Fetal Assessment Ch. 17

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wiscflor
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46135
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Fetal Assessment Ch. 17
Updated:
2010-10-30 22:02:49
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FA17
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  1. How can fetal oxygen supply decrease?
    • Maternal hemorrhage or anemia
    • Reduced blood flow to uterus
    • Reduced blood flow from maternal vessels (HTN, HPN)
    • Reduced fetal circulation
  2. Normal uterine activity is characterized by contractions occurring every ______ and lasting less than ______
    • Every 2-5 minutes
    • Less than 90 seconds
  3. Uterine Activity

    Normal vs Tachysystole
    Normal - 5 or less contractions in 10 minutes averaged over a 30 minute window

    Tachy - 5 or more contractions in 10 minutes averaged over a 30 minute window
  4. When is an internal fetal scalp monitor contraindicated?
    When the mom has HIV
  5. When can a mom with beta strep use internal fetal scalp monitor?
    After she is given antibiotics
  6. What are reassuring fetal heart rate patterns?
    • Normal baseline heart rate between 110 and 160
    • Moderate variability
    • Presence of accelerations
    • Absence of decelerations
  7. What are nonreassuring fetal heart rate patterns?
    • Baseline heart rate less than 110 or more than 160
    • Absent or minimal variability
    • Late or variable decelerations
    • Bradycardia
  8. Nonreassuring fetal heart rate patterns are associated with _____?
    Hypoxemia (or hypoxia in later stages)
  9. What mm Hg are contractions and resting tone typically in an internal uterine pressure catheter?
    • Contractions - 50-85mm Hg
    • Resting tone - 20mm Hg
  10. What is the one value that cannot be monitored on an external fetal monitor?
    Uterine contraction intensity
  11. What monitor is this: High frequency sound waves reflect mechanical action of the fetal heart. It is noninvasive, does not requir rupture of membranes or cervical dilation, and is used during both the antepartum and intrapartum periods

    A) Ultrasound transducer
    B) Spiral electrode
    C) Intrauterine pressure catheter
    D) Tocotransducer
    A) Ultrasound transducer
    (this multiple choice question has been scrambled)
  12. What monitor is this: this instrument monitors frequency and duration of contractions by means of a pressure-sensing device applied to the maternal abdomen. It is used during both the antepartum and intrapartum periods.

    A) Ultrasound transducer
    B) Tocotransducer
    C) Spiral electrode
    D) Intrauterine pressure catheter
    B) Tocotransducer
    (this multiple choice question has been scrambled)
  13. What monitor is this: this electrode converts fetal ECG to the FHR. This method can be used only when membranes rupture and the cervix is sufficiently dilated during intrapartum period.

    A) Intrauterine pressure catheter
    B) Spiral electrode
    C) Ultrasound transducer
    D) Tocotransducer
    B) Spiral electrode
    (this multiple choice question has been scrambled)
  14. What monitor is this: this instrument monitors frequency, duration and intensity of contractions. Can be used when membranes rupture and the cervix is sufficiently dilated during the intrapartum period.

    A) Ultrasound transducer
    B) Tocotransducer
    C) Spiral electrode
    D) Intrauterine pressure catheter
    D) Intrauterine pressure catheter
    (this multiple choice question has been scrambled)
  15. What is the definition of variability?
    Fluctuations in the baseline FHR
  16. What are the types of variabilty?
    • Absent
    • Minimal - less than 5bpm
    • Moderate - 6-25bpm
    • Marked - more than 25bpm
  17. What is possibly going on with the fetus when the variability goes from moderate to minimal?
    Most likely the fetus is sleeping. Wait about 30minutes to intervene.
  18. What variability is ideal to have?
    Moderate
  19. Changes in fetal heart rate patterns

    Periodic vs Episodic
    P - fluctuations with contractions

    E - fluctuations without contractions
  20. An acceleration is classified as an increase of _____ bpm and last for at least _____
    15bpm

    15 seconds
  21. What are the types of decelerations?
    • Early
    • Variable
    • Late
    • Prolonged
  22. Early Decelerations

    Cause:
    Clinical Significance:
    Nursing Interventions:
    Fetal strip pattern:
    Cause - head compression

    Clinical - reassuring patterns are not associated with fetal hypoxemia

    Nursing - none

    Pattern - gradual decrease, then return to baseline
  23. Variable Decelerations

    Cause:
    Clinical Significance:
    Nursing Interventions:
    Fetal strip pattern:
    Cause - cord compression

    Clinical - occur inj 50% of labors and are usually correctable

    Nursing - change mom's position, stop oxytocin, O2

    Pattern - abrupt decrease from baseline that is 15bpm or lasts more than 15 seconds. Tend to have a U, V or W shape. After deceleration, has an acceleration before going back to baseline.
  24. Late Decelerations

    Cause:
    Clinical Significance:
    Nursing Interventions:
    Fetal strip pattern:
    Cause - uteroplacental insufficiency

    Clinical - Nonreassuring pattern associated with hypoxemia, considered ominous if not corrected

    Nursing - change mom's position, stop oxytocin, O2, use internal monitor, palpate uterus

    Pattern - gradually decrease in association with contractions; start after contractions start, end after contractions end. The lowest point of deceleration is at the peak of contractions.
  25. What are the 5 components of a FHR tracing that determines if the nurse needs to intervene?
    • Rate
    • Variability
    • Accelerations
    • Decelerations
    • Changes
  26. What is the pattern of a prolonged deceleration?
    Apparent decrease below the baseline 15bpm or more last more than 2 minutes but less than 10 minutes.
  27. What are the 3 basic interventions for managing a nonreassuring FHR pattern?
    • Give O2 at 10L/min
    • Assist mom to side-laying position
    • Increase maternal blood volume by increasing the rate of IV infusion
  28. What should the nurse do if the mom is experiencing hypotension?
    • Increase the IV infusion
    • Position to lateral or trendelenburg

    *Give ephedrine or phenylephrine if other measures are unsuccessful
  29. What should the nurse do if the mom is experiencing uterine tachysystole?
    • Stop the oxytocin or pitocin
    • Give a uterine relaxant (tocolytic or terbutaline)
  30. What are the rank of priorities of intrauterine resuscitation?
    1st - open maternal and fetal vascular systems

    2nd - increase blood volume

    3rd - continue circulation to have oxygenation
  31. How should the nurse treat fetal tachycardia?
    • Give antipyretics for fever
    • Use cooling measures
    • Give O2
  32. How should the nurse treat bradycardia?
    Treat the underlying cause
  33. Why should the Valsalva maneuver be discouraged?
    Stimulate the parasympathetic nervous system and decreases the maternal heart rate and blood pressure

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