- Placental abruption
- Maternal supine hypotension
Late decelerations are almost always caused by uteroplacental insufficiency. Insufficiency is caused by uterine tachysystole, maternal hypotension, epidural or spinal anesthesia, IUGR, intraamniotic infection, or placental abruption. Spontaneous fetal movement, vaginal examination, fetal scalp stimulation, fetal reaction to external sounds, uterine contractions, fundal pressure, and abdominal palpation are all likely to cause accelerations of the FHR. Early decelerations are most often the result of fetal head compression and may be caused by uterine contractions, fundal pressure, vaginal examination, and the placement of an internal electrode. A variable deceleration is likely caused by umbilical cord compression, which may happen when the umbilical cord is around the babys neck, arm, leg, or other body part or when a short cord, a knot in the cord, or a prolapsed cord is present.
C, E
Late decelerations are almost always caused by uteroplacental insufficiency. Insufficiency is caused by uterine tachysystole, maternal hypotension, epidural or spinal anesthesia, IUGR, intraamniotic infection, or placental abruption. Spontaneous fetal movement, vaginal examination, fetal scalp stimulation, fetal reaction to external sounds, uterine contractions, fundal pressure and abdominal palpation are all likely to cause
accelerations of the FHR. Early decelerations are most often the result of fetal head compression and may be caused by uterine contractions, fundal pressure, vaginal examination, and placement of an internal electrode. A variable deceleration is likely caused by umbilical cord compression. This may happen when the umbilical cord is around the baby's neck, arm, leg, or other body part or when there is a short cord, a knot in the cord, or a prolapsed cord.
b. Notify the primary health care provider immediately.
To relieve an FHR deceleration the nurse can reposition the mother, increase IV fluid, and provide oxygen. Also, if oxytocin is being infused, it should be discontinued. If the FHR does not resolve, the primary health care provider should be notified immediately. Although it is always a good idea to have extra help during any unanticipated obstetric event, calling for help is not the most important nursing measure at this time. If the FHR were to continue in an abnormal or nonreassuring pattern, a cesarean section might be warranted. This would require the insertion of a Foley catheter; however, the physician must make that determination. Oxytocin may put additional stress on the fetus.
ANS: C, E
Late decelerations are almost always caused by uteroplacental insufficiency. Insufficiency is caused by uterine tachysystole, maternal hypotension, epidural or spinal anesthesia, IUGR, intraamniotic infection, or placental abruption. Spontaneous fetal movement, vaginal examination, fetal scalp stimulation, fetal reaction to external sounds, uterine contractions, fundal pressure and abdominal palpation are all likely to cause accelerations of the FHR. Early decelerations are most often the result of fetal head compression and may be caused by uterine contractions, fundal pressure, vaginal examination, and placement of an internal electrode. A variable deceleration is likely caused by umbilical cord compression. This may happen when the umbilical cord is around the babys neck, arm, leg, or other body part or when there is a short cord, a knot in the cord, or a prolapsed cord.
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Terms in this set [10]
The nurse caring for a laboring woman is aware that maternal cardiac output can be increased by:
A. Change in position.
B. Oxytocin administration.
C. Regional anesthesia.
D. Intravenous analgesic.
A. Change in position.
A group of fetal monitoring experts [National Institute of Child Health and Human Development, 2008] recommends that fetal heart rate [FHR] tracings demonstrate certain characteristics to be described as reassuring or normal [category I]. These characteristics include:
A. Bradycardia not accompanied by baseline variability.
B. Early decelerations, either present or absent.
C. Sinusoidal pattern.
D. Tachycardia.
B. Early decelerations, either present or absent.
When using intermittent auscultation [IA] to assess uterine activity, nurses should be aware that:
A. The examiner's hand should be placed over the fundus before, during, and after contractions.
B. The frequency and duration of contractions are measured in seconds for consistency.
C. Contraction intensity is given a judgment number of 1 to 7 by the nurse and client together.
D. The resting tone between contractions is described as either placid or turbulent.
A. The examiner's hand should be placed over the fundus before, during, and after contractions.
Fetal bradycardia is most common during:
A. Maternal hyperthyroidism.
B. Fetal anemia.
C. Viral infection.
D. Tocolytic treatment using ritodrine.
C. Viral infection.
Which of the following statements is not used to describe a characteristic of a uterine contraction?
A. Frequency [how often contractions occur]
B. Intensity [the strength of the contraction at its peak]
C. Resting tone [the tension in the uterine muscle]
D. Appearance [shape and height]
D. Appearance [shape and height]
You are evaluating the fetal monitor tracing of your client, who is in active labor. Suddenly you see the fetal heart rate [FHR] drop from its baseline of 125 down to 80. You reposition the mother, provide oxygen, increase IV fluid, and perform a vaginal exam. The cervix has not changed. Five minutes have passed, and the FHR remains in the 80s. What additional nursing measures should you take?
A. Call for help.
B. Insert a Foley catheter.
C. Start oxytocin [Pitocin].
D. Notify the primary health care provider immediately.
D. Notify the primary health care provider immediately.
A nurse caring for a woman in labor understands that increased variability of the fetal heart rate might be caused by:
A. Narcotics.
B. Barbiturates.
C. Methamphetamines.
D. Tranquilizers.
C. Methamphetamines.
The nurse providing care for the laboring woman understands that accelerations with fetal movement:
A. Are reassuring.
B. Are caused by umbilical cord compression.
C. Warrant close observation.
D. Are caused by uteroplacental insufficiency.
A. Are reassuring.
The most common cause of decreased variability in the FHR that lasts 30 minutes or less is:
A. Altered cerebral blood flow.
B. Fetal hypoxemia.
C. Umbilical cord compression.
D. Fetal sleep cycles.
D. Fetal sleep cycles.
Fetal well-being during labor is assessed by:
A. The response of the fetal heart rate [FHR] to uterine contractions [UCs].
B. Maternal pain control.
C. Accelerations in the FHR.
D. An FHR greater than 110 beats/min.
A. The response of the fetal heart rate [FHR] to uterine contractions [UCs].
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