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92 Cards in this Set
- Front
- Back
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2 devices used to externally monitor the fetus |
TOCO and ultrasound transducer |
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where is the TOCO placed and what does it read |
on the funds and it reads uterine activity |
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where is the ultrasound transducer placed and what does it read |
placed in the lower abdomen and it reads infant's heart rate |
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what 4 things does fetal monitoring tell |
-fetal oxygen -acid/base status of the infant -ability of CNS to regulate FHR -prevent hypoxia/asphyxia |
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normal fetal heart rate |
110-160 |
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what happens to the fetus without oxygen |
brain damage |
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the most crucial part of the uterus? |
the funds |
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what does the funds do during labor |
contracts |
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7 consequences of hypoxia/asphyxia |
1. cerebral palsy 2. mental retardation 3. epilepsy 4. RDS (respiratory distress syndrome) 5. renal damage 6. NEC (necrotizing enterocolitis) 7. chronic brain impairment (permanent brain damage) |
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what happens after lack of perfusion to the kidney... |
...lack of oxygen... leads to ischemia... leads to necrosis... leads to permanent damage |
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what is exsanguinate |
lose all the blood |
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how long will it take for a mother to completely hemorrhage |
4-5 minutes
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what does every patient get during labor? |
pitocin |
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what does pitocin do in labor |
contracts the uterus to close it |
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how many ml's go to the placenta per minute |
500-1000 mls
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which device gets ultrasound jelly |
ultrasound transducer |
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FSE |
fetal scalp electrode |
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IUPC |
intrauterine pressure catheter |
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what 2 things need to happen before using a FSE or IUPS |
-dilated to atleast a 3 -bag of water must be broken
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what does the IUPC read |
pressure (reads the contraction internally) |
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when is FSE contraindicated |
with HIV |
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when do you use internal monitoring |
if external monitoring isn't working |
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what does the FSE readq |
internal heart monitor |
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what administers the IUPC |
doctor only
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two internal monitoring devices |
IUPC & FSE |
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2 external monitoring devices |
TOCO & ultrasound device |
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what does a TOCO do |
reads the tracing of a contraction but can not tell how strong a contraction is |
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what device can tell how strong a contraction is? |
IUPC |
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how does the nurse assess the strength of a contraction |
subjectively by palpating the funds |
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a mild contraction feels like... |
the tip of the nose |
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a moderate contraction feels like... |
the chin |
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a strong contraction feels like... |
the forehead |
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where will you feel a mild, moderate, or strong contraction |
at the funds |
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the top line of the fetal monitor strip displays what? |
the fetal heart rate |
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the bottom line of the fetal monitor strip displays what? |
represents contractions |
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normal uterine resting tone score = |
20 |
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how do you measure the duration of a contraction |
from the beginning to the end of one contraction |
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how do you measure the frequency of contractions? |
beginning of one contraction to the beginning of the next contraction |
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when is the baby not being perfused? |
during the most intense part of the contraction |
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how do you administer piton? |
start low and go slow |
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normal blood sugar |
40-80 |
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what are 3 important components of the Fetal Heart Monitor strip? |
1. baseline heart rate 2. variability 3. periodic changes |
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atony? |
flacid |
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tetany |
contraction with no relaxation |
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what happens with too much tetany? |
causes the uterus to rupture & kill baby & possibly mom |
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2 different types of periodic changes |
accelerations & decelerations |
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what are accelerations and are they good or bad |
increases in fetal heart rate & they're good |
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what does the baseline heart rate tell? |
if it's normal, bradycardia, or tachycardia |
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what is variability |
the squigglyness of the line |
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what are decelerations? |
decreases in fetal heart rate |
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3 types of decelerations |
1. early (benign) 2. late (ominous) 3. variable (ominous)
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what causes variability
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cord compression |
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baseline FHR |
110-160 |
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fetal tachycardia |
>160 for >10 min |
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fetal bradycardia |
<110 for >10 min |
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is tachycardia or bradycardia worrisome and why? |
bradycardia and it means the child is losing his fight with life
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variability is the best indicator of what? |
fetal well being |
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are accelerations good or bad |
good. they mean the baby is responding to something
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what are transient increases above FHR baseline from? |
-fetal movements -contractons -accelerations are positive and reassuring |
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what are early decelerations? |
when baby's heart rate mirrors contractions |
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what are early decelerations |
-gradual onset before peak of contraction -return to baseline before end of contraction -uniform shape; similar to one another -not associated with hypoxia or acidosis
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what causes early decelerations? |
- head compression which causes increased ICP and vagal nerve stimulation w an accompanying decrease in FHR
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early decelerations may indicate what? |
CPD - cephalo-pelvic disproportion (the baby's head is too big to get thru the birth canal)
pt usually needs a c-section |
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variable decelerations are associated with what? |
cord compression |
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what "shapes" are variable decelerations? and what do they vary in? |
U or V or W - they vary in duration, timing, depth, |
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interventions for variable decelerations? |
-position change -vaginal exam to R/O prolapse cord -stop oxytocin -anticipate amnioinfusion -notify MD |
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try interventions for how long before calling doc? |
10 minutes |
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what do contractions do to the baby? |
decrease oxygen availability |
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#1 intervention for variable decelerations |
change position |
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why would you give an amnioinfusion? |
1. effective for replacing diminished amniotic fluid levels (helps prevent cord compression) 2. procedure also helps dilute/flush meconium-stained amniotic fluid |
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how is an amnioinfusion administered? how much is given? |
administered by an IUPC usually 500 ml |
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why would muconium be in the amniotic sac and what does it mean? |
the baby stooled and is at risk for aspiration. He stooled because the anal sphincter relaxed due to an episode of hypoxia.
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if baby does stool in utero what do you do? |
amnioinfusion of warmed NS to dilute the muconium |
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when do late decelerations happen? |
heart rate drops after the contraction |
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what are late decelerations? |
-decent of FHR begins after the contraction -delayed onset. also delayed return to fetal baseline HR after contraction ends. -late recovery |
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what causes late decelerations? |
utero-placental insufficiency |
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interventions for late decelerations |
-lateral positioning -stop oxytocin (to increase perfusion) -oxygen (to increase perfusion) -fluid bolus of LR (increase fetal perfusion) -notify MD (esp if placental abruption) -anticipate expedient delivery |
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how do you apply oxygen with late decelerations |
8-10 L by mask (not nasal cannula)
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what causes utero-placental insufficiency? |
-rupture -HTN (vasoconstriction) -preeclampsia (cardinal vasoconstriction) -positioning (smashed aorta & vena cava) |
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what meds would be a critical drip? |
heparin or insulin. it's always the piggy back and not the main infusion the main infusion would be the NS |
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can decelerations be within the normal range |
yes |
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what type of deceleration would you see with a knot in the cord? |
variable deceleration |
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what are the categories of fetal heart rate patterns? |
category I: normal category II: indeterminate category III: abnormal |
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what does a category II FHR mean? |
something is not quite right |
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a category II FHR shows what |
tachycardia bradycardia without absent variability minimal variability absence of accelerations after stimulation prolonged deceleration > 2 min but < 10 *possible acid/base imbalance |
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category III FHR shows... |
-sinusoidal patter -absent variability with recurrent late decelerations -recurrent variable decelerations -bradycardia |
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an abnormal (category III) FHR is definitive of... |
an acid/base imbalance |
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late decelerations are due to... |
not enough perfusion to the placenta |
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early decelerations are due to ... |
contractions |
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variable decelerations are due to... |
cord compressions |
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VEAL CHOP |
V= variable C=cord compression E=early decel H=head compression A=accelerations O=ok L=late decel P=placental insufficiency |
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compare all decelerations to what |
the baseline heart rate |
