Question

Discuss the differences among the nursing interventions used for managing Fetal Heart Rate (FHR) patterns, involving tachycardia and bradycardia, absent or minimal variability and late and variable decelerations. Use appropriate terminology and abbreviation according to Maternity.

Answer 1

1)Ans) FHR Pattern:
     Assessment parameters of the FHR are classified as baseline rate, baseline variability and periodic changes in the rate accelerations and decelerations. The nurse must be able to interpret the various FHR parameters to determine if the pattern
is indicating fetal well-being or
indicating fetal problems to care for the woman effectively during labor and birth.

Fetal bradycardia occurs when the FHR is below 110 bpm and lasts 10 minutes or longer. It can be the initial response of a healthy fetus to asphyxia. Causes of
fetal bradycardia might include fetal hypoxia, prolonged maternal hypoglycemia, fetal acidosis.

Bradycardia may be benign if it is an isolated event, but it is considered anominous sign when accompanied by a decrease in long-term variability and late decelerations.

Nursing interventions for fetal bradycardia:

reposition the mother to limit cord compression and improve her blood pressure,

correct the maternal blood pressure as required; and

eliminate the uterine activity, if present, with 250μg SC terbutaline

Fetal tachycardia is a baseline FHR greater than 160 bpm that lasts for 10 minutes or longer. It can represent an early compensatory response to asphyxia.
Other causes of fetal tachycardia include fetal hypoxia, maternal fever, maternal dehydration, amnionitis
Fetal tachycardia is considered an ominous sign if it is accompanied by a decrease in variability and late decelerations.

Nursing interventions for tachycardia:

# 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.

A deceleration is a transient fall in FHR caused by stimulation of the parasympathetic nervous system.
Decelerations are described by their shape and association to a uterine contraction. They are classified as early,
late, variable, and prolonged
Early decelerations are characterized by a gradual decrease in the FHR in which the occurs at the peak of the contraction. They rarely decrease more than 30 to 40 bpm below the baseline. Early decelerations mirror the appearance of the uterine contraction below it on the fetal tracing.Early decelerations are not indicative
of fetal distress and do not require intervention.

Late decelerations are transitory decreases in FHR that occur after a contraction begins. The FHR does not return to baseline levels until well after the contraction
has ended. Delayed timing of the deceleration occurs,with the nadir of the uterine contraction. Late decelerations are associated with uteroplacental insufficiency,
which occurs when blood flow within the intervillous space is decreased to the extent that fetal hypoxia exists

Nursing interventions:

If a patient develops a nonreassuring deceleration pattern such as late or variable decelerations:

• Notify the healthcare provider about the pattern and obtain further orders, making sure to document all interventions and their effects on the FHR pattern.
• Reduce or discontinue oxytocin as dictated by the facility’s protocol, if it is being administered.
• Provide reassurance that interventions are being done to effect a pattern change.

Additional interventions specific for a late deceleration FHR pattern would include:

• Turning the client on her left side to increase placental perfusion
• Administering oxygen by mask to increase fetal oxygenation
• Increasing the IV fluid rate to improve intravascular volume
• Assessing client for any underlying contributing causes
• Providing reassurance that interventions are to effect pattern change.

Specific interventions for a variable
deceleration FHR pattern would include:

• Changing the client’s position to relieve compression on the cord
• Providing reassurance that interventions are to effect pattern change
• Giving oxygen and IV fluids as ordered