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Flashcards in T2 - Fetal Assessment EFM (Josh) Deck (41):
1

What are the types of Fetal Heart Monitoring?

Auscultation/Intermittent Auscultation

External Fetal Monitoring

Internal Fetal Monitoring

2

What are the advantages of Auscultation in regards to FHM?

Non-invasive

Fetoscope detects actual heat sound (so dysrhythmias can be heard)

No straps to hold mother down

No 'machine error'

3

What are the disadvantages of Ausculation in regards to FHM?

Requires skill / practice

Disrupted by contractions

Unable to review/archive info

4

What can be done to stimulate birth?

nipple stimulation to cause oxytocin to increase

5

What is a Biophysical Profile?

Real-time ultrasound that permits detailed assessment of the physical and physiologic characteristics of the developing fetus

***scored on a basis of 10 points

***normal finding = 2

***abnormal finding = 0

6

Biophysical Profile Scoring:

What are the five variables that are scored?

Breathing movements

Gross Body Mvmt

Muscle Tone

Amniotic Fluid Index (vol.)

Fetal HR via Nonstress Test (NST)

7

Biophysical Profile:

What is the normal and abnormal findings for FHR via Nonstress Test?

Normal (Reactive) = 2

Abnormal (Nonreactive) = 0

8

Biophysical Profile:

What is the normal and abnormal findings for FETAL BREATHING MOVEMENTS?

at least 1 episode > than 30 sec duration in 30 min = 2

absent or less than 30 sec duration = 0

9

Biophysical Profile:

What is the normal and abnormal findings for GROSS BODY MOVEMENTS?

at least 3 body/limb extensions w/ return to flexion in 30 min = 2

less than 3 episodes = 0

10

Biophysical Profile:

What is the normal and abnormal findings for FETAL TONE?

at least 1 episode of extension w/ return to flexion = 2

slow extension and flexion, lack of flexion, or absent movement = 0

11

Biophysical Profile:

What is the normal and abnormal findings for QUALITATIVE AMNIOTIC FLUID VOL?

at least 1 pocket of fluid that measures at least 2 cm in 2 perpendicular planes = 2

pockets absent or less than 2 cm = 0

12

Biophysical Profile:

Interpretation of scores

8-10 = normal (low risk of chronic fetal asphyxia)

4-6 = abnormal (suspect chronic fetal asphyxia)

13

Types of External Monitoring Devices

U/S (Ultrasound Transducer) for Fetal Monitoring

TOCO (Tocotransducer) for Maternal Monitoring

14

Types of Internal Monitoring Devices

ISE (Internal Scalp Electrode) for Fetal Monitoring

IUPC (Intrauterine Pressure Catheter) for Maternal Monitoring

15

Monitoring Strip:

Top strip =
Bottom strip =
Each vertical dark red line =
Each lighter vertical line =

Top strip = FHR

Bottom strip = Uterine Activity

Each vertical dark red line = 1 min

Each lighter vertical line = 10 sec

16

What is the Resting Tone?

palpation of uterus when no contraction is taking place

***important b/c it allows fetus to recover and have O2 exchange occur

17

How is Resting Tone documented?

Mild = touch nose

Moderate = touch chin

Strong = touch forehead

18

What is a MVU?

Montevideo Units
- measure indicating intensity of uterine contractions in mmHg

***only when using IUPC

19

How do you determine MVU?

Contraction intensity - Resting Tone * number of contractions in 10 mins

20

What is another term for the Top of the Contraction?

Acme (Peak)

21

How long do we measure FHR?

2 clear minutes and rounded to 5 BPM

***uterus must be at rest

***must last greater than 10 mins

22

When would FHR by tachycardic?

Bradycardic?

> 160 BPM for longer than 10 mins

23

What is FHR Variability?

EXPECTED irregular fluctuations of the baseline that are an indicator of fetal well being

24

Measuring FHR Variability

Absent = 0 beats or undetectable

Minimal = 0 to 5 BPM

Moderate = 6-25 BPM

Marked = > 25 BPM

25

--- changes happen WITH UC

--- changes happen WITHOUT UC

Periodic

Non-periodic (Episodic)

26

What is an Acceleration?

an abrupt, temporary increase in FHR taht peaks at least 15 BPM above the baseline and lasts at least 15 secs

***for fetus 33 wks or greater

***if 32 wks, it should be 10 BPM for 10 secs

27

What is Prolonged Acceleration?

when accelerations lasts longer than 2 mins and less than 10

*** if longer than 10 mins, the baseline has changed

28

Accelerations:

For 33 weeks and more, what do we want to see?

For 32 weeks, what do we want to see?

15 bpm x 15 secs

10 bpm x 10 secs

29

How many accels do we want to see in a 10 minutes strip?

at least 2

30

How many types of Declerations are there?

Three

- Early
- Variable
- Late (worst b/c there is not enough profusion to baby)

31

What does an EARLY Decel look like?

mirror image of a contraction

- gradual descent from baseline and returns to baseline by end of contraction

32

What are possible causes of Early Decels?

head compression on vagal nerve slowing FHR during UC

***not bad and doesn't require intervention

***periodic

33

What does a VARIABLE Decel look like?

abrupt rise and fall from baseline (looks like a V or W)

- must be 15 x 15 and less than 2 mins

34

What are possible causes of Variable Decels?

Cord Compression

Short Cord

Knot in Cord

Prolapsed Cord (Emergency)

***can be periodic or nonperiodic

35

Nursing Interventions for Variable Decels?

change Maternal position

Increase fluid intake

Put on O2

36

What is a LATE Decel?

FHR decreases at peak of UC and returns to baseline AFTER UC has ended

***must be periodic

37

What causes Late Decels?

impairment of placental/oxygen exchange

- Maternal Hypo/Hypertension
- Diabetes
- Decrease in fetal O2 reserves
- Maternal supine position
- Epidural anesthesia
- Placenta previa/abruption

38

Nursing Internventions for Late Decels?

Change maternal position

Increase IV fluids

Administer O2

Call MD

Call delivery team if doesn't change (prepare for C-section)

39

What are the BIG 5 Internvetions?

1) Turn/Reposition mom

2) O2 at 8-10 L/min (facemask)

3) IV fluids of bolus

4) Stop Oxytocin

5) Call MD

40

Which maternal position should always be avoided?

supine

**always use a wedge

41

Word associations for Decels:

E
V
L

Early starts with E= Starts Early and ends when UC Ends = Ear = Ear = part of head = Head Compression

Variable starts with V = V or W in shape = Can happen anywhere = V like vise. Vise cuts off O2 supplies via Cord Compression

Late = Happens at the peak of UC and does not return until Later, Long after the UC has ended. Starts with L = UteroPLacental insufficiency.