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Maternal Exam 1 > Monitoring FHR & Uterine Contractions > Flashcards

Monitoring FHR & Uterine Contractions Flashcards

1
Q

What is purpose of monitoring the baby with FHR monitor?

A

Assessing how well a baby is being oxygenated

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2
Q

Hypoxemia

A

Not enough oxygen in the blood

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3
Q

Hypoxia

A

Not enough oxygen to cells/tissues

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4
Q

Types of FHR monitoring

A

Intermittent

Continous

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5
Q

Intermittent

A

no permanent record

fetoscope
doppler

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6
Q

Continuous

Two different types of continuous monitoring?

A

permanent record is stored

External - over uterus and back w transducer

Internal - inside the uterus w scalp electrode

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7
Q

Fetoscope used what to monitor hr?

A

bone conduction

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8
Q

Three ways to monitor uterine contractions

A

Manual
External
Internal

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9
Q

Manual contraction monitoring

A

Finger tips over fundus or top of uterus during contraction

Palpate and feel firmness then relexation to pick out contraction

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10
Q

Different descriptions for contractions for manual monitoring

Mild
Moderate
Board

A

mild - cheeks
moderate - chin
board - forehead

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11
Q

External monitoring for contractions/activity

A

tocotransducer over the fundus

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12
Q

Internal monitoring defintion

what does it require?

A

IUPC going up uterine cavity to directly measure contraction

membrane must be ruptured already
some cervical dilation - 2 cm or more

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13
Q

Where should a FHR belt be placed on fetus? Will this be on top or bottom of belly?

A

On the fetus back.

Bottom

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14
Q

Where does the contraction monitoring system belt (external tocotransducer) go on the belly?

A

On fundus or top of belly

Note: has pressure button

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15
Q

When discussing why your patient might want to use the external electronic monitoring system for contractions , what advantages do you mention?

Where do we save the strips?

A

Noninvasive so no surgery

It’s relatively easy to put in place

Can be used anytime even if membrane is non-ruptured yet

You can take it off (but must be left on for 20 min) or leave it on to provide a permanent continuous recording

Saved in records and go into salt mines

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16
Q

What disadvantages are there to electronic monitoring of contractions?

A

Must compare what you feel vs what the strip says

Belt can be uncomfortable

May have to readjust

Can inhibit movement

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17
Q

When discussing an internal electronic contraction monitoring device, what advantages do you mention?

A

More accurate of uterine contractions and timing

Provides pressure measurement for contraction intensity and relaxation

Permanent record

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18
Q

Will they start out as internal or external?

A

External first but then provider will choose internal

BUT you can have a combination

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19
Q

Disadvantages of using an internal electronic heart monitor like the electrode?

A

Infection
Injury
Need membrane to be ruptured
Sufficient cervical dilation

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20
Q

What is the name of an external heart rate monitor?

A

fetal ultrasound doppler

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21
Q

Leopold’s Maneuvers

First

Second

Third

Fourth

A

First check for soft rounded area at top for baby’s butt

Second, slide hands down to feel a smooth back & then knobby edges for elbows and hands on the other side

Third, move hands down to feel round head

Feel the back and head again to know where to put the ultrasound HR transducer

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22
Q

Baseline FHR is what interval?
How is it baseline FHR found?
Where do you round it to?
What is normal?

A

RR interval of QRS complex

Found by average FHR during 10 min

Round to increments of 5 bmp

Normal is 110-160

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23
Q

Mistake made when trying to read FHR?

A

Cana accidentally take moms HR.

Clue: if the fhr shows up slower, then take moms HR too.

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24
Q

What can cause FHR changes?

A

Episodic changes not bc of contractions like exam or some form stimulation

Periodic changes that have to do with contractions

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25
Q

What does a strip look like?

Bold lines

squares

A

Upper bar is HR
Lower bar is fetal activity and contractions
mmHg

bold lines indicate 1 minute

squares are 10 seconds

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26
Q

How to find mean of HR strip?

A

So look at highest moments and lowest moments and divide by two

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27
Q

Are fluctuations bad when looking at the strip?

A

No not usually. Some fluctuation is a variability and is good.

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28
Q

Uterus at rest means

A

in between contractions

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29
Q

Bradycradia in fhr

Tachycardia in fhr

What if change is less than 10 min?

A

FHR lower than 110 for 10 minutes

FHR higher than 160 for 10 min

Just a baseline fetal hr change

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30
Q

Causes of bradycardia part 1

A

abruptio placenta

congenital heart block

Fetal arrhythmia

Late fetal hypoxia

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31
Q

Causes of bradycardia part 2

A

Maternal Hypotension

Maternal hypothermia

Prolonged umbilical cord compression that reduces vagal stimulation

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32
Q

causes of bradycardia part 3

A

Uterine hyperstimulation

uterine rupture

vagal stimulation during pushing of labor

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33
Q

Tachycardia causes part 1

A

Amnionitis or inflammation of amnion

Beta sympathatic drugs that stimulte HR

Early fetal hypoxia (HR compensates)

34
Q

Tachycardia causes part 2

A

Fetal anemia

Fetal dysrhythmias

35
Q

Tachycardia causes part 3

A

Maternal dehydration

Maternal fever

Maternal hyperthyroidism

36
Q

Variability

Which creates

A

Measures the sympathetic and parasympathetic NS causing HR to rise and fall

Creates fluctuations in baseline FHR that are irregular

37
Q

sympathetic ns

A

raises hr

38
Q

parasympathetic ns

A

drops hr

39
Q

How are variability fluctuations evaluated

Does this include acceleration and deceleration

A

Peak to trough

Excludes them (meaning it is period between contractions when nothing is going on… I think)

40
Q

Variability classifications and ranges

A

absent or none
minimal or small so less than 5
moderate or normal which is 6-25
marked or greater than 25 bpm

41
Q

If a strip goes from 120 to 150 then that is what type of varaibility

A

Marked or it should be… idk need to doube check

42
Q

Causes of decreased variability

Reminder: This isn’t necessarily a bad sign - just that their activity is less.

A

Baby could be asleep - which is leading reason

Hypoxia and acidosis

CNS depressants drugs

immature fetus below 32 weeks

cardiac anomalies

previous neuro insult - such as certain drugs causing a stroke in the baby that is permanent and so won’t have normal HR resposne

prematurity

tachycardia - you lose varaibility of HR is too fast

43
Q

Causes of marked or extremely noticeable varaibility

A

early mild hypoxia to compensate for something

Fetal stimulation of autonomic ns

44
Q

What are accelerations of FHR?
Are they bad?

How long does it last

A

Abrupt increase in FHR about baseline
No, these are not bad. They’re good. Just means they’re moving.

Last less than 30 seconds

45
Q

Pre-term baby under 32 weeks acceleration rule

Rule for baby over 32 weeks

A

Rule of tens for pre-term under 32 weeks

Rule of 15

46
Q

What if you don’t see any accelerations?

A

Try to stimulate them
move them in uterus
drink something cold

Probably just be sleeping.

47
Q

How do we count accels on graph?

A

Check the squares. If it is less than 15 for older babies it is just movement. (or 10 if premie)

48
Q

Can an accel happen during contractoin?

A

Yep and before & after. No specific time.

49
Q

What is a Deceleration?

A

Abrupt slowing of FHR

50
Q

Types of decelerations

Extra type?

A

Early
Late
Variable
Prolonged (longer than 2 min)

And then there is a way to describe all of these which is Recurrent which just means they happen half of contractions

51
Q

Early Decelerations

How are these rt contractions?

A

Slowing on strip and you can also hear the HR slow if listening

When the contraction is building, the HR is slow.

52
Q

Nadir meaning

A

low point of HR

53
Q

Number one cause for early decelerations? How?

A

Head compression

Causes vagel stem response to slow HR

54
Q

When should you expect early deceleration?

A

Early stages of progressing labor as head comes down birth canal

55
Q

Should you have to do interventions for early deceleration?

A

Nothing really. Just document.

56
Q

Will the strip showing the deceleration coincide with anything on the graph?

A

Yes - the contractions. And then hr will raise when contraction is over. A fragile picture.Onset & offset will be parallel

57
Q

Late decelerations cause?

What may mom’s hx look like?

A

There is a deceleration of HR that has something to do with the placenta

Hypertensive, diabetic, post due mother could cause this to happen since placenta can’t get oxygen. Check mom’s history

58
Q

When will a late deceleration happen in relation to contractions?

What shift will occur on the strip?

A

Onset of deceleration in lates will happen after the contraction begins & it will only recover after the contraction ends.

The strip of the HR will be shifted to the right of the contractions

59
Q

What is the state of the baby then if you’re having late decelerations? Why?

A

The baby is stressed but this is only specific to late decelerations.

Impaired perfusion to placenta, stimulates receptors to cause a parasympathetic response which lowers HR

60
Q

Causes of Late decelerations

A

hypotension in mom

hypertension or diabetes in mom

Uterine tachysystole

Placenta issue such as rupture or previa

Old placenta bc fetus is past term

61
Q

Interventions for Late decelerations

A

Stop oxytocin : If late decels are occuring & you see oxytocin on their MAR

Change maternal position - extreme side lying.

Treat hypotension with IV fluids or elevate legs

Palpate uterus for tachysytole

Administer O2 in non-rebreather mask

Alert doc

Give pt and family explanation

Assess cervical status

Consider internal monitoring

Prepare for C section if nothing else works or do a crash rescue

62
Q

Prolonged Deceleration time range

A

Last more than 2 min but less than 10 min

63
Q

Prolonged Deceleration causes (6)

A 
Cord compression
Fetal vagal stimulation
maternal hypoxia
maternal hypotension
occult cord prolapse 
uterine hyperactivity
64
Q

Variable Deceleration

Can these occur with contractions?

What shape on strip?

A

Not the same as variability

Abrupt and quick decel in HR. Very noticeable and drops more than 15 bpm.

Can happen during, before, or after contractions

Shape is U, W,V

65
Q

Main cause for variable deceleration?

A

Cord is compressed

Could be around neck, shoulder, just compressed. Maybe they grab a hold of it.

66
Q

Why is a recurrent variable deceleration a concern?

A

It means there are many moments when the baby can’t get oxygen

67
Q

Order of interventions for variable decelerations?

A

Change moms position to get baby off the cord.
Get a o2 mask going
Fluid bolus
tell physician

68
Q

A more invasive procedure to help with variable decels if ruptured?

A

Amnioinfusion- just place a tube up uterine cavity to get more fluid into sac if ruptured This way more fluid surrounds the cord and keeps it safer from compression through pressure

69
Q

What if there is no improvement with variable decelerations?

A

Must do a c-section

70
Q

Concerning tracings

A

abnormal FHR

Late decelerations

Variable decelerations

Absence of variability

prolonged decels

lack of accels

bradycardia
t
tachycardia

71
Q

Methods to stimulate the fetus

A

Stimulate fetal scalp

Use sound

Use light hologen

72
Q

How to go about interpreting a strip in the right steps

A

Determine baseline

Determine variability

Accels

Any period or episodic changes

Any decels and what kind?

73
Q

Category 1 strip

A

A category of strip for a totally normal fetus

normal baseline
moderate varaibility
can have accels & no fariable or late decels
early decels could be there
no intervention
74
Q

Category 2 strip

A 
baseline is brady or tachy
variability isn't a moderate
no accels after stimulation
decels are variable or late
and could be prolonged

So some slight abnormalities

75
Q

Category 3 strip

A 
Absent variability
no accelerations with stimulation
recurrent decels
brady
sinusoidal pattern

Need to do intervention immediately!
Resuscitate fetus

Can only do a C section if at this point

76
Q

Uterine contractions are normal if

A

less than 5 contractions in in 10 minutes

77
Q

Tachysytole contraction defintion

Why are these bad?

A

More than 5 contractions in 10 minutes & this is stressful to the baby bc they can’t relax and get oxygen

Fetus holds breath during contraction

78
Q

What is the nurses responsibility?

A

Document and report findings

79
Q

Cord Blood Analysis

ph range

trend

A

Check pH of blood

7.25-7.40

arteries have used deoxygenated
veins are oxygenated
So flipped ABGS

80
Q

VEAL CHOP

A

variable decels Cord compression
early decelerations head compression
accelerations OK
late decels placenta issue

Maternal Exam 1 (9 decks)

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