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Maternal-Newborn (Josh) > T2 - Fetal Assessment EFM (Josh) > Flashcards

T2 - Fetal Assessment EFM (Josh) Flashcards

1
Q

What are the types of Fetal Heart Monitoring?

A

Auscultation/Intermittent Auscultation

External Fetal Monitoring

Internal Fetal Monitoring

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2
Q

What are the advantages of Auscultation in regards to FHM?

A

Non-invasive

Fetoscope detects actual heat sound (so dysrhythmias can be heard)

No straps to hold mother down

No ‘machine error’

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3
Q

What are the disadvantages of Ausculation in regards to FHM?

A

Requires skill / practice

Disrupted by contractions

Unable to review/archive info

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4
Q

What can be done to stimulate birth?

A

nipple stimulation to cause oxytocin to increase

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5
Q

What is a Biophysical Profile?

A

Real-time ultrasound that permits detailed assessment of the physical and physiologic characteristics of the developing fetus

***scored on a basis of 10 points

***normal finding = 2

***abnormal finding = 0

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6
Q

Biophysical Profile Scoring:

What are the five variables that are scored?

A

Breathing movements

Gross Body Mvmt

Muscle Tone

Amniotic Fluid Index (vol.)

Fetal HR via Nonstress Test (NST)

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7
Q

Biophysical Profile:

What is the normal and abnormal findings for FHR via Nonstress Test?

A

Normal (Reactive) = 2

Abnormal (Nonreactive) = 0

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8
Q

Biophysical Profile:

What is the normal and abnormal findings for FETAL BREATHING MOVEMENTS?

A

at least 1 episode > than 30 sec duration in 30 min = 2

absent or less than 30 sec duration = 0

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9
Q

Biophysical Profile:

What is the normal and abnormal findings for GROSS BODY MOVEMENTS?

A

at least 3 body/limb extensions w/ return to flexion in 30 min = 2

less than 3 episodes = 0

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10
Q

Biophysical Profile:

What is the normal and abnormal findings for FETAL TONE?

A

at least 1 episode of extension w/ return to flexion = 2

slow extension and flexion, lack of flexion, or absent movement = 0

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11
Q

Biophysical Profile:

What is the normal and abnormal findings for QUALITATIVE AMNIOTIC FLUID VOL?

A

at least 1 pocket of fluid that measures at least 2 cm in 2 perpendicular planes = 2

pockets absent or less than 2 cm = 0

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12
Q

Biophysical Profile:

Interpretation of scores

A

8-10 = normal (low risk of chronic fetal asphyxia)

4-6 = abnormal (suspect chronic fetal asphyxia)

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13
Q

Types of External Monitoring Devices

A

U/S (Ultrasound Transducer) for Fetal Monitoring

TOCO (Tocotransducer) for Maternal Monitoring

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14
Q

Types of Internal Monitoring Devices

A

ISE (Internal Scalp Electrode) for Fetal Monitoring

IUPC (Intrauterine Pressure Catheter) for Maternal Monitoring

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15
Q

Monitoring Strip:

Top strip =
Bottom strip =
Each vertical dark red line =
Each lighter vertical line =

A

Top strip = FHR

Bottom strip = Uterine Activity

Each vertical dark red line = 1 min

Each lighter vertical line = 10 sec

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16
Q

What is the Resting Tone?

A

palpation of uterus when no contraction is taking place

***important b/c it allows fetus to recover and have O2 exchange occur

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17
Q

How is Resting Tone documented?

A

Mild = touch nose

Moderate = touch chin

Strong = touch forehead

18
Q

What is a MVU?

A

Montevideo Units
- measure indicating intensity of uterine contractions in mmHg

***only when using IUPC

19
Q

How do you determine MVU?

A

Contraction intensity - Resting Tone * number of contractions in 10 mins

20
Q

What is another term for the Top of the Contraction?

A

Acme (Peak)

21
Q

How long do we measure FHR?

A

2 clear minutes and rounded to 5 BPM

***uterus must be at rest

***must last greater than 10 mins

22
Q

When would FHR by tachycardic?

Bradycardic?

A

> 160 BPM for longer than 10 mins

23
Q

What is FHR Variability?

A

EXPECTED irregular fluctuations of the baseline that are an indicator of fetal well being

24
Q

Measuring FHR Variability

A

Absent = 0 beats or undetectable

Minimal = 0 to 5 BPM

Moderate = 6-25 BPM

Marked = > 25 BPM

25
Q

— changes happen WITH UC

— changes happen WITHOUT UC

A

Periodic

Non-periodic (Episodic)

26
Q

What is an Acceleration?

A

an abrupt, temporary increase in FHR taht peaks at least 15 BPM above the baseline and lasts at least 15 secs

***for fetus 33 wks or greater

***if 32 wks, it should be 10 BPM for 10 secs

27
Q

What is Prolonged Acceleration?

A

when accelerations lasts longer than 2 mins and less than 10

*** if longer than 10 mins, the baseline has changed

28
Q

Accelerations:

For 33 weeks and more, what do we want to see?

For 32 weeks, what do we want to see?

A

15 bpm x 15 secs

10 bpm x 10 secs

29
Q

How many accels do we want to see in a 10 minutes strip?

A

at least 2

30
Q

How many types of Declerations are there?

A

Three

  • Early
  • Variable
  • Late (worst b/c there is not enough profusion to baby)
31
Q

What does an EARLY Decel look like?

A

mirror image of a contraction

  • gradual descent from baseline and returns to baseline by end of contraction
32
Q

What are possible causes of Early Decels?

A

head compression on vagal nerve slowing FHR during UC

***not bad and doesn’t require intervention

***periodic

33
Q

What does a VARIABLE Decel look like?

A

abrupt rise and fall from baseline (looks like a V or W)

  • must be 15 x 15 and less than 2 mins
34
Q

What are possible causes of Variable Decels?

A

Cord Compression

Short Cord

Knot in Cord

Prolapsed Cord (Emergency)

***can be periodic or nonperiodic

35
Q

Nursing Interventions for Variable Decels?

A

change Maternal position

Increase fluid intake

Put on O2

36
Q

What is a LATE Decel?

A

FHR decreases at peak of UC and returns to baseline AFTER UC has ended

***must be periodic

37
Q

What causes Late Decels?

A

impairment of placental/oxygen exchange

  • Maternal Hypo/Hypertension
  • Diabetes
  • Decrease in fetal O2 reserves
  • Maternal supine position
  • Epidural anesthesia
  • Placenta previa/abruption
38
Q

Nursing Internventions for Late Decels?

A

Change maternal position

Increase IV fluids

Administer O2

Call MD

Call delivery team if doesn’t change (prepare for C-section)

39
Q

What are the BIG 5 Internvetions?

A

1) Turn/Reposition mom
2) O2 at 8-10 L/min (facemask)
3) IV fluids of bolus
4) Stop Oxytocin
5) Call MD

40
Q

Which maternal position should always be avoided?

A

supine

**always use a wedge

41
Q

Word associations for Decels:

E
V
L

A

Early starts with E= Starts Early and ends when UC Ends = Ear = Ear = part of head = Head Compression

Variable starts with V = V or W in shape = Can happen anywhere = V like vise. Vise cuts off O2 supplies via Cord Compression

Late = Happens at the peak of UC and does not return until Later, Long after the UC has ended. Starts with L = UteroPLacental insufficiency.

Maternal-Newborn (Josh) (29 decks)

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