Managing decelerations

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How soon when there are decelerations noted on the fetal monitor strip do you do oxygen, left side, and fluids wide open? When they are experiencing the beginning of a decel, even if its just a variable? I didnt have too good of an orientation for labor and delivery and when I would be with different preceptors, noone would be on the right page with each other, would always be told two different things.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

It depends. IF it's an isolated late or variable and the overall strip is reassuring; I wait and observe to see all is ok. If the decels are recurring, then I do the usual resuscitation measures: decrease uterine activity, oxygen by nonrebreather mask, IV fluids as warranted (be careful to keep fluid counts so as not overload them), and repositioning. I also call the physician and report the decels, my actions and how effective they are.

You need a fetal heart monitoring class. AWHONN has them. They spell out very clearly the various decelerations/classes and what to do about them. I would ask the manager about classes or check out AWHONN site to find classes. There usually is a certified instructor in every unit who can help you. Get beginning and advanced FHM classes ASAP.

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Thanks for the post! They were orienting a couple other new grads when I was, so our orientation wasnt the best, and depending on who the nurse I was working with, when someone had the start of one decel, it was right away resuscitative measures, and some nurses are like oh, she had a late there, oh a variable there, so it was frustrating. I was going to sign up for the online fetal monitoring course by awhonn, the basic one. I am surprised they didnt make us do that before even starting back in labor and delivery, but we have a lady who just recertified in awhonn classes that as soon as we get so many months experience they are going to make us to the advance class, which to me is stupid because we didnt even get the basic class! Its just frustrating because I been at this job for 7 and a half months and feel like I know nothing, and being a smaller hospital, we dont get too much high risk, I never even was able to hang mag before! I feel like when I go to another job I will have "experience" so to say, but not the kind I need.

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Also, say you are charting from 9-9:15 and the baby only had one acceleration, under your charting, do you still put that the baby is having accels even though they only had one? I've been told you do, but some other nurses said to just write a comment that there was only one noted.

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Specializes in Nurse Manager, Labor and Delivery.

WOW.....if you were my staff member, you certainly would've had that basic AWHONN course by now, and then moved right along into the intermediate course. I cannot believe you have not had formal training yet.

As smiling blue eyes said, it depends on the situation. You also need to have a good knowledge of each type of decel, what the physiology is and what it means to the baby. Same thing goes for accels. Why would you not chart the presence of a 15x15 accel? Accels tell you that the baby is not metabolically challenged and has good oxygenation. We even give credit to 10x10 accels in our charting. Two accels in 20 mins gives you a reactive NST, but an accel will rule out metabolic acidemia all by its lonesome. So go ahead and give credit to that baby.

You really need to go ahead and take that basic course and then get into an intermediate course. If you don't have an instructor in your facility, go to the AWHONN website and look for one close to you. Get a copy of the Fetal Monitoring Principles and Practices book. It is an excellent resource and teaches in a down to earth manner so you can understand. I think it may help you.

Good luck to you.

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Thank you very much!

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Go to http://www.awhonn.org or http://www.proedcenter.com and look for educational courses you can attend ASAP. Also like babyktchr suggested, get the Fetal Heart Monitoring Principles and Practice book (there is a brand new edition out now) right away. You can find that book at the AWHONN site. Or ask your manager as he/she ought to have at LEAST one copy on the unit.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Also, please consider becoming an AWHONN member while you are at it. It's something I have never regretted.

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Specializes in L&D.

Take the basic online AWHONN class now. The intermediate class requires 6 months monitoring experience, so you'll be ready for that when that staff member is ready to teach. If that doesn't happen soon, you'll want to go to the AWHONN website and look for one close to you. It's not cheap, but it's worth the money and it is tax deductible, or perhaps your hospital would pay for it.

As far as when I would start the interventions, it depends on the whole picture. If there is moderate variability and there have been recent accelerations, I'm not going to jump on a variable or even a late. If the baseline is smooth and I haven't had an acceleration in a while and the baseline is rising, I'll start everything right away.

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Specializes in OB/GYN, Emergency.

Familiarize yourself with the various interventions you can take for decels and what each decel means.

-Early decel - head compression, not a problem

-Variable decel - cord compression

-Late decel - uteroplacental insufficiency, problem

When you see decels, assess your patient as you're doing interventions. Is there an obvious cause of the decel (tachysystole, bleeding, cord prolapse)? Based on the type of decel you see, your interventions could include position changes, fluid bolus, oxygen facemask, pausing Pitocin or stopping it completely if the baby's heart is staying down, SVE to check for cord prolapse or rapid dilation, and once mom and baby are ok, notify the provider if you have a nonreassuring strip. You mentioned the left lateral position. Remember that the left side isn't always the best! If the decel started with the patient on her left, flip her to her right. If that doesn't work, try flipping her back to her left, semi-fowlers, etc. Sometimes babies tolerate some positions more than others. Oxygen takes a few minutes to affect your baby, so it shouldn't be your first intervention.

If you aren't comfortable with the basic concepts of fetal monitoring and decel interventions, I would definitely suggest that you let your nurse manager and/or nurse educator know. You might benefit from a longer orientation period, which is nothing to be ashamed of. Ask if they'd be willing to pay for you to attend a fetal monitoring course so that you can provide your patients with the best and safest care.

Good luck!

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