RELIAS - FETAL HEART MONITORING EXAM QUESTIONS WITH COMPLETE SOLUTIONS GUARANTEED PASS., Exams of Nursing

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RELIAS - FETAL HEART MONITORING EXAM QUESTIONS WITH COMPLETE SOLUTIONS GUARANTEED PASS Uterine blood supply - ANSWER - >- uterine arteries deliver oxygenated blood to spiral arteries which bring oxygen rich blood to intervillous space of placenta that has fetal capillaries

• fetal capillaries carry the O2 rich blood to umbilical VEIN that goes to fetus
• in contrast, the umbilical ARTERIES return waste products to that intervillous space that go into mother's venous system Potential issues that negatively affect fetal oxygenation - ANSWER - >Maternal Oxygenation: asthma, hyper- or hypo- ventilation Maternal Circulation: decreased maternal cardiac output, hypotension, decreased Hgb Placental O2 and CO2 Exchange: postterm, abruption, HTN, hypotension, uterine tachysystole

Fetal circulation: cord compression or occlusion Fetal hypoxemia - ANSWER - >- can occur d/t reduced fetal O2 reserves, excessive uterine activity, or reduced uteroplacental blood flow

• worsening fetal hypoxemia can lead to abnormal FHR patterns, mostly minimal or absent variability from acidemia (1) hypoxemia vs. (2) hypoxia - ANSWER - > 1 - reduce O2 in blood 2 - reduced O2 delivery at tissue level Fetal anaerobic metabolism - ANSWER - >- occurs when long term O2 delivery is insufficient to meet cellular needs of tissues
• results in production of lactic acid and other noncarbonic acids

~ they are equivalent and terms are used interchangeably ~ fetal acidosis - ANSWER - >- when O2 is decreased to fetus, tissue hypoxia results in acidosis, which then shows a drop in pH, a loss of bicarb, and increase in base deficit acidemia - ANSWER - >assoc w/ widespread, deleterious effects on vital organ and body function fetal hypoxia during birth - ANSWER - >assoc w/ neonatal depression, low apgars, neonatal encephalopathy, and cerebral palsy respiratory acidosis - ANSWER - >low pH (< 7.10), high pCO2 (> 60), normal base deficit ( < 12)

• increase of pCO2 for fetus that lowers pH but doesn't affect base deficit factors that contribute to resp acidosis - ANSWER -

• sudden decrease in placental or cord perfusion

• uterine tachysystole
• maternal hypoventilation metabolic acidosis - ANSWER - >ph < 7.10 , normal pCO2 (<60), high base deficit (>12)
• a higher base deficit (such as > 12) has been assoc w/higher risk for severe neonatal complications
• most common cause of metabolic acidosis in fetus is r/t inadequate O2 delivery
• prolonged hypoxic insult to fetus results in depletion of bicarb, which is a base buffer that normalizes pH levels mixed acidosis - ANSWER - >*pH < 7.10 , high pCO

60, and high base deficit >12*

• may develop when resp acidosis persists for a prolonged period of time

pCO2 33- 50 base excess - 1 to - 8 factors for neonatal encephalopathy or cerebral palsy - ANSWER - >Data shows that intrapartum hypoxia-ischemia is rarely sole significant contributing factor for this Other contributing factors include:

• infection
• prolonged intermittent hypoxia assoc w/subcortical and cortical or preventricular damage
• acute total or near total hypoxia is assoc w/damage to midbrain and brainstem low pH in newborns - ANSWER - >- no absolute fetal arterial pH threshold assoc w/harm in all newborns
• typically if pH is < 7.10 that is used to determine acidosis and if the pH is < 7 then that is associated w/ low apgars, early neonatal seizues, and neonatal deaths

prolonged intermittent hypoxia is assoc w/ - ANSWER - >subcortical and cortical (term) or perventricular (preterm) damage acute total or near total hypoxia is assoc w/damage to - ANSWER - >midbrain and brainstem fetal hypoxemia can occur under the following conditions - ANSWER - >- excessive uterine contractions

• prolonged contractions without adequate resting tone or duration between contractions
• abnormal uterine physiology or anatomy is present
• separation of placenta and uterus (recurrent late, variable, or prolonged decels suggest this) Risk factors for late decels - ANSWER -

Uteroplacental factors:

• tachysystole
• post term
• placental abruption

Maternal factors:

• positioning risk factors for prolonged decels - ANSWER -

Uteroplacental:

• excessive activity
• uterine rupture
• abnormal placentation
• hypertonic/prolonged contractions
• hypoperfusion Fetal factors:
• OP position
• vagal stimulation d/t head compression and or rapid descent
• cord compression
• hypoxia
• acute fetal hemorrhage Maternal:
• hypotension; acute hypoxia

maternal factors for prolonged decels - ANSWER - >- supine position

• hypotension
• resp or cardiac arrest
• seizures FHR features of normal fetal acid base status - ANSWER - >presence of moderate variability and FHR accelerations are both strong indicators of absence of fetal acidemia moderate FHR variability - ANSWER - >- amplitude 6 to 25 bpm
• represents well oxygenated, nonacidemic accelerations - ANSWER - >for 32+ wks gestation it is a 15 by 15 accel before 32 wks: 10x prolonged is lasting 2+ mins and < 10 mins (if longer, bsl change)

decels then hypoxia and evolving acidemia should be assumed hypoxic causes for minimal variability - ANSWER - >- placental abruption

• excessive uterine activity
• fetal hypoxemia ^ less common and usually require immediate resolution or intervention nonhypoxic causes of minimal variability - ANSWER

• • extreme preterm ( < 28 wks)

• fetal sleep cycle
• fetal tachycardia
• fetal anomalies (esp CNS) or previous neurologic insult
• meds ^causes are more common and less acute, immediate resolution is not always required Fetal scalp electrode requires - ANSWER - >- adequate cervical dilation

• rupture membranes
• presentation of appropriate fetal part (head) risks of FSE - ANSWER - >- infection: maternal and fetal
• increased risk for fetal hemorrhage or injury FSE is contraindicated in these circumstances - ANSWER - >- fetal presentation of face, fontanelles, genitalia
• presence of maternal blood borne infection (HIV, hep)
• placental previa
• undx vaginal bleeding FHR tachycardia definition - ANSWER - >- bsl range

160 bpm

• variability often decreased or absent
• characteristic that falls into cat 2 pattern regardless of variability or accels causes for tachycardia - ANSWER - >maternal fever intraamniotic infection

• thought to be benign d/t head compression
• most commonly seen when cervix i 4 to 6 cm dilated, when transient, and resolve w/progession of labor
• may also be seen in early labor when fetus is in breech overview of late decels - ANSWER - >- gradual onset to nadir (> 30 s) and shallow depth of decel
• onset, nadir, and recovery are delayed r/t time of contraction
• often assoc w/ fetal hypxoemia
• cat 2 strip causes of late decels - ANSWER - >- uterine tachysystole
• maternal hypotension
• placental abruption

• severe maternal anemia variable decels - ANSWER - >- abrupt (< 30 s from onsent to nadir).
• depth usually greater than early or late decel
• 15 bpm or greater decel from bsl, lasts at least 15 sec but less than 2 min
• if recurrent then cat 2 tracing causes of variable decels - ANSWER - >- cord compression may be d/t

oligo (in early labor or after ROM) during descent of presenting part d/t stretching of nuchal or short cord cord prolapse unusual issue like knot, short cord, tangle, occult prolapse

• abnormalities in variability: minimal or absent without recurrent variable, late or prolonged decels
• presence of intermittent variable or late decels with any variability
• prolonged decel *tachysystole is not a consideration but may be a cause cat 3 tracing - ANSWER - >patterns include:
• absent variability w/recurrent late decels
• recurrent variable decels
• bradycardia
• sinusoidal fhr minimal variability - ANSWER - >- may be assoc w/fetal hypoxia although other more benign factors may be responsible such as sleep cyce or meds (terb, mag, parenteral narcotics)

absent variability - ANSWER - >- if there are recurrent or late decels w/absent variability that equals cat 3 strip

• if absent variability without recurrent variable or late decels that is a cat 2 tracing but does require prompt eval and surveillance management of late fhr decels - ANSWER - >- maternal repositioning
• IV fluid bolus
• O
• tocolysis (in situations where decels persist, accels are absent, minimal or absent variability then immediate delivery should be considered) management of variable fhr decels - ANSWER - >- maternal repositioning
• amnioinfusion tachysystole - ANSWER - >more than 5 contractions in 10 minutes