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OB Exam 1
OB chapter 14 pt 1
| Question | Answer |
|---|---|
| key terms related to fetal heart rate | Accelerations Artifact Baseline fetal heart rate Baseline variability Deceleration Electronic fetal monitoring Periodic baseline changes |
| accelerations | temporary increases in fetal heart rate (FHR) above the baseline generally a good thing, shows that baby is getting adequate O2 |
| Artifact | false or inaccurate heart rate reading caused by something other than the actual fetal heart rate |
| Baseline fetal heart rate | over 10 minute period, FHR was 130 and if you know baseline then you can identify other FHR patterns |
| variable decelerations | drop in FHR from baseline before, during and after contraction associated with cord compression/prolapsed cord |
| what to do when variability decelerations are occurring and you can see the cord | insert fingers to remove some of the pressure on the cord and rush to c section |
| variability decels require | intervention, you must tell the HCP because baby is not recovering |
| what can you do to help variable decels | Turn! Knee-chest Assess for cord prolapse! Notify HCP! Consider amnioinfusion D/C Pitocin Consider deliver |
| early decelerations | gradual decrease in FHR that happens at the peak of the contraction, there is increase oxytocin so baby could not be getting enough O2 |
| what can late decels do to the baby | cause acidemia |
| what do you as the nurse do during early decels | leave alone and monitor the quality/intensity of contractions and monitor the FHR |
| late decelerations | gradual decrease in FHR that starts after the contraction begins and reaches its lowest point after the peak of the contraction |
| what to do during late decels | D/C Pitocin Side-lying IVF bolus Notify HCP Consider internal monitoring Consider delivery |
| Summary of periodic/episodic changes | Variable decels can occur at any point in the EFM strip - ”V” shape w/ abrupt drop & return to/from baseline Early & Late decels must be interpreted w/in the context of ctx - “U” shape with gradual drop & return to/from baseline |
| how to remember periodic/episodic changes | VEAL CHOP |
| additional FHR assessments | fetal scalp stim vibroacoustic stim umbilical cord blood gases |
| normal range for FHR | 110-160 |
| bradycardia | <110 lasting 10 or more minutes |
| tachycardia | >160 lasting 10 or more minutes |
| in order for probe to go into uterus, | RoM needs to happen |
| in order to push, fetus needs to | descend to +1 or +2 |
| purpose of FHR monitoring | Labor is stressful Snapshot of fetal well-being and tolerance of labor |
| classifications of FHR patterns | Category I – Normal Category II – Indeterminate Category III – Abnormal |
| Category I - Normal | FHR wnl moderate variability no decelerations |
| Category II – Indeterminate | FHR outside normal limits minimal, absent, or marked variability variable or late decel |
| Category III – Abnormal | absent variability and decels or bradycardia sinusoidal pattern |
| variability is | beat to beat fluctuations in FHR |
| variability categories | Absent - 0 changes Minimal - 0-5 beat fluctuations Moderate - 5-25 beat fluctuations Marked - >25 beat fluctuations |
| Fetal assessment FHR monitoring | round disc like band: picks up FHR rectangular band is located @ fundus: picks up quality of contractions |
| if baby is breech, where do you hear HR | below abdominal umbilicus |
| if baby is normal, where do you hear HR | on the back |
| who does the vaginal exams | trained HCPs |
| what are the vaginal exams done for | examination of cervix to determine dilation, effacement, fetal station, fetal presenting part, & membrane status |
| when are vaginal exams done | on admission, before administering medications….why?, significant changes in uterine/fetal activity, maternal request or urge to push, when membranes rupture |
| vaginal exams help HCPs determine | labor progress & membrane status |
| PPE during vaginal exams | sterile gloves and gel |
| where do you want fetus head when doing vaginal exams | 0 station at ishcial spines |
| what do your fingers do during vaginal exam | one finger is in the os which is open if two fingers inside, os may open 2-3 cms |
| what happens to os during birth | will dilate, open and thin so will not palpate |
| amniotic fluid is | alkaline and will turn strip blue |
| if the strip determines the fluid is AF, what follow up questions should you ask | !!when did RoM occur? having contractions? how far along are you? |
| the longer ago the RoM, | the higher risk for infection |
| Leopold's maneuvers | 4 abdominal palpation techniques used during pregnancy to determine the fetal position, presentation, lie, and engagement |
| 4 maneuvers | 1. Fundal grip — “What's in the fundus?” 2. Lateral/umbilical grip — “Where is the back?” 3. Pawlik's grip — “What is presenting?” 4. Pelvic grip — “Is the head engaged?” |
| Nursing Management of Laboring Patients | Assessment Comfort measures Emotional support Information and instruction Advocacy Support for the partner |
| Maternal Assessment During Labor and Birth | Maternal status (vital signs, pain, prenatal record review) |
| Maternal status includes | Vaginal examination (cervical dilation, effacement, membrane status, fetal descent, and presentation) Rupture of membranes Uterine contractions Leopold maneuvers |
| Guidelines for Assessing Fetal Heart Rate | Initial 10- to 20-minute continuous FHR assessment on entry into labor/birth area |
| Completion of a prenatal and labor risk assessment on | all patients! |
| Intermittent auscultation | every 30 minutes during active labor for low-risk patients and every 15 minutes for high-risk patients |
| second stage of labor intermittent auscultation | every 15 minutes for low-risk patients and every 5 minutes for high-risk patients |
| Continuous Electronic Fetal Monitoring | Uses a machine to produce a continuous tracing of the FHR Produce a graphic record of the FHR pattern |
| primary objective of Continuous Electronic Fetal Monitoring | To provide information about fetal oxygenation and prevent fetal injury from impaired oxygenation To detect fetal heart rate changes early before they are prolonged and profound |
| Criteria for Using Continuous Internal Monitoring of the FHR | Ruptured membranes Cervical dilation of at least 2 cm Present fetal part low enough to allow placement of the scalp electrode Skilled practitioner available to insert spiral electrode |
| Comfort and Pain Management | Pain as universal experience; intensity highly variable Mandate for pain assessment in all patients admitted to health care facility Numerous nonpharmacologic and pharmacologic choices available |
Created by:
leh195