Trust & Distrust as Cultural Frames Kevin Perry [email protected].
Perry Key Points Chapter_15
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All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. CHAPTER 15 Fetal Assessment During Labor KEY POINTS • Because labor is a period of physiologic stress for the fetus, fre- quent monitoring of fetal status is part of the nursing care during labor. The fetal oxygen supply must be maintained during labor to prevent fetal compromise and promote newborn health after birth. • The goals of intrapartum FHR monitoring are to identify and differentiate the normal (reassuring) patterns from the abnormal (nonreassuring) patterns, which can indicate fetal compromise. • Fetal well-being during labor is gauged by the response of the FHR to UCs. • Standardized definitions for many common FHR patterns have been adopted for use in clinical practice by the ACNM, ACOG, and AWHONN. • The monitoring of fetal well-being includes FHR and UA assess- ment and assessment of maternal vital signs. • Intermittent auscultation (IA) involves listening to fetal heart sounds at periodic intervals to assess the FHR. IA of the fetal heart can be performed with a Pinard stethoscope, Doppler ultrasound, an ultrasound stethoscope, or a DeLee-Hillis feto- scope. IA is easy to use, inexpensive, and less invasive than EFM. It is often more comfortable for the woman and gives her more freedom of movement. • The purpose of EFM is the ongoing assessment of fetal oxygen- ation. FHR tracings are analyzed for characteristic patterns that suggest fetal hypoxic events and metabolic acidosis during labor. • The technique of continuous internal FHR or UA monitoring provides a more accurate appraisal of fetal well-being during labor than external monitoring because it is not interrupted by fetal or maternal movement or affected by maternal size. • The five essential components of the FHR tracing are baseline rate, baseline variability, accelerations, decelerations, and changes or trends over time. • Assessing FHR and UA patterns, implementing independent nursing interventions, and reporting abnormal patterns to the physician or nurse-midwife are the nurse’s responsibilities. • The AWHONN and ACOG have established and published health care provider standards and guidelines for FHR monitoring. • The emotional, informational, and comfort needs of the woman and her family must be addressed when the mother and her fetus are being monitored. • Documentation of fetal assessment is initiated and updated according to institutional protocol.
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Transcript of Perry Key Points Chapter_15
All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
C H A P T E R
15 Fetal Assessment During Labor
K E Y P O I N T S• Because labor is a period of physiologic stress for the fetus, fre-
quent monitoring of fetal status is part of the nursing care during labor. The fetal oxygen supply must be maintained during labor to prevent fetal compromise and promote newborn health after birth.
• The goals of intrapartum FHR monitoring are to identify and differentiate the normal (reassuring) patterns from the abnormal (nonreassuring) patterns, which can indicate fetal compromise.
• Fetal well-being during labor is gauged by the response of the FHR to UCs.
• Standardized definitions for many common FHR patterns have been adopted for use in clinical practice by the ACNM, ACOG, and AWHONN.
• The monitoring of fetal well-being includes FHR and UA assess-ment and assessment of maternal vital signs.
• Intermittent auscultation (IA) involves listening to fetal heart sounds at periodic intervals to assess the FHR. IA of the fetal heart can be performed with a Pinard stethoscope, Doppler ultrasound, an ultrasound stethoscope, or a DeLee-Hillis feto-scope. IA is easy to use, inexpensive, and less invasive than EFM. It is often more comfortable for the woman and gives her more freedom of movement.
• The purpose of EFM is the ongoing assessment of fetal oxygen-ation. FHR tracings are analyzed for characteristic patterns that suggest fetal hypoxic events and metabolic acidosis during labor.
• The technique of continuous internal FHR or UA monitoring provides a more accurate appraisal of fetal well-being during labor than external monitoring because it is not interrupted by fetal or maternal movement or affected by maternal size.
• The five essential components of the FHR tracing are baseline rate, baseline variability, accelerations, decelerations, and changes or trends over time.
• Assessing FHR and UA patterns, implementing independent nursing interventions, and reporting abnormal patterns to the physician or nurse-midwife are the nurse’s responsibilities.
• The AWHONN and ACOG have established and published health care provider standards and guidelines for FHR monitoring.
• The emotional, informational, and comfort needs of the woman and her family must be addressed when the mother and her fetus are being monitored.
• Documentation of fetal assessment is initiated and updated according to institutional protocol.
