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NURS ADN004 Maternity > Week 4 FHR Monitoring > Flashcards

Week 4 FHR Monitoring Flashcards

1
Q

Uterine Activity Assessment

A

Frequency
Duration
Intensity
Resting Tone

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2
Q

Number of contractions in a 10 minute window averaged over 30 min

A

Uterine Contractions

Count from beginning of one UC or until the beginning of the next UC

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3
Q

What is normal UC contractions?

A

< 5 uc’s in 10 min

Tachysystole is >5 uc’s in 10 min

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4
Q

Characteristics of uterine contractions include

A

Increment
Acme
Decrement
Intensity
Duration
Frequency

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5
Q

NST have accelerations of

A

15 bpm lasting 15 seconds with each FM
Top shows FHR and bottom shows Uterine activity

Note FHR increase at least 15 beats and remains at least 15 seconds before returning to the former baseline

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6
Q

FHR Interpretation includes what?

A

Baseline
- Variability
-Bradycardia
Periodic changes
- Accelerations
Early, late, and variable and prolonged decelerations
Interpretation and Management

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7
Q

Slowing or speeding of the FHR in response to a uterine contraction

A

Periodic changes

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8
Q

110-160 BPM is what?

A

FHR Baseline

Approximate mean is FHR rounded to 5 BPM increments
- Over 10 min(min 2 min)
- Between UC’s, decels and accels

Highest early in gestation
- BL progressively lowers as PSNS matures
- PSNS dominates SNS at term

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9
Q

Fluctuations or variations in baseline FHR
- Absent- Undetectable
- Minimal- <5BPM
- Moderate-6-25 BPM
- Marked->25BPM

Presence reflects an intact, oxygenated CNS
- Due to opposing effects of PSNS and SNS

A

Variability

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10
Q

How can variability be viewed?

A

Over a minute externally with at least 2 fluctuating sine waves of peaks and troughs

Also measured internally with a fetal scalp electrode to detect FHR changes from one R wave to the next and is recorded

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11
Q

The PSNS and SNS are pushing and pulling to the fine tune the FHR from beat to beat based on what?

A

fetus oxygenation needs at the moment

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12
Q

What are causes of decreased or absent variability?

A

Fetal sleep
Drugs
Gestation < 28-32 weeks

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13
Q

May be no apparent cause and may be benign

A

Nonreassuring if late or variable decels also present

  • Possible warning sign of chronic hypoxia or fetal acidosis
  • Place internal monitor to confirm if possible
  • Consider prompt delivery
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14
Q

Many factors like fetal sleep or drugs may due what?

A

Decrease CNS activity and variability of FHR

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15
Q

Name drugs that may reduce variability

A

CNS depressants
Barbiturates
Tranquilizers
Narcotics
Mag Sulfate
Epidural Anesthesia

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16
Q

If decelerations are present in the FHR are, what is advised?

A

Internal Fetal Scalp Monitoring Electrodes

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17
Q

Name types of Fetal Stimulation

A

Acoustic fetal stimulation
- Handheld buzzer or other noisemakers
close to the abdomen, as well as maternal ice chewing, are effective methods prior to labor or with closed cervix

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18
Q

Once labor has begun and the cervix is dilated ….

A

Fetal scalp stimulation during vaginal examination gives the same result

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19
Q

Severe variable decels
Late decels of any magnitude
Absent variability
Prolonged deceleration
Severe bradycardia

A

Nonreassuring EFM Tracings

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20
Q

Maternal Causes of bradycardia include

A

Hypotension 2 supine position or anesthetics
Beta blockers
Acute event- PE, AFE, Uterine Rupture, ETC
Prolonged Hypoglycemia

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21
Q

Metals causes of bradycardia

A

Mature PSNS
Umbilical cord prolapse
Hypoxia
Hypothermia
CCHB
Cardiac structural defect

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22
Q

What requires assessment and interventions immediately after onset?

A

Bradycardia

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23
Q

parasympathetic system becomes more dominate late in

A

Gestation

Baseline of 100 in a postmature fetus would not be cause for concern

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24
Q

Cardiac Output is dependent on

A

FHR

As FHR slows, CO falls

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25
Q

Indicates fetus may be severely compromised, especially if accompanied by decels

Immediate delivery indicated if interventions ineffective

A

Nonreassuring

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26
Q

Causes of maternal tachycardia

A

-Fever/ infection
- Hyperthyroidism
- Drug response
- Anemia

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27
Q

Fetal causes of tachycardia

A
  • Infection
  • Anemia
  • Hypoxia
  • Tachyarrhythmia
  • Cardiac Anomaly
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28
Q

This occurs with loss of variability and late or severe variable decels

A

Nonreassuring

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29
Q

Identified after min of 2 minutes, but technically not official as a baseline reading until at least 10 minutes

A

Tachycardia

Cause must be investigated and it is always abnormal

30
Q

What is suspected of first causes of tachycardia?

A

Maternal or fetal infection

31
Q

Every degree of maternal temp., what happens to FHR?

A

Rises 10 BPM

32
Q

Medications both legal and illegal producing tachycardia in maternal and fetal include?

A

Terbutaline
Albuterol
Stimulants
Decongestants
Cocaine

33
Q

Tachycardia may be response to______________ release due to maternal or fetal stress

A

Catecholamine

34
Q

As sympathetic NS begins to dominate, variability may what?

A

Decrease due to less parasympathetic tone

35
Q

What is Nonreassuring?

A

Tachycardia with decelerations or loss of variability

May indicate hypoxia or acidosis

Once find cause= Tx

36
Q

Increase in fetal HR lasting>15 secs and rising >15 beats over the baseline

A

Accelerations

37
Q

Accelerations may be less if what?

A

Gestational age < 32 weeks (10x10 rule)

38
Q

How many accelerations should one see in 30 minute?

A

1

39
Q

What are nursing actions if less than 1 accelerations?

A

o2, hydrate, position change

40
Q

Presence of 2 accelerations in 20 minutes at least 15 bpm above the baseline and lasting at 15 seconds if >32 weeks of gestation or at least 10 BPM above the baseline and lasting at least 10 sec. if <32 weeks meet criteria for nonreactive stress test

A

Accelerations

41
Q

Visually apparent decrease in FHR

A

Decelerations

42
Q

Gradual onset >30 seconds from onset to nadir, nadir simultaneously with peak of uc

A

Early

43
Q

Gradual onset >30 sec. from onset to nadir, delayed in timing-nadir after peak of uc

A

Late

44
Q

Abrupt onset <30 seconds to nadir, lasting > 15 sec. but <2min; depth >15BPM

A

Variable

45
Q

Decreased of FHR >15 BPM lasting>2min but<10 min

A

Prolonged

46
Q

Early deceleration shape

A

Waveform consistently uniform inversely mirrors contraction

Onset is just prior to or early in contraction

Cause is head compression

47
Q

Lowest level range and ensemble of early decelerations

A

Consistently at or before midpoint of contraction

Range is usually within normal range of 120-160 BPM

Ensemble can be single or repetitive

48
Q

Shape and onset for late deceleration

A

Waveform is uniform shape; shape reflects contraction

Onset is late

Late deceleration- Uteroplacental Insufficiency

49
Q

Lowest level, range, and ensemble of late decelerations?

A

Consistently after the midpoint of the contraction
Usually within normal range of 120-130 BPM/min
Occasional, consistent, gradually increase- repetitive

50
Q

Shape and onset of variable deceleration

A

Waveform variable, generally sharp drops and returns
Abrupt with fetal insult; not related to contraction

51
Q

Lowest level, range, and ensemble for variable decelerations`

A

Variable around midpoint
Not usually within normal range
Variable- single or repetitive

52
Q

Start when the contraction begins, ends when the contraction ends
May indicate head compression
Check for impending delivery
If not read: -position change-O2-IV hydration

A

Early Decelerations

53
Q

Starts at the peak of contractions after the contraction is over

Caused by Uteroplacental insufficiency
- Aged or damaged placenta
- Maternal position ( Supine hypotension or vena cava syndrome)

  • Inadequate maternal blood flow (IE: hypotension from epidural anesthesia, shock, blood loss, etc)
A

Late Decelerations

54
Q

Gradual decrease in FHR related to the time it takes for intervillous blood to reach the fetal heart and brain in the presence of a contraction

A

Late Deceleration

55
Q

What are some interventions to improve fetal oxygenation and placental perfusion?

A

Position change for optimal UBF
- Lateral
- Knee to chest

100% O2 by mask 8-10 l/min
Stop Pitocin
IV fluid bolus
Assess BP
Vaginal Exam
Inform MD/ Midwife

56
Q

Variable Decelerations are reassuring if

A

Duration < 60 sec.
Rapid return to BL
Normal BL rate and variability
Presence of accels

57
Q

Nonreassuring variable decelerations if

A

Loss of variability
Tachycardia or bradycardia
Slow return to BL
Deepening to <70 BPM
Prolonged >60 sec
Overshoots

58
Q

Over time if variable persist and progress in depth and width, watch for

A

presence of accels and variability for reassuring status

59
Q

__________________ is main indicator of fetal response to the decel.

A

Variability

60
Q

Tachycardia and loss of variability with variables are correlated with

A

Fetal Acidosis

61
Q

Interventions to improve or correct variable decels

A

Reposition pt- side to side or hands and knees
Perform vaginal exam to r/o cord prolapse
IV bolus
Oxygen by 10L/ min by mask

62
Q

Defined as decrease in the BL for>2minutes and <10 minutes from onset to return

A

Prolonged deceleration

  • deceleration for longer than 10 minutes is change in baseline
63
Q

What are some reassuring and Nonreassuring EFM tracings ?

A

Reassuring
- Normal baseline
- Accelerations with fetal movement
- Present short term variability
- 3-5 cycles of long term variability per minute
- Early decels may be present

64
Q

Considered normal category and no need for concern

A

Category 1

65
Q

Some abnormal components, requires close observation, some intervention may be required; provider notification and/or presence

A

Category II

66
Q

FHR indicates fetal distress requiring immediate intervention and delivery

A

Category III

67
Q

What testing is included in antepartum?

A

Biophysical profile
NST
CST

68
Q

Score of 8-10 is normal in biophysical profile if

A

AFI is adequate

Equivocal is 6

Abnormal is less than 4

69
Q

Biophysical profile variables include ?

A

Fetal breathing
Movements
Grossbody Movements Fetal Tone
Reactive NST
Amniotic Fluid
Index Planes

70
Q

Biophysical normal includes ?

A

1 movement in 30 min
3 limb or body moves in 30 min
1 or more slow or extensions/ flexions episodes (active)
2 accels. 15x15
1 or more pockets
More than 1 cm of fluid in 2 perpendicular planes

71
Q

Abnormal in biophysical profile includes?

A

No moves lasting 30 sec.
Less than 3 in 30 min
No ext/ flex
Non reactive NST
Less than 1 cm fluid in 2

72
Q
A

NURS ADN004 Maternity (11 decks)

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