Sherpath chapter 15 Interpretation of Fetal and Uterine Monitoring
Nonreassuring FHR signs that warrant additional assessment and possible intervention
- Abnormal baseline FHR - Absence of FHR variability - Recurrent, late, or variable decelerations
Accelerations in FHR: Characteristics
- Abrupt increases of at least 15 beats/min above the baseline FHR -> Time from onset to peak is <30 seconds -> Duration is ≥15 seconds -> Return to baseline in <2 minutes from onset
Accelerations in FHR: Clinical Significance
- Accelerations are considered an indicator of fetal wellness and normal acid-base balance. - Acceleration with fetal movement indicates fetal alertness. -> No intervention is necessary.
internal UA monitoring
- An invasive approach that uses an IUPC inserted into the uterus adjacent to the fetus --> IUPCs can measure frequency, duration, and intensity of contractions and uterine resting tone.
4 steps of Assessing Fetal Heart Rate Pattern
- Determine Baseline FHR - Assess FHR Variability - Assess for Accelerations - Assess for Decelerations
External UA Monitoring
- External monitoring of uterine activity is a noninvasive approach performed via external electronic fetal monitoring (EFM) and palpation. - External EFM uses a tocodynamometer (toco) positioned over the fundus to detect pressure changes of the abdomen contour that indicate contractions. --> The uterus pushes outward against the patient's anterior abdominal wall with each contraction. --> The toco transmits the information about the pressure from the abdomen to a bell-shaped curve located on the bottom grid of the EFM tracing strip. - External EFM measures uterine contraction frequency and duration. Palpation is needed to assess contraction intensity and uterine resting tone.
Absent Baseline FHR variability Possible causes
- Fetal hypoxemia with metabolic acidemia - Congenital anomalies - Preexisting neurologic injury - Drug effects with CNS depressants and/or local anesthetic agents - Tachycardia - Prematurity - Fetus is in a temporary sleep state
The nurse evaluates Uterine Activity by determining the - - - -
- Frequency - duration - intensity of contractions - assessing uterine resting tone
Nurse Responsibilities Ultrasound Transducer
- Gel on transducer - Is the FHR tested and noted on strip? - Compare FHR to maternal pulse and note - verify flashing light with Fetal Pulse - Belt secure and comfortable
Common interventions: Maternal Hypotension
- Increase the rate of the primary intravenous (IV) infusion. - Change to lateral or Trendelenburg positioning. - Administer ephedrine or phenylephrine
Nurse Responsibilities Spiral electrode
- Is the connector attached firmly to the electrode pad (on the leg plate or abdomen)? - Is the spiral electrode attached to the presenting part of the fetus? - Is the inner surface of the electrode pad pregelled or covered with electrode gel? - Is the electrode pad properly secured to the woman's thigh or abdomen?
Nurse Responsibilities Internal Catheter or Strain Gauge
- Is the length line on the catheter visible at the introitus? - Is it noted on the monitor paper that a UA test or calibration was performed? - Has the monitor been set to zero according to the manufacturer's directions? - Is the IUPC properly secured to the woman? - Is the baseline resting tone of the uterus documented?
Causes
- Maternal fever (resulting in either increased fetal temperature or a transfer of infection) - Maternal or fetal hypoxia - Fetal acidosis - Maternal or fetal hypovolemia (may be caused by maternal dehydration) - Maternal severe anemia - Maternal hyperthyroidism - Drugs administered to the patient
During labor, the responsibilities of the nurse include:
- Ongoing assessment and interpretation of FHR and UA patterns - Implementation of interventions - Reporting of any nonreassuring patterns or findings - Documentation of assessments and care - Evaluation of effectiveness of interventions
Common interventions: Uterine tachysytole
- Reduce or discontinue the dose of any uterine stimulants in use (e.g., oxytocin). - Administer a uterine relaxant (tocolytic; e.g., terbutaline).
Common interventions: Decrease cord compression
- Reposition patient side to side and/or elevate hips. - Amnioinfusion may be ordered to increase fluid around fetus.
sinusoidal pattern of FHR:
- Smooth, undulating, wavelike FHR pattern - 3 to 5 cycles per minute with amplitude of 5 to 15 beats/min Persists for ≥10 minutes - Rare - associated with sever fetal anemia
Accelerations in FHR: Causes
- Spontaneous fetal movement - Vaginal examination - Electrode application - Fetal scalp stimulation - Fetal reaction to external sounds - Breech presentation - Occiput posterior position - Uterine contractions - Fundal pressure - Abdominal palpation
Common interventions: Abnormal FHR pattern during the second stage of labor
- Use open-glottis pushing. - Use fewer pushing efforts during each contraction. - Make individual pushing efforts shorter. - Push only with every other or every third contraction. - Push only with a perceived urge to push (in women with regional anesthesia).
Nurse Responsibilities Tocotransducer
- toco firmly positioned at the site of the least maternal tissue - Note gel or paste application - Check if UA baseline has been adjusted between contractions to print at the 20-mm Hg line?
The nurse understands that Montevideo units (MVUs) or more are considered adequate for normal labor progression
200
Fetal monitoring ultra sound paper speed
3 cm/minute (verify time and date)
A nurse is caring for a patient in labor who is receiving oxytocin via intravenous infusion to stimulate uterine contractions. Which assessment finding would indicate to the nurse that the infusion needs to be discontinued? Three contractions occurring within a 10-minute period A fetal heart rate of 90 beats/min A resting uterine tone of 15 mm Hg via the intrauterine pressure catheter Early decelerations
A fetal heart rate of 90 beats/min A normal fetal heart rate is 110 to 160 beats/min. Bradycardia and/or late or variable decelerations indicate fetal distress and the need to discontinue the oxytocin infusion.
The maternity nurse is monitoring a patient with dysfunctional labor for signs of potential fetal compromise. Which assessment findings would alert the nurse to a potential for fetal compromise? Select all that apply. - Fetal heart rate 115 beats/min - Absent variability - No cervical change in 4 hours - Contractions occurring every 3 minutes and lasting 50 to 60 seconds each - Uterine resting tone 30 mm Hg via intrauterine pressure catheter - Recurrent late decelerations
Absent variability Variability is defined as fluctuations in the fetal heart rate of more than 2 cycles per minute. Normal fetal variability in labor should be in the moderate range of 6 to 25 beats/min. Absent variability in the absence of maternal drugs can indicate severe fetal anemia or severe fetal hypoxia. No cervical change in 4 hours Labor is defined by cervical change. Cervical change includes both dilation and effacement of the cervix. Contractions with the absence of cervical change can indicate an arrest in labor and may result in the need for a cesarean section. Uterine resting tone 30 mm Hg via intrauterine pressure catheter Uterine resting tone, via an intrauterine pressure catheter, should remain under 25 mm Hg. Uterine resting tone higher than 25 mm Hg is considered hypertonic, and it can result in uterine rupture, placental abruption, or uterine tachysystole. Recurrent late decelerations Late decelerations are the most ominous decelerations among the three types of fetal heart rate decelerations during labor. They are caused by decreased blood flow to the placenta, and they can signify an impending fetal acidemia.
Recommendations for assessment timing in low-risk pregnancies
Active first stage of labor: assess every 15-30 minutes after a contraction Second-stage labor: assess every 5-15 minutes Assessment of membranes pre and post rupture Temperature Q4 until membrane rupture, then Q2 Pulse, respirs, BP Q1
common interventions: Increase patient oxygen saturation
Administer 100% oxygen at 8-10 L/min via facemask. If not already monitoring, begin monitoring patient oxygen saturation.
When is fetal heart rate (FHR) and uterine activity (UA) assessment indicated for a low-risk patient in the first stage of labor? Every 5 to 15 minutes After rupture of membranes After administration of oxytocin Every 2 hours
After rupture of membranes FHR and UA should be assessed after rupture of membranes to assess fetal response to rupture and whether UA changes.
Duration
Amount of time the contraction lasts from start to end
Baseline FHR
Average FHR range of 110-160 beats/min at term as assessed during a 10-minute period that excludes periodic and episodic changes and periods of marked variability *minimum 2 minutes * The mean heart rate is rounded to the closest multiple of 5 beats/min.
Fetal tachycardia
Baseline FHR >160 beats/min for ≥10 minutes Considered a sign of fetal hypoxemia, especially if co-occurring with late decelerations and minimal or absent variability
Fetal bradycardia
Baseline FHR below 110 beats/min for ≥10 minutes Fairly rare and needs to be distinguished from prolonged deceleration
Which qualities are considered normal when assessing fetal heart rate (FHR)? Select all that apply. FHR variability of <5 beats/min Baseline FHRof 140 beats/min FHR variability of 20 beats/min Baseline FHR of 100 beats/min Baseline FHR of 170 beats/min
Baseline FHRof 140 beats/min A baseline FHR of 110 to 160 beats/min is considered normal. FHR variability of 20 beats/min FHR variability of 6 to 25 beats/min is classified as moderate variability and is considered normal (reassuring).
Reassuring uterine activity
Contraction frequency ranges from 2-5 per 10 minutes I -> Interval between contractions >30 seconds -> No more frequent than every 1.5 minutes Contraction duration ranges from 45-80 seconds Strength of contractions ->First stage: 40-70 mm Hg ->Second stage: >80 mm Hg Uterine resting tone >20 mm Hg with IUPC (if palpation: soft, no palpable resistance) -> <400 MVUs (with internal EFM via IUPC)
Which fetal condition can cause a fetal heart rate (FHR) of <60 beats/min for more than 60 seconds that does not quickly return to baseline? Cord compression Fetal head compression Uteroplacental insufficiency No compromise; variable decelerations are normal
Cord compression Variable decelerations that last a long time and do not quickly return to baseline can occur with cord compression, which could compromise the fetus.
Which nursing actions are appropriate when the fetal monitor shows a pattern of late decelerations? Select all that apply. Discontinue oxytocin. Provide water to the patient. Administer oxygen by face mask. Reposition the patient onto her side. Continue monitoring and document findings.
Discontinue oxytocin. Discontinuing oxytocin will decrease the effect of uterine stimulants on the contractions. Administer oxygen by face mask. Oxygen increases the oxygenation to the patient, which increases perfusion of oxygen to the placenta. Reposition the patient onto her side. Repositioning the patient on her side, rather than allowing a supine position, is preferred. A supine position increases pressure on the vena cava, which reduces the blood supply, causing decreased perfusion of the placenta.
Match the type of non-reassuring deceleration with the associated cause. Disrupted oxygen transfer Interrupted oxygen supply Umbilical cord compression Variable Late Prolonged
Disrupted oxygen transfer =Late Interrupted oxygen supply= =Prolonged Umbilical cord compression=Variable
Which deceleration is considered a normal finding? Variable Prolonged Early Late
Early Early decelerations are a result of fetal head compression and are considered a normal finding that is not associated with poor fetal status or outcomes.
Early decelerations: Characteristics
Early decelerations are a visible, gradual decrease in FHR associated with a uterine contraction. Nadir (lowest) FHR is usually no lower than 30 to 40 beats/min from baseline. Onset, nadir, and recovery (return to baseline) correspond to beginning, peak, and end of contraction Sometimes called a mirror image of a contraction Most common during first stage of labor (cervix dilated 4 to 7 cm); may occur during second-stage pushing
Causes of fetal bradycardia
Fetal head compression Fetal hypoxia Fetal acidosis Fetal heart block Umbilical cord compression Late second-stage labor
Which description of moderate variability of the fetal heart rate is accurate? Fetal heart rate is 100 beats/min for 15 minutes. Fetal heart rate fluctuates between 10 and 20 beats/min. Fetal heart rate at baseline has a smooth, flat appearance and fluctuates 2 beats/min. Fetal heart rate accelerates 26 beats/min above baseline for a duration of 20 seconds.
Fetal heart rate fluctuates between 10 and 20 beats/min. A fluctuating fetal heart rate of 6 to 25 beats/min is considered moderate variability and is normal and reassuring.
Which fetal heart rate finding may result from maternal fever? No expected changes Prolonged decelerations Fetal heart rate of 90 beats/min for 15 minutes Fetal heart rate of 180 beats/min for 12 minutes
Fetal heart rate of 180 beats/min for 12 minutes A maternal fever can directly increase the fetal temperature or infect the fetus in cases of infection. The fetus responds with an increased heart rate, which can lead to fetal tachycardia.
The nurse caring for the patient in labor understands that absent (or minimal) variability is usually considered nonreassuring. However, which condition related to decreased variability is considered benign? Metabolic acidemia Central nervous system (CNS) depressant effects Fetal sleep Local anesthetic agent effects
Fetal sleep Fetal sleep states are benign causes of absent baseline variability. The episodes are usually 40 minutes or less and happen occasionally.
Internal Monitoring Indcators - What gets measured and how?
Frequency and Duration calculated by EFM Intensity -->IUPC in mm HG (50-75 is normal during labor (110 in second stage w/ pushing) --> Montevideo units first stage (100-250) second (300-400) Resting tone IUPC in mm Hg (5-15)
External Monitoring Indicators - What gets measured and how?
Frequency and duration are calculated by EFM Intensity and resting tone are assessed by palpation (Fundal tone)
Early decelerations: Causes
Head compression resulting from: - Uterine contractions - Vaginal examination - Fundal pressure - Placement of internal fetal monitoring
Which uterine contraction strength classification is used when labor is measured at >500 Montevideo units (MVUs)? Normal Moderate Hypotonic Hypertonic
Hypertonic Above 400 MVUs, the uterine contraction strength is considered hypertonic, which is abnormal.
Nonreassuring UA
Hypertonic contractions ->abnormal with respect to frequency, duration, intensity, and/or resting uterine tone. Frequency: more frequent than every 1.5 minutes and/or <30-second interval between contractions Duration >90 seconds Uterine resting tone >20 mm Hg and/or > soft tone >400 MVUs (with internal EFM via IUPC)
A patient arrives at a birthing center in active labor. Her membranes are still intact, and the health care provider prepares to perform an artificial rupture of membranes (AROM). What will the nurse relay to the patient as the most likely outcome of the procedure? Less pressure on the cervix Decreased number of contractions Increased pressure on the cervix The need for more cervical exams
Increased pressure on the cervix The rupture of the amniotic membranes releases the cushion provided by the amniotic sac and causes an increase in the pressure of the fetal head on the cervix. This increased pressure will often result in an increase in contractions and a decrease in the time for dilation and effacement of the cervix.
Which uterine activity indicators does the intrauterine pressure catheter (IUPC) measure in mm HG? Frequency Duration Intensity Resting Tone Variability
Intensity Contraction intensity is measured by the IUPC in mm Hg and is 50 to 75 mm Hg during labor and up to 110 mm Hg with pushing during the second stage. Resting tone Resting tone is measured by the IUPC in mm Hg and is usually between 5 and 15 mm Hg.
Which uterine contraction intensity classification is defined as a firm but not rigid fundus that is difficult to indent with fingertips? Mild Strong Normal Moderate
Moderate A moderate-strength contraction means a firm fundus that is difficult to indent with fingertips (feels like touching a finger to a chin).
Classifications of baseline FHR:
Normal = 110-160 beats/min Bradycardia = Less than 110 beats/min persisting for at least 10 minutes Tachycardia = More than 160 beats/min persisting for at least 10 minutes
Which methods are used to assess uterine activity externally? Select all that apply. Fetal scalp electrode Ultrasound transducer Palpation Intrauterine pressure catheter Tocodynamometer
Palpation If using external electronic fetal monitoring, palpation is needed to assess contraction intensity and uterine resting tone. Tocodynamometer --> measures uterine contraction frequency and duration; palpation is needed to assess intensity and uterine resting tone.
common interventions: Increase placental perfusion
Position patient on side to minimize compromise of placental blood flow. Administer intravenous bolus of isotonic fluid to increase maternal blood volume.
Which nonreassuring fetal heart rate (FHR) pattern includes a reduction in FHR of ≥15 beats/min for more than 2 minutes? Accelerations Tachycardia Early decelerations Prolonged decelerations
Prolonged decelerations Prolonged decelerations cause a decrease in FHR of ≥15 beats/min below baseline and last longer than 2 minutes but less than 10 minutes. The return to baseline FHR usually occurs after the contraction is over.
Category I: Normal (reassuring)
Reassuring patterns are associated with fetal well-being and indicate fetal tolerance of intrapartum stressors.
Which characteristics describe early decelerations? Select all that apply. - Most common during second stage of labor - Referred to as mirror images of contraction - Primarily periodic and often benign - Onset, nadir, and recovery correspond with beginning, peak, and end of contraction - Lowest fetal heart rate usually no lower than 20 beats/min from baseline
Referred to as mirror images of contraction Early decelerations are sometimes called a mirror image of a contraction because they correspond to the beginning, peak, and end of a contraction. Primarily periodic and often benign Early decelerations are usually periodic and are considered a benign finding, as they are not associated with fetal hypoxia, academia, or low Apgar scores. Onset, nadir, and recovery correspond with beginning, peak, and end of contraction The onset, nadir, and recovery of an early deceleration correspond with the beginning, peak, and end of a contraction.
The nurse is caring for a woman who is receiving oxytocin. The data displayed on the electronic fetal monitor shows that the contractions are approximately 10 seconds apart. Which intervention would the nurse perform next? Stop the oxytocin. Call the health care provider. Reposition the woman to her side. Administer oxygen to the patient.
Stop the oxytocin. One of the side effects of oxytocin or other uterine stimulants is excessive uterine activity, which can be harmful to the patient and fetus. Therefore the first action would be to stop the medication.
Intensity
Strength of contraction, classified as mild, moderate, or strong
The nurse is monitoring a patient in the active stage of labor with internal fetal monitoring. The patient has been experiencing contractions that last 70 to 90 seconds and occur every 1 to 2 minutes, and she has a uterine resting tone of 25 mm Hg. The nurse recognizes that the patient is experiencing which type of difficult labor? Hypotonic Precipitous Tachysystole Postterm labor
Tachysystole Tachysystole, or hypertonic uterine dysfunction, is a potential complication of labor induction. It is defined by an increase in the uterine resting tone or more than 5 uterine contractions in a 10-minute time frame.
The nurse notes accelerations on the fetal heart rate pattern. Which information is the nurse able to determine given this assessment? The fetus has a cord prolapse. The patient requires oxygen therapy. Immediate nursing intervention is necessary. The fetus has normal acid-base balance.
The fetus has normal acid-base balance. Accelerations are usually a reassuring sign that the fetus has a responsive central nervous system and is not in acidosis.
Early decelerations: Clinical significance
This is a normal finding and is not associated with fetal hypoxemia, acidemia, or low Apgar scores. No intervention is necessary.
Recurrent variable decelerations
Umiblical cord compression U,V or W shape scary if HR below 60 for 60 - knotted, prolapsed, short, cord wrapped around a body part - hypoxemia, metabolic acidemia
Uterine Resting Tone
Uterine relaxation between contractions; should be soft to touch
VC EH AO LP VEAL CHOP
V - variable deceleration, E - early deceleration, A - acceleration, L - late deceleration C - cord compression, H- head compression, O - okay!, P - placental insufficiency VC EH AO LP
A patient is concerned about the baseline variability in the heart rate of her fetus. Which responses by the nurse describe the significance of baseline variability to the patient? Select all that apply. "Variability is an artifact." "Variability is a periodic pattern." "Variability demonstrates that there is adequate oxygenation of the fetus." "Variability suggests that the fetus is able to adapt to the labor process." "Variability indicates that the fetus has no congenital abnormalities."
Variability demonstrates that there is adequate oxygenation of the fetus." -Adequate oxygenation of the fetus, demonstrated by variability, is necessary, and therefore variability is significant. "Variability suggests that the fetus is able to adapt to the labor process." - Variability is significant because its presence indicates that the autonomic nervous system is intact, allowing the fetus to adapt to the normal stress of labor.
Category III: Abnormal (nonreassuring)
an absence of favorable signs and/or presence of signs of fetal hypoxia or acidosis. -> In the presence of non-reassuring patterns, additional assessment and intervention may be indicated.
Fetal Heart Rate Variability Calculation
beats/min from the peak to the trough of a single cycle and does not include accelerations or decelerations of FHR.
Absent Baseline FHR variability
fluctuation range undetectable not reassuring Undetectable to ≤5 beats/min of variability Baseline FHR appears smooth, flat
normal FHR accelerations
increase in FHR ≥15 beats/min >15bpm for longer than 15-20s 2 in 20min= reassuring
Fetal Heart Rate Variability
irregular waves or fluctuations in the baseline FHR for two cycles per minute or more
Early Decelerations - Fetal Heart Rate
usually normal (reassuring) and mirror the contractions on the strip.
The nurse knows that patient education has been effective when the patient makes which statement about the difference between a tocodynamometer and an intrauterine pressure catheter (IUPC)? "Only the tocodynamometer shows my uterine activity." "The tocodynamometer is much more accurate than the IUPC." "The tocodynamometer is positioned outside my body, while the IUPC is positioned inside my body." "The tocodynamometer will be connected to my bedside monitor, but the IUPC will not."
"The tocodynamometer is positioned outside my body, while the IUPC is positioned inside my body." Whereas the tocodynamometer is an external monitoring device, the IUPC is an internal monitoring device.
The nurse is assessing the fetal heart rate of a woman who is currently lying supine and identifies a nonreassuring pattern. Which recommendation would the nurse make to address this pattern? "Elevate your legs." "Turn on your side." "Walk around the room to reposition the fetus." "Remain on your back, and we will reassess in an hour."
"Turn on your side." The patient should not lie supine, because compression of the aorta could negatively affect the fetus. *A change of position, such as lying on the side, is the first response to a nonreassuring fetal heart rate pattern in this situation.
Which response would the nurse provide the patient who asks why oxygen is being given after the nurse identifies a nonreassuring fetal heart rate? "I will call the health care provider to discuss the new care plan." "We need to increase the perfusion of the baby's placenta." "We need to increase your oxygen, which will increase the baby's oxygen." "Don't worry. This happens all of the time, and everything is fine."
"We need to increase your oxygen, which will increase the baby's oxygen." The nurse provides a simple and direct explanation for the intervention being provided.
Prolonged deceleration
-Right now! cut off from O2 in mom; Supine Hypotentsion, seizure, PE, CVA really compressed/ prolapsed cord. If lasts over 10 minutesit is a baseline change Imminant cardiac Failure
Normal FHR range
110-160 bpm
Which uterine resting tones are considered reassuring? Select all that apply. > 18 mm Hg with an intrauterine pressure catheter (IUPC) > 45 mm Hg with an intrauterine pressure catheter (IUPC) > 350 Montevideo units with electronic fetal monitoring (EFM) > 300 Montevideo units with fetal scalp electrode (FSE) > Less than 810 Montevideo units (MVUs) as measured externally
18 mm Hg with an intrauterine pressure catheter (IUPC) The average uterine resting tone is expected to be less than 20 mm Hg if measured with the IUPC. 350 Montevideo units with electronic fetal monitoring (EFM) The average uterine resting tone is expected to be less than 400 Montevideo units by internal EFM with an intrauterine pressure catheter (IUPC).
normal FHR variability
6-25 bpm
A nurse is caring for a patient in labor who is receiving oxytocin via intravenous infusion to stimulate uterine contractions. Which assessment finding would indicate to the nurse that the infusion needs to be discontinued? Three contractions occurring within a 10-minute period A fetal heart rate of 90 beats/min A resting uterine tone of 15 mm Hg via the intrauterine pressure catheter Early decelerations
A fetal heart rate of 90 beats/min A normal fetal heart rate is 110 to 160 beats/min. Bradycardia and/or late or variable decelerations indicate fetal distress and the need to discontinue the oxytocin infusion.
Late decelerations
Bad (placenta) you LION Disruption of oxygen transfer leads to fetal hypoxemia, acidemia, and low apgar score
Frequency
Beginning of one contraction to the beginning of the next
3 FHR patterns
Category I: Normal (reassuring) Category II: Indeterminate (equivocal or ambiguous) Category III: Abnormal (nonreassuring)
Which fetal heart rate classification is considered nonreassuring? Category I Category II Category III Category IV
Category III Category III classification refers to abnormal findings that are nonreassuring.
A nurse is beginning to care for a patient in labor. The health care provider has prescribed an intravenous (IV) infusion of oxytocin. The nurse makes sure that which implementations occur before initiation of the infusion? Select all that apply. Placing the patient on complete bed rest Continuous electronic fetal monitoring An IV infusion of antibiotics Making sure that a vial of terbutaline is immediately available Preparing an IV infusion pump Placing a code cart at the patient's bedside
Continuous electronic fetal monitoring Continuous electronic fetal monitoring, either external or internal, is a standard of practice with the administration of IV oxytocin. Making sure that a vial of terbutaline is immediately available Terbutaline, administered either intravenously or subcutaneously, is a tocolytic that can be used to decrease or stop uterine contractions when uterine tachysystole occurs. Preparing an IV infusion pump IV oxytocin should only be administered via an IV pump. IV oxytocin during labor should never be administered without the use of a pump for titration.
Early Decelerations - Fetal Heart Rate
Decelerations are categorized in relation to the uterine contraction: early, late, variable, or prolonged. -->Early decelerations are often a result of fetal head compression that triggers a parasympathetic response, which lowers the HR.
The nurse notes fetal tachycardia and suspects that the patient may be dehydrated. Which nursing action is appropriate to address this nonreassuring finding? Consult with the dietician. Administer parenteral feeding. Increase the rate of intravenous (IV) saline administration. Provide the patient an oral (PO) electrolyte replacement.
Increase the rate of intravenous (IV) saline administration. Tachycardia can be the result of maternal hypovolemia caused by dehydration. Increasing the rate of nonadditive intravenous fluids can improve placental perfusion by increasing maternal blood volume.
Category II: Indeterminate (equivocal or ambiguous)
Indeterminate patterns do not fall clearly into reassuring or nonreassuring categorization. Such patterns have elements of reassuring characteristics but also data that may be nonreassuring.
