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NURS: 2146 OB > Test 2 EFM Video > Flashcards

Test 2 EFM Video Flashcards

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1
Q

AFI (Amniotic fluid index)

Measure Fluid by Ultrasound

Normal changes with GA

Slowly increasing and decrease post term

Range norm…

A

5 - 25

Same as Fetal heart rate variability range for moderate

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2
Q

Abruption

A

Separation of Placenta from uterus wall

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3
Q

VEAL CHOPS

Variable Decelerations from Cord Compression = (Good or Bad) / What is the cause

A

Bad

Pressure changes noted from Baroreceptors

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4
Q

VEAL CHOPS

Early Decelerations from Head Compression = (Good or Bad)
This happens from….

A

Good

Vagal nerve response

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5
Q

VEAL CHOPS

Accelerations from O2 reserves (extra oxygen)

Good or bad

What does it mean….

A

Good

Baby is active

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6
Q

VEAL CHOPS

Late decelerations from utero-Placental Insufficiency (Good or bad)
How is it detected

A

Bad

Chemoreceptors from chemical changes

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7
Q

Prolonged decelerations =

A

Greater than 2 but less than 10 minutes

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8
Q

VEAL

CHOP

Stands for…

A

Variable Decelerations/ Cord Compression BAD

Early Decelerations/ Head Compression GOOD

Accelerations/ O² Reserves GOOD

Late Decelerations/ uetro-Placental Insufficiency BAD

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9
Q

FHR Strip

6 small boxes = 1 large box

What length of time is 1 large box?

A

1 min

10 sec = small box

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10
Q

Background information for FHR Strips

GA of baby

A

Accelerations change at GA

<32 weeks 10x10

> 32 weeks 15x15

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11
Q

Background information for FHR Strips

Is mom feeling baby moving

A

Moving baby correlates with moving baby

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12
Q

Background information for FHR Strips

Ruptured AROM/SROM or low fluid (oligohydramnios/ low AFI)

Will have this affect on variable Decelerations

A

Increase

Fluid acts as a cushion for the cord. When the fluid is low the effect is increasing variable Decelerations

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13
Q

Background information for FHR Strips

Maternal fever

This affect on FHR

A

Fetal tachycardia

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14
Q

Background information for FHR Strips

If fetal monitor is showing Contractions

Do this assessment to mom….

A

Ask if she feels the Contractions

Palpate the abdomen & simultaneously look at graph to see if they correlate

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15
Q

Background information for FHR Strips

What is a normal Resting Tone for the uterus….

A

Soft & non-tender Between contractions

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16
Q

Oxytocin/ misoprostol = this affect on contractions / Increased Risk of….

Nalbuphine (Nubain) & Butorphanol (Stadol) this affect on FHR

Magnesium Sulfate ( Used for treatment of Tocolysis for preterm labor, Preventing preterm birth, Preventing & treating eclampsia & preeclampsia

Epidural….

Narcotics

A

Oxytocin/ misoprostol = Longer, Stronger, Closer together

Increase risk of Tachysystole >5 in 10 minutes

Nalbuphine / Butorphanol (Analgesics) makes mom & baby feel “outta it” DECREASED VARIABILITY

Magnesium Sulfate can lower base fetal HR

Epidural decrease moms BP, resulting in less perfusion to baby (LATE DECELERATIONS)

Narcotics: Pseudosinusoidal FHR pattern:
Oscillation frequency: Synchronized with the frequency of uterine contractions
Amplitude: 19 beats per minute (bpm) or more
Frequency: 1.3 cycles per minute or less

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17
Q

What condiciones in the mother may have an impact on external FHR monitoring

A

Obesity

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18
Q

Common reason why you may have to adjust posistion on the External fetal monitor

A

Mother adjusted posistions

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19
Q

When applying TOCO monitor perform Leopold Maneuver first to assess placement

T or F

A

F

TOCO only needs to be at top of the Fundus

Use it to determine posistion of baby for Clearest US signal

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20
Q

Describe how to perform Leopold Maneuver….

A

Steps 1 - 3 Facing Mom / Step 4 Facing Away from mom

  1. Place both hands in fundus and determine if it’s the head or butt. Butt will feel softer.
  2. Slide hands down the uterus and determine which side is the back
  3. Pawlik’s Grip: using 1 hand determine if head is engaged in the pelvis
  4. Facing moms feet. Both hands lower abdomen to determine if babies neck is flexed or extended
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21
Q

For best placement of US you are looking for this landmark with the Leopold Maneuver

A

Fetal back

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22
Q

Which is preferred for delivery

Babies neck Flexed or Extended

A

Flexed. Chin towards chest

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23
Q

How to tell difference between TOCO & US monitoring equipment?

Which requires gel

A

Both look similar

TOCO will have a pressure monitoring disc on the back

US only requires gel

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24
Q

Wireless Monica has this use / advantage.

A

Fetal/ maternal ECG & Uterine electromyogram

Better on obese patients

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25
ISL/ FECG/ FSE Work how? Nursing considerations...
Corkscrew into scalp of baby Monitor for infection
26
Purpose of Blue port on IUPC (Interuterine Pressure Catheter)
Instill fluids
27
Fetal HR Strips Steps 1. Baseline Ignore Accelerations & Decelerations Look for area in between contractions to determine baseline. How to determine baseline using the above advice
Eyeball it. Between contractions
28
Normal variation Amniotic fluid embolism Cord Compression Complete/ Congenital Heart block Fetal arrhythmias Maternal hypoglycemia Hypothermia Low BP Maternal Drugs Hypoxemia Have this affect in fetal HR
Bradycardia
29
Fetal hydrops Maternal Hyperthyroidism Severe fetal anemia Fetal heart failure Arrhythmias Fetal Hypoxemia Drugs Fetal sepsis Chorioamnionitis Maternal fever Have this affect on Fetal HR
Tachycardia
30
How long of a strip to assess fetal baseline
2 min minimal 2 big boxes
31
How long of a change in FHR is needed to have a new baseline
10 minutes
32
Serious condition where abnormal amounts of fluid accumulate in two or more fetal compartments, such as under the skin (edema), in the abdomen (ascites), around the lungs (pleural effusion), or around the heart (pericardial effusion). This fluid buildup can lead to severe complications, including heart failure, organ damage, or even fetal death.
Fetal hydrops, or hydrops fetalis
33
Step 2 of FHR monitoring strips VARIABILITY (How much the HR changes up / down) Give ranges Absent Minimal Moderate Marked Sinusoidal
Absent 0 BMP Minimal 1 - 5 BPM Moderate 6 - 25 Bpm Marked >26 Sinusoidal: Smooth with a cycle of 3 - 5 smooth lines per minute and last >20 minutes
34
Smooth, sinewave-like undulating pattern in FRH baseline with a cycle frequency of 3 - 5 per minute and last >20 minutes = Sinusoidal Describe reason why
Sinusoidal FHR pattern Severe fetal anemia Rh isoimmunization Fetal hypoxia and can indicate fetal distress. It requires immediate evaluation and intervention, as it’s considered a sign of fetal compromise.
35
Variability in FRH is due to...
Intact Nervous System Fluctuations in Sympathetic (Increase) & Parasympathetic (Decreased)
36
Steps 2 Variability To determine Variability Ignore Accelerations & Decelerations on the strip T or F? Minium of 2 minutes of test strip
T
37
Etiology of (Marked or Decreased) variability Hypoxemia/acidosis, fetal sleep cycle, drugs (Nalbuphine (Nubain) & Butorphanol (Stadol), Magnesium Sulfate, Narcotics), Premature delivery, arrhythmias, fetal tachycardia, preexisting neurological abnormalities, congenital abnormalities
Decreased variability
38
Etiology of (Marked or Decreased) variability Fetal stimulation, drugs, mild/transient hypoxemia
Marked variability
39
Which type of variability is desired in FHR
Moderate 6 - 25 BPM
40
____ is the best predictor of fetal oxygenation
Variability Moderate 5 - 25 is best predictor of fetal oxygenation
41
Accelerations differ according to GA Describe <32 weeks >32 weeks
<32 weeks = 10 bpm × 10 seconds >32 weeks = 15 bpm × 15 seconds
42
FHR Step 3 is....
Accelerations
43
FRH baseline 125 What would be the peak for Accelerations <32 wks >32 wks And time frame
<32 wks ( 135 & 10 seconds) >32 wks ( 140 & 15 seconds)
44
Etiology of Accelerations (1) Ways to illicit Accelerations...
Oxygen reserves: Happens due to fetal movement in response to stimulation and Increased FHR Illicit: Fetal Scalp Stimulantion, sounds, vibration, drinking cold water, juice , eating, maternal movement
45
What is the longest time an Acceleration can last?
10 mins After this it's considered a new baseline
46
Steps 4 of interpretation of FHR strips
Decelerations Abrupt decrease in FHR may or may not be associated with Contractions
47
Distinguish between Variable Decelerations & Early Decelerations Cause? Which are normal findings How can you spot the difference Shape?
Cause: Variable Decelerations = Cord Compression BAD Early Decelerations = Head Compression GOOD FHR strip: Onset: Variabie Decelerations: Abrupt Onset to Nadir <30 secs Early Decelerations: Gradual Onset to Nadir is >30 secs Shape: Variable Decelerations = V,U,W Early Decelerations = Spoon shaped
48
Do Variable Decelerations happen with contractions?
Yes, but they can also happen from pressure being put on the Cord (Baby grasping cord, laying on cord)
49
Oligohydramnios Low AFI <5 will likely cause this condition...
Variable Decelerations Cord compression due to low fluid level
50
Size of Variable Decelerations
Lower 15 FHR beats for atleast 15 seconds
51
Etiology Cord compression detected by pressure sensing baroreceptors Baby grasping cord, oligohydramnios, ROM, Prolapse/ Nuchal Cord
Variable Decelerations
52
Nursing interventions for Variable Decelerations ( Onset to Nadir <30 seconds).... Nursing interventions for Early Decelerations (Gradual: Onset to Nadir: Equal to or >30 seconds)
Decrease pressure on the cord Posistion changes Evaluate how close to delivery with SVE PRN Amnionfusion Evaluate Oxytocin use Early Decelerations; Continue to monitor, SVE to evaluate imminence of delivery, Consider cephalopelvic disproportion (Failure to descend)
53
IUPC The cap can be used for this purpose to help this problem...
Inject amniotic fluid Helps with Variable Decelerations / Relive pressure on the cord
54
Decelerations Increase or Decreased Oxytocin
Decrease
55
The Nadir of decelerations and peak of UC Mirror eachother in this Decelerations. Is it a normal finding?
Early Decelerations from baby head being compressed Yes normal finding
56
Variable Decelerations vs Early Decelerations Describe the Onset time
Variable Decelerations (Onset to Nadir <30 secs) Early Decelerations (Onset to Nadir > or equal to 30 sec)
57
Compare FHR of Late and early Decelerations what is the difference in appearance. What is the same?
Both gradual (Onset to Nadir >30 secs) and spoon shaped. Timing is the difference. Nadir of late decelerations doesn't match the peak of the UC. While Nadir of early Decelerations matches the peak of UC
58
Which FHR is the most serious
Late decelerations
59
Etiology Utero-placental insufficiency = Perfusion problems. Detected by chemoteceptors Uterine hyperactivity Maternal hypotension Maternal HTN Abruption Previa IUGR DM Chorioamnionitis Postterm gestation Maternal anemia SS anemia Rh isoimmunization Cardiac disease Smoking Nursing interventions
Late decelerations Dangerous Nursing interventions: Increase perfusion and oxygenation through positioning. IVF Bolus 02
60
Chemoteceptors that detect Ox and CO² are used to detect this problem
Late decelerations
61
Uterine hyperactivity, tachysystole, Doesn't allow for perfusion between contractions. Low maternal BP
Late decelerations
62
Difference between Intermittent & Recurrent
Intermittent: Occurs <50% of contractions Recurrent: Occurs >50% of contractions
63
UC frequency Range in minutes Measure....
Measured from beginning of contraction to the beginning of next contraction
64
To get range for contractions calculate which contractions...
Closest together and farthest apart
65
Always measure contractions with this time frame
Minutes Never seconds
66
More than 5 contractions in a 10 minute period. Averaged over 30 minutes
Tachysystole
67
Step 6 is duration Measure from beginning of one UC to the end of same UC length: must be atleast ___ seconds to be considered an UC Uterine "Irritability "..... Duration is always measured in...
UC is atleast 40 seconds Uterine Irritability is Uterine activy that last <40 seconds Duration is always measured in seconds
68
UC duration is measured and seconds and given in this format UC is minimal 40 sec
Range 50 - 110 sec
69
How to assess UC intensity with toco monitor How to assess UC Intensity with IUPC
Palpation: Firmer the stronger the Intensity. Mild, Moderate, Strong In addition, ask mother her subjective perception of UC Intensity IUPC strips will be smoother lines. Read the mmHg in increment of 5
70
Step 8 resting tone of the uterus Is the uterus resting between contractions. Toco vs IUPC
Toco: Palpate the uterus (Soft & relaxed between contractions) IUPC( Select average lowest number in between contractions) to determine Uterine Resting Tone
71
Step 9 Montevideo Units Are the contractions strong enough for labor to progress? Represents total intensity of each UC added together for 10 minute period MVU >____ are considered adequate for 90% of labors to progress
200
72
How to calculate MVU ? Which number indicates they are strong enough for labor to progress?
10 minute time span Add all peaks of contractions and Minus from each peak the Resting Tone located to its right. Add together all and if # is > than 200 it is 90% likely ready for labor
73
Step 10 FHR Category Strong predictive of normal acid-base balance at time of observation. Routine Care Fetal heart rate tracing shows ALL of the following Must have Baseline 110 - 160 BPM & Moderate Variability May Have (Present or Absent) Accelerations & Early Decelerations Can't have: Late, variable or prolonged Decelerations Which category
Category 1 NORMAL
74
Category 1 NORMAL Must have Baseline ____ BPM & _____ Variability May Have (Present or Absent) ______&_________ Can't have: _____, ______ or ______ Which category
Fetal heart rate tracing shows ALL of the following Must have Baseline 110 - 160 BPM & Moderate Variability May Have (Present or Absent) Accelerations & Early Decelerations Can't have: Late, variable or prolonged Decelerations Strong predictive of normal acid-base balance at time of observation. Routine Care
75
Category ____ ABNORMAL Predictive of abnormal fetal-acid base status at time of observation. Efforts to quickly resolve the underlying cause of abnormal fetal heart rate pattern should be made. Fetal heart rate shows EITHER of the following Sinusoidal pattern Absent variability Plus One of the following Recurrent late decelerations Recurrent variable Decelerations Bradycardia
Category III
76
Category III ABNORMAL Predictive of abnormal fetal-acid base status at time of observation. Efforts to quickly resolve the underlying cause of abnormal fetal heart rate pattern should be made. Fetal heart rate shows EITHER of the following _______ pattern ______ variability Plus One of the following ________ late decelerations ________ variable Decelerations Bradycardia
Fetal heart rate shows EITHER of the following Sinusoidal pattern Absent variability Plus One of the following Recurrent late decelerations Recurrent variable Decelerations Bradycardia
77
A C/S is called in the FHR Category
Category II Intermediate
78
FHR Interventions When seeing diffent types of decelerations POISON IS AT CVS
P posistion change (Increases perfusion & Lowers Oxytocin Effects. Left/Right Lateral then hands and knees NEVER SUPINE) O oxytocin off (Lowers fetal stess from contractions & Increases fetal Perfusion I ivf Bolus: 300 - 500 mL (Increase Fluid volume, Perfusion to baby, Lowers Oxytocin effects) S sve (Assess imminence of delivery, rapid vaginal change and cord Prolapse. O o² 10 L face mask for material Ox Sat <95 N notify provider I internal monitors Consider ISL/UPC placement for more accurate data S support maternal coping (Fight or Flight = Catecholamine = Lower uterine perfusion A aminoinfusion (Variable Decelerations ONLY Provides fluid cushion back around cord T terbutaline Stops UC with unresolved tachysystole + fetal distress. Cardiac /PPH SE C c/s or svd Deliver baby. Push, Forceps, Vaccumm. Remote from delivery = C/S V vital signs S staff help: Altert the team
79
Only decelerations caused by cord compression
Variable Decelerations
80
Terbutaline is used for this problem
Tachysystole (6 or more contractions in 10 min) Terbutaline stops UC SE = Cardiac/ PPH
81
26 y.o. G2P1 41.2 IOL for oligohydramnios (AFI 2cm)
26 years old Pregant twice Give birth once 41 weeks 2 days GA Induction of labor due to oligohydramnios (Amniotic fluid index 2) low AFI normal = 5 - 25
82
AROM (mec) and IUP/ISL placed at 1700.
Artificial rupture of membranes due to meconium in fluid. Internal monitors placed at 1700
83
Late decelerations = Utero-placental insufficiency which is a problem with...
Perfusion
84
When to use an Amnionfusion
Recurrent variable Decelerations
85
Describe Category 1 Nomral FHR pattern (3) Category 3 Abnormal
1. (A) Must have Baseline 110 - 160 BPM & Moderate Variability (B) May have (Present or Absent) Accelerations & Early Decelerations (C) Can't have Late, Variable, Prolonged Decelerations Category III Either of the following (A) Sinusoidal pattern (B) Absent variability PLUS One of the following Recurrent late decelerations Recurrent variable Decelerations Bradycardia
86
Mom gets epidural which type of Bad decelerations is expected... Give interventions
Late Decelerations Turn left side Give O² If HPTN give fluids If oligohydramnios, call md, prepare for Amnionfusion
87
UPI uterine-placental insufficiency can happen from.... Interventions . ..
HTN/ Preeclampsia Post Term Turn left side 10L ox via face mask Monitor BP D/C IV oxytocin aka Pitocin Call Dr
88
Which is bigger concern Variable or Late decelerations
Late Call Dr. Variable you can monitor
89
Average fetal HR is rounded in increments of....
5 BPM
90
Onset to peak of Accelerations Time? Duration of Accelerations? Prolonged Accelerations
Onset to peak <30 ABRUPT Duration 15 sec - 2 minutes Prolonged 2 - 10 min
91
Variable Decelerations V,U,W shaped With or without contractions (Commonly occurs with UC) Onset: Abrupt Onset to Nadir _____ BMP & TIME considerations to be considered Variable Decelerations....
Onset = Onset to Nadir < 30 secs Variable Decelerations = 15 secs & 15 BMP lower
92
Early Decelerations / Late Decelerations Shape: Spoon/ Saucer Onset _____ Timing_____ Etiology ____
Onset Both Early Onset to Nadir + 30 sec Time: Early: Decel mirrors UC ; Late Nadir of decelerations arrives after UC Etiology: Early = Head Compression/ Vagal response Late = Utero-placental insufficiency = Perfusion problems
93
Prolonged Decelerations are DANGEROUS. Nursing interventions....
POISON IS AT CVS

NURS: 2146 OB (16 decks)

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