Question

AT&T 10:27 AM Close Case Study Fetal Heart Rate Mon... DOCX - 13 KB Case Study Fetal Heart Rate Monitoring A 28 year old patient is admitted to the L & D unit for triage. She is a Gi PO and 32 weeks pregnant and has stated she feels decreased fetal movement. Her vital signs are: BP: 12068 RR 14 HR 76 Temp 100.1 She tells the nurse she has felt as if she has fluid leaking one time this morning, but has not since. She is not bleeding and her abdomen is soft. When the nurse applies the FHR monitor, the FHR is 172 with minimal variability. She has no accelerations and no decelerations. What nursing considerations/implementaion should be given to this patient? What is a priority nursing diagnosis for her? What further care or testing would you foresee? Name three causes of late decelerations? What are three causes of bradycardia in a fetus? What are three causes of tachycardia in a fetus? Name one assessment finding in this scenario that would affect your judgement of the fetal heart ratet racing? Eail Word Save

Answer 1

NURSING CONSIDERATIONS/ IMPLICATIONS

The nursing considerations for the above case includes making the patient comfortable and relaxed.

The nurse should keep a close check on the patient’s conditions and vital signs.

The patient should be taught vaginal hygiene.

Nurse should administer antipyretics and antibiotics as directed by the physician

Fetal heart rate and other parameters should be monitored regularly by the nurse.

PRIMARY DIAGNOSIS

The primary diagnosis in the above case is chorioamnionitis.

Chorioamnionitis is the inflammation of the fetal membranes caused due to bacterial infections. Chorioamnionitis is characterised by maternal pyrexia, maternal tachycardia, fetal tachycardia, leucocytosis, foul smelling vaginal discharge.

The above case shows three important features : maternal pyrexia, fetal tachycardia, vaginal discharge. Thus we can say chorioamnionitis as primary diagnosis.

Further tests include checking for maternal heart rate, differential WBC count.

Deceleration is defined as decrease in fetal heart rate below the normal. Late decelerations is seen when reduce level of oxygen in the fetal blood triggers fetal chemoreceptors causing reflex constriction of blood vessels in peripheral areas in order to divert blood supply to vital organs. Peripheral blood vessels constriction results in hypertension. This stimulates a baroreceptor mediated vagal response slowing down the heart rate. The time consumed during this process leads to delay in the deceleration timing relative to the contraction.

Causes of deceleration are maternal hypotension, maternal hypoxemia and excessive uterine contraction.

Causes of fetal bradycardia includes placental abruption, reduced uterine perfusion and fetal hypotension.

Causes of fetal tachycardia include maternal hyperthyroidism, maternal fever, fetal hypoxia.

The history given by mother of vaginal discharge and maternal pyrexia will lead to need for assessing the fetal heart rate.