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107 Ch, 17
Fetal Assessment During Labor
| Question | Answer |
|---|---|
| What is a normal uterine contraciton | q2-5min, last <90sec, intensity ,100mmHg, 30sec bn, ,5 in 10 min Tachysystole: >5 in 10 min |
| where does the fetus get it's oxygen | uteroplacental exchange, fetal circulation |
| what can decr fetal O2 | mom hypertension, hypotension, hypovolemia from hemorrhage, compression of cord |
| how is well being of fetus monitored | FHR in comparison to contraction |
| Nonreassuring FHR patterns are associated with | fetal hypoxemia: low O2 in aa blood...can deteriorate to fetal hypoxia: low O2 at cellular level |
| what are signs of nonreassuring FHR | <110bpm/>160bpm, decels |
| What are two methods for EFM electronic fetal monitoring | external and internal |
| what are external methods of EFM | FHR: ultrasound transducer(below umbilicus) UC: tocotransducer (on fundus) |
| what is internal method of EFM | spiral electrode or (FSE) fetal scalp electrode must be 2cm dilated and (ROM) rupture of membrane |
| What is an (IUPC) intrauterine pressure catheter | measure pressure of uterus |
| What is best FHR pattern | accels and moderate variability |
| what are causes of tachycardia >160 from baseline FHR | fetal hypoxia, infection in amnio, fetal anemia, mom fever, drugs, dehydration |
| what is causes of bradycardia <110 from baseline FHR | late fetal hypoxia, umbilical cord compression, mom hypotension |
| If water breaks what should nurse do | check temp q2h, birth w/in 24hrs |
| what are two types of changes in FHR | periodic: occur with UCs episodic: Not with UCs |
| what defines an accelerated contraction | 15 beats high, 15 long and return to baseline |
| what are 4 types of decels | early: response to fetal head compromise late: uteroplacental insufficiency...FIX..occurs after UC variable: umblilical cord compression prolonged: below baseline of 15bm last more than 2 min. |
| what are nursing interventions for decels | change mom position, incr IV fluids, discontinue pitocin, O2(8-10L) |
| what are 5 components to evaluate of an FHR tracing | baseline rate, variability, accels, decels, change or trends in FHR pattern |
| What are interventions for hypotension | incr IV, change to later/Trendelenburg, give ephedrine or phenylephedrine |
| what are interventions of uterine tachysystole | reduce pitocin, give Brethine(relax UC) |
| what are interventions for nonreassuring FHR 2nd stage | use open glottis pushing, not Valsalva fewer pushing shorter pushing efforts push only Q 2nd/3rd contraction push only with urge to push |
| 2 factors that effect fetal status | positioning and pushing |
| Interventions for vag bleeding | notify MD anticipate C-section do NOT do vag exam |
| Interventions for infection | cooling measures IV collect urine/amnio sample to lab |
| Interventions for Prolapse Cord | upward pressure on presenting part, relieve compression Trendelenburg/modified Sims' sterile wrap cord w/ NS O2 IV do NOT replace cord prepare for birth |
| what do you monitor for in fetal well being | FHR assessment meconium stained amnio fluid mom vitals and UC activity |
| Interventions for nonreassuring FHR patterns | ID cause fetal O2 mom O2 reduce cord compression |
| Causes of decr variability | fetal sleep cycle, drugs, hypoxia, <32wks gestation |
| Causes of incr variability | early mild hypoxia, fetal stimulation |
Created by:
palmerag
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