fetal heart tracing quiz 10fetal heart tracing quiz 10

fetal heart tracing quiz 1030 Apr fetal heart tracing quiz 10

c. Reassure the family the finding is normal. Internal monitoring involves intravaginal placement of monitors within the uterine cavity.7 A fetal scalp electrode is recommended for fetal heart monitoring when fetal position and/or maternal habitus make external monitoring suboptimal.4 External monitors measure only contraction frequency, but an intrauterine pressure catheter can also determine the strength of contractions.13 Placement of an intrauterine pressure catheter or fetal scalp electrode requires cervical dilation and amniotomy, which can increase the risk of intrauterine infection, fetal injury, and the transmission of herpes simplex virus and hepatitis B or C.4,13, Structured intermittent auscultation is a fetal monitoring option for detecting fetal acidosis in low-risk pregnancies.7,14,15 Typically, the labor nurse auscultates the fetal heartbeat with a handheld Doppler device (Table 1).7,1417 Structured intermittent auscultation is not standard practice in the United States because of 1:1 nursing staff requirements and physician oversight concerns, whereas continuous electronic fetal monitoring can be monitored centrally with continuous recording capabilities.7,1418, Despite these challenges, structured intermittent auscultation should be considered for low-risk labor because it statistically decreases cesarean and operative vaginal delivery rates without an increase in unfavorable outcomes associated with continuous monitor use and a high false-positive rate.1,7,14,16,17 Compared with women who receive structured intermittent auscultation, those who receive continuous electronic fetal monitoring for an initial 20-minute period at admission are at increased risk of continuing use for the duration of their labor (relative risk [RR] = 1.30; 95% CI, 1.14 to 1.48; n = 10,753) and a possible 20% increased rate of cesarean delivery.19. This content is owned by the AAFP. C. Evaluate the patient's understanding of the monitoring methods and notify the practitioner. Continuous electronic fetal monitoring is the continuous monitoring of fluctuations of the fetal heart rate (FHR) in relation to maternal contractions and is considered standard practice during active labor.13 Continuous electronic fetal monitoring was developed for widespread use in the 1970s as a screening test for fetal hypoxia/acidosis during labor, specifically to reduce hypoxic-ischemic encephalopathy, cerebral palsy, and fetal death.13, Fetal acidemia (pH < 7.15) is most accurately diagnosed via umbilical cord arterial sampling immediately after delivery.46 Because fetal acidosis can affect autonomic control and therefore variability of FHR, continuous electronic fetal monitoring is considered a surrogate marker for measurement.2,7 However, the very low prevalence of cerebral palsy (antepartum events are most likely causative agents), hypoxic-ischemic encephalopathy, and fetal death has led to a false-positive rate of 99%3 for continuous electronic fetal monitoring and a low predictive value.810 Additionally, continuous electronic fetal monitoring is falsely positive for fetal acidosis two-thirds of the time, with low sensitivity (57%) and specificity (69%).1,3 Furthermore, user variability in interpretation is high, with agreement between experts only half the time.11,12, Continuous electronic fetal monitoring includes external and internal monitoring.7 External monitoring involves placement of two monitors (one for FHR and the other for contractions) against the maternal abdomen. 5. electronic fetal heart monitoring trivia quiz questions web mar 22 2022 questions and answers 1 according to awhonn the normal baseline fetal heart rate fhr is a 90 150 -4: Suspect lack of adequate oxygen, If >36 wks: deliver, If < 36 wks: Lung Maturity Test In the United States, an estimated 700 infant deaths per year are associated with intrauterine hypoxia and birth asphyxia.5 Another benefit of EFM includes closer assessment of high-risk mothers. -6:Suspect lack of adequate oxygen, Repeat BPP in 24 hours & deliver if <= 6 Category II tracing abnormalities can be addressed by treating reversible causes and providing intrauterine resuscitation, which includes stopping uterine-stimulating agents, fetal scalp stimulation and/or maternal repositioning, intravenous fluids, or oxygen. All Rights Reserved. Electronic fetal monitoring is performed in a hospital or doctors office. Recurrent deep variable decelerations can be corrected with amnioinfusion. 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. Powered by. Powered by. Sketch or describe how the Initiate scalp stimulation to provoke fetal heart rate acceleration, which is a sign that the fetus is not acidotic. 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. When continuous EFM tracing is indeterminate, fetal scalp pH sampling or fetal stimulation may be used to assess for the possible presence of fetal acidemia.5 Fetal scalp pH testing is no longer commonly performed in the United States and has been replaced with fetal stimulation or immediate delivery (by operative vaginal delivery or cesarean delivery). Gene amplification in cancer cells has been shown to lead to resistance to cancer-killing medications when the dose of medication is increased gradually. Patient information: See related handout on electronic fetal monitoring, written by the author of this article. -Fetal muscle tone Variable decelerations associated with a nonreassuring pattern, Late decelerations with preserved beat-to-beat variability, Persistent late decelerations with loss of beat-to-beat variability, Nonreassuring variable decelerations associated with loss of beat-to-beat variability, Confirmed loss of beat-to-beat variability not associated with fetal quiescence, medications or severe prematurity, Administer oxygen through a tight-fitting face mask, Change maternal position (lateral or knee-chest), Administer fluid bolus (lactated Ringer's solution), Perform a vaginal examination and fetal scalp stimulation, When possible, determine and correct the cause of the pattern, Consider tocolysis (for uterine tetany or hyperstimulation), Consider amnioinfusion (for variable decelerations), Determine whether operative intervention is warranted and, if so, how urgently it is needed, A blunt acceleration or overshoot after severe deceleration, Late decelerations or late return to baseline (. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. 150 155 160 Fetal Assessment in Non-Obstetric Settings 9. Your obstetrician reviews the fetal heart tracing at regular time intervals. Category II tracings are indeterminate, are present in the majority of laboring patients, and can encompass monitoring predictive of clinically normal to rapidly developing acidosis. Which nursing intervention is necessary before a second trimester transabdominal ultrasound? 4. Tachycardia is considered mild when the heart rate is 160 to 180 bpm and severe when greater than 180 bpm. Although continuous EFM remains the preferred method for fetal monitoring, the following methodologies are active areas of research in enhancing continuous EFM or developing newer methodologies for fetal well-being during labor. While caring for a patient in active labor at 39 weeks' gestation, the nurse interprets the FHR tracing as a Category III. Table 4 lists recommended emergency interventions for nonreassuring patterns.4,14 These interventions should also be considered for ominous patterns while preparations for immediate delivery are initiated. Non-reactive: Suppose the 4040 \Omega40 resistance in the distribution circuit is replaced by a 2020 \Omega20 resistance. The FHR normally exhibits variability, with an average change of 6 to 25 bpm of the baseline rate, and is linked to the fetal central nervous system. 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. Variability (V; Online Table B). 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). Give intravenous fluids if not already administered; consider bolus, 7. The nurse understands that that if the woman has hypotension the fetal monitor tracing would indicate which of the following? May 2, 2022. A nurse is teaching a woman how to do "kick counts." See permissionsforcopyrightquestions and/or permission requests. T(t)=50+50cos(6t).T(t)=50+50 \cos \left(\frac{\pi}{6} t\right) . If the new rate is below 110 BPM, the pattern is considered a bradycardia. distribution of tributaries influences Patient information: See related handout on intrapartum fetal monitoring, written by the authors of this article. Correct. The number of migratory animals (in hundreds) counted at a certain checkpoint is given by. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. -2 points for each normal, 0 for abnormal, -8-10: Normal result ,Repeat BPP weekly No. Fetal heart tracing is also useful for eliminating unnecessary treatments. 140 145 150 155 160 2. 2. The nurse has no other patients to care for at this time. Beta-adrenergic agonists used to inhibit labor, such as ritodrine (Yutopar) and terbutaline (Bricanyl), may cause a decrease in variability only if given at dosage levels sufficient to raise the fetal heart rate above 160 bpm.19 Uncomplicated loss of variability usually signifies no risk or a minimally increased risk of acidosis19,20 or low Apgar scores.21 Decreased FHR variability in combination with late or variable deceleration patterns indicates an increased risk of fetal preacidosis (pH 7.20 to 7.25) or acidosis (pH less than 7.20)19,20,22 and signifies that the infant will be depressed at birth.21 The combination of late or severe variable decelerations with loss of variability is particularly ominous.19 The occurrence of a late or worsening variable deceleration pattern in the presence of normal variability generally means that the fetal stress is either of a mild degree or of recent origin19; however, this pattern is considered nonreassuring. The patient's membranes ruptured 1 hour ago, and the fluid was clear. 1. The patient is having contractions every 4 minutes, each lasting 50 seconds. 5. A student nurse is placing a tocotransducer on a woman for electronic fetal monitoring. One benefit of EFM is to detect early fetal distress resulting from fetal hypoxia and metabolic acidosis. Recurrent variable decelerations are frequently seen in association with maternal expulsive efforts in the 2nd stage of labor. An acceleration pattern preceding or following a variable deceleration (the shoulders of the deceleration) is seen only when the fetus is not hypoxic.15 Accelerations are the basis for the nonstress test (NST). 5 contractions in 10 minutes averaged over thirty minutes Continuous electronic fetal monitoring is the continuous monitoring of fluctuations of the fetal heart rate (FHR) in relation to maternal contractions and is considered standard practice. 2. Scroll down for another when you're done. 90-150 bpm B. 4. Normal. Strongly Predictive of normal acid-base status at the time of observation. Thus, it has the characteristic mirror image of the contraction (Figure 5). This type of deceleration has a uniform shape, with a slow onset that coincides with the start of the contraction and a slow return to the baseline that coincides with the end of the contraction. AMIR SWEHA, M.D., TREVOR W. HACKER, M.D., AND JIM NUOVO, M.D. The nurse is reviewing a non-stress test (NST) and notes the following: FHR baseline of 120-130 bpm with increase in FHR noted to 150 for 15 seconds and an increase of FHR noted to 135 for 10 seconds over a 20 minute time frame. -Reassuring for fetal well being A.>6 contractions in 10 minutes averaged over twenty minutes B. If the cause cannot be identified and corrected, immediate delivery is recommended. Tracing patterns can and will change! It involves using an electronic fetal monitor that records the fetal heart rate and the frequency and duration of uterine contractions. Early. (f) Comment on the agreement between the answers to parts (a) and (e). Because these events have a low prevalence, continuous electronic fetal monitoring has a false-positive rate of 99%. Most patients who undergo internal fetal monitoring during labor accept monitoring as a positive experience.6. The National Institute of Child Health and Human Development terminology is used when reviewing continuous electronic fetal monitoring and delineates fetal risk by three categories. -Moderate FHR variability. Identify changes in the FHR recording over time, if possible. Contraction Stress Test (CST) Additionally, an Apgar score of less than 7 at five minutes, low cord arterial pH (less than 7.20), and neonatal and maternal hospital stays greater than three days were reduced.22, Tocolytic agents such as terbutaline (formerly Brethine) may be used to transiently stop contractions, with the understanding that administration of these agents improved FHR tracings compared with untreated control groups, but there were no improvements in neonatal outcomes.23 A recent study showed a significant effect of maternal oxygen on increasing fetal oxygen in abnormal FHR patterns.24. What is the baseline of the FHT? -No late or variable decelerations. The purpose of initiating contractions in a CST is to. Copyright 1999 by the American Academy of Family Physicians.

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