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N113 Monitoring

N113 - Monitoring during labor

What is the traditional method of fetal monitoring? Palpation of uterine contractions with hand on fundus. Auscultation of fetal heart rate with fetoscope.
What are the limitation of traditional monitoring? Information was intermittent. Fetal heart rate changes during contraction and is difficult to hear.
What is direct electronic monitoring? Plastic catheter (IUPC) is placed into uterus after rupture of membranes. Gives actual strength of contraction. Fetal heart rate is measured by attaching small electrode to fetal scalp.
What is indirect electronic monitoring? Transducer applied to maternal abdomen. Not accurate due to fetal & maternal movement. Tocodynamometer records uterine contractions - measures tension of abdominal wall.
At what rate is a FHR tachycardic? FHR above 160 bpm for 10 minutes
What can cause fetal tachycardia? Maternal fever, maternal hyperthyroidism, amnionitis, fetal hypoxia (will have other symptoms), illicit drug use
At what rate is a FHR bradycardic? FHR below 110 for 10 minutes or more - is it true bradycardia or deceleration?
What can cause fetal bradycardia? beta-adrenergic blockers, anesthetics, maternal hypotension, prolonged umbilical cord compression, maternal hypothermia
Why is baseline variability so important? It indicates that the sympathetic & parasympathetic nervous systems are intact.
How is minimal variability rated? 0-5 bpm - occur occasionally after pain meds are given, absence or undetected variability is considered nonreassuring
How is moderate variability rated? 6-25 bpm - what we like to see
How is marked variability rated? > 25 bpm
What are accelerations? Transient elevations in FHR of 5-15 bpm from baseline for several seconds to minutes then return to baseline. Indicates functioning of the cardiac control center of the medulla.
What are decelerations compared to? Always relate a deceleration to the contraction
What is an early deceleration? Gradual decrease in FHR during a contraction. Nadir (lowest point of decel)occurs at the same time as peak of contraction. Baseline viability remains intact.
What is a late deceleration? Gradual decrease in FHR during a contraction. Onset, nadir & recovery occur after beginning, peak & end of contraction. Late decels are always a concern and are NEVER normal.
What can be the cause of a late deceleration? Can be caused by hypoxia - baby is running out of O2.
What nursing interventions can be done to try to correct late decelerations? Change maternal position, increase mainline IV solution, observe character of contractions, SHUT OFF pitocin if being used, administer O2 by face mask, notify physician if interventions do not help.
What is a variable deceleration? Abrupt decrease in FHR ≥15 bpm below baseline lasting ≥15 seconds but <2 minutes.
What is a prolonged deceleration? Deceleration ≥15 bpm below baseline lasting ≥ 2 minutes or more but < 10 minutes - greater than 10 minutes id bradycardia or change in baseline
What nursing interventions can be done for a prolapsed cord? Try putting women in knee chest position (on hands and knees with head lower than chest). If cord is visible in vagina, put on sterile glove an manually push the presenting part off the cord - do not remove hand! - C-section must be done.
Created by: jrb265