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Module 6 > Unit 1- Electronic Fetal Monitoring > Flashcards

Unit 1- Electronic Fetal Monitoring Flashcards

1
Q

What are the guidelines for intermittent auscultation?

REVIEW

A
  1. Assess for active labor
  2. Immediately after rupture of membranes
  3. Preceding and following ambulation
  4. Prior to and following pain medications and/or anesthesia
  5. Following-vaginal exam, enema, catheterization
  6. Events of abnormal or excessive uterine contractions
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2
Q

What are nursing considerations for intermittent auscultation & uterine palpation?

ASK

A
  1. Auscultate FHR for 30-60 seconds between contractions
    • determine baseline: find out how baby is responding to moms contractions
  2. Auscultate, before, during and after a contraction
    • determine FHR response to the contractions
  3. Identify any FHR patter
    • Placement of electronic fetal monitor for assessment
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3
Q

FHM application and nursing interventions for FHM include?

REVIEW

A
  1. Provide education regarding continous EFM
  2. Patient comfort- empty bladder, position of comfort, left lateral to avoid vena cava compression
  3. Perform leopold’s- identify uterine activity- place toco on fundus
  4. Encourage frequent maternal position changes
    • External FHM- ambulate for voiding
    • Internal FHM- Bedpan
  5. Monitor vital signs- temp q 2hours after ruptured membranes
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4
Q

Leopold’s position helps identify uterine activity by….

ASK

A

Finding point of maximum impulse

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5
Q

True or false: With external FHM we can have mom walk as tolerated and place monitor back on for 20-30 mins increments.

A

True

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6
Q

After water breaks we should deliever the baby within…..

ASK

A

24 hours to reduce chance of infection

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7
Q

What are maternal indications for continous fetal monitoring?

ASK

A
  1. Gestation diabetes
  2. HTN
  3. Kidney disease
  4. Placenta abruption
  5. Placenta previa
  6. Induction/augmentation
    • Cervical ripening or oxytocin
  7. Abnormal FHM testing
    • Non stress or CST
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8
Q

What are fetal indication for continous fetal monitoring?

ASK

A
  1. Multiple gestations
  2. Post- date gestation
  3. IUGR
  4. Meconium-stained fluid
  5. Fetal bradycardia
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9
Q

What is internal fetal monitoring?

ASK

A
  1. Fetal scalp electrodes (FSE) attaches to presenting part
    • Requires ruptured membranes with cervical dilation of 2-3 cm
  2. Intrauterine pressure catheter (IUPC)
    • Measures uterine pressure in MMHG
    • membranes must be ruptures
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10
Q

What are the benfefits of intermittent auscultation & palpation?

ASK

A
  1. Noninvasive
  2. Promotes “natural atomosphere
  3. Comfortable, and allows for ambulation
  4. Outcomes comparable- EFM in low-risk
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11
Q

What are limitations to intermittent auscultation & palpation?

ASK

A
  1. Difficult- if obese, unable to tolerate touch
  2. No permenant record of FHR or UA
  3. Unable to determine UA intensity
  4. Patterns not identified such as fetal hypoxemia
  5. Not recommended for high-risk
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12
Q

What are benefits of external fetal monitoring?

ASK

A
  1. Easy to apply
  2. Noninvasive- decreases the risk for infection
  3. ROM, Cervical dilation not required
  4. No known risk to women or fetus
  5. Permanent record of the FHR & UA
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13
Q

What are the limitations of external fetal monitoring?

ASK

A
  1. Maternal movement requires repositioning
  2. Contraction intensity is not measured
  3. Double FHR <60 BPM & Half FH> 180bpm
  4. Maternal HR may be recorded
  5. Maternal obesity, fetal size position or multiples
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14
Q

What are benefits to internal fetal monitoring?

ASK

A
  1. FHR tracing- not affected by movement, obesity or fetal position
  2. Displays FHR between 30-240bpm
  3. Identify fetal cardiac arrhythmias
  4. Accurate measurement- uterine activity
  5. allows for use of amnioinfusion
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15
Q

What are some limitations to internal fetal monitoring?

ASK

A
  1. ROM, cervical dilation required- increased risk of infection
  2. Risk of injury if imporperly placed
  3. Record maternal HR if fetal demise
  4. Excessive fetal hair can interfere
  5. IUPC reading vary based on IUPC types
  6. Inaccurate reading w/position changes
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16
Q

Each square on the x axis of an electronic fetal monitor is ____ seconds?

ASK

A

10

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17
Q

Each square on the y axis on a fetal heart monitor is ___ bpm?

ASK

A

10 BPM

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18
Q

What is another name for the beginning/peak of a contraction?

ASK

A

acme

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19
Q

What is duration during our uterine activity assessment?

ASK

A

Length of contraction from begining to end

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20
Q

What is does frequency mean in our uterine activity assessment?

ASK

A

The time between the beginning of one contraction to the beginning of the next

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21
Q

What is relaxation time mean during our uterine activity assessment?

ASK

A

End of the contraction to the beginning of the next
- > or equal to 60 seconds of relaxation to allow for uterine blood flow is ideal

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22
Q

What does resting tone mean?

ASK

A

Uterine tone at rest– obersved during our uterine activity assessment

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23
Q

Intensity of utierine activity refers to the…

ASK

A

strength of contraction at its peak

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24
Q

When should you palpate to determine intensity of contraction?

ASK

A
  1. During peak (acme) of contraction
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25
Q

How do we document intensity of uterine contraction?

ASK

A
  1. Mild or 1+ (easily dented)- nose
  2. Moderate or 2+ ( can slightly indent)- chin
  3. Strong or 3+ (cannot indent utures) - Forehead
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26
Q

How is IUPC measured?

ASK

A

Contraction strength measured in mmHg after membranes rupture
1. Mild contraction
2. Strong

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27
Q

What is considered normal uterine activity?

ASK

A

Normal- 5 or fewer contractions in 10 mins averaged over 30 mins
1. Last 45-90 seconds
2. Intenisty- 25-80 mmhg
3. Resting tone 10mm hg

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28
Q

What is considered abnormal uterine activity?

ASK

A
  1. Tachysystole- >5 contractions in 10 mins, averaged over 30 mins
  2. Hypertonic uterine activity-resting tone >20-25 mmhg
    • Abnormal uterine activity- spontanous or stimulated labor
    • Contributes- decreased uteroplacental blood flow: hyppoxemia, hypoxia, metabolic acidosis, metabolic academia
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29
Q
A
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30
Q

What is a baseline fetal heart rate?

ASK

A

110-160bpm

When using a FHM- must have at least 2 mins. of identifiable baseline segments that exclude accelerations, decelerations and marked variability

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31
Q

What is the most important indicator of fetal central nervous system health?

ASK

A

FHR

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32
Q

True or false: Moderate variablity means good CNS health?

ASK

A

True

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33
Q

What are periodic FHR patterns?

ASK

A

FHR changes in relation to the uterine contractions
1. Accelerations
2. Early decelerations
3. Variable decelerations
4. Prolonged decelerations

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34
Q

What are episodic FHR patterns?

ASK

A

FHR changes unrelated to uterine contractions
1. Accelerations
2. Variable decelerations
3. Prolonged decelerations

35
Q

What are FHR accerelations?

ASK

A

Increase in FHR of in the baseline
1. Term- 15bpm above the 15 seconds
2. Preterm (<32wks.)- 10bpm above baseline for 10 seconds

36
Q

For a NST how many accelerations in a 20 mins period must a baby have to have a reactive result?

ASK

A

2

37
Q

For a NST how many accelerations must they have in a 40 mins period to be considered non-reactive?

ASK

A

No accelerations in 40 mins- follow up w/ CST

38
Q

What causes a FHR acceleration?

ASK

A

Caused by sympathetic fetal response that can occur with fetal movement, contractions, vaginal exams or breech presentations. They are reassuring signs and indicates a healthy fetus.

39
Q

What are our nursing interventions for FHR accelerations?

ASK

A

No nursing interventions required

40
Q

What are early declerations?

ASK

A

FHR slowly decelerates as the contraction begins and returns to baseline as the contraction ends

Uniform in shape and mirrors the uterine contraction

41
Q

What causes a early deceleration?

ASK

A

Benign parasympathetic response to fetal head compression

not associated with fetal compromise

42
Q

What are our nursing interventions for a early deceleration?

ASK

A

No nursing intervention required- consider a vaginal exam to monitor labor progress

Typically about 5-6cm dilated at this point… usually a sign from baby that they are on their way

43
Q

What is NDAIR as far as contractions go?

ASK

A

Lowerst point of the contraction

44
Q

What is baseline variability?

ASK

A
  1. Baseline characteristic
  2. Normal irregulatrity of cardia rhythem
  3. Fluctuations (rise & fall) in baseline
  4. Excludes accelerations & decelerations
45
Q

Baseline variablity is a predictor of…

ASK

A

Fetal oxygenation & reserve

46
Q

What are the four categories of baseline variablity?

ASJ

A
  1. Absent- 0-1bpm- considreded non-reassuring
  2. minimal- <5bpm- consider possible fetal sleep cycle
  3. Moderate - Considred reassuring- 6-25bpm
  4. Marked- dependant on diff. factors- >25bpm
47
Q

Absent or minimal- variabilty is a ____ sign

ASK

A

Non-reassuring warning sign

48
Q

What causes absent or minimal variability? (fetal & Maternal)

ASK

A

Fetal
1. Fetal sleep cycle– normally last less than 30 mins
- ** #1 cause of decreased variability**
2. Hypoxia, hypoxemia, acidosis
- persistent decreased variability >60 mins despite intervention
- Prematurity, fetal anemia, preexisting neurological injuries

Maternal
1. Medications- narcotics, CNS depressents, Magnisium sulfate
2. General anesthesia

49
Q

What is considered bradycardia for FHR?

ASK

A

<110bpm for 10 mins

50
Q

> 90 bpm with variability is…

ask

A

benign-if tolerated by fetus

51
Q

<80 bpm is a….

ask

A

obsterical emergency

52
Q

What maternal/fetal reasons can cause bradycardia?

ASK

A
  1. Maternal hypotention (supine position is a NO)
  2. Medication induced- narcotics, mag. sulfate, anesthesia
  3. Late manifestation of fetal hypoxia- prolonged cord compression
  4. Fetal heart block
53
Q

True or false: Post-term babies may have a slightly lower HR than a term baby?

ASK

A

True

54
Q

Tachycardia is considred what on a FHR?

ASK

A
  1. > 160 bpm for 10 mins
  2. Persist 200-220 bpm- fetal demise may occur
55
Q

What are fetal/maternal causes of tachycardia on a FHR?

ASK

A

Fetal
1. Early sign of fetal hypoxia
2. Fetal anemia

Maternal
1. Dehydration
2. Maternal fever, infection-chorioamnionitis
3. Maternal hyperthyroid disease
4. Medication-induced (atropine, terbutaline, hydroxine, illicit drugs, cocaine, meth)

56
Q

What are the five factors (maternal and fetal) for adequate fetal oxygenation?

ASJ

A

Maternal
1. Normal maternal o2 saturation
2. Adequate exchange of o2 and co2
3. Sufficient blood flow to the placenta

Fetal
1. Placental circulation to the fetus throught the umbilical cord
2. Normal fetal ciculatory & oxygen- carrying functions

57
Q

What is the fetuses response to stress?

ASK

A
  1. Prolonged hypoxemia depletes reserve
  2. Decompensation
  3. Aerobic to anaerobic metabolism
  4. Accumulation of lactic acid
  5. Metabolic acidemia
  6. Leads to cellular death
58
Q

What is the fetal response to interruption in oxygen pathways?

A

FHR accelerations
Variable decelerations
Late declerations

59
Q

What are 3 questions you should ask in terms of fetal response to interruption in oxygen pathway?

REview

A
  1. What do we call the pattern
  2. What does it mean
  3. What do we do about it
60
Q

What are our nursing interventions to fetal responses to interruption in oxygen pathway?

ASK

A

Nursing intervention is based on cause
1. Assess fetal response to scalp stimulation
2. Consider internal fetal monitoring
3. Place patient in left lateral position
4. Consider intrauterine resuscitation (IUR)

61
Q

What are variable decelerations?

ASK

A

Abrupt decrease in FHR- varied in shape, duration, depth and timing in relation to the contraction

Most common FHR pattern

62
Q

Non-reassuring (ominous) signs of variable decelerations include?

ASK

A

Severe variable decelerations- FHR below 70bpm lasting greater to or equal than 30-60 seconds

  1. slow return to baseline
  2. Decreasing or absent variablility
  3. Intrauterine resuscitation nursing intervention required
63
Q

What causes variable decelerations?

ASK

A
  1. Umbilical cord compression
  2. Prolapsed cord
  3. Nuchal cord
  4. Short cord
  5. Sudden rapid descent of the fetus
64
Q

What are late decelerations?

ASK

A

Gradual decrease in FHR baseline that begins after the contraction & return & returns after the contraction is over

65
Q

Late decelerations depth ____ inidicate severity, rarely falls below 100bpm?

ASK

A

Does not

66
Q

What are ominous and potientally disastours non-reassuring signs of late decelerations?

ASK

A
  1. Associated with decreased or absent variability and tachycardia
  2. Indicates uteroplacental insuffciency-postdates, preeclampsia, diabetes, cardiac disease, placental abruption
67
Q

What nursing interventions are required for late decelerations?

ASK

A
  1. Intrauterine resuscitation nursing intervention required
68
Q

CST is postive if late decelerations occur or do not occur?

ASK

A

Occur

69
Q

CST is considred negative when there are ____ late declerations?

ASK

A

No

70
Q

What causes late decelerations?

ASK

A
  1. uteroplacental insufficency
  2. Maternal
    • Hypotension
    • placenta abruption
    • preeclampsia/hypertensin
    • diabetes
    • placenta changes- abnormalities/post date
    • uterine hyperstimulation or tachysystole
71
Q

What is prolonged decelerations?

ASK

A

decrease in FHR below baseline lasting longer 2 mins or long but less than 10 mins
May be abrupt or gradual which can could be caused by interruption of uteroplacental perfusion or umbilical blood flow
Intrauterine resuscitation nursing intervention is required

72
Q

What is intrauterine resuscitation (IUR)?

ASK

A
  1. Turn patient-maternal reposition-lest lateral 1st
  2. Stop oxytocin- reduce uterine activity
  3. Turn IV fluid up- Iv fluid bolus 500ml NS or RL
  4. Turn O2 on- apply oxygen 10L/min. non-rebreather mask
  5. Notify provider for immediate evaluation- you are responsible until notified

Additional considerations
1. Admin tocolytics (terbutaline)
2. Performing amnioinfusion-variable decelerations
3. Modifying second state pushing effors (every other contraction)

73
Q

VEAL CHOP MINE…explain

ASK

A
  1. Variable-Cord Compression-Move the patient
  2. Early- Head compression- Intervention not nec.
  3. Acceleration- OK- NOthing
  4. Late- Placenta insufficiency- Emergency delivery
74
Q

A category 1 FHR interpretation system means…

REVIEW/ASK

A

Category 1-normal
1. Predictive of normal fetal acid-base balance
2. FHR tracings Must have
- Moderate variability
- Baseline rate of 110-160bpm
3. FHR tracings may include the following
- Accelerations present or absent
- early decelerations present or absent
- Late or variable decelerations MUST be absent
4. No action is required- observe

75
Q

A category III FHR interpretation system meams

ASk?review

A

Category III-abnormal
1. Predictive of abnormal fetal acid-base status
2. FHR tracings MUST have
- Absent variablity & any of the following
- Recurrent late decelerations
- Recurrent variable decelerations
- Bradycardia
- Sinusodial pattern

3.Initiate intrauterine resuscitation based on clinical situation
4.Category III patterns warrnet immediate provide evaluation & delivery

76
Q

Category II FHR interpreatation system means?

ASK/REview

A

Category II- intermediate
1. fetal acid-base status is unknown
2. Tracings not categorized as cat 1 or 3
3. Requires continued intervention, evaluation and reevaluation

77
Q

What are our nursing interventions for abnormal FHR patterns?

asl

A
  1. assess maternal vital signs
    • confirm fetal heart rate vs. maternal heart rate
    • Rule out maternal fever
    • r/o maternal hypotension
  2. Assess maternal hydration status
  3. Assess abonormal uterine activity
  4. Assess for maternal anxiety and/or pain– can give small amount of pain medicaiton to relax
  5. Perform vaginal exam to r/o prolapsed cord
  6. Consider IUR
78
Q

Accprdomg tp AWHONN FHR & uterine contraction assessments should be done when for high risk/low risk patients

ASK

A
  1. Latent phase of labor (0-3cm)- 30mins-60mins
  2. Active phase of labor (4-7cm)- 15-30mins
  3. Second stage of labor (10cm and/or pushing) 5-1mins
79
Q

What is the minimum systematic assessment that should be done during labor?

Review

A
  1. Admission evaluation of the women and fetus
  2. Maternal-fetal assessments of FHR & UA using standarded defininations
    • Baseline, variablity
    • Presence or absence of accelerations, decelerations including type
    • UA, frequency, duration, intensity and resting tone
  3. Corrective measures implemented and evaluations of responses
  4. Communication w/pt and support system
  5. Communication w/provider w/response and actions taken
80
Q

What are the ABCD managment of FHR tracings?

ASK

A

A- assess the oxygen pathway-consider cause of FHR change
B- Begin conservative corrective measures
C- Clear obsticles to rapid delivery
D- delivery plan

81
Q

Special monitoring cicumstancess for preterm include

ASK

A
  1. Physiological repsonse depends on fetal developmental stage
  2. Tolerance of stress may be different
  3. More likely to be subject to hypoxia

Characteristics include
1. Higher baseline w/in normal range
2. accelerations may have lower amplitude
3. variablity may be decreased

82
Q
A
83
Q
A

Module 6 (19 decks)

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