On entering the room, the nurse sees the patient lying supine and notices that there has been abrupt slowing in the FHR to 90 bpm during the last two contractions, each episode lasting 30 seconds or less. (They start and reach maximum value in less than 30 seconds.) Mosby's Pocket Guide to Fetal Monitoring: A Multidisciplinary - eBay Early decelerations (mirror contraction, with nadir at peak of contraction, likely fetal head compression) and accelerations (FHR increase of 15 bpm or more over at least 15 seconds) may be present.2,5,7,34 No intervention is required for Category I tracings. Powered by. A baseline of less than 110 bpm is defined as bradycardia.11 Mild bradycardia (100 to 110 bpm) is associated with post-term infants and occipitoposterior position.15 Rates of less than 100 bpm may be seen in fetuses with congenital heart disease or myocardial conduction defects.15 A baseline greater than 160 bpm is defined as tachycardia11 (Online Figure B). The widespread use of continuous electronic fetal monitoring has increased operative and cesarean delivery rates without improved neonatal outcomes, but its use is appropriate in high-risk labor. 9. All Rights Reserved. A gradual decrease is defined as at least 30 seconds from the onset of the deceleration to the FHR nadir, whereas an abrupt decrease is defined as less than 30 seconds from the onset of the deceleration to the beginning of the FHR nadir.11, Early decelerations (Online Figure H) are transient, gradual decreases in FHR that are visually apparent and usually symmetric.11 They occur with and mirror the uterine contraction and seldom go below 100 bpm.11 The nadir of the deceleration occurs at the same time as the peak of the contraction. 5. Structured intermittent auscultation is a technique that employs the systematic use of a Doppler assessment of fetal heart rate (FHR) during labor at defined timed intervals (Table 1).4 It is equivalent to continuous EFM in screening for fetal compromise in low-risk patients.2,3,5 Safety in using structured intermittent auscultation is based on a nurse-to-patient ratio of 1:1 and an established technique for intermittent auscultation for each institution.4 Continuous EFM should be used when there are abnormalities in structured intermittent auscultation or for high-risk patients (Table 2).4 An admission tracing of electronic FHR in low-risk pregnancy increases intervention without improved neonatal outcomes, and routine admission tracings should not be used to determine monitoring technique.6. -Contractions started by: IV pitocin or Nipple stimulation Management includes correction of identified reversible causes. Patient information: See related handout on electronic fetal monitoring, written by the author of this article. The use of amnioinfusion for recurrent deep variable decelerations demonstrated reductions in decelerations and cesarean delivery overall. Continuous electronic fetal monitoring, compared with structured intermittent auscultation, has been shown to increase the need for cesarean delivery (number needed to harm = 56; RR = 1.63; 95% CI, 1.29 to 2.07; n = 18,861) and operative vaginal delivery (number needed to harm = 41; RR = 1.15; 95% CI, 1.01 to 1.33; n = 18,615), with no statistical decrease in fetal death or cerebral palsy.1 Continuous electronic fetal monitoring has also led to a 50% reduction in the incidence of neonatal seizure vs. structured intermittent auscultation, but this has no effect on long-term outcomes.1, Several adjuncts have been studied to overcome the high false-positive rate of continuous electronic fetal monitoring. The onset, nadir, and recovery of the deceleration usually coincide with the beginning, peak, and ending of the contraction, respectively.11 Early decelerations are nearly always benign and probably indicate head compression, which is a normal part of labor.15, Variable decelerations (Online Figure I), as the name implies, vary in terms of shape, depth, and timing in relationship to uterine contractions, but they are visually apparent, abrupt decreases in FHR.11 The decrease in FHR is at least 15 bpm and has a duration of at least 15 seconds to less than two minutes.11 Characteristics of variable decelerations include rapid descent and recovery, good baseline variability, and accelerations at the onset and at the end of the contraction (i.e., shoulders).11 When they are associated with uterine contractions, their onset, depth, and duration commonly vary with successive uterine contractions.11 Overall, variable decelerations are usually benign, and their physiologic basis is usually related to cord compression, with subsequent changes in peripheral vascular resistance or oxygenation.15 They occur especially in the second stage of labor, when cord compression is most common.15 Atypical variable decelerations may indicate fetal hypoxemia, with characteristic features that include late onset (in relation to contractions), loss of shoulders, and slow recovery.15. Initiate scalp stimulation to provoke fetal heart rate acceleration, which is a sign that the fetus is not acidotic. When you've finished these first five, here are five more. Count FHR between contractions for 60 seconds to determine average baseline rate, 6. This system can be used in conjunction with the Advanced Life Support in Obstetrics course mnemonic, DR C BRAVADO, to assist in the systematic interpretation of fetal monitoring. Subtle, shallow late decelerations can be difficult to visualize, but can be detected by holding a straight edge along the baseline. The fetal membranes must be ruptured, and the cervix must be at least partially dilated before the electrode may be placed on the fetal scalp. A nurse notes the following fetal heart rate pattern on the external fetal monitor. Study with Quizlet and memorize flashcards containing terms like The nurse is caring for a patient in labor when repetitive late decelerations are noted on the external fetal monitor. Yes, and the strip is reactive. Patient Safety, Risk Management, and Documentation 11. No. B. Reposition the patient, check blood pressure, and continue to monitor the FHR pattern. Per the practitioner's order and the patient's request, the nurse has been monitoring the fetal heart rate by IA. Bradycardia of this degree is common in post-date gestations and in fetuses with occiput posterior or transverse presentations.16 Bradycardia less than 100 bpm occurs in fetuses with congenital heart abnormalities or myocardial conduction defects, such as those occurring in conjunction with maternal collagen vascular disease.16 Moderate bradycardia of 80 to 100 bpm is a nonreassuring pattern. Your doctor will explain the steps of the procedure. C. Evaluate the patient's understanding of the monitoring methods and notify the practitioner. The perception that structured intermittent auscultation increases medicolegal risk, the lack of hospital staff trained in structured intermittent auscultation, and the economic benefit of continuous EFM from decreased use of nursing staff may promote the use of continuous EFM.8 Online Table A lists considerations in developing an institutional strategy for fetal surveillance. D. Determine the onset and end of each deceleration in relation to the onset and end of the contraction. Fetal heart rate patterns are classified as reassuring, nonreassuring or ominous. This is associated with certain maternal and fetal conditions, such as chorioamnionitis, fever, dehydration, and tachyarrhythmias. Contractions are classified as normal (no more than five contractions in a 10-minute period) or tachysystole (more than five contractions in a 10-minute period, averaged over a 30-minute window).11 Tachysystole is qualified by the presence or absence of decelerations, and it applies to spontaneous and stimulated labor. Category 1. Rate and decelerations B. The nurse's action after turning the patient to her left side should be: Applying oxygen per face mask at 8-10 L/min. T(t)=50+50cos(6t). Ominous patterns require emergency intrauterine fetal resuscitation and immediate delivery. Combine your ability to read fetal tracings with clinical management with some cases: Cases 1-5. Your doctor analyzes FHR by examining a fetal heart tracing according to baseline, variability, accelerations, and decelerations. Fetal Tracing Index. Practice Quizzes 6-10 - Electronic Fetal Monitoring. What would be an appropriate next action by the nurse? Initiate oxygen at 6 to 10 L per minute, 5. Assess maternal vital signs (temperature, blood pressure, pulse), 3. For more information on the use, interpretation and management of patients based on Fetal Heart Tracings check out the resources below. Fetal Heart Rate Tracing Flashcards | Quizlet Interpretation of intrapartum electronic fetal heart rate (FHR) tracings has been hampered by interobserver and intraobserver variability, which historically has been high [].In 2008, the American College of Obstetricians and Gynecologists (ACOG), the Society for Maternal-Fetal Medicine (SMFM), and the United States National Institute of Child Health and Human Development (NICHD . Obstetric Models and Intrapartum Fetal Monitoring in Europe NEW! Tracing patterns can and will change! The nurse's first action should be which of the following? -Fetal body movements Adequate documentation is necessary, and many institutions are now employing flow sheets (e.g., partograms), clinical pathways, or FHR tracing archival processes (in electronic records). Electronic fetal monitoring may help detect changes in normal FHR patterns during labor. Practice basic fetal tracing analysis with some quizzes: Quizzes 1-5. See permissionsforcopyrightquestions and/or permission requests. Fetal Heart tracings (FHR) Flashcards | Quizlet If the cause cannot be identified and corrected, immediate delivery is recommended. Your doctor evaluates the situation by reviewing fetal heart tracing patterns. The nurse understands that the primary intervention is to: The nurse notes that the fetal heart rate baseline is 120-130 with an increase in FHR to 145 bpm lasting 15 seconds. Auscultation of the fetal heart rate (FHR) is performed by external or internal means. 8. Theyre empowered by these results to intervene and hopefully prevent an adverse outcome. What is the baseline of the FHT? If one of the following is detected during structured intermittent auscultation for a low-risk patient, switch to continuous electronic fetal monitoring to assess the National Institute of Child Health and Human Development category and to determine necessary clinical management: Fetal tachycardia (> 160 beats per minute for > 10 minutes), Fetal bradycardia (< 110 beats per minute for > 10 minutes), Recurrent decelerations following contractions (> 50% of contractions) or prolonged deceleration (> 2 minutes but < 10 minutes). Continuous EFM reduced neonatal seizures (NNT = 661), but not the occurrence of cerebral palsy. 2023 National Certification Corporation. -Contraction Stress Test (CST), How? Tachycardia is certainly not always indicative of fetal distress or hypoxia, but this fetal tracing is ominous. B. Activate the organization's chain of command. The nurse would chart this change in baseline as which of the following? This is followed by occlusion of the umbilical artery, which results in the sharp downslope. Patient information: See related handout on intrapartum fetal monitoring, written by the authors of this article. External monitoring is performed using a hand-held Doppler ultrasound probe to auscultate and count the FHR during a uterine contraction and for 30 seconds thereafter to identify fetal response. A. Are there accelerations present? A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. While caring for a patient in active labor at 39 weeks' gestation, the nurse interprets the FHR tracing as a Category III. Accelerations (A). The normal range for baseline FHR is defined by NICHD as 110 to 160 beats per minute (bpm; Online Figure A). Electronic fetal monitoring may help detect changes in normal FHR patterns during labor. The patient's membranes ruptured 1 hour ago, and the fluid was clear. Prolonged decelerations (Online Figures K and L) last longer than two minutes, but less than 10 minutes.11 They may be caused by a number of factors, including head compression (rapid fetal descent), cord compression, or uteroplacental insufficiency. b) basalt plateau If any problems arise, reviews are done more frequently. Interventions to increase fetal activity fail, Reactive NST: You have to lie down or sit in a reclined position for the test, which lasts about 20 minutes. Remember, the baseline is the average heart rate rounded to the nearest five bpm. Non-reactive: y=4105xy=4 \times 10^{5 x}y=4105x, -Fetoscope: horn or stethoscope-like instrument, -Fetal movement decreases with low oxygen intake, -Test for fetal well-being after 28 weeks, -Any maternal or fetal condition that increases risk of "fetal demise", Reactive (Normal): Am J Obstet . None. Correlate accelerations and decelerations with uterine contractions and identify the pattern. The nurse notes that the fetal heart rate is 140-170 bpm and charts that the variability is which of the following? Self Guided Tutorial. 4. Questions and Answers 1. VEAL CHOP Nursing Mnemonic: Complete Guide - Nurseslabs The recommendations for the overall management of FHR tracings by NICHD, the International Federation of Gynecology and Obstetrics, and ACOG agree that interpretation is reproducible at the extreme ends of the fetal monitor strip spectrum.10 For example, the presence of a normal baseline rate with FHR accelerations or moderate variability predicts the absence of fetal acidemia.10,11 Bradycardia, absence of variability and accelerations, and presence of recurrent late or variable decelerations may predict current or impending fetal asphyxia.10,11 However, more than 50 percent of fetal strips fall between these two extremes, in which overall recommendations cannot be made reliably.10 In the 2008 revision of the NICHD tracing definitions, a three-category system was adopted: normal (category I), indeterminate (category II), and abnormal (category III).11 Category III tracings need intervention to resolve the abnormal tracing or to move toward expeditious delivery.11 In the ALSO course, using the DR C BRAVADO approach, the FHR tracing may be classified using the stoplight algorithm (Figure 19), which corresponds to the NICHD categories.9,11 Interventions are determined by placing the FHR tracing in the context of the specific clinical situation and corresponding NICHD category, fetal reserve, and imminence of delivery (Table 4).9,11, If the FHR tracing is normal, structured intermittent auscultation or continuous EFM techniques can be employed in a low-risk patient, although reconsideration may be necessary as labor progresses.2 If the FHR tracing is abnormal, interventions such as position changes, maternal oxygenation, and intravenous fluid administration may be used. Finally, the recovery phase is due to the relief of the compression and the sharp return to the baseline, which may be followed by another healthy brief acceleration or shoulder (Figure 8). -Reassuring for fetal well being Challenge yourself every tracing collection is FREE! d. Places the tocotransducer over the uterine fundus, An NST in which two or more fetal heart rate (FHR) accelerations of 15 beats per minute (bpm) or more occur with fetal movement in a 20-minute period is termed. Variability describes fluctuations in the baseline FHR, whether in terms of frequency, amplitude, or magnitude. -Positive Contraction Stress Test: Hasten fetal delivery. The patient is having contractions every 4 minutes, each lasting 50 seconds. With a Doppler ultrasound, for example, an ultrasound probe is fastened to your stomach. PDF Awhonn Fetal Monitoring Test Questions And Answers Pdf Copy
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