Flashcards in Lecture 3 Fetal assessment during labor Deck (21):
While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the FHR for five sequential contractions begins to decelerate late in the contraction, with the nadir of the decelerations occurring after the peak of the contraction. What is the nurse’s first priority?
Change the woman’s position. [Late FHR decelerations may be caused by maternal supine hypotension syndrome. These decelerations are usually corrected when the woman turns onto her side to displace the weight of the gravid uterus from the vena cava. If the fetus does not respond to primary nursing interventions for late decelerations, then the nurse should continue with subsequent intrauterine resuscitation measures and notify the health care provider.]
Which alteration in the FHR pattern would indicate the potential need for an amnioinfusion?
Variable decelerations. [Amnioinfusion is used during labor to either dilute meconium-stained amniotic fluid or supplement the amount of amniotic fluid to reduce the severity of variable FHR decelerations caused by cord compression.]
Late decelerations are the most ominous FHR finding because they are caused by _ and are associated with _
Uteroplacental insufficiency; fetal hypoxemia.
What is a distinct advantage of external EFM?
The tocotransducer is especially valuable for measuring uterine activity during the first stage of labor. [The tocotransducer is valuable for measuring uterine activity during the first stage of labor and is especially true when the membranes are intact. Short-term variability and beat-to-beat changes cannot be measured with this technology. The tocotransducer cannot measure and record the intensity of uterine contractions. The transducer must be repositioned when the woman or the fetus changes position.]
Which definition of an acceleration in the fetal heart rate (FHR) is accurate?
An acceleration in the FHR presents a visually apparent and abrupt peak. [Acceleration of the FHR is defined as a visually apparent abrupt (only to peak 30 seconds) increase in the FHR above the baseline rate. *Periodic accelerations occur with uterine contractions and are usually observed with breech presentations. Episodic accelerations occur during fetal movement and are indications of fetal well-being.* Preterm accelerations peak at 10 beats per minute above the baseline and last for at least 10 seconds.]
Which information related to a prolonged deceleration is important for the labor nurse to understand?
A disruption to the fetal oxygen supply causes prolonged decelerations. [Prolonged decelerations are caused by a disruption in the fetal oxygen supply. They usually begin as a reflex response to hypoxia. If the disruption continues, then the fetal cardiac tissue, itself, will become hypoxic, resulting in direct myocardial depression of the FHR. Prolonged decelerations can be caused by prolonged cord compression, uteroplacental insufficiency, or perhaps sustained head compression. Prolonged decelerations lasting longer than 10 minutes are considered a baseline change that may require intervention.]
In which situation would the nurse be called on to stimulate the fetal scalp?
To elicit an acceleration in the FHR. [The scalp can be stimulated using digital pressure during a vaginal examination. The nurse stimulates the fetal scalp to elicit an acceleration of the FHR.]
In which clinical situation would the nurse most likely anticipate a fetal bradycardia?
Prolonged umbilical cord compression. [Fetal bradycardia can be considered a later sign of fetal hypoxia and is known to occur before fetal death. Bradycardia can result from placental transfer of drugs, prolonged compression of the umbilical cord, maternal hypothermia, and maternal hypotension. Intraamniotic infection, fetal anemia, and tocolytic treatment using terbutaline would most likely result in fetal tachycardia.]
Which nursing intervention would result in an increase in maternal cardiac output?
Change in position. [Maternal supine hypotension syndrome is caused by the weight and pressure of the gravid uterus on the ascending vena cava when the woman is in a supine position. This position reduces venous return to the woman’s heart, as well as cardiac output, and subsequently reduces her blood pressure. The nurse can encourage the woman to change positions and to avoid the supine position. Oxytocin administration, regional anesthesia, and IV analgesic may reduce maternal cardiac output.]
The nurse observes a sudden increase in variability on the ERM tracing. Which class of medications may cause this finding?
Methamphetamines. [Narcotics, barbiturates, and tranquilizers may be causes of decreased variability; whereas methamphetamines may cause increased variability.]
What is the correct placement of the tocotransducer for effective EFM?
Over the uterine fundus. [The tocotransducer monitors uterine activity and should be placed over the fundus, where the most intensive uterine contractions occur. The tocotransducer is for external use.]
Absent or minimal variability in FHR is _
Concerning - baby’s CNS is experiencing decompensation between sympathetic and parasympathetic nervous systems.
To declare fetal tachycardia or fetal bradycardia, the FHR must be sustained for _
At least 10 minutes.
Intrauterine resuscitation interventions
1. D/C Pitocin (priority)
2. Supplemental oxygen
3. Maternal position changes
4. Increasing intravenous fluids
Category I - *normal*
Normal FHR; moderate variability; no concerning decelerations; normal accelerations. *Continue auscultation, palpation, EFM.*
Category II - *indeterminate*
Bradycardia not accompanied by absent baseline variability; tachycardia; marked variability; no accelerations in response to fetal stimulation; periodic or episodic decelerations; minimal or absent variability not accompanied by recurrent decelerations. *Requires evaluation and continued surveillance, may need to use intrauterine resuscitation measures.*
Category III - *non-reassuring*
Non-reassuring FHR patterns associated with fetal hypoxemia; absent baseline variability; recurrent or late decelerations; bradycardia; sinusoidal pattern. *Initiate intrauterine resuscitation measures.*
Amnioinfusion is only used for what type of FHR abnormality?
Injected subcutaneously for tocolytic (relaxes uterus and improves placental blood flow) purposes. Contraindicated if the mother's heart rate is above 120.
Minimum frequency of fetal monitoring - no risk factors
1st stage of labor - every 30 minutes.
2nd stage of labor - every 15 minutes.