions/interactions: contraindicated with placental insufficiency. Side effects: intense uterine contractions, uterine hyperstimulation (contraction longer than 90 seconds), uterine rupture.
Labetolol
Drug given in labor for extremely high blood pressure 160/110
Airway management will always take precedence over Narcan
In a newborn with respiratory depression.
Spinal block
Post-dural headache is common.
gated pain theory
Theory that the brain can only process one form of stimulation/pain at a time. Providing a secondary source of stimulation such as light touch or deep massage can reduce the perception of pain.
LION
Intervention for interrupted oxygen pathway:
When membranes rupture the nurse should assess
Color, quality, smell, fetal heart rate, and time
