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OB > Fetal Monitoring Chap 9 > Flashcards

Fetal Monitoring Chap 9 Flashcards

1
Q

Baseline FHR

A

mean FHR in increments of 5 bpm during 10 min period w at least 2 identifiable segments

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2
Q

tachycardia

A

baseline FHR above 160 bpm in 10 mins

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3
Q

bradycardia

A

baseline FHR under 110 bpm in 10 mins

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4
Q

FHR variability

A

fluctuations in baseline FHR that are irregular in amplitude/frequency occuring in 10 mins from exertion of PNS

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5
Q

cycles per min

A

oxygenated fetuses have 2-8 cycles per min

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6
Q

amplitude

A

bpm measured from peak to trough of single cycle

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7
Q

absent variability

A

amplitude range undetectable

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8
Q

minimal variability

A

amplitude range detectable but 5 bpm

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9
Q

mod variability

A

amplitude range btw 6-25 bpm

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10
Q

marked variability

A

amplitude range above 25 bpm

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11
Q

periodic patterns

A

associated w uterine contractions

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12
Q

episodic patterns

A

not associated w uterine contractions

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13
Q

periodic changes

A

accel, decel, variable, late, early

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14
Q

episodic changes

A

accel, decel, variable, prolonged

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15
Q

acceleration

A

abrupt increase in FHR more than .15 shorter than .30 lasting total 10 mins

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16
Q

periodic decels

A

early, late, variable

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17
Q

episodic decels

A

prolonged and variable

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18
Q

acme

A

highest point of contraction

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19
Q

nadir

A

lowest point of contraction

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20
Q

onset

A

time from start of decel to nadir

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21
Q

offset

A

time from nadir of decel to return of baseline

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22
Q

abrupt

A

less than 30 seconds

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23
Q

gradual

A

at least 30 secs

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24
Q

recurrent

A

occurring with more than 50% of uterine contractions in 20 min window

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25
Q

intermittent

A

occurring with less that 50% of uterine contractions in 20 min window

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26
Q

early decelerations

A

symmetrical and gradual decrease/return of FHR associated w contraction

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27
Q

causes of early decels

A

fetal head compression during contraction causing vagal stimulation and low HR

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28
Q

late decelerations

A

symmetrical and gradual decrease/return of FHR associated w contraction with delay in timing

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29
Q

late decels are associated with

A

uteroplacental insufficiency by contractions, decrease in uterine blood flow, placental dysfunction

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30
Q

physiology of late decels

A

protective reflex mechanism in response to fetal hypoxemia during contractions

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31
Q

causes of late decels

A

maternal hypotension, uterine hyperstimulation, postdate gestation, preeclampsia, chronic hypertension, diabetes, hypovolemia

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32
Q

during actions for late decels

A

admin O2 at 10 L/min, fetal spiral electrode, support, plan for delivery, fetal scalp stimulation, IV bolus

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33
Q

if late decels continue

A

peripheral vasoconstriction fails, decreased blood flow to brain, ischemic injury to brain/heart

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34
Q

variable decels

A

abrupt decrease in FHR greater than 15 bpm more than 15 sec under 2 mins

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35
Q

characteristics of variable decels

A

variable in duration, intensity, timing that arent consistent w contractions

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36
Q

variable decels are common in

A

PROM and decreased amniotic fluid vol

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37
Q

causes of variable decels

A

compression of umbilical cord

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38
Q

if persistent variable decels occur and not fixed

A

cause acidosis and fetal distress

39
Q

nursing actions of variable decels

A

change position, sterile vaginal exam to eval cord, amnioinfusion, admin O2 at 10 l/min, decrease/discontinue oxytocin

40
Q

category 1 FHR (normal)

A

110-160 bpm (baseline), mod variability, no late/variable decels, early or accel may be present

41
Q

category 2 FHR (indeterminate)

A

inconclusive and include all tracings not in 1 or 3

42
Q

category 3 FHR (abnl)

A

absent baseline FHR variability and recurrent late/variable decels, bradycardia, sinusoidal pattern

43
Q

uterine activity

A

contains adrenergic receptors, estrogen stimulate cervical ripening and increase oxytocin receptors, estrogen and prostaglandins cause contractions

44
Q

frequency

A

time from beginning of one contraction to beginning of next

45
Q

duration

A

time from beginning to end of contraction

46
Q

intensity

A

difference btw peak pressure and rest (mild, mod, strong)

47
Q

norm uterine activity

A

under 5 contractions in 10 mins over 30 min period

48
Q

peak IUP

A

acme of contraction in mmHg when an IUPC in place

49
Q

interval of uterine activity

A

time from end of one contraction to beginning of next (rest)

50
Q

resting tone/baseline tone

A

lowest intrauterine pressure found btw contractions w IUPC

51
Q

tachysystole

A

more than 5 contractions in 10 min over 30 min period regardless of FHR

52
Q

hypertonus

A

abnl high resting tone (above 30 mmHg)

53
Q

uterine tetany

A

uterine contraction that is strong to palpation or over 90 mmHg more than 90 sec

54
Q

hypertonus and uterine tetany

A

need to be confirmed w palpation

55
Q

documenting uterine activity

A

method, frequency, duration, intensity, relaxation

56
Q

if oxygenation changes is not the cause of FHR

A

interventions to improve O2 will not correct FHR

57
Q

fetal tachycardia causes

A

infection, supra-ventricular tachycardia, tachyarrhytmia, congenital anomalies

58
Q

maternal causes of tachycardia

A

fever, infection, dehydration, hyperthyroidism, anxiety, meds, illicit drugs

59
Q

fetal causes of bradycardia

A

hypothermia, cardiac defect/arrhytmia, excessive vagal response

60
Q

maternal causes of bradycardia

A

drug response, prolonged hypoglycemia, CT disease

61
Q

absent variability causes

A

medications (CNS depressants), fetal anemia, arrhythmias, congenital brain anomaly, cerebral ischemia

62
Q

minimal variability causes

A

fetus in sleep cycle, tachycardia, CNS depressants

63
Q

marked variability causes

A

fetal activity/stimulation, ephedrine administration

64
Q

physiological goals

A

maximize umbilical cord circulation/blood flow/O2, maintain activity, reduce anxiety

65
Q
A
66
Q

A

A

assess oxygen pathways

67
Q

B

A

begin corrective measures

68
Q

C

A

clear obstacles to rapid delivery

69
Q

D

A

determine decision to delivery time

70
Q

assessing lungs

A

airway and breathing (give O2 and meds)

71
Q

assessing heart

A

BP/HR (treat abnls)

72
Q

assessing vasculature

A

BP/HR?volume status (position change, IV bolus)

73
Q

assessing uterus

A

contractions/tone (discontinue stimulants, use relaxants)

74
Q

assessing placenta

A

rapid delivery

75
Q

assessing cord

A

amnioinfusion, rapid delivery

76
Q

assessing O2 carrying capacity

A

maternal hemoglobin

77
Q

Kleihauer-betke

A

treat maternal/fetal anemia and rapid delivery

78
Q

intrauterine resuscitation

A

IV fluids, O2, position changes

79
Q

supplemental O2

A

discontinue oxytocin before, causes oxidative stress (consider other options first)

80
Q

lateral positioning

A

relieves pressure on vena cava, improve blood return, relieve cord compression

81
Q

IV fluid bolus

A

increases intravascular vol, CO, venous return and preload

82
Q

correcting BP

A

lateral positioning improves venous return/CO, ephedrine increases HR

83
Q

excessive uterine activity

A

causes disruption in oxygen pathway

84
Q

oxytocin induced tachysystole with Category 1

A

maternal reposition, IV bolus (if not norm: reduce oxytocin by half…10-15mins later: stop all oxytocin)

85
Q

oxytocin induced tachysystole with Category 2/3

A

discontinue oxytocin, maternal reposition, IV bolus, O2, terbutaline (prolonged)

86
Q

If oxytocin has been discontinued for less than 30 min, Category I tracing, and contractions are less than five in 10 mins

A

resume oxytocin at half original dose and resume titration

87
Q

If oxytocin has been discontinued for at least 30 mins, Category I tracing, and contractions are less than five in 10 mins

A

resume oxytocin and titration

88
Q

2nd stg pushing

A

open glottis pushing but pushing fewer with every other/3rd contraction and only when need to push improves FHR

89
Q

amnioinfusion

A

replaces amniotic fluid, relieves cord compression

90
Q

maternal anxiety

A

include fam, support, expectations, coping skills

91
Q

clearing for delivery

A

notify providers, epidural, IV, labs, meds, skin prep, prep OR

92
Q

determine decision to delivery time

A

dilation, efface, station, uterine activity, past/expected progress rate

93
Q

fetal metabolic acidemia

A

with recurrent decels and min/absent variability can happen in 1 hr

94
Q

be aware of

A

rising FHR, loss of variability, worsening decels

OB (9 decks)

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