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11 Cards in this Set
- Front
- Back
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how is fetal heart rate monitored? what are the two ways of monitoring fetal heart rate. |
fetal heart rate can be monitored in various ways such as using a doppler/fetoscope intermittently or external/internal fetal monitoring for continuous monitoring. *EXTERNAL FETAL MONITORING IS USED FOR HIGH RISK WOMAN* |
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what are the guidelines pertaining to assessing fetal heart rate? |
when a laboring mother comes in initially, she is put on a continuous fetal monitoring system for the first 10-20 minutes in order to determine baseline fetal heart rate. assessing fetal heart rate intermittently: during active labor: low-risk women q30 minute and high risk women q15 minutes. 2nd stage of labor: low-risk women q15 minutes and high risk women q5 minutes. |
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what is baseline fetal heart rate? what is normal fetal heart rate? what is the heart rate for fetal tachycardia? what is the heart rate for fetal bradycardia? what are causes of fetal bradycardia and tachycardia? |
baseline fetal heart rate is obtained during the initial assessment of the fetal heart rate. this obtained within the first 10-20 on a continuous monitoring system. normal fetal heart rate: 110-160bpm fetal tachycardia: >160bpm over 10 minutes fetal bradycardia: <110bpm over 10 minutes causes of fetal tachycardia: maternal fever, fetal hypoxia, maternal dehydration, amnionitis, drugs (cocaine, nicotine, amphetamines) causes of fetal bradycardia: fetal hypoxia, epidural, fetal acidosis, prolonged maternal hypoglycemia or hypotension |
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what does variability mean? what are the categories of variability? |
variability: is the fluctuation of beats on the baseline of the fetal heart rate (the up and down ridges). it measures the amplitude of peak to trough in bpm. it represents interplay between parasympathetic and sympathetic. categories of variability: absent: undetectable (cannot measure the amplitude). there is no variability. THIS IS BAD. minimal: fluctuation range < 5bpm. THIS IS CAUSED BY UTEROPLACENTAL INSUFFICIENCY, CORD COMPRESSION, DRUGS THAT CAUSE CNS DEPRESSION. moderate: fluctuation range 6 - 25bpm. marked: fluctuation range >25bpm. |
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what does V.E.A.L C.H.O.P mean? |
Variability decelerations: this is when the heart rate drops abruptly. this is caused by Cord compression. mother would need to reposition herself into a side-lying position. Early declerations: this is when the heart rate drops in response to a peaked contraction. this is caused by Head compression. as the mother contracts the baby is moving towards or into the pelvic inlet causing the head to compress. Acceleration: this is when the heart rate shoots up. this could be be associated with fetal movements. THIS IS OKAY. Late decelerations: this is a gradual drop in heart rate after a contraction as a result of Placental insufficiency. you would need to discontinue oxytocin, 10L of oxygen in non-breather bag, provide bolus fluid, change positions to left lateral side lying. |
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what is category III fetal heart rate pattern mean? what are the interventions for category III? |
category III fetal heart pattern: is fetal bradycardia as a result of recurrent late decelerations and recurrent variable decelerations. interventions: reduce uterine activity: discontinue oxytocin and provide fluid bolus. promote fetal oxygenation: lateral positioning, oxygenation using 10L non-breather face mask, discontinue or decrease oxytocin, and IV fluid bolus. |
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what are some nonpharmacological pain management? |
continuous labor support hydrotherapy ambulation and position change massage technique: upper and lower back, shoulder, sacrum, buttocks heat and cold compression focusing and imagery breathing technique |
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what are the categories of pharmacological pain management techniques used for women in labor? |
systemic analgesia: this affects the whole body, stimulates CNS depression and respiratory depression in both mother and fetus. regional analgesia: this provides pain relief without affecting CNS. this is a local anesthesia general anesthesia: overall sedation of the body. |
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what are types of systemic analgesia? what are interventions? |
opioids: -agonist: this activates receptors that produce natural analgesia. e.g. Demerol and Fentanyl -agonist/antagonist: this activates some receptors while blocking others e.g. Stadol, Nubain. THIS DOES NOT AFFECT CNS. HOWEVER, THIS MEDICATION CAN THROW ADDICTS INTO WITHDRAWAL DUE TO ITS ABILITY TO BLOCK CERTAIN RECEPTORS. -antagonist: block receptors e.g. Narcan -antiemetics: this is given w/ opioids to reduce nausea and vomiting and anxiety. e.g. Vistaril and Phenergan. -benzodiazapines: this is used to give a light sedation e.g. valium and midazolam intervention: WHEN RESPIRATORY DEPRESSION OCCURS GIVE NARCAN TO REVERSE THE EFFECTS OF THE OPIOIDS. |
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what are types of regional analgesia? how do you prepare a patient for an epidural? what is a complication of epidural analgesia? what is an intervention when using regional analgesia? |
epidural analgesia: this is an injection of a local anesthesia (lidocaine or bupivacaine) and a opioid analgesia (morphine and fentanyl). -epidural block: continuous infusion or intermittent injection in the epidural space. THIS IS GIVEN ONLY WHEN THE CERVIX IS 5CM DILATED TO PREVENT SLOWING DOWN OF CONTRACTIONS. - combined spinal-epidural block: this is injection of opioids in both the epidural and subarchoid space of the spine. -patient-controlled epidural: this is administering of opioids via an epidural cathether with a pump. the patient can press the button to administer preset of medication from the pump into the epidural space to aid in relieving pain. - intrathecal (spine) analgesia/anesthesia: this is administering analgesia/anesthesia into the subacharoid space. - local infiltration: this administering local anesthesia "caine agents" superficially onto the perineum prior to an episiotomy or suturing a perineum laceration. - pudendal nerve block: this is the administering of anesthesia into the pudendal nerves near the ischial spine of the pelvis. this aids to relieve pain in the lower vagina, vulva, and perineum. preparation: - take baseline v/s: especially BP and Temp. - place the patient in position - give local anesthesia - hang a liter of fluids since epidural can cause decreased BP. complication: respiratory depression causing fetal bradycardia interventions: - monitor v/s q5 minutes for the first 15 minutes (3x total) afterwards, monitor v/s q15 until birth. - when having respiratory depression give 8-10L of oxygen via non-rebreather bag, give a liter of bolus fluids, and change position. |
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when is general anesthesia given? what are the steps? |
general anesthesia: this causes overall CNS depression and leads to loss of consciousness. steps: - either IV (thiopental IV) or inhalation of general anesthesia - next is a muscle relaxant - then intubation, this is needed to supply the mother with oxygen since she is under and cannot breathe on her own. - place a wedge underneath the woman's hips to prevent the gravid uterus from compressing on her inferior vena cava while lying in a supine position. |
