問題一覧
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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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What is tachy systole?
More than 5 contraction in 10 minutes (averaged over a 30 minute period)
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Variable decelerations ☹️:
Visually apparent abrupt ⬇️in FHR that may or may not be associated with UC
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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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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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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!
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How to measure UC frequency?
From beginning to beginning of each UC
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Variable decel shape:
V,U, or W shaped
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UC Frequency
How often is mom having contractions?, And how long? , Unit: Range in MINUTES
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Late decels ☹️
Placental insufficiency
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Etiology of marked variablity:
Fetal stimulation, drugs, mild/transient Hypoxemia
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FHT
Fetal heart tones
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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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MVUs
Montevideo units
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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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Prolonged Decel ☹️☹️☹️:
Longer than 2mins but less than 10 mins (baseline change), Interventions are POISON IS AT CVS
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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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Variable decel size:
⬇️ FHR 15 bpm lasting at least 15 seconds 15x15
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Nadir
Low point
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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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Early Decel etiology:
Head compression= vagal response
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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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Variablity is the best indicator of?
Fetal oxygenation!!
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Baseline change:
Last AT LEAST 10 mins or more!
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AFI
Amnitotic fluid index
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Early Decel Nursing interventions:
Continue to monitor, SVE PRN to evaluate imminence of delivery
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ROM/SROM/AROM
Rupture of membranes either spontaneous or artificial
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Onset to peak:
30 seconds or less= ABRUPT
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FM
Fetal movement
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Baseline is:
Average FHR rounded in increments of 5 bpm
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Acceleration 😁=
O2 reserves
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Variable decel onset:
Abrupt- onset to nadir less than 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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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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Baseline change:
Change in baseline over 10 minutes
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Early Decel timing:
Nadir of decel and peak of UC= same time (decel mirrors UC)
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UC/CTX
Uterine contraction
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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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Prolonged acceleration:
2mins-10mins
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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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Variable decels ☹️=
Cord compression
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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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Late Decel shape:
Spoon/saucer shaped
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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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ISL (internal monitor)
Internal scalp lead (FHR)
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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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mmHg
Millimeters mercury
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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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Early decels 😁=
Head compression
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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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Variable decel timing:
With or without contractions, can happen anytime commonly seen with UC
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Normal FHR?
110-160 bpm
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IUPC (internal monitor)
Intrauterine pressure catheter (UC) (in your pussy computer)
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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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Variability:
Assess overall bpm fluctuations in FHR up or down, whole strip not one event (variability in baseline)
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Etiology of acceleration:
Oxygen reserves present. Fetal movement or response to stimulus causes ⬆️in FHR
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Late Decel onset:
Graudal (insert to Nadir 30+ seconds)
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Early Decel onset:
Gradual (onset to nadir: equal to or greater than 30 seconds)
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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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FHR category’s
Category 1: Normal, Category 2: Intermediate , Category 3: Abnormal
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Late Decel ☹️☹️:
Apparent gradual ⬇️FHR and return to baseline associated with UC
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GA
Gestational age
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TOCO (external monitor)
Tocodynamometer (UC)
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FHR
Fetal heart rate
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Duration:
15 seconds-2 mins
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Peak
High point
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Variable decel etiology:
*Cord compression* any cord compression, grasp reflex, oligohydroamnios, ROM, prolapsed or nuchal cord
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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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US (external monitor)
Ultrasound (FHR)