Chapter 18 - 2 Flashcards Preview

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Flashcards in Chapter 18 - 2 Deck (20):
1

three basic FHR measurements

1)Baseline FETAL HEART RATE
2)Baseline VARIABILITY
3)Periodic RATE

2

baseline rate

Normal 120-160 bpm (some authors say 110 for normal term infant

3

tachycardia

>160 persisting for 10 mins.
-Causes: fetal hypoxia (increase HR to pump more oxygen), maternal tachycardia (mom's HR and temp are reflective of babies), infection, maternal anxiety
-Interventions: monitor closely, identify possible factors and intervene

4

bradycardia

<110 persisting for at least 10 mins.
-Causes: congenital heart disease, fetal distress with decreased variability, maternal hypothermia, postmaturity
-Interventions:change position, notify MD, give O2, prepare for immediate delivery

5

baseline variability

-The amount of baseline FHR variance from minute to minute
-The interplay of the symphatic/parasympathic central nervous system
-Usually 6-25 bpm variance

6

with hypoxic baby you

lose variability; should intervene if you loose variability

7

good variability =

good thing, adequate oxygen

8

-Short term variability-

beat to beat which is most accurate with scalp electrode

9

-Long term variability-

over a 10 minute period

10

-No variability:

fetal acidosis, immature CNS, analgesics to mom
-DO: check med times, assess if fetal problems are present, with decelerations intervene as recommended

11

-Decreased variability

<6 bpm causes include prematurity, infant sleep, medication, fetal acidosis, fetal cardiac arrhythmias
- DO: estimate fetal age, stimulate fetus(scalp or vibroacoustic stimulation, check med schedule

12

Increased Variability-

>25 bpm
causes include maternal hypoxia and anxiety, tetanic contractions, immature CNS of fetus
-DO: check contractions, change positions, evaluate maternal status, notify MD if it persists

13

periodic rate -

Shows how the fetal heart rate is affected by uterine contractions
Either Accelerations or Decelerations

14

periodic rate accelerations -

-Above the FHR baseline, usually 15+bpm that lasts at least 15 seconds(10 w/<32 wks)
-Can occur at any time but often associated with fetal movement, vaginal exams, etc.
-Due to the stimulation of fetal autonomic nervous system -- GOOD SIGN (baby trying to compensate for HR dropping)
-Seen with variable decelerations as a compensation mechanism
Do: Explain and watch

15

periodic rate declarations -

Three Types and causes
1) Early
2) Variable
3) Late

16

interventions for non reassuring patterns

-What’s the cause?
-Stop Pitocin
-Reposition
-Increase IV rate of nonadditive fluid
-Give oxygen
-Keep monitoring
-Notify MD/Midwife
-If continues or worsens prepare for c-section
-increase lactated ringers for hypotension

17

Ways to clarify fetal monitor data

-Fetal Scalp Stimulation - acceleration of FHR of 15bpm for at least 15 seconds
- Vibroacoustic Stimulation - used in place of scalp stimulation
- PH Fetal Blood sample - < 7.20 (normal 7.25-7.35 in fetus) For evaluation of fetal distress with persistent abnormal FHR patterns
-Cord Blood Samples Same as fetal blood samples- after delivery

18

early

-bc of head compression, pressure on the head, and stimulates the vagal nerve, so HR drops
-contaction occurring and correlation of HR dropping (contraction and drop minor each other)
-normal physiological occurance
- fetal HR decrease before peak of contraction (why called early)
-repetitive and usually doesn't drop below 100 bpm
-does not mean fetal distress
-benign - don't intervene

19

late

-drops after peak of contraction
-cause is uteroplacental insufficiency** - not adequate blood flow/oxygen to fetus
-doesn't drop below 100 bpm
-maternal hypotension, excessive uterine activity, placental problem, or abdominal blood flow through placenta, IV to mom can cause
-give oxygen (non rebreather mask for 10 min), position change
-if loose variability with late then could be a CNS problem but with opioid variability pos O2

20

variable -

not varability!!
-can occur at anytime, don't have relation to contraction
-caused by cool compression
-**change position of mother
-often drops below 100 bpm
- often W shaped
-can give O2 and increase IV fluids (hypoxia - lost of variability)
-see w/in an hour of delivery
-decrease in fetal HR of at least 15 beats/min at least 2 min