There are three basic types of decelerations: early decelerations, late decelerations, and variable decelerations. The mechanisms underlying variable decelerations, the technique for amnioinfusion administration, and two case studies are reported. That is the âCâ. If the fetus does not respond to primary nursing interventions for late decelerations, then the nurse should continue with subsequent intrauterine resuscitation measures and notify the health care provider. They account for the majority of decelerations (>88%). Record FHR, note any changes or decelerations during and following contractions. Intrapartum Electronic Fetal Monitoring Lisa A. Miller Donna J. Ruth Part 1 Introduction and Overview This module will provide clinicians with practical information on intrapartum fetal monitoring, with a primary focus on electronic fetal monitoring (EFM). C) This pattern reflects variable decelerations. The umbilical cord connects the fetus to the placenta and contains three vessels, 2 arteries and 1 vein. ⢠Differentiate among the nursing interventions used for managing specific fetal heart rate patterns, including tachycardia and bradycardia, absent or minimal variability, and late and variable decelerations. Variable Decelerations Cause o Umbilical cord compression caused by the following: o Maternal position with cord between fetus and maternal pelvis o Cord around fetal neck, arm, leg, or other body part o Short cord o Knot in cord o Prolapsed cord Clinical Significance o Variable decelerations occur in approximately 50% of all labors and usually are transient and correctable Nursing ⦠422, 423 Variable decelerations are commonly seen with cord compression. Nursing Interventions Rationale Review the history of labor, onset, and duration. So now that you know what early decelerations are and what causes it, let's see how to interpret them on a graph. The technique may ⦠Along with this new term, ACOG further recommends physicians add to the diagnosis a list of additional findings such as fetal tachycardia, bradycardia, repetitive variable decelerations, low biophysical profile, and late decelerations. Clarification: Significant Decelerations ⢠Variable decelerations that are less than 60 bpmat the nadir regardless of the baseline AND lasting greater than 60 seconds ⢠Variable decels60 x 60 have an association with increased morbidity Clark, et al, Management of Second Stage Guideline, AJOG, Aug 2013. allnurses is a Nursing Career & Support site. Variable decelerations also require a maternal position change (side to side). Variable deceleration- At least 15 beats/min or more below baseline, lasts at least 15 seconds, and returns to baseline in less than 2 minutes from time of onset. This is when there are abrupt decreases in the fetal heart rate and occurs because of cord compression. DIF: Cognitive Level: Understand REF: pp. No interventions are necessary at this time. Our members represent more than 60 professional nursing specialties. Nursing Interventions Rationale; Note progress of labor. The deceleration lasts >= 2 minutes but less than 10 minutes. ⢠Describe nursing measures that can be used to maintain fetal heart rate patterns within normal limits. Lowdermilk: Maternity Nursing, 8th Edition Chapter 11: Fetal Assessment during Labor Test Bank MULTIPLE CHOICE 1. Decelerations are temporary drops in the fetal heart rate. The reduced flow through the umbilical cord causes variable decelerations. Suddenly, as a contraction is beginning to subside, the fetal heart rate drops to a low of 80 bpm and has a slow return to the baseline 1 minute after the contraction has ended. Decreased circulating volume or vasospasms within the placenta decrease oxygen available for fetal uptake. Intrapartum FHR monitoring allows for the identification of changes associated with fetal ⦠The module is divided into six sections. However, they are classified either as category II or III depending on the accompanying change in baseline variability c. Late - Late decelerations are visually apparent, usually symmetrical, transitory decreases in FHR that occur after the peak of the contraction. Requires nursing intervention to improve blood flow and fetal oxygen supply; VEAL CHOP. In nursing, the acronym VEAL CHOP can be used to remember the types of fetal heart rate patterns and the causative factors associated with them. Below is a graph showing early decelerations. She has external fetal monitoring in place, which reveals a baseline fetal heart rate of 120 bpm, minimal variability, and occasional variable decelerations. 2- What nursing interventions are needed for the above decelerations to return fetal heart to normal range? Human and animal studies have demonstrated an association between decreased amniotic fluid and the occurrence of variable decelerations in the fetal heart rate. The V stands for variable decelerations. Because late decelerations also indicate reduced placental perfusion, nursing interventions are aimed primarily at improving maternal oxygenation and circulation to the uterus. 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 ⦠Variable decelerations are the most common type of decelerations and are transient decreases in fetal heart rate that characteristically vary in duration, shape/magnitude, and timing/onset. Prolonged or dysfunctional labor with an extended latent phase can contribute to problems of infection, maternal exhaustion, severe stress, and hemorrhage caused by uterine atony/rupture, putting the fetus at greater risk for hypoxia and injury. Variable decelerations are a condition in which there is a reduced flow through the umbilical cord. Interventions for Variable Decelerations: Variable decelerations are associated with cord compression. Nursing Interventions Rationale; Note presence of maternal factors that negatively affect placental circulation and fetal oxygenation. Late decelerations treatment and management If the fetal heart rate pattern is atypical, then your obstetrician will initially try to determine the underlying problem. Despite the ambiguity surrounding fetal monitoring, physicians and nursing (and ideally, neonatal specialty nurses) must work collaboratively, particularly in cases with variable decelerations, so that both mother and baby can receive the best care and the therapeutic direction taken is the best possible choice. They are reductions in FHR of more than 15 bpm from the baseline for 15 seconds, which vary in length and amplitude and are not uniform. Amnioinfusion is a new investigational technique directed at decreasing the number and severity of variable decelerations by infusion of a normal saline solution into the uterine cavity. c. Uteroplacental insufficiency. Interventions for late decelerations are: Lower the head of the bed and turn the mom on her left side to take the pressure off the vena cava and allow blood flow to the heart and to the lungs. Our mission is to Empower, Unite, and Advance every nurse, student, and educator. Our members represent more than 60 professional nursing specialties. Part 1 provides an overview of intrapartum fetal monitoring and includes ⦠The nurse providing care for the laboring woman should understand that variable fetal heart rate (FHR) decelerations are caused by: a. Altered fetal cerebral blood flow. Therefore, it requires no medical intervention. They correspond with uterine contractions and are likely a result of umbilical cord compression against the fetus leading to decreased umbilical blood flow. Hon and Quilligan first described three types of decelerations (early, variable, and late) in 1967 based on the shape and timing of decelerations relative to uterine contractions. Lastly, late decelerations and fetal hypoxia during the second stage of labor could be the result of your pushing. Early decelerations don't cause any compromise to the status of the fetus, such as oxygenation or anything. Caused by compression of the umbilical cord. Our mission is to Empower, Unite, and Advance every nurse, student, and educator. Nursing responsibilities regarding amnioinfusion include pattern recognition, assisting with or initiation of amnioinfusion, and maintenance and evaluation of this intervention. Since 1997, allnurses is trusted by nurses around the globe. Next are early decelerations and these are associated with a contractions that cause head compression as we are close to delivery. A fetal scalp electrode would provide accurate data for evaluating the well-being of the fetus; however, this is not a nursing intervention that would alleviate late decelerations, nor ⦠B) This deceleration pattern is associated with uteroplacental insufficiency, so the nurse acts quickly to improve placental blood flow and fetal oxygen supply. Prolonged decelerations are late or variable decelerations that last for a prolonged period (longer than 2 minutes) and require intervention. The FHR pattern associated with this situation most likely reveals variable deceleration. This fetal heart rate deceleration quiz will help you learn how to differentiate between early decelerations, late decelerations, and variable decelerations. This is something known as VEAL-CHOP. On the NCLEX exam and in your maternity OB nursing lecture classes, you will have to know how to identify each fetal heart rate tone deceleration. Recurrent decelerations ( variable, early, or late ): Decelerations occur with > 50% of uterine contractions in any 20 minute segment. : Monitor baseline FHR manually and/or electronically Decelerations are temporary decreases in the fetal heart rate (FHR) during labor. Moderate decelerations are not an accepted category. Prolonged deceleration : A decrease in FHR of > 15 beats per minute measured from the most recently determined baseline rate. Since 1997, allnurses is trusted by nurses around the globe. Note: This is a key nursing intervention so you have to keep this in mind. allnurses is a Nursing Career & Support site. Variable Decelerations- Explained. Variable decelerations (Online Figure I), as the name implies, vary in terms of shape, depth, and timing in relationship to uterine contractions, but ⦠Observe for visible cord prolapse when membranes rupture, and occult cord prolapse as indicated by variable decelerations on monitor strip, especially if fetus is in breech presentation. These decelerations are usually corrected when the woman turns onto her side to displace the weight of the gravid uterus from the vena cava. Definition/Introduction. It also gives you a clue as to what the correlating nursing interventions should be for each pattern. b. Umbilical cord compression. Variable deceleration The fetal heart response is asynchronous with respect to uterine contractions; the curves on the fetal heart monitor are more angled and saw-toothed, and may be related to compromise in placental blood flow, eg umbilical cord compression and, like late decelerations, may signify parturition-related difficulties
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