iffy strip and discharged

[babymamaRN6]

ugh. i can't stop thinking of this. i had a triage pt yesterday, came in for uc's q3-5 had been going on all day. was seen day prior and discharged with dem/vist. her strip when she was there wasn't very great, but MD had reviewed it and oked her, her baseline was 150s-160s withperiods of minimal variablity, no decels, 15x15, nurse had put on 02 to see if it would help, didn't. pt reported not drinking water all day. so when she came in i was expecting similar strip, and it was, 15x15, 155-165s, no decels, min to mod variablity. she drank 2 glasses of water all day, urine was amber colored, dipped moderate for ketones. cervix still 1.5/75/-2. discharged her home as per MD orders, but now i've been thinking about it all day. a few of us were talking about the strip, that kid is probably sitting in mec? plus she is very dehydrated?

upon discharge i emphasized hydration and continue to watch for uc's and fetal kick counts.

i guess im just thinking worst case scenario. i don't work for 3 days and im curious if she came back in and what her strip looked like. anyone with advice or tips?

[rn4babies63]

Document. Document. Document. I always make sure that I document EVERYTHING including that the doctor reviewed the tracing. Also the discharge teaching is very important. I always stress hydration as well as the importance of coming back in if she experiences labor s/s, decreased fetal movement, bag bleeding, arom, etc. The doctor gave you the order to discharge her. As long as you documented well, you should be OK.

[Hushi05]

Did the docs do a BPP?

[klone, MSN, RN]

I'm confused as to why you say her strip was iffy. You say there were no decels, had min to moderate variability, and accels 15x15. That's a category 1 strip.

[babyktchr, BSN, RN]

I agree. You say there are accels with minimal to moderate variability. That right there rules out metabolic acidemia..you have an oxygenated baby. Periods of minimal variability can have a differential of varying things, but I am wondering if this woman couldn't have benefitted from a liter or two of IV fluids. She is obviously dehydrated (mod ketones??) and isn't making the efforts to hydrate herself. That alone could be making her uterus angry and causing those ineffective contractions. It certainly couldn't hurt and would probably perk that baby right up. As someone else said, document your butt off (although you described a reactive strip).

You didn't mention how many weeks this mom was? Term???