34
Fetal Monitoring Ann Hearn RNC, MSN 2010

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

Embed Size (px)

Citation preview

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

Page 4: 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

Page 5: 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 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

Page 7: Fetal Monitoring Ann Hearn RNC, MSN 2010. Electronic Fetal Monitoring Standard of Care “Nurses who care for women during the childbirth process are legally

Methods of Fetal Monitoring

Intermittent auscultation Continuous external Continuous internal

Page 8: Fetal Monitoring Ann Hearn RNC, MSN 2010. Electronic Fetal Monitoring Standard of Care “Nurses who care for women during the childbirth process are legally

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

Page 10: 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 Paper

Page 11: 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 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.

Page 12: 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 Variability

Page 13: Fetal Monitoring Ann Hearn RNC, MSN 2010. Electronic Fetal Monitoring Standard of Care “Nurses who care for women during the childbirth process are legally

Periodic Changes of FHR

Acceleration

Deceleration

Page 14: Fetal Monitoring Ann Hearn RNC, MSN 2010. Electronic Fetal Monitoring Standard of Care “Nurses who care for women during the childbirth process are legally

Acceleration

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

A determinant of fetal wellbeing

Page 15: Fetal Monitoring Ann Hearn RNC, MSN 2010. Electronic Fetal Monitoring Standard of Care “Nurses who care for women during the childbirth process are legally

Reassuring Fetal Heart Rate Pattern

Page 16: 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

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.

Page 18: Fetal Monitoring Ann Hearn RNC, MSN 2010. Electronic Fetal Monitoring Standard of Care “Nurses who care for women during the childbirth process are legally

Early Deceleration

Page 19: Fetal Monitoring Ann Hearn RNC, MSN 2010. Electronic Fetal Monitoring Standard of Care “Nurses who care for women during the childbirth process are legally

Variable Deceleration

Page 20: Fetal Monitoring Ann Hearn RNC, MSN 2010. Electronic Fetal Monitoring Standard of Care “Nurses who care for women during the childbirth process are legally

Late Deceleration

Page 21: Fetal Monitoring Ann Hearn RNC, MSN 2010. Electronic Fetal Monitoring Standard of Care “Nurses who care for women during the childbirth process are legally

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.

Page 22: Fetal Monitoring Ann Hearn RNC, MSN 2010. Electronic Fetal Monitoring Standard of Care “Nurses who care for women during the childbirth process are legally

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

Page 25: 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

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

Page 27: 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

Page 28: 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

Page 29: 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:

Page 30: 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:

Page 31: 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:

Page 32: 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:

Page 33: 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:

Page 34: Fetal Monitoring Ann Hearn RNC, MSN 2010. Electronic Fetal Monitoring Standard of Care “Nurses who care for women during the childbirth process are legally

The End