NCC EFM Exam Breakdown & Study Guide

Document Content and Description Below

1. Content on exam: -Pattern recognition & intervention: 70% -Physiology: 11% -Fetal assessment methods: 9% -EFM equipment: 5% -Professional issues: 5% 2. Pattern recognition & intervention: -FHR ... baseline -FHR variability -FHR accelerations -FHR decelerations -Normal uterine activity -Abnormal uterine activity -Fetal dysrhythmias -Maternal complications -Uteroplacental complications -Fetal complications 3. FHR Descriptors: 1) Baseline 2) Variability 3) Presence of accels 4) Presence of decels 5) Changes in trends overtime 4. FHR Baseline: Average FHR rounded to nearest 5 during a 10 min window -110 to 160 -excludes accels, decels, & marked variability -must have 2 mins to identify as a baseline (doesn't need to be continuous) 5. Fetal Bradycardia: <110 for e10 min -Causes: hypotension (ex: after epi), cord prolapse, head compression, congen- ital defect, rapid descent, abruption or rupture, tachysystole, post dates, hypo- glycemia, lupus (heart block) -With “ O2, blood will be shunted to brain, heart, & adrenals, eventually “ FHR to “ O2 demands of heart muscle -Verify not mom's HR, vaginal exam (r/o prolapse), resuscitate, evaluate arrhyth- mia, expedite delivery 6. Fetal Tachycardia: >160 for e10 min -Causes: fetal anemia, maternal fever or infection, fetal immaturity (preterm), SVT, maternal anxiety (catecholamines), dehydration, hyperthyroid, hypoxia -Med causes: terbutaline, catecholamines (epinephrine, norepi) -Assess mom's temp & infection risk (GBS, PROM) 7. FHR Variability: Irregular in amplitude & frequency, quantified by peak to trough -Caused by sympathetic vs parasympathetic, r/t neuro maturity -Less in preterm due to undeveloped CNS -Absent: undetectable, flat -Minimal: d5 bpm but detectable -Moderate: 6-25 bpm -Marked: >25 bpm (indeterminate baseline), significance unknown 8. Minimal variability: d5 bpm but detectable Sleep, sedated, or sick -Sleep cycle: 20-60 mins -Sedated: CNS depressant (ex: mag), 1-2 hrs -Sick (acidemia): unresolved w intervention -Priority: maximize oxygenation (position, bolus, O2 if needed) 9. Moderate variability: 6 to 25 bpm -Reliably predicts the absence of metabolic acidosis (even w decels) 10. FHR Accelerations: Reliably predicts absence of metabolic acidemia (spon- taneous or stimulated) -Onset to peak in <30 sec -For e32 wks: 15x15 (peak e15 bpm above baseline lasting e15 se -For <32 wks: 10x10 -Prolonged accel: 2-9 mins (at 10 becomes change of baseline) 11. Early deceleration: Nadir aligns w contraction peak, gradual onset (e30 secs to nadir), benign vagal response 1) Pressure on fetal head 2) Increased intracranial pressure 3) Alteration in cerebral blood flow 4) Central vagal stimulation 5) FHR deceleration 12. Periodic vs Episodic: Periodic: caused by contractions -recurrent: occurs w e50% of contractions in 20 min -intermittent: w <50% of contractions in 20 mins Episodic: spontaneous 13. Variable deceleration: Caused by cord compression -Interventions: position change, amnioinfusion -Abrupt onset: <30 seconds from onset to nadir dropping e15 bpm l s to <2min -Transient rise in PCO2 & fall in PO2 14. Mechanisms of variable decelerations: Abruptness r/t pressure changes 1) Vein obstruction ’ reflex tachy -“ venous return & cardiac output ’ hypotens ’ baroreceptor reflex ‘ in FHR to maintain BP 2) Arterial obstruction ’ decreased FHR -obstructed blood flow back to placenta ’ HTN ’ baroreceptor reflex of slowing FHR to maintain BP 15. Late decelerations: Uteroplacental insufficiency -Indicative of transient fetal hypoxemia -Gradua [Show More]

Last updated: 3 years ago

Preview 1 out of 13 pages