NUR 102 Exam 1 Fetal Monitoring Flashcards
When do you perform Fetal monitoring?
During Pregnancy
During Labor
Fetal monitoring during pregnancy involves what three things?
- Non-stress test
- Stress test
- BPP (Biophysical profile) (non stress test and ultrasound study)
Biophysical profile (non stress test and ultrasound study for) what 4 things?
- Fetal breathing
- Fetal movement
- Fetal tone
- Amniotic fluid volume
In BPP..if the scoring drops what does this mean?
The baby is headed for trouble!!!
To determine the well being of the fetus what do we do?
The decisions for care is based on what?
Fetal monitoring
Fetal heart tracing
What are the 3 fetal heart tracings?
- Reassuring- (this is good..we are happy with this)
- Non-reassuring (we watch this closely)
- Omnious (DELIVER THE BABY ASAP!!!)
As a nursing student..can I touch the strip?
NOOOO!!!!!!!!!! DON’T EVER TOUCH THE STRIP!!
If pt has an “internal fetal monitoring” is a transducer helpful also?
NO, you DON’T NEED a TRansducer if you have an internal fetal monitoring.
What is on the top and bottom of the Fetal Heart Monitor Tracing?
On the top - Fetal heart tracing
On the bottom- Uterine Contractions
If we need to monitor with out a baseline can we?
NO… WE ALWAYS NEED A BASELINE 1ST!!!
If the fetal heart line is going straight..is that okay?
No..not mostly..although it may be the baby is sleeping..but if the beats are absent..give the mom’s belly a little nudge or (even some juice if not contraindicated..per my sister) to wake the baby up!
On fetal heart monitor tracing…each dark line is what?
A minute
On the fetal heart monitoring tracing The unbolded lines are what?
10 beats a minute!
What device is used to rupture the membranes ( break the bag of waters)?
Amnihook
How is a contraction timed?
From the beginning of 1 contraction to the beginning of the next contraction.
Does timing the contraction include the mountain and the rest period?
YES IT DOES! Count each dark line, the lump of contraction (mountain) and the rest period is your frequency
When we are assessing the baseline of FHR, do we ignore the episodic changes?
YES! The baseline..is the mean FHR over a 10 minute segment EXCLUDING the episodic(significant changes)
The beat to beat changes in the baseline FHR are called what?
Variability
It is irregular in amplitude and frequency
What is the most important predictor of adequate fetal oxygenation during labor?
Baseline VARIABILITY
What are the 4 characteristics of Variabilty?
Absent- undetectable -Omnious
Minimal -5 beats per min of fewer
Moderate (normal) 6-25 beats per min
Marked -More than 25 beats per min
What is the average FHR for early gestation?
140-160
What is the average for baby’s FHR once born?
120-160
Does FHR Increase or decrease with age?
The older it is..the FHR decreases!!
The older we get the lower our HR gets..that’s why an adults range is 60-100 bpm!
Minimal variability is what?
5 beats per min or fewer
Moderate variability is what?
6-25 beats per min?
This is normal..WE like moderate!!
Marked variability is what?
More than 25 beats per min
If the FHR of newborn is 110..what does this mean?
He’s probably sleeping
NOTE!! You can eyeball to see the trend on the FHR Monitor
NOTE!!
A visually apparent, abrupt increase in fetal heart rate of 15 or more beats per min above baseline is what?
Accelerations
Are accelerations good or bad?
Accelerations are a good thing, the baby is responding to whatever the baby is doing..NOT what the mom is doing!!!
But if it goes up too high, i.e 220 something is wrong, i’e if baby or mom is septic it may stay high & it won’t be alot of variability.
Are there accelerations due to what the mom is doing?
No..Accelerations are only to what the baby is doing!
Decrease in FHR is called a what?
Decelerations
What is the lowest FHR in a deceleration called?
NADIR
What 3 ways are FHR decelerations classified?
Early
Late
Variable
* A Prolonged Deceleration is Omnious*
“We had a de-cel to the 20’s with no recovery”
NOTES!!
Onset, nadir and recovery coincide with the beginning, peak and ending of the contraction.
It’s caused by head compression is called what?
Early decelerations
Nadir occurs after the peak of the contraction & the deceleration is caused by uteroplacental insufficiency is called what?
Late Decelerations
“U” or “W” shaped and vary with successive contractions & caused by umbilical cord compression is called what?
Variable Decelerations
What are the deceleration Nursing Interventions for Early Decelerations? (head compression)
May NOT require intervention
What are the Nursing interventions for Late Decelerations? (uteroplacental insufficiency)
Turn to LEFT SIDE & Administer oxygen!
Discontinue oxytocin per Chapman
What are the Nursing interventions for Variable Decelerations? ( cord compression)
Turn patient to lateral position!
Decrease or discontinue oxytocin per Chapman
Visually apparent decrease from baseline that is more than 15 bpm, lasting equal or more than 2 min, but less than 10 minutes is what?
Prolonged Deceleration
What are the nursing interventions for Prolonged Decelerations?
- Assess for prolapsed cord
- Change maternal position as needed to alleviate decelerations
- Anticipate immediate intervention for a deceleration lasting more than 3 minutes!
What has an absence of variability
Smooth, wave like undulating shape
Caused by severe fetal hypoxia, anemia
Pseudosinusoidal: which is caused by medications i.e demerol?
Sinusoidal pattern
Greater than 5 contractions per 10 minutes is called what?
Uterine Hyperstimulation….
note that hyperstimulation may also produce contractions that are sustained!
When timing contractions..The beginning to the end of the same contraction is called the what?
Duration
When timing contractions….the beginning of one whole contraction to the beginning of the NEXT contraction is called the what?
Frequency
In order to do Internal Fetal Monitoring..how should the membranes be?
The Membranes must be ruptured
Spiral electrode into fetal scalp
Uterine Pressure Catheter into amniotic sac to measure intensity of contractions and for amnioinfusions is all for what?
Internal Fetal Monitoring
& remember Membranes MUST be RUPTURED!!
