Unit 8

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Unit 8
2012-05-24 15:17:00

Fetal Assessment
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  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. what is the occurance of 5 or more uterine contractions in 10 minutes averaged over a 30 minute window
  6. what is listening to fetal heart sounds at periodic intervals to assess fetal HR
    intermittent auscultation
  7. what is a method used to continuously assess the FHR pattern
  8. what are the 2 methods of EFM
    • internal
    • external
  9. what is a device used in external monitoring to assess fetal HR and pattern
    US transducer
  10. 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
  11. what is a device used in internal monitoring to obtain a continuous assessment of the FHR and pattern
    spinal electrode
  12. 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
  13. 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
  14. 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
  15. Abnormally small amount of amniotic fluid
  16. absence of amniotic fluid
  17. relaxation of the uterus achieved through the administration of drugs that inhibit uterine contractions
    tocolytic therapy
  18. 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
  19. Absence of the expected irregular fluctuations in the baseline FHR
    Undetected variability
  20. Persistent (10 min or longer) baseline FHR less than 110 beats/min
  21. 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
  22. Changes from baseline patterns in FHR that occur with uterine contractions
    periodic changes
  23. Persistent (10 min or longer) baseline FHR greater than 160 beats/min
  24. expected irregular fluctuations in the baseline FHR as a result of the interaction b/t the sympathetic and parasympathetic nervous system
  25. visually apparent gradual decrease in and return to baseline FHR in response to transient fetal head compression during a uterine contraction
    early deceleration
  26. 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
  27. 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
  28. 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
  29. changes from the basline patterns in FHR that are not associated with uterine contraction
    epidsodic changes
  30. 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
  31. what finding is a concern during a uterine contraction
    average resting pressure of 25-30 mm Hg (should be 15 or less)
  32. 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
  33. 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
  34. 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 <
  35. 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
  36. 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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