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parent/child: ch 15
| Question | Answer |
|---|---|
| Normal | Reassuring |
| Abnormal | Nonreassuring |
| What complications are associated with abnormal FHR patterns? | Hypoxemia (deficiency of oxygen in the blood), hypoxia (an inadequate supply of oxygen at the cellular level that can cause metabolic acidosis), & academia (increased hydrogen ions content & decreased pH in the blood) |
| Intermittent auscultation | Involves listening to fetal heart sounds at periodic intervals to assess the FHR; the nurse can assess the counted FHR, the rhythm, the presence of increases & decreases in FHR, & whether these changes are abrupt or gradual |
| Intensity | Usually described as mild, moderate, or strong |
| Duration | Measured in seconds from the beginning to the end of the contraction |
| Frequency | Measured in minutes, from the beginning of one contraction to the beginning of the next |
| Resting tone | Between contractions; usually described as soft or hard |
| Electronic fetal monitoring | The purpose is to assess the adequacy of the fetal oxygenation during labor |
| Spiral electrode | Applied to the fetal presenting part to assess the FHR |
| Intrauterine pressure catheter (IUPC) | Monitors the frequency, duration, & intensity of contractions |
| Ultrasound transducer | Works by reflecting high-frequency sound waves off a moving interface (the fetal heart & valves) |
| Tocotransducer | Measures UA transabdominally; placed above the umbilicus; can measure & record the frequency & approximate duration of UCs, but not their intensity |
| Internal monitoring qualifications | Membranes must be ruptured, the cervix sufficiently dilated (at least 2 to 3 cm), & the presenting part, which is usually the fetal head, low enough to allow placement of the spiral electrode or IUPC or both |
| Fetal monitor display | Each small square on the monitor paper or screen represents 10 seconds; each larger box of 6 squares equals 1 minute |
| Baseline fetal heart rate | Average rate during a 10 min segment that excludes periodic or episodic changes, periods of marked variability, & segments of the baseline that differ by more than 25 bpm. There must be at least 2 min of interpretable baseline data in 10 min to determine |
| Normal FHR range | 110 - 160 bpm |
| Variability | Can be described as irregular waves or fluctuations in the baseline FHR of 2 cycles per min or greater; 4 categories: absent & minimal (bad), moderate (good), & marked (significance unknown); sinusoidal pattern: wavelike & persists for at least 20 min |
| Tachycardia | Baseline FHR greater than 160 bpm for 10 min or longer |
| Bradycardia | Baseline FHR less than 110 bpm for 10 min or longer; must be distinguished from prolonged deceleration as the causes & management are different |
| Periodic changes | Those that occur with UCs |
| Episodic changes | Those that are not associated with UCs |
| Acceleration | Visually apparent, abrupt increase in FHR above the baseline rate; more than 10 min -> baseline change; indicate that significant interruption of fetal oxygenation is not occurring |
| Deceleration | Caused by the dominance of a parasympathetic response; may be benign or abnormal |
| Early deceleration | Visually apparent, gradual decrease in & return to baseline FHR associated with UCs; sometimes called the mirror image of a contraction; benign |
| Late deceleration | Visually apparent, gradual decrease in & return to baseline FHR associated with UCs; disruption of oxygen transfer from the environment to the fetus |
| Variable deceleration | Visually abrupt decrease in FHR below the baseline; have a U, V, or W shape |
| Prolonged deceleration | Visually apparent decrease in FHR of at least 15 bpm below the baseline & lasting more than 2 min, but less than 10 min |
| Three-tier system of categorizing FHR tracings | Category I - normal Category II - indeterminate Category III - abnormal |
| Management of abnormal fetal heart rate patterns | Administer O2 by non-rebreather mask at a rate of 10L/min for 15 - 30 min, maternal position changes, increasing rate of primary IV infusion, discontinue uterine stimulants & administer relaxants, & adjust pushing pattern |
| Fetal scalp stimulation & vibroacoustic stimulation | The desired result of these stimulation methods is acceleration in the FHR of at least 15 bpm for at least 15 sec |
| Umbilical cord acid-base determination | In assessing the immediate condition of the newborn after birth, a sample of cord blood is a useful adjunct to the Apgar score; suggested to obtain when the score is 5 or less at 5 min of age |
| Fetal scalp blood sampling | Performed by obtaining a blood sample from the fetal scalp through the dilated cervix after the membranes have ruptured |
| Amnioinfusion | The purpose is to relieve intermittent umbilical cord compression that results in variable decelerations & transient fetal hypoxemia by restoring the amniotic fluid volume to a normal or near-normal level |
| Tocolysis | Relaxation of the uterus; improves blood flow through the placenta by inhibiting UCs; commonly used tocolytic - terbutaline |
| Intrauterine resuscitation | Specific interventions initiated when an abnormal FHR pattern is noted |
| Frequency of FHR tracing evaluation | Low risk - 1st stage: every 30 min & 2nd stage: every 15 min; Risk factors - 1st stage: every 15 min & 2nd stage: every 5 min |
Created by:
tatianalopez03
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