A pregnant client arrives to labor and delivery unit and the nurse places a fetal monitor on her. A nurse is caring for a laboring client who is having a fetal scalp electrode placed. Maternal status is stable. We want to see accelerations and good variability. A nurse is caring for a client who is in labor. A good fetal heart rate shows that there is good perfusion through the placenta and to the fetus. This will increase blood flow into the placenta. The “L” is late decelerations and are bad. We first want to figure out the cause. If the mom is getting pitocin then it needs to be stopped. What possible situations could be causing this? by Holly BSN, RN | Jun 30, 2020 | Maternal Nursing. But remember that medicines can only be given at certain times during labor, so they may not always be appropriate. (Cheat Sheet), Signs of Pregnancy (Presumptive, Probably, Positive), 04.06 Disseminated Intravascular Coagulation (DIC), 04.09 Hydatidiform Mole (Molar pregnancy), 07.04 Abruptio Placentae (Placental abruption), 08.01 Postpartum Physiological Maternal Changes, 10.01 Initial Care of the Newborn (APGAR), 12.06 Uterine Stimulants (Oxytocin, Pitocin), 12.07 Meds for PPH (postpartum hemorrhage), 12.10 Eye Prophylaxis for Newborn (Erythromycin). Review: Spend at least ten minutes every week reviewing all your previous notes. The heart rate drops after the start of the contraction. Infection is a risk anytime something from outside is entering the uterus. It is a mirror image. Intrapartum fetal monitoring consists of the assessment and evaluation of fetal status during labor. We had a patient once that the physician broke the patient’s bag of water and the fetal head was not well engaged in the pelvis. At NURSING.com, we believe Black Lives Matter ✊, No Human Is Illegal , Love Is Love ️‍, Women's Rights Are Human Rights , Science Is Real , Water Is Life , Injustice Anywhere Is A Threat To Justice Everywhere ☮️. The fetal heart rate should increase or accel with movement. The following are 3 different methods of fetal monitoring: Now that we know how to monitor the fetal heart rate, let’s look into what this information will clue us into. The nurse places an external fetal monitor on the client’s abdomen to assess fetal heart tones. If you have any questions, please let me know. NCLEX® and NCLEX-RN® are Registered Trademarks of the NCSBN, HESI® is a registered trademark of Elsevier Inc., TEAS® and Test of Essential Academic Skills™ are registered trademarks of Assessment Technologies Institute, CCRN® is a Registered trademark of the AACN; all of which are unaffiliated with, not endorsed by, not sponsored by, and not associated with NRSNG, LLC or TazKai, LLC and its affiliates in any way. Variability in the fetal heart rate can be affected by many factors. The external fetal monitor indicates a reassuring fetal heart rate at 130 beats per minute. So for this the patient should be put either in trendelenburg or knees to chest as she is rushed to the operating room for delivery. A non stress test is a way to look at fetal status and the heart rate should increase with movement. The labor nurse has to remain in this position in between the patient’s legs lifting the head off the cord until it is delivered. That occurs when the cord is delivered prior to the fetus. Because of this the cord prolapsed because the head wasn’t there to act as a “cork” so the physician said she had the cord in her hand and she stayed at the foot of the bed holding the head off of the cord while the nurse put the patient with her knees to chest and several nurses rolled her emergently to the OR. (2) The FHTs should be checked immediately following rupture. There is external and internal. (Mnemonic), OB Non-Stress Test Results The nurse knows this causes a risk of which of the following? The fetal heart rate is assessed to be 123. We help you understand what common risks and complications are, how the baby grows and develops, and how to assess both mom and baby after the baby is born. If the fetal heart rate is not responding well to labor then we can turn, reposition, give oxygen, and stop the pitocin. And any signs of infection for internal monitor. The priority nursing intervention is to maintain perfusion to the cord by removing the presenting part that is compressing it. There are two methods of fetal heart rate monitoring in labor. Medical interventions during labor and birth ... Internal fetal monitoring. Monitor placed on mother’s abdomen over the fetal back, Requires rupture of membranes and mother to be dilated 2-3 cm, Reassuring – good, healthy fetal response, Nonreassuring – Not okay, needs intervention and notify MD, What we’re assessing for (VEAL-CHOP mnemonic), Variable decelerations→  Cord compression, Deceleration that occurs at the start of the contraction and returns to baseline at the end of the contraction, happens with head compression and is ok, Late decelerations→ Placental insufficiency, Deceleration that occurs after the start of the contraction, caused by fall in O2 to the fetus, stress test → 20 minutes of noninvasive fetal monitoring, Reactive if there are 2+ accelerations in a 20 min period, Nonreactive if less than 2 accelerations in a 20 min period, Late decelerations ( issues with placenta), Hypertonic uterine activity (uterus not resting in between contractions, which decreases uterine circulation and therefore O2 supply to fetus), Variable decelerations lasting longer than 1 minute with a FHR less than 70, We want accelerations and healthy variability, What to do when these abnormal  FHR’s occur, Check mom’s vitals for hyper/hypotension, fever, Stop oxytocin, if infusing (this can worsen the nonreassuring pattern), Change mother’s position (preferably to left side-lying if not already there), Prepare to initiate appropriate monitoring (i.e. Describe appropriate nursing interventions to address nonreassuring fetal heart rate patterns. Which of the following responses from the nurse is most appropriate? These monitoring tools are going to assess the fetal heart rate which should be 110-160. Accelerations is the “A” and means there is Oxygenation so this is good. Start a trial to view the entire video. (Learning Objectives 1, 5, and 8) A. You can see in this image the fetus in the uterus. For more information, visit www.nursing.com/cornell. This is not a good thing and shows that the fetus is not living in a healthy environment. Category I: Normal- associated with fetal well-being; accelerations, Category II: Indeterminate- ambiguous data- describes patterns or elements of reassuring characteristics but also data that may be nonreassuring; not an emergency but important to continue monitoring, Category III: abnormal- nonreassuring- favorable signs are absent, Category II= NOT GOOD= nursing intervention required. The testing results are either reactive or nonreactive. It is very quick because it is emergent! The choice of what to use for pain relief and relaxation is up to you and your health care provider. The V stands for variable decelerations. 6. Once you review the information in this post, be sure to download this PDF cheat sheet that includes all the important information. Select all that apply. So here on the fetal back side of the uterus is where the external monitor would be placed.
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