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When assessing a fetal heart rate (FHR) tracing, the nurse notes a decrease in the baseline rate from 155 to 110. The rate of 110 persists for more than 10 minutes. The nurse could attribute this decrease in baseline to:
Initiation of epidural anesthesia that resulted in maternal hypotension.
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On review of a fetal monitor tracing, the nurse notes that for several contractions the fetal heart rate decelerates as a contraction begins and returns to baseline just before it ends. The nurse should:
- Describe the finding in the nurse's notes.
- An early deceleration pattern from head compression is described. No action other than documentation of the finding is required since this is an expected reaction to compression of the fetal head as it passes through the cervix.
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Which finding meets the criteria of a reassuring fetal heart rate (FHR) pattern?
- Variability averages between 6 to 10 beats/min.
- Variability indicates a well-oxygenated fetus with a functioning autonomic nervous system.
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Late deceleration patterns are noted when assessing the monitor tracing of a woman whose labor is being induced with an infusion of Pitocin. The woman is in a side-lying position, and her vital signs are stable and
fall within a normal range. Contractions are intense, last 90 seconds, and occur every 1½ to 2 minutes. The nurse's immediate action would be to:
Stop the Pitocin.
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what is the occurance of 5 or more uterine contractions in 10 minutes averaged over a 30 minute window
tachysystole
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what is listening to fetal heart sounds at periodic intervals to assess fetal HR
intermittent auscultation
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what is a method used to continuously assess the FHR pattern
EFM
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what are the 2 methods of EFM
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what is a device used in external monitoring to assess fetal HR and pattern
US transducer
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what is a device used in external monitoring to measure UA transabdominally, it can determine the fequency, regularity, and approximate duration of uterine contractions but not their intensity
tocotransducer
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what is a device used in internal monitoring to obtain a continuous assessment of the FHR and pattern
spinal electrode
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what is a device used in interal monitoring to measure the frequency, duration, and intensity of uterine contractions as well as uterine resting tone
intrauterine pressure catheter
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what are the interventions initiated when a nonreassuring FHR pattern is detected, these interventions involve providing supplemental O2, instituting maternal position changes and increasing IV fluids
intrauterine resuscitation
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Assessment method that uses digital pressure or vibroacoustic stimulation to elicit an accerleration of the FHR of 15 beats/min for at least 15 seconds and/or to improve FHR variability
Fetal HR response to stimulation
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Abnormally small amount of amniotic fluid
oligohydramnios
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absence of amniotic fluid
anhydramnios
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relaxation of the uterus achieved through the administration of drugs that inhibit uterine contractions
tocolytic therapy
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Average FHR during a 10 min segment that excludes accelerations, decelerations, and periods of marked variability, it is assessed during the absence of uterine activity or b/t contractions
Basline fetal HR
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Absence of the expected irregular fluctuations in the baseline FHR
Undetected variability
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Persistent (10 min or longer) baseline FHR less than 110 beats/min
Bradycardia
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Visually apparent decrease in the FHR of 15 beats/min or more below the baseline, which lasts more than 2 minutes but less than 10 minutes
prolonged decleration
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Changes from baseline patterns in FHR that occur with uterine contractions
periodic changes
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Persistent (10 min or longer) baseline FHR greater than 160 beats/min
tachycardia
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expected irregular fluctuations in the baseline FHR as a result of the interaction b/t the sympathetic and parasympathetic nervous system
variability
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visually apparent gradual decrease in and return to baseline FHR in response to transient fetal head compression during a uterine contraction
early deceleration
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visually apparent gradual decrease in and return to baseline FHR in response to uteroplacental insufficiency resulting in a transient disruption of O2 transfer to the fetus, lowest point occurs after the peak of the contraction and baseline rate is not usually regained until hte uterine contraction is over
late deceleration
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visually abrupt decrease in FHR below baseline of 15 beats or more lasting 15 seconds are returning to baseline in less than 2 minutes from the time of onset, which can occur at any time during a contraction as a result of umbilical cord compression
variable deceleration
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viually apparent abrupt increase in the FHR of 15 beats/min or greater above the baseline, which lasts 15 seconds or more with return to baseline less than 2 minutes from the beginning of the increase
Acceleration
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changes from the basline patterns in FHR that are not associated with uterine contraction
epidsodic changes
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What are normal findings when internally monitoring uterine contractions?
- frequency every 2 1/2 to 3 min
- duration of 80-85 seconds
- intensity during a uterine contraction of 55-80 mm Hg
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what finding is a concern during a uterine contraction
average resting pressure of 25-30 mm Hg (should be 15 or less)
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what does the nurse do (in the correct order) when there are signs of persistent late deceleration patterns
- change maternal position to lateral, elevate legs if woman is hypotensive
- increase rate of maintenance IV solution
- palpate uterus for intenisty of contractions
- stop pitocin
- administer O2 at 8-10 L/min with mask
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what are nonreassuring fetal signs
- average baseline FHR of 100 beats/min
- late deceleration patterns about every 3 to 4 contractions
- FHR of 165 b/t contractions
- tachycardia of 160 beats or more
- progressive decrease in baseline variability
- absence of FHR variability
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what are characteristics of normal UA
- contractions every 2-5 min, lasting less than 90 seconds
- contractions are moderate to strong in intensity as evidenced by palpation
- contraction intensity is <100 mg Hg as measured by intrauterine pressure catheter
- 30 seconds or more should elapse b/t end of one contration and beginning of next
- uterine relaxation sould be detected by palpation or by average intrauterine pressure of 15 mm Hg or <
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what is the goal of intrapartum FHR monitoring
to identify and differentiate the reassuring patterns from the nonreassuring patterns, which may be indicative of fetal compromise
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what are non-reassuring patterns associated with
- fetal hypoxemia (deficiency of O2 in arterial blood, can lead to severe fetal hypoxia)
- fetal hypoxia (inadequate supply of O2 at cellular level)
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