Fetal Monitoring Ann Hearn RNC, MSN 2010. Electronic Fetal Monitoring Standard of Care “Nurses who...

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Fetal Monitoring Ann Hearn RNC, MSN 2010

Transcript of Fetal Monitoring Ann Hearn RNC, MSN 2010. Electronic Fetal Monitoring Standard of Care “Nurses who...

Page 1: Fetal Monitoring Ann Hearn RNC, MSN 2010. Electronic Fetal Monitoring Standard of Care “Nurses who care for women during the childbirth process are legally.

Fetal Monitoring

Ann Hearn RNC, MSN2010

Page 2: Fetal Monitoring Ann Hearn RNC, MSN 2010. Electronic Fetal Monitoring Standard of Care “Nurses who care for women during the childbirth process are legally.

Electronic Fetal Monitoring Standard of Care “Nurses who care for women

during the childbirth process are legally responsible for correctly interpreting FHR patterns, initiating appropriate nursing interventions based on the pattern seen, and documenting the outcome of those interventions.”

Page 3: Fetal Monitoring Ann Hearn RNC, MSN 2010. Electronic Fetal Monitoring Standard of Care “Nurses who care for women during the childbirth process are legally.

Placental Physiology

Maternal blood flow Fetal blood flow Gas/substance Exchange

– Contraction’s affect

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Placental Physiology

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Fetal Heart Rate Monitoring Devices

Fetoscope Hand held dopple

Page 6: Fetal Monitoring Ann Hearn RNC, MSN 2010. Electronic Fetal Monitoring Standard of Care “Nurses who care for women during the childbirth process are legally.

Electronic Fetal Monitor

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Methods of Fetal Monitoring

Intermittent auscultation Continuous external Continuous internal

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Patterns of Fetal Heart Rate Monitoring

Page 9: Fetal Monitoring Ann Hearn RNC, MSN 2010. Electronic Fetal Monitoring Standard of Care “Nurses who care for women during the childbirth process are legally.

Fetal Heart Rate Baseline FHR = 110 – 160 bpm

– Average rate over 10 minutes

Tachycardia – baseline above 160 BPM– RT= maternal fever, fetal hypoxia,

intrauterine infection, drugs

Bradycardia – baseline below 110 BPM– RT = profound hypoxia, anesthesia, beta-

adrenergic blocking drugs

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Electronic Fetal Monitor Paper

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Fetal Heart Rate Variability

Normal irregularity of the cardiac rhythm.

Absence of variability, or a smooth flat baseline is a sign of fetal compromise.

A determinant of fetal wellbeing.

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Fetal Heart Rate Variability

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Periodic Changes of FHR

Acceleration

Deceleration

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Acceleration

Increase in the fetal heart rate from baseline by 15 bpm lasting 15 seconds or more.

A determinant of fetal wellbeing

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Reassuring Fetal Heart Rate Pattern

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Deceleration

Decreases in the fetal heart rate from the normal baseline.– Variable– Early– Late– Prolong

Page 17: Fetal Monitoring Ann Hearn RNC, MSN 2010. Electronic Fetal Monitoring Standard of Care “Nurses who care for women during the childbirth process are legally.

Deceleration

Variable – related to cord compression. Interventions vary.

Late – related to utero-placental insufficiency. Immediate intervention.

Early – related to head compressions. Interventions not necessary.

Prolong – lasts > 2 minutes. Interventions necessary.

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Early Deceleration

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Variable Deceleration

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Late Deceleration

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Prolong Deceleration

Fetal heart rate deceleration that lasts greater than 2 minutes.

Sinusoidal Pattern (Undulating) Fetal heart rate repeating cycle of

upward increase in the heart rate followed by a decrease in the rate.

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Prolonged Deceleration

Sinusoidal Pattern

Page 23: Fetal Monitoring Ann Hearn RNC, MSN 2010. Electronic Fetal Monitoring Standard of Care “Nurses who care for women during the childbirth process are legally.

Nursing Care for FHR Decelerations

Reposition: Turn woman to a side-lying position, or knee- chest position. Avoid supine position

Hydrate: Increase rate of mainline IV

Decrease uterine activity: – Stop Pitocin infusion– Give Terbutaline sub-q.

Oxygenate: Provide oxygen by mask at 10 L/min.

Page 24: Fetal Monitoring Ann Hearn RNC, MSN 2010. Electronic Fetal Monitoring Standard of Care “Nurses who care for women during the childbirth process are legally.

VEAL CHOP

Variable

Early

Acceleration

Late

Cord

Head

Okay

Placenta

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Review

Page 26: Fetal Monitoring Ann Hearn RNC, MSN 2010. Electronic Fetal Monitoring Standard of Care “Nurses who care for women during the childbirth process are legally.

Review

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Review

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Review

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Review:

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Review:

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Review:

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Review:

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Review:

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The End


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127 - 142 Electronic Fetal Monitoring

127 - 142 Electronic Fetal Monitoring