Question

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.

Answer 1

FHR Pattern

Reassuring FHR signs

• Normal baseline (110–160 bpm) • Moderate bradycardia (100–120 bpm); good variability • Good beat-to-beat variability and fetal accelerations

Nonreassuring signs

• Fetal tachycardia (>160 bpm) • Moderate bradycardia (100–110 bpm); lost variability • Absent beat-to-beat variability • Marked bradycardia (90–100 bpm) • Moderate variable decelerations

Ominous signs

• Fetal tachycardia with loss of variability • Prolonged marked bradycardia (<90 bpm) • Severe variable decelerations (<70 bpm) • Persistent late decelerations

INTERVENTIONS FOR NONREASSURING DECELERATIONS

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.