A Study Guide in Fetal Surveillance

Topics: Childbirth, Pregnancy, Umbilical cord Pages: 7 (1373 words) Published: August 17, 2013
17 - Fetal Surveillance (11)

Acceleration: Reassuring
-Description/Appearance:
oRate increase of at least 15 beats/minute that lasts for a minimum of 15 seconds oRate increases often in response to fetal movement
oMay accompany contractions
-Cause:
oInteraction between sympathetic and parasympathetic nervous systems -Nursing Interventions:
oNone

Early Decelerations: Reassuring
-Description/Appearance:
oRate decrease during contraction
oOften seen in late labor when head is on perineum
oUsually FHR begins to decrease at start of contraction with lowest point of FHR corresponding with the peak of the contraction oFHR returns to baseline by end of contraction
oFHR is uniform in shape and mirrors the contraction with gradual descent and return to baseline -Cause:
oHead compression
This causes the vagus nerve to slow the HR
-Nursing Interventions:
oNone

Late Decelerations:
-Description/Appearance:
oRate decrease during contraction
oNon-reassuring if persistent
oMay occur WNL of the FHR (110-160)
oWorse if accompanied by decreased variability or tachycardia oUsually FHR does not decrease until peak of contraction
oLowest point of FHR is after the peak of the contraction
oReturn to baseline does not occur until after contraction is over oFHR is uniform in shape with gradual descent and return to baseline; May be very subtle -Cause:
oInsufficient function of the uteroplacental unit (impaired gas exchange) -Nursing Interventions:
oTurn off oxytocin, if applicable
oGive mom O2 per mask at 10L
oIncrease IV fluids
oReposition mom to (Left) side
oCall Dr
oAnticipate possible order for tocolytic

Variable Decelerations:
-Description/Appearance:
oFHR decreases; may or may not be associated with contractions oNon-reassuring if:
Occurs frequently
Takes a long time to return to baseline
Drop is very deep
oClassified as mild, moderate, or severe
oFHR decrease begins and ends abruptly
oFHR often has a “V”, “W”, or “U” shape
oFHR decrease may be very deep
-Cause:
oCompression of the umbilical cord d/t:
Nuchal cord
Prolapsed cord
Short cord
-Nursing Interventions:
oSame as for late decelerations (except administering tocolytic)

1.Implement nursing interventions based of FHR assessment.(2)

Acceleration:
-Reassuring
-No nursing interventions needed

Early Deceleration:
-Reassuring
-No nursing interventions needed

Late Deceleration:
-Non-reassuring if persistent
-Turn off oxytocin, if applicable
-Give mother O2 per mask at 10 L
-Increase IV fluids
-Reposition mother to side (left side)
-Call Dr
-May anticipate order for tocolytic

Variable Deceleration:
-Non-reassuring if occurs frequently
-Turn off oxytocin, if applicable
-Give mother O2 per mask at 10 L
-Increase IV fluids
-Reposition mother to side (left side)
-Call Dr

2.Describe nursing considerations for the use of the different fetal monitoring technology.(2) External Fetal Monitoring
-Apply belts, an adhesive ring, or other method to secure sensors -A rolled washcloth, roll of tape, etc may be used to maintain the best tracing -Use Leopold’s maneuvers to locate the fetus’s back

oBecause the FHR is best detected through the back of the fetus -Apply gel to the transducer
oBecause gel improves transmission and reception of the US waves to provide more accurate data -Place the transducer on the mom’s abdomen at about the location of the fetal back -Continuously changing numbers indicates the fluctuations of the FHR -Place the uterine activity sensor in the fundal area or the area where contractions feel the strongest when palpated oBecause the external uterine activity monitor senses the change in the abdominal contour as the uterus rotates forward with each contraction oContractions are usually strongest in the upper uterus

-When the mom has a contraction, observe...
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