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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
What does a strip look like? Bold lines squares
Upper bar is HR Lower bar is fetal activity and contractions mmHg bold lines indicate 1 minute squares are 10 seconds
26
How to find mean of HR strip?
So look at highest moments and lowest moments and divide by two
27
Are fluctuations bad when looking at the strip?
No not usually. Some fluctuation is a variability and is good.
28
Uterus at rest means
in between contractions
29
Bradycradia in fhr Tachycardia in fhr What if change is less than 10 min?
FHR lower than 110 for 10 minutes FHR higher than 160 for 10 min Just a baseline fetal hr change
30
Causes of bradycardia part 1
abruptio placenta congenital heart block Fetal arrhythmia Late fetal hypoxia
31
Causes of bradycardia part 2
Maternal Hypotension Maternal hypothermia Prolonged umbilical cord compression that reduces vagal stimulation
32
causes of bradycardia part 3
Uterine hyperstimulation uterine rupture vagal stimulation during pushing of labor
33
Tachycardia causes part 1
Amnionitis or inflammation of amnion Beta sympathatic drugs that stimulte HR Early fetal hypoxia (HR compensates)
34
Tachycardia causes part 2
Fetal anemia Fetal dysrhythmias
35
Tachycardia causes part 3
Maternal dehydration Maternal fever Maternal hyperthyroidism
36
Variability Which creates
Measures the sympathetic and parasympathetic NS causing HR to rise and fall Creates fluctuations in baseline FHR that are irregular
37
sympathetic ns
raises hr
38
parasympathetic ns
drops hr
39
How are variability fluctuations evaluated Does this include acceleration and deceleration
Peak to trough Excludes them (meaning it is period between contractions when nothing is going on... I think)
40
Variability classifications and ranges
absent or none minimal or small so less than 5 moderate or normal which is 6-25 marked or greater than 25 bpm
41
If a strip goes from 120 to 150 then that is what type of varaibility
Marked or it should be... idk need to doube check
42
Causes of decreased variability | Reminder: This isn't necessarily a bad sign - just that their activity is less.
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
Causes of marked or extremely noticeable varaibility
early mild hypoxia to compensate for something Fetal stimulation of autonomic ns
44
What are accelerations of FHR? Are they bad? How long does it last
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
Pre-term baby under 32 weeks acceleration rule Rule for baby over 32 weeks
Rule of tens for pre-term under 32 weeks Rule of 15
46
What if you don't see any accelerations?
Try to stimulate them move them in uterus drink something cold Probably just be sleeping.
47
How do we count accels on graph?
Check the squares. If it is less than 15 for older babies it is just movement. (or 10 if premie)
48
Can an accel happen during contractoin?
Yep and before & after. No specific time.
49
What is a Deceleration?
Abrupt slowing of FHR
50
Types of decelerations Extra type?
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
Early Decelerations How are these rt contractions?
Slowing on strip and you can also hear the HR slow if listening When the contraction is building, the HR is slow.
52
Nadir meaning
low point of HR
53
Number one cause for early decelerations? How?
Head compression | Causes vagel stem response to slow HR
54
When should you expect early deceleration?
Early stages of progressing labor as head comes down birth canal
55
Should you have to do interventions for early deceleration?
Nothing really. Just document.
56
Will the strip showing the deceleration coincide with anything on the graph?
Yes - the contractions. And then hr will raise when contraction is over. A fragile picture.Onset & offset will be parallel
57
Late decelerations cause? What may mom's hx look like?
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
When will a late deceleration happen in relation to contractions? What shift will occur on the strip?
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
What is the state of the baby then if you're having late decelerations? Why?
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
Causes of Late decelerations
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
Interventions for Late decelerations
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
Prolonged Deceleration time range
Last more than 2 min but less than 10 min
63
Prolonged Deceleration causes (6)
``` Cord compression Fetal vagal stimulation maternal hypoxia maternal hypotension occult cord prolapse uterine hyperactivity ```
64
Variable Deceleration Can these occur with contractions? What shape on strip?
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
Main cause for variable deceleration?
Cord is compressed Could be around neck, shoulder, just compressed. Maybe they grab a hold of it.
66
Why is a recurrent variable deceleration a concern?
It means there are many moments when the baby can't get oxygen
67
Order of interventions for variable decelerations?
Change moms position to get baby off the cord. Get a o2 mask going Fluid bolus tell physician
68
A more invasive procedure to help with variable decels if ruptured?
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
What if there is no improvement with variable decelerations?
Must do a c-section
70
Concerning tracings
abnormal FHR Late decelerations Variable decelerations Absence of variability prolonged decels lack of accels bradycardia t tachycardia
71
Methods to stimulate the fetus
Stimulate fetal scalp Use sound Use light hologen
72
How to go about interpreting a strip in the right steps
Determine baseline Determine variability Accels Any period or episodic changes Any decels and what kind?
73
Category 1 strip
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
Category 2 strip
``` 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
Category 3 strip
``` 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
Uterine contractions are normal if
less than 5 contractions in in 10 minutes
77
Tachysytole contraction defintion Why are these bad?
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
What is the nurses responsibility?
Document and report findings
79
Cord Blood Analysis ph range trend
Check pH of blood 7.25-7.40 arteries have used deoxygenated veins are oxygenated So flipped ABGS
80
VEAL CHOP
variable decels Cord compression early decelerations head compression accelerations OK late decels placenta issue

Maternal Exam 1 (9 decks)

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