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56 Cards in this Set
- Front
- Back
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Fetoscope and doppler monitor FHR in what fashion?
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hand-held devices
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There are two versions of electronic FHR monitors. What are they?
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external and internal
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What type of electronic FHR monitor is most accurate?
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internal
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Examples of external FHR monitors
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U/S transducer + tacometer
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Examples of internal FHR monitors
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scalp electrode + intrauterine pressure catheter
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FSE/ISE
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scalp electrodes
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IUPC
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intrauterine pressure catheter
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Where is a U/S transducer placed to obtain FHR?
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over the fetal back
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Where is the tacometer place to obtain uterine contractions?
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over the fundus
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Describe the measures obtained with external FHR monitoring
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long-term variability continuously or intermittently
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Describe the measures obtained with internal FHR monitoring
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long-term and short-term variability (more accurately) continuously
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How is internal FHR monitoring obtained?
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must have ROM
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Where is the IUPC placed?
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between the fetus and the abdominal wall
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Where is the scalp electrode placed
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on the fetal head
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BTBV
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short-term, beat to beat variability, only seen with internal FHR monitoring
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When is intermittent monitoring appropriate
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low-risk pregnancies
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When is continuous monitoring a more useful method
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high risk women/fetus, fetal distress in labor
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What 3 characteristics need to be assessed when taking a FHR
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baseline, periodic changes, variability
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When do we determine baseline FHR
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measure between cx's
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When do we measure periodic changes of FHR
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measure during and after cx's
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How do we measure variability of FHR
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baseline and range
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Define "penset"
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uterine resting tone @ 20mmhg
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FHR, tachycardia
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FHR baseline >160 for duration of 10min or longer
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Maternal causes of fetal tachycardia
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fever, chorioamnionitis, drugs, hyperthyroidism, dehydration, anxietyF
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Fetal causes of fetal tachycardia
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early sign of fetal hypoxia, fetal anemia, asphyxia, infection, prematurity
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FHR, bradycardia
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FHR baseline < 110 for duration of 10min or longer
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Causes of fetal bradycardia
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late sign of fetal hypoxia, drugs, prolonged compression of umbilical cord, maternal hypotension, maternal supine hypotension, maternal hypothermiaW
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Example of a drug that can result in fetal bradycardia
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anesthetics
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What causes maternal supine hypotension
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weight and pressure of the gravid uterus on the inferior vena cava; decreases blood return to the heart which reduces CO and BP
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What is know to occur before fetal death
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fetal bradycardia
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Define long-term variability
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irregularity of FHR over 10min; waves or cycles from baseline
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Define short-term variability
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fluctuations of FHR from beat to beat
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Types of variability
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absent, minimal, moderate, marked
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What does absent variability signify?
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No CNS reactivity
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Define minimal variability
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undetected to < 5bpm
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Define moderate variability
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6-25bpm
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Define marked variability
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> 25bpm
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What level of variability is considered normal
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moderate = average
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Accelerations versus decelerations
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increase/decrease in baseline of 15bpm for 15sec
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What do accelerations and decelerations detect
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fetal activity
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What do accelerations in FHR indicate
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fetal well being
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What do decelerations in FHR indicate
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may be benign or may be non-reassuring
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VEAL CHOP
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Variable = Cord compression
Early = Head circumference Accelerations = Ok Late = Placental insufficiency |
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Early Decelerations
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contractions and deceleration mirror each other
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Variable Decelerations
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visually abrupt decelerations independent of contractions; shaped like a "V," "U," or "W"
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What are "shoulders" r/t FHR decelerations
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may or may not accompany variable decelerations, sudden acceleration as a result of overcompensation
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Late Decelerations
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happens after contractions, slow drop and slow return
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How frequently should we be assessing FHR during the latent phase of labor
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q1h
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How frequently should we be assessing FHR during the active phase of labor
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q15m-30m
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How frequently should we be assessing FHR during the 2nd stage of labor
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q5m or between cx's
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Criteria for a "reassuring FHR"
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baseline between 110-160, no decelerations or changes in baseline, accelerations w/ fetal movement, moderate variability (6-25bpm)
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Tachycardia, bradycardia, decreased or absent variability, late decelerations, or severe variable decelerations are all signs of, what?
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non-reassuring FHR pattern
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Nursing management of FHR changes
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if pit is infusing, turn of the pit; l. lateral position, increase IV fluids, O2 mask, notify provider
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How much O2 should be administered via face mask?
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8-10L
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Fetal stimulation, amniofusion, discourage valsalva maneuver, change maternal positions are all examples of, what?
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other inventions when a non-reassuring FHR is detected
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Define amniofusion
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warm water inside vagina, baby floats off cord
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