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What does a low fetal heart rate suggest and what is the appropriate treatment?
What is indicated by variable decelerations in fetal heart monitoring?
During stage #2 delivery, what is the first action to take?
What does high baseline variability in fetal heart rate indicate?
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What should be checked during stage #3 after delivering the placenta?
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In the fourth stage of recovery, what is one of the critical checks performed four times per hour?
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Which of the following actions should be taken if the fundus is boggy after delivery?
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What does low variability in fetal heart rate signify?
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What is the purpose of uterine contractions during stage #3?
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How should the mother be positioned if variable decelerations are detected?
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Which medication is specifically indicated for stopping labor?
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What condition do Mongolian spots commonly appear in?
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Which medication can cause maternal tachycardia?
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What is the effect of administering Magnesium Sulfate with a respiratory rate below 12?
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Which fetal lung maturing medication is administered to the mother before delivery?
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What is the key characteristic of nevus flammeus?
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Which of the following is a contraindication for Hemabate administration?
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What is the primary risk associated with excessive use of Oxytocin?
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What physiological condition is characterized by cyanosis of a newborn's hands and feet?
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What type of birthmark describes blanchable pink spots referred to as 'stork bites'?
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Which of the following indicates excessive postpartum bleeding?
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What is the expected uterine fundus height on the 4th postpartum day?
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What characterizes lochia rubra during the postpartum period?
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When performing a postpartum assessment, a boggy uterine fundus should be addressed how?
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Which of the following is a sign of potential thrombophlebitis in extremity checks?
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What condition is described as a symmetrical head swelling crossing sutures in a newborn?
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What should be the next step if the uterine fundus is found to be midline but boggy?
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Which type of lochia is characterized by pink discharge occurring days after delivery?
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What indicates that a newborn may have a cephalohematoma?
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Which of the following assessments should be performed every 4-8 hours in the postpartum period?
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Study Notes
Fetal Heart Monitoring
- Always check fetal heart rate; crucial for assessing fetal wellbeing.
- Low fetal heart rate (below 110) is concerning; implement LION protocol (Left side, IV, O2, Notify) and stop Pitocin if running.
- High fetal heart rate (above 160) typically indicates no issues; document findings and assess mother's temperature.
- Low baseline variability is a bad sign; indicates consistent fetal heart rate; apply LION protocol.
- High baseline variability is acceptable; reflects healthy variability in fetal heart rate; document accordingly.
- Late decelerations signify distress, slowing heart rate at the end or after contractions; use LION protocol for intervention.
- Early decelerations occur before or at the beginning of contractions; considered normal; require documentation only.
- Variable decelerations are extremely concerning, signifying possible cord prolapse; push head off the cord and position mother in knee-chest until delivery.
Stages of Delivery
-
Stage 2 (Delivery of Baby):
- Order of delivery: head, suction mouth then nose, check for nuchal cord, deliver shoulders, then body.
- Ensure baby has ID band before leaving the delivery area.
-
Stage 3 (Delivery of Placenta):
- Main goal is to expel placenta; guarantee placenta is intact and cord contains three vessels (two arteries, one vein).
-
Stage 4 (Recovery):
- Purpose of uterine contractions: prevent hemorrhage.
- Postpartum begins two hours post placenta delivery; monitor vital signs for shock (drops in pressure, rapid heart rate, pallor).
- Assess fundus firmness; massage if boggy, check for displacement.
- Monitor pad saturation; saturated in less than 15 minutes is excessive bleeding; one-hour saturation is unacceptable.
- Roll patient to check for bleeding underneath.
Postpartum Assessment
- Conducted every 4-8 hours; evaluate:
- Breasts
- Uterine fundus: must be firm and midline; fundal height corresponds to days postpartum.
- Bladder
- Bowel
- Lochia: assess color—rubra (red), serosa (pink), alba (white); saturation levels indicate potential issues.
- Episiotomy
- Hemoglobin & Hematocrit levels
- Extremity checks for pulses, edema, thrombophlebitis; measure bilateral calf circumference.
- Affect (emotions)
- Discomfort management
Normal Variations in Newborns
- Caput succedaneum: symmetric edema crossing sutures caused by delivery pressure.
- Cephalohematoma: asymmetric, does not cross sutures; results from traumatic birth.
- Milia: tiny white spots from distended sebaceous glands.
- Epstein's pearls: benign cysts on gums.
- Mongolian spots: bluish-black marks in darker-skinned infants.
- Erythema Toxicum Neonatorum: benign red rash on torso.
- Hemangiomas: benign capillary tumors.
- Vernix caseosa: protective white substance on newborn skin.
- Acrocyanosis: normal transient cyanosis of hands and feet.
- Nevus/Nevi: general term for birthmarks, including non-blanchable and blanchable varieties.
OB Medications
- Tocolytics: help stop labor; major drugs include Terbutaline (causes maternal tachycardia) and Magnesium Sulfate (watch for side effects including decreased respiratory rate and reflexes).
- Oxytocics: stimulate labor; Oxytocin can lead to uterine hyperstimulation; monitor contraction frequency and duration.
- Fetal Lung Maturing Medications: include Betamethasone (IM to mother pre-delivery) and Survanta (given post-birth to newborn via trachea).
- Only antipsychotic permitted during pregnancy: Haldol.
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Description
This quiz covers essential fetal heart monitoring techniques, including the implications of low and high fetal heart rates. It provides strategies for treatment and the importance of monitoring variability in heart rates during labor. Perfect for nursing students and healthcare professionals!
