問題一覧
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FHT
Fetal heart tones
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mmHg
Millimeters mercury
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MVUs
Montevideo units
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UC/CTX
Uterine contraction
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GA
Gestational age
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FM
Fetal movement
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Nadir
Low point
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Peak
High point
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ROM/SROM/AROM
Rupture of membranes either spontaneous or artificial
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AFI
Amnitotic fluid index
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US (external monitor)
Ultrasound (FHR)
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TOCO (external monitor)
Tocodynamometer (UC)
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IUPC (internal monitor)
Intrauterine pressure catheter (UC) (in your pussy computer)
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ISL (internal monitor)
Internal scalp lead (FHR)
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FHR
Fetal heart rate
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Normal FHR?
110-160 bpm
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Leopoldo’s Maneuver is done to determine placement of external monitors. Where should the US be placed for FHR?
Over baby’s left shoulder is technically the best spot, so on the smooth side not the bumpy side.
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What do the x and y axis represent on EFM strips?
X-is always time Y-is either FHR or mmHg which is uterine pressure
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Baseline is:
Average FHR rounded in increments of 5 bpm
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Where to assess baseline:
Ignore increases and decreases, must have at least 2 mins of EFM (not consecutive) to determine baseline
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Baseline change:
Change in baseline over 10 minutes
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Etiology of Bradycarida:
Hypoxemia, drugs, maternal ⬇️ BP, hypothermia, maternal hypoglycemia, fetal arrhythmias, complete/congenital heart block, umbilical cord compresssion, amniotic fluid embolism or normal variation
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Etiology of tachycardia:
Maternal fever (infection), chorioamnionitis, fetal sepsis, drugs, fetal hypoxemia, arrhythmias, fetal heart failure, severe fetal anemia, fetal hydrops or maternal hyperthyroid
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Variability:
Assess overall bpm fluctuations in FHR up or down, whole strip not one event (variability in baseline)
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Variability:
Absent- 0 bpm fluctuation (line will literally look. straight pretty much), Minimal- 1-5 bpm fluctuation , Moderate- 6-25 bpm fluctuation , Marked- Over 26 bpm fluctuation, Sinusoidal- visually apparent, smooth THIS IS AN EMERGENCY!
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Variablity:
Refelects an intact nervous system with functioning parasympathetic (FHR decrease), and sympathetic (FHR increase) nerve pathways
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Where to assess variability:
Ignore increases and decreases Must have at least 2 mins of EFM to determine variability
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Etiology of decreased variablility:
Hypoxemia/acidosis, fetal sleep cycles, drugs, prematurity, arrhythmias, fetal tachycardia, preexisting neurobiological abnormality or congenital anomalies
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Etiology of marked variablity:
Fetal stimulation, drugs, mild/transient Hypoxemia
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Variablity is the best indicator of?
Fetal oxygenation!!
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Accelerations
Vissually apparent abrupt 15 bpm x 15 sec⬆️ in FHR above baseline (for over 32 weeks its 15x15 which is all we are worried about rn)
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Onset to peak:
30 seconds or less= ABRUPT
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Duration:
15 seconds-2 mins
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Prolonged acceleration:
2mins-10mins
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Baseline change:
Last AT LEAST 10 mins or more!
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Etiology of acceleration:
Oxygen reserves present. Fetal movement or response to stimulus causes ⬆️in FHR
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Ways to illicit acceleration:
Fetal scalp stimulation, sounds, vibroacustic stimulation, drinking cold water, juice, eating a meal, maternal belly movement or repositioning
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Decelerations:
Variable ☹️, Early 😁, Late☹️☹️, Prolonged ☹️☹️☹️
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Variable decelerations ☹️:
Visually apparent abrupt ⬇️in FHR that may or may not be associated with UC
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Variable decel shape:
V,U, or W shaped
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Variable decel onset:
Abrupt- onset to nadir less than 30 seconds
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Variable decel timing:
With or without contractions, can happen anytime commonly seen with UC
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Variable decel size:
⬇️ FHR 15 bpm lasting at least 15 seconds 15x15
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Variable decel etiology:
*Cord compression* any cord compression, grasp reflex, oligohydroamnios, ROM, prolapsed or nuchal cord
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Early Decel 😁:
Apparent gradual ⬇️FHR and return to baseline with UC
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Early Decel shape:
Spoon or saucer shaped
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Early Decel onset:
Gradual (onset to nadir: equal to or greater than 30 seconds)
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Early Decel timing:
Nadir of decel and peak of UC= same time (decel mirrors UC)
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Early Decel etiology:
Head compression= vagal response
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Early Decel Nursing interventions:
Continue to monitor, SVE PRN to evaluate imminence of delivery
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Late Decel ☹️☹️:
Apparent gradual ⬇️FHR and return to baseline associated with UC
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Late Decel shape:
Spoon/saucer shaped
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Late Decel onset:
Graudal (insert to Nadir 30+ seconds)
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Late Decel timing:
Arrives late (does not mirror UC)= Nadir of decel is after peak of UC
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Late Decel Etiology:
Utero-placental insufficiency= Perfusion problems Uterine hyperactivity, maternal hypotension, maternal HTN, abruption, preiva, IUGR, DM, chorioamnionitis, post term gestation, maternal anemia, SS anemia, RH isoimmunization, cardiac disease or smoking, all bad basically
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Late Decel nursing interventions:
Increase perfusion and oxygenation through positioning, IVF blouse, O2, disease mgmt, evaluate oxytocin use, etc
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Prolonged Decel ☹️☹️☹️:
Longer than 2mins but less than 10 mins (baseline change), Interventions are POISON IS AT CVS
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Frequency
Intermittent: occurring with less than 50% of contractions , Reccurrent: occurring with more than 50% of contractions
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UC Frequency
How often is mom having contractions?, And how long? , Unit: Range in MINUTES
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How to measure UC frequency?
From beginning to beginning of each UC
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What is tachy systole?
More than 5 contraction in 10 minutes (averaged over a 30 minute period)
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UC Duration: How long do contractions last?
Unit: Range in SECONDS (50-110), Measurement: From beginning of one UC to the end of the same UC , UC length: must be at least 40 seconds to be considered a UC, Uterine irritability: increase in uterine activity that lasts less time than 40 seconds
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FHR category’s
Category 1: Normal, Category 2: Intermediate , Category 3: Abnormal
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FHR category 1😁: Normal
Strongly predictive of normal acid-base status at the time of observation , Must have baseline FHR of 110-160 bpm with moderate variablility , May have (present or absent): Accelerations & earl decelerations , Can’t have: No late, variable or prolonged decelerations
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FHR Category 3 ☹️: Abnormal
Predicitve of fetal acid-base status at time of observation. Depending on the. clinical situation, efforts to expeditiously resolve the underlying cause of the abnormal heart rate should be made, Etiher: Sinusoidal pattern or absent variablity PLUS one of the following: Reccurrent late decals Recurrent variable decels Bradycardia , *Take a moment to read and understand*
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Select VEAL CHOP in order! Remember the letters of the two coincide V-C E-H A-O L-P
Variable Deceleration ☹️, Early Deceleration 😁, Acceleration 😁, Late Deceleration ☹️, Cord compression , Head compression , O2 reserves (baby is active), Placental insufficiency
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Variable decels ☹️=
Cord compression
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Early decels 😁=
Head compression
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Acceleration 😁=
O2 reserves
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Late decels ☹️
Placental insufficiency
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Select POISON IS AT CVS in order!
Position change , Oxytocin off (for late decels), IVF bolus (moms BP low), SVE , O2, Notify provider , Internal monitors , Support maternal coping , Amnioinfusion , Terbutaline , C/S or SVD, Vital signs, Staff help!