Suppose the 4040 \Omega40 resistance in the distribution circuit is replaced by a 2020 \Omega20 resistance. The nurse teaches a pregnant woman that which diagnostic test evaluates the effect of fetal movement on fetal heart activity? Hypoxia, uterine contractions, fetal head compression and perhaps fetal grunting or defecation result in a similar response. A prolonged fetal heart rate deceleration lasts >2 minutes, but <10 minutes. T(t)=50+50cos(6t).T(t)=50+50 \cos \left(\frac{\pi}{6} t\right) . -6:Suspect lack of adequate oxygen, Repeat BPP in 24 hours & deliver if <= 6 "The test results are within normal limits.". You have to lie down or sit in a reclined position for the test, which lasts about 20 minutes. Increased variability in the baseline FHR is present when the oscillations exceed 25 bpm (Figure 2). Determine whether accelerations or decelerations from the baseline occur. 150 155 160 Multivariate logistic regression analyses were performed to control for confounding variables (SPSS). What action by the nurse is most appropriate? This type of deceleration has a uniform shape, with a slow onset that coincides with the start of the contraction and a slow return to the baseline that coincides with the end of the contraction. Accelerations are transient increases in the FHR (Figure 1). Because these events have a low prevalence, continuous electronic fetal monitoring has a false-positive rate of 99%. Continuous EFM may adversely affect the labor process and maternal satisfaction by decreasing maternal mobility, physical contact with her partner, and time with the labor nurse compared with structured intermittent auscultation.7 However, continuous EFM is used routinely in North American hospitals, despite a lack of evidence of benefit. fetal heart tracing quiz 12 - islamichouseofisrael.com Which nursing intervention is necessary before a second trimester transabdominal ultrasound? What should the nurse do before appropriate clinical interventions are initiated? Maternal hypotension and uterine hyperstimulation may decrease uterine blood flow. Perform amnioinfusion for recurrent variable decelerations to reduce the risk of cesarean delivery. How an individual's senses are elevated by arousing the central nervous system? The FHR baseline is 130 bpm with moderate variability. The patient's labor has been normal to this point. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. ), What do Braxton Hicks contractions feel like? Decelerations represent a decrease in FHR of more than 15 bpm in bandwidth amplitude. Variability (V; Online Table B). The American College of Obstetricians and Gynecologists (ACOG) states that with specific intervals, intermittent auscultation of the FHR is equivalent to continuous EFM in detecting fetal compromise.4 ACOG has recommended a 1:1 nurse-patient ratio if intermittent auscultation is used as the primary technique of FHR surveillance.4 The recommended intermittent auscultation protocol calls for auscultation every 30 minutes for low-risk patients in the active phase of labor and every 15 minutes in the second stage of labor.4 Continuous EFM is indicated when abnormalities occur with intermittent auscultation and for use in high-risk patients. The workshop introduced a new classification scheme for decision making with regard to tracings. Continuous monitoring of your babys heart rate is conducted during labor and delivery as well. Assessments. Tachysystole in term labor: incidence, risk factors, outcomes, and effect on fetal heart tracings. It takes that professionals understanding of what the continuous tracings show to properly assess the fetal condition. This content is owned by the AAFP. 1. AMIR SWEHA, M.D., TREVOR W. HACKER, M.D., AND JIM NUOVO, M.D. The presence of at least two accelerations, each lasting for 15 or more seconds above baseline and peaking at 15 or more bpm, in a 20-minute period is considered a reactive NST. Are there decelerations present? Subtle, shallow late decelerations can be difficult to visualize, but can be detected by holding a straight edge along the baseline. -Try to get 3 uterine contractions within 10-minute period, -Absolute: Placenta Previa, Cerclage, Incompetent cervix The fetal membranes must be ruptured, and the cervix must be at least partially dilated before the electrode may be placed on the fetal scalp. Membranes have to be rupture in order to establish direct contact. -Fetal muscle tone Decompression melting as the mantle rises, C. Melting of continental crust caused by an influx of mantle-derived magmas. Recurrent deep variable decelerations can be corrected with amnioinfusion. The presence of moderate variability and/or accelerations is predictive of a lack of fetal acidosis. T(t)=50+50cos(6t). Give amnioinfusion for recurrent, moderate to severe variable decelerations, 9. Table 7 lists signs associated with variable decelerations indicating hypoxemia4,11,26 (Figures 9 and 10). Variable decelerations may be classified according to their depth and duration as mild, when the depth is above 80 bpm and the duration is less than 30 seconds; moderate, when the depth is between 70 and 80 bpm and the duration is between 30 and 60 seconds; and severe, when the depth is below 70 bpm and the duration is longer than 60 seconds.4,11,24 Variable decelerations are generally associated with a favorable outcome.25 However, a persistent variable deceleration pattern, if not corrected, may lead to acidosis and fetal distress24 and therefore is nonreassuring. The inhibitory influence on the heart rate is conveyed by the vagus nerve, whereas excitatory influence is conveyed by the sympathetic nervous system. You scored 6 out of 6 correct. Unfortunately, precise information about the frequency of false-positive results is lacking, and this lack is due in large part to the absence of accepted definitions of fetal distress.7 Meta-analysis of all published randomized trials has shown that EFM is associated with increased rates of surgical intervention resulting in increased costs.8 These results show that 38 extra cesarean deliveries and 30 extra forceps operations are performed per 1,000 births with continuous EFM versus intermittent auscultation. However, the strength of contractions cannot always be accurately assessed from an external transducer and should be determined with an IUPC, if necessary. Persistent tachycardia greater than 180 bpm, especially when it occurs in conjunction with maternal fever, suggests chorioamnionitis. PDF Awhonn Fetal Monitoring Test Questions And Answers Pdf Copy Antepartum Fetal Assessment 10. The nurse is assessing a fetal monitor tracing and notes that the FHR baseline is 140-150 bpm with decreases to 120 bpm noted beginning after the contraction begins with return to baseline after the contraction ends. Variable decelerations associated with a nonreassuring pattern, Late decelerations with preserved beat-to-beat variability, Persistent late decelerations with loss of beat-to-beat variability, Nonreassuring variable decelerations associated with loss of beat-to-beat variability, Confirmed loss of beat-to-beat variability not associated with fetal quiescence, medications or severe prematurity, Administer oxygen through a tight-fitting face mask, Change maternal position (lateral or knee-chest), Administer fluid bolus (lactated Ringer's solution), Perform a vaginal examination and fetal scalp stimulation, When possible, determine and correct the cause of the pattern, Consider tocolysis (for uterine tetany or hyperstimulation), Consider amnioinfusion (for variable decelerations), Determine whether operative intervention is warranted and, if so, how urgently it is needed, A blunt acceleration or overshoot after severe deceleration, Late decelerations or late return to baseline (. This pattern is most often seen during the second stage of labor. https://www.acog.org/~/media/For%20Patients/faq015.pdf, Current version ( A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Any tracing not meeting the criteria of Category I or III, with any of the following findings: 5 contractions in 10-minute period averaged over 30 minutes, Tachysystole: > 5 contractions in 10-minute period averaged over 30 minutes, No response to intrauterine resuscitative measures; stopping/reducing uterotonic agents or tocolytics with persistent Category II/III tracing, 110 to 160 bpm; determine by 2-minute segment in 10-minute period, Fluctuations from baseline over 10-minute period, with 6 to 25 bpm: moderate, 15 bpm above baseline rate, onset to peak < 30 seconds, lasts for at least 15 seconds, Early: onset to nadir 30 seconds, nadir occurs with peak of contraction, Variable: onset to nadir < 30 seconds, decrease in fetal heart rate 15 bpm with duration 15 seconds to < 2 minutes, Recurrent late or prolonged decelerations for > 30 minutes or for > 20 minutes if reduced variability, No hypoxia/acidosis; no intervention necessary, Low probability of hypoxia/acidosis; take action to correct reversible causes and monitor closely, High probability of hypoxia/acidosis; take immediate action to correct reversible causes and expedite delivery. Auscultation of the fetal heart rate (FHR) is performed by external or internal means. Obstetric Models and Intrapartum Fetal Monitoring in Europe NEW! Interventions to increase fetal activity fail, Reactive NST: 4 It is. Recently, second-generation fetal monitors have incorporated microprocessors and mathematic procedures to improve the FHR signal and the accuracy of the recording.3 Internal monitoring is performed by attaching a screw-type electrode to the fetal scalp with a connection to an FHR monitor. The term hyperstimulation is no longer accepted, and this terminology should be abandoned.11. A student nurse is placing a tocotransducer on a woman for electronic fetal monitoring. B. Reposition the patient, check blood pressure, and continue to monitor the FHR pattern. The most important risk of EFM is its tendency to produce false-positive results. Chemoreceptors located in the aortic and carotid bodies respond to hypoxia, excess carbon dioxide and acidosis, producing tachycardia and hypertension.15 The FHR is under constant and minute adjustment in response to the constant changes in the fetal environment and external stimuli. Finally, the recovery phase is due to the relief of the compression and the sharp return to the baseline, which may be followed by another healthy brief acceleration or shoulder (Figure 8). Early decelerations are caused by fetal head compression during uterine contraction, resulting in vagal stimulation and slowing of the heart rate. Identify type of monitor usedexternal versus internal, first-generation versus second-generation. Compared with structured intermittent auscultation, a period of EFM on maternity unit admission results in a lack of improved neonatal outcomes and increased interventions, including epidural analgesia (NNH = 19), continuous EFM (NNH = 7), and fetal blood scalp testing (NNH = 45). Fetal heart rate (FHR) may change as they respond to different conditions in your uterus. distribution of tributaries influences All rights reserved. Table 1 lists examples of the criteria that have been used to categorize patients as high risk. Stimulation of the peripheral nerves of the fetus by its own activity (such as movement) or by uterine contractions causes acceleration of the FHR.15. -NST Your doctor can confirm the likelihood of hypoxic injury using fetal heart tracing. The nurse understands that this NST will be read as: A woman in active labor has just received an epidural. While assessing the FHR, the nurse notices a pattern of uniform decelerations that have an abrupt onset with a nadir down to 90 bpm for 30 seconds. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. If you have any feedback on our "Countdown to Intern Year" series, please reach out to Samhita Nelamangala at d4medstudrep@gmail.com. Statistical analysis included univariate analyses with Student T-test, one-way ANOVA, chi-square and Fisher exact test. 740-591-8118. What is the baseline of the FHT? Continuous electronic fetal monitoring is the continuous monitoring of fluctuations of the fetal heart rate (FHR) in relation to maternal contractions and is considered standard practice. The nurse's first action should be which of the following? The patient's membranes ruptured 1 hour ago, and the fluid was clear. Detection is most accurate with a direct fetal scalp electrode, although newer external transducers have improved the ability to detect variability. : Your doctor evaluates the situation by reviewing fetal heart tracing patterns. Practice Quizzes 1-5 - Electronic Fetal Monitoring The recommendations for the overall management of FHR tracings by NICHD, the International Federation of Gynecology and Obstetrics, and ACOG agree that interpretation is reproducible at the extreme ends of the fetal monitor strip spectrum.10 For example, the presence of a normal baseline rate with FHR accelerations or moderate variability predicts the absence of fetal acidemia.10,11 Bradycardia, absence of variability and accelerations, and presence of recurrent late or variable decelerations may predict current or impending fetal asphyxia.10,11 However, more than 50 percent of fetal strips fall between these two extremes, in which overall recommendations cannot be made reliably.10 In the 2008 revision of the NICHD tracing definitions, a three-category system was adopted: normal (category I), indeterminate (category II), and abnormal (category III).11 Category III tracings need intervention to resolve the abnormal tracing or to move toward expeditious delivery.11 In the ALSO course, using the DR C BRAVADO approach, the FHR tracing may be classified using the stoplight algorithm (Figure 19), which corresponds to the NICHD categories.9,11 Interventions are determined by placing the FHR tracing in the context of the specific clinical situation and corresponding NICHD category, fetal reserve, and imminence of delivery (Table 4).9,11, If the FHR tracing is normal, structured intermittent auscultation or continuous EFM techniques can be employed in a low-risk patient, although reconsideration may be necessary as labor progresses.2 If the FHR tracing is abnormal, interventions such as position changes, maternal oxygenation, and intravenous fluid administration may be used. The nurse observes smooth, gradual decelerations to 135 bpm occurring with more than 50% of the contractions. Be sure to ask any questions you might have beforehand. The nurse is caring for a patient in labor when repetitive late decelerations are noted on the external fetal monitor. efm.com/fhm/files/quiz2.php?QiD=DCABCC 1/2Correct. Treat placental fetal perfusion through intrauterine resuscitation before proceeding to immediate delivery for all Category II or III tracings with concern for fetal acidosis. Rate and decelerations B. Health care professionals play the game to hone and test their EFM knowledge and skills. Every piece of content at Flo Health adheres to the highest editorial standards for language, style, and medical accuracy. On entering the room, the nurse sees the patient lying supine and notices that there has been abrupt slowing in the FHR to 90 bpm during the last two contractions, each episode lasting 30 seconds or less. Baroreceptors influence the FHR through the vagus nerve in response to change in fetal blood pressure. -Moderate FHR variability. DR C BRAVADO incorporates maternal and fetal risk factors (DR = determine risk), contractions (C), the fetal monitor strip (BRA = baseline rate, V = variability, A = accelerations, and D = decelerations), and interpretation (O = overall assessment). Late decelerations (Online Figure J) are visually apparent, usually symmetric, and have the characteristic feature of onset of the deceleration after the onset of the uterine contraction.11 The timing of the deceleration is delayed, with the nadir of the deceleration occurring after the peak of the contraction.11 The onset, nadir, and recovery of the deceleration usually occur after the beginning, peak, and ending of the contraction, respectively. A.True B.False According to the 2008 NICHD consensus report, the normal frequency of uterine contractions is which of the following? Health care professionals play the game to hone and test their EFM knowledge and skills. Nonreassuring variable decelerations associated with the loss of beat-to-beat variability correlate substantially with fetal acidosis4 and therefore represent an ominous pattern. If you want to see how you are doing overall, try the comprehensive assessment: A new nurse is asking an experienced nurse about interpreting a Category III FHR tracing. The searches included systematic reviews, meta-analyses, randomized controlled trials, and review articles. Variability and accelerations C. Variability and decelerations D. Rate and variability 3. This content is owned by the AAFP. d) volcanic neck -Monitor fetal heart rate response to The Value of EFM Certification (One Team One Language), showcases the national PSA campaign Your Baby Communicates along with peer-to-peer video discussions on the value of EFM Board Certification. Sketch or describe how the They are usually associated with fetal movement, vaginal examinations, uterine contractions, umbilical vein compression, fetal scalp stimulation or even external acoustic stimulation.15 The presence of accelerations is considered a reassuring sign of fetal well-being. What should the incoming nurse do FIRST? Powered by. You scored 6 out of 6 correct. Use a logarithmic transformation to find a linear relationship between the given quantities and graph the resulting linear relationship on a log-linear plot. b) basalt plateau A meta-analysis showed that if there is absent or minimal variability without spontaneous accelerations, the presence of an acceleration after scalp stimulation or fetal acoustic stimulation indicates that the fetal pH is at least 7.20.19, If the FHR tracing remains abnormal, these tests may need to be performed periodically, and consideration of emergent cesarean or operative vaginal delivery is usually recommended.15 Measurements of cord blood gases are generally recommended after any delivery for abnormal FHR tracing because evidence of metabolic acidosis (cord pH less than 7.00 or base deficit greater than 12 mmol per L) is one of the four essential criteria for determining an acute intrapartum hypoxic event sufficient to cause cerebral palsy.20, When using continuous EFM, tracings should be reviewed by physicians and labor and delivery nurses on a regular basis during labor.