Unit 9: Perfusion and Gas Exchange Flashcards
What are perinatal nurses legally responsible for?
Monitoring woman’s response to pain, vital signs, FHR, cervix changes, hydration status and bladder function
Fetal response after administration of anesthesia
Record time of opioid administration
Assess for return of sensory function after epidural
Document findings
What are normal and abnormal FHR patterns
Normal: 110-160, FHR moderate variability, absent decelerations; accelerations can be present or absent
Abnormal: hypoxemia –> fetal hypoxia –> metabolic acidosis –> academia (increased hydrogen iron content and decreased pH)
What is the purpose of amniofusions?
increase the amount of amniotic fluid volume to relieve intermittent umbilical cord compression
What is tocolytic therapy
Usage of drugs (terbutaline) to inhibit UCs which improves blood flow through the placenta
What is fetal scalp stimulation?
using digital pressure during a vaginal examination; desired result is accelerations
What is intrauterine resuscitation?
Refers to the specific interventions initiated when a FHR abnormal pattern is noted
Hypotension: increase IV rate, change position, medication stopped (oxytocin), O2
Uterine Tachysystole: reduce/discontinue uterine stimulants used; administer uterine relaxant
Abnormal pattern during 2nd stage: use fewer pushing efforts, use open-glottis pushing, push with every other contraction
What are the causes/interventions of early decelerations?
Causes: fetal head compression (uterine contractions, vaginal assessment, fundal pressure, placement of internal monitoring)
Interventions: not needed
What are causes/interventions of variable decelerations?
Causes: compression of cord (twisted, wrapped around neck, arm, or leg, knot in cord)
Interventions: discontinue oxytocin, change position, administer O2 (10mL non-rebreather mask), amnioinfusion, notify physician
What are causes/interventions of late decelerations?
Causes: uterine tachysystole, maternal supine hypotension, medication
Interventions: discontinue oxytocin, change positions, administer O2, elevate legs, increase IV maintenance fluid, notify physician
What is category 1 for FHR classification?
Base line 110-160
Moderate variability
Absent decelerations (except early)
Accelerations can be present
What is category 2 for FHR classification?
Tachycardia/bradycardia
Minimal, absent, marked variability
No acceleration produced from stimulation
Periodic decelerations (late, prolonged, variable)
What is category 3 for FHR classification?
Absent variability with decelerations or bradycardia
Sinusoidal pattern
What is normal uterine activity during labor?
2-5 contractions/10 minutes
Contractions last from 45-80 seconds
Strength is 40-70 and then 80 during second stage
Resting tone is 10 mmHg
MVU 100-250 first stage; 300-400 second stage
Abnormal patterns: tachysystole, hypertonus (resting >25mmHG or MVU >400), paired contractions
What is external monitoring?
external transducers placed on maternal abdomen; cant measure the strength of contractions
What is internal monitoring?
Fetal scalp electrode: attaches to fetal scalp; only used when membranes are ruptured and cervix dilated
Intrauterine Pressure Catheter: monitors frequency, duration, and intensity of contractions
What is the fetal monitor display?
Each square is 10 seconds; bold lines is 1 minute
What is the baseline FHR?
Average rate during a 10 sec segment that excludes periodic changes, marked variability, and segments that differ more than 25 beats/min
What is periodic changes in FHR?
Occurs with contractions
What are accelerations?
abrupt increase of FHR of 15 bpm for 15 seconds
What is absent variability?
fluctuations aren’t detectable to the unaided eye
What is minimal variability?
<6 bpm difference from baseline
What is moderate variability?
Considered normal
6-25 bpm fluctuations
What is marked variabilty?
> 25 bpm changes
What is a sinusoidal pattern?
regular, smooth wavelike pattern that persists for 20 minutes
What are causes and interventions for Tachycardia?
Causes: interruption of oxygenation, fever, infection, and drugs
Interventions: administer oxygen, treat underlying cause
What is fetal tachycardia?
> 160 bpm for at least 10 minutes
What is fetal bradycardia?
<110 bpm for at least 10 minutes
What are causes and interventions for bradycardia?
Causes: maternal hypotension, hypoglycemia, heart blocks, drugs, hypoxemia, amniotic fluid embolism, bradyarrhythmias
Interventions are based on the cause
