Fetal Monitoring: Comprehensive Study Guide, Exams of Advanced Education

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AWHONN FETAL MONITORING COURSE COMPLETE STUDY REVIEW SOLUTION normal fetal heart rate range - 110-160 what could it mean if FHR is high - infection, low o2, young what could it mean if FHR is low - post date pregnancy what is the number one way to know a babies age - sonogram what do you do if theres low amniotic fluid, variable decels - amnioinfusion if baby is stressed, the baby will divert the blood flow to the brain, heart, and adrenals. this organ won't get good blood flow which will lead to what? - kidneys, low urine output, low amniotic fluid what category tracing is absent variability without decels - 2 what category tracing is absent variability with decels - 3 influences on fetal heart patterns that are outside the fetus - extrinsic what type of influences are associated with maternal-fetal exchange: -placenta -maternal utero placental circulation -fetal placental circulation -placental transfer -uterine blood flow -umbilical cord -amniotic fluid - extrinsic ALL transfer takes place here - intervillous space all babies have this with uterine contraction but it's worse with a problematic placenta - transient hypoxemia when is the only time you give an amnioinfusion - cord compression influences on fetal heart rate that are inside the babies heart - intrinsic where is the most oxygenated blood - ductus venosus, liver where does the blood go to avoid the lungs - foramen ovale if the baby has this, then they DO NOT have metabolic acidosis - moderate variability what would cause a sympathetic response (things speed up, accelerations) - infection, movement , loud noise, repositioning what would cause parasympathetic response - variable decel, early decal, post dates, head compression what nerve decreases bp - vagus nerve during this, the blood flow gets shunted to the brain heart and adrenals. can't tolerate labor - hypoxemia the degree of hypoxemia a fetus can tolerate before true tissue hypoxia and acidosis occur - fetal reserve 3 things that indicate fetal well being - normal baseline, moderate variability, no late or variable decels signs of utero-placental insufficiency - late or variable decels what is the first thing you should do with recurrent late decels - change position what should pH be - 7.10 or higher early decel definition - gradual greater than 30 seconds from onset to nadir, nadir simultaneous with peak of contraction late decel definition - gradual greater than 30 seconds from onset to nadir , nadir after peak of contraction variable decel definition - abrupt onset less than 30 seconds from onset to beginning of nadir, lasting more than 15 seconds but less than 2 minutes, depth more than 15 bpm prolonged decel definition - decrease greater than 15 bpm lasting more than 2 minutes but less than 10 minutes late decels lead to decreased uteroplacental oxygenated and transfer to the fetus with acidemia. which acid base imbalance - metabolic acidosis should you perform scalp stimulation during a decel - no can exaggerate response what does category 1 tracing need - baseline 110-160, moderate variability, no late or variable decels category ____ tracing, indeterminate, not predictive of abnormal fetal aid-base status, require evaluation , surveillance - 2 what category tracing? -bradycardia without absent variability -tachycardia -minimal baseline variability -absence of induced acceleration after fetal stimulation -prolonged decels -recurrent late decels with moderate variability - 2 category 3 tracings include either - absent baseline variability and recurrent late decels, recurrent variable decels, bradycardia, OR sinusoidal what tracing requires prompt evaluation and expeditious resolution - 3 what can you do for category 3 tracing - position change, discontinue tocolytics, IV fluids, oxygen how far apart the contractions are from beginning of one to beginning of the other in minutes - frequency how long the contraction lasts in seconds - duration contractions -mild, moderate, or strong- palpation or internal monitor - intensity soft or hard, palpation or internal monitor - resting tone normal uterine activity- less than or equal to____ contractions in _____ minutes averaged over a _____ minute window - 5, 10, 30 tachysystole - greater than ____ contractions in ____ minutes averaged over a _____ minute window - 5, 10, 30 is it tachysystole if it is 5 contractions? - NO moderate variability is a good sign of an adequately oxygenated baby, guarantees a ph of ____ - 7.10 there has been no change in anything with fetal monitoring except what - increase c/s rate listening with fetoscope or hand held doppler ultrasound - intermittent auscultation detects heart sounds - fetoscope detects reflected sound from heart motion - doppler detects fhr baseline detects fhr rhythm verifies presence of irregular rhythm detects increases and decreases from FHR baseline clarifies double counting or half counting by EFM - fetoscope detects fhr baseline detects fhr rhythm detects increases and decreases - doppler direct monitoring of fetal ECG indicated when continuous detection of FHR clinically necessary and not achievable by US transducer - fetal spiral electrode fetal spiral electrode requires what - ruptured membranes and 2 cm dilation when the heart rate goes up when contractions goes up, what is on the strip - moms heart rate results from mechanical limitations of the monitor, electronic interference or weak signal. appears as gaps or dots with external monitoring and irregular lines of varying lengths with a fetal scalp electrode - artifact out of herpes, hiv, placenta previa, hepatitis, what can you use the fetal spiral electrode with - hepatitis when palpating to assess uterine activity, what do you put on the maternal abdomen over the area where changes in uterine firmness is best felt (usually funds) - fingertips detects changes in shape of abdomen resulting from uterine tension - toco what does the toco detect from the uterine muscle - pressure quantitative measurement for strength of contractions and resting tone; still have to palpate - intrauterine pressure catheter what do you do an amnioinfusion for?; can be gravity or on the pump. make sure what goes in comes out - variable decels