Beruflich Dokumente
Kultur Dokumente
FALL 2009
NURSING 2111
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The electronic fetal monitor (EFM) is a device that provides a graphic display
of the fetal heart rate (FHR) and monitoring of uterine activity by digital
readout and tracing. EFM can be either external, which is noninvasive or
internal, which requires the attachment of an electrode to the presenting
fetal part. Nursing staff may routinely initiate external monitoring; initiating
the internal route is generally performed by a physician or midwife. A nurse
may also be certified in this skill. Monitoring of uterine contractile activity
can also be executed by an external or internal method.
A. External
1. Noninvasive
2. Two devices are secured to the maternal abdomen by belts and
connected to the monitoring machine.
a. Ultrasound Transducer
1. Detects fetal heart sounds
i. Water soluble conducting gel is placed on the
surface to the transducer.
ii. Transducer is placed on the maternal abdomen
where the fetal heart tones (FHT) are heard
loudest
iii. Ultrasound waves generated from this device
bounce back from the fetus.
iv. The ultrasound waves are then displayed on
the monitor paper and by digital readout.
b. Tocotransducer
1. Detects the relative strength of uterine contractions.
i. Placed over the uterine fundus and secured by a
belt.
ii. As the uterus contracts, pressure is exerted
against the transducer and is recorded.
iii. FHT and contractions pressure (intensity) cannot
be accurately recorded on obese clients or if there
are problems securing the belt.
B. Internal
1. Invasive
2. Provides the most accurate fetal heart monitoring and
monitoring of uterine pressure.
3. Two devices
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Uterine contractions occur about every 3-5 minutes with a duration of 30-60
seconds and an intensity of 40-60 mm HG (contraction intensity is measured
by mm HG only when the internal method is utilized). Uterine contractions
are assessed in the following manner
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The upper section of the chart paper is used to record the FHR by both the
external and internal modes of monitoring. The vertical scale is related to
FHR, which can be recorded between 30 and 240 beats/min (bpm). The
horizontal scale is divided into 1 millimeter sections, which are subdivided by
six sections representing 10 seconds of time. The lower section is used to
record uterine activity.
The baseline heart rate is the average rate when no contractions are
occurring. Note the baseline on the strip below. Also, note the variability of
the heart rate.
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The normal FHR is between 110 and 160 bpm. The baseline FHR is the mean
(average) FHR rounded to increments of 5-10 bpm in a 10 minute segment.
Need 2 minutes total over the entire 10 minute period to determine FHRB.
These 2 minutes do not need to be consecutive minutes! The evaluation
also must exclude periodic segments with periodic or episodic changes or
periods of marked FHR variability.
Accelerations are transient increases in FHR greater than 15 bpm for at least
15 seconds. Two accelerations in 20 minutes are considered to be a reactive
trace. Accelerations are reassuring patterns as they indicate fetal
responsiveness and the integrity of the mechanisms controlling the heart.
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F. Fetal tachycardia
G. Fetal brain damage
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Note the decreased variability of the above strip. If lasts for longer than 10
minutes this reflects a change in baseline FHR.
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FETAL TACHYCARDIA
FETAL BRADYCARDIA
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DECELERATIONS
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Early Decelerations
A. Begins at the onset of the contraction and ends at the end of the
contraction.
B. Cause of this type of deceleration is head compression and is
caused by vagal stimulation; may be prevented by avoiding
early rupture of membranes.
C. Is a reassuring pattern that is usually seen late in labor and
reinforces the fetus is moving downward in the birth canal.
D. No nursing intervention is necessary.
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Late Decelerations
A. Occurs after the peak of the contraction or late in the contraction
B. Transitory decreases in FHR caused by uteroplacental
insufficiency;
compromised blood flow to the fetus does not deliver the amount
of oxygen necessary for the fetus to withstand the stress of
labor.
C. Regardless of the depth of the deceleration, all late decals are
considered potentially ominous.
D. Persistent late decals with decreased variability lead to an
ominous pattern (fetal hypoxia). Also associated with fetal
acidosis and low Apgar scores.
E. Nursing Intervetions:
1. Place in lateral position, preferably left side.
2. Administer O2 by tight face mask
3. Discontinue oxytocin, if hyperstimulation present consider
using terbutaline 0.25 mg SC
4. Correct maternal hypotension
5. Hydrate by bolus infusion of fluid
6. If persist > 30 minutes despite above, consider fetal scalp
pH and/or emergency procedure
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Variable Decelerations
A. Shown by an acute fall in the FHR with a rapid downslope and a
variable recovery phase.
B. Variable in duration, intensity and timing. They may not bear a
constant relationship to uterine contractions. Are caused by
umbilical cord compression
C. Resemble letter “U”, “V” or “W”
D. Occur frequently in women who have PROM and decreased
amniotic fluid volume.
E. As many as 50% of all monitored fetus experience variable
decels during labor.
F. If baseline FHR remains stable and variability remains good,
these decels are not associated with poor fetal outcome.
G. Nursing Interventions:
1. Change maternal position
2. Discontinue oxytocin if associated with poor variability
3. Assist with amnioinfusion
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