With Picmonic, facts become pictures. We've taken what the science shows - image mnemonics work - but we've boosted the effectiveness by building and associating memorable characters, interesting audio stories, and built-in quizzing.DOWNLOAD PDF Show
Recommended PicmonicsLate DecelerationsLate-moon Decelerating fetus heart Decelerations which are caused by a parasympathetic response during labor can be benign in nature (a normal pattern occurrence) or can be abnormal or nonreassuring. They are identified visually on a fetal monitor tracing by when they occur in the contraction cycle either the onset or at the end of a contraction and also by their shape. A late deceleration is a gradual decrease and return to the baseline FHR during the contraction with the lowest point (nadir) occurring after the peak of the contraction. It does not return to the FHR baseline until after the contraction is over. 8 KEY FACTS When there is insufficient oxygenation between the placenta and fetus, uteroplacental insufficiency occurs and causes late decelerations. There are many causes for late decelerations, such as uterine tachysystole, which occurs when there are more than 5 contractions in 10 minutes. Frequent contractions do not allow sufficient recovery and adequate oxygen exchange in the placenta. Other conditions are maternal supine hypotension, placental previa, hypertensive disorders, diabetes mellitus, intraamniotic infection, intrauterine growth restriction, epidural or spinal anesthesia, and postmaturity. A late deceleration is associated with fetal hypoxemia, acidemia, and low Apgar scores. When late decelerations become persistent or repetitive, it is considered an ominous sign, especially when associated with fetal tachycardia and loss of contraction variability. If oxytocin (Pitocin) is infusing, it should be discontinued until the late decelerations are corrected. This will slow the rate and strength of the contractions to allow for better perfusion of the placenta. It is important to provide oxygen by nonrebreather face mask to the mother to alleviate the shortage of oxygen exchanging across the placental to the fetus. An immediate and priority nursing action would be to change the laboring patient’s position to side-lying to eliminate any supine hypotension issue. When maternal blood pressure is low, it is helpful to elevate the legs to assist with alleviating maternal hypotension. Dehydration and hypovolemia can cause a reduction of blood flow to the placenta, so by increasing the rate of the maintenance IV solution will address this problem. DOWNLOAD PDFTake the Late Decelerations QuizPicmonic's rapid review multiple-choice quiz allows you to assess your knowledge. Picmonic for Nursing RN CoversRegistered Nurse (RN) *Average video play time: 2-3 minutes Our Story Mnemonics Increase Mastery and RetentionMemorize facts with phonetic mnemonics Unforgettable characters with concise but impactful videos (2-4 min each) Ace Your Registered Nurse (RN) Classes & Exams with Picmonic:Choose the #1 Registered Nurse (RN) student study app.Works better than traditional Registered Nurse (RN) flashcards. The clinical practice of auscultating fetal heart tones began in 1818 when a Swiss surgeon reported hearing the fetal heart rate by placing his ear against a pregnant woman’s abdomen. In 1888, an American physician, Dr. Killian, suggested that Fetal Heart Rate information could be used to identify the need for intervention for fetal distress. FHR was first introduced to the public by Yale in 1958 but did not become widely used in obstetric care until the 1970’s. Since then, it has become an accepted standard in the management of ob gyn patients who are in labor and close to delivery. There are external and internal fetal monitors. External monitors (also known as ultrasound transducers) are usually composed of a belt with a doppler ultrasound that is strapped to the pregnant woman’s belly. Internal monitors consist of an electrode attached to the fetal scalp. The fetal membranes must be ruptured to apply an internal monitor. External monitoring is subject to loss of signal related to maternal positioning, fetal positioning, maternal body fat. A normal fetal heart rate range is 115-150 beats per minute (much faster than a normal adult heart rate). A slow heart rate, or bradycardia, may indicate the baby is not getting enough oxygen delivery to the brain. A fast heart rate, or tachycardia, may indicate oxygen deprivation. There is an acceptable range of acceleration and deceleration – or speeding up and slowing down – of fetal heart rates during contractions and labor. “Variable deceleration” or “late deceleration”, however, may be signs that the baby is not doing well. Variable decelerations are irregular dips in the fetal heart rate that may indicate cord compression, a potentially dangerous condition for the baby. Late decelerations begin with a uterine contraction and continue for too long after the contraction has resolved. This may be a sign that the baby is distressed. Obstetricians and nurses must carefully review fetal monitor strips throughout labor and delivery to ensure fetal heart tones are reassuring and the baby is getting enough oxygen. If non-reassuring conditions occur, appropriate and timely actions must be taken. Generally, nursing interventions are attempted first to restore normal oxygenation to the baby. These include the administration of supplemental oxygen, changes in maternal position, increasing intravenous fluids, and the administration of medications that subdue contractions and maximize placental blood flow. If fetal heart tones remain non-reassuring despite nursing interventions, the fetus should be delivered by emergency cesarean section. Emergency cesarean section should be performed within 5 to 30 minutes depending on the circumstances. It is hard to help a distressed baby in the uterus: a C-section is the best and fastest way to handle a baby in distress. Resuscitation, oxygen, fluids, and other lifesaving interventions may be quickly administered once the baby is born. What to look for in the medical records:
http://www.aafp.org/afp/1999/0501/p2487.html What is the priority action for late decelerations?The principal goal of management of late decelerations is to: Replenish uteroplacental blood flow by correcting the underlying cause. Increase fetal PO2. Prevention or correction of fetal acidemia.
How are late decelerations treated?These decelerations are completely benign as they do not affect fetal oxygenation and, therefore, do not require treatment. Late decelerations are caused by uteroplacental insufficiency, which is a decrease in the blood flow to the placenta that reduces the amount of oxygen and nutrients transferred to the fetus.
What are the 3 major decelerations?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.
What are nursing interventions for early decelerations of the fetal heart rate?NCLEX and HESI may ask what is causing this type of strip and the answer would be uteroplacental insufficiency. Some nursing interventions include: turn mom onto her side, stop Picotin if infusing, administer 10 L of O2, maintain IV access, determine the Fetal Heart Rate variability, and contact doctor.
|
