Newborn Assessment Wake sleep states influences reflex response Deep sleep no REM activity of the eye Light sleep with REM noted Drowsy the newborn could fall back asleep or the baby could wake up Quiet alert is awake but not moving arms and legs very much just looking around with eyes open and taking in environment may be able to lick its lips interact with newborn bc taking things in if getting ready to eat get ready for feeding process mom Active alert more body movements of arms and legs Crying not the best situation to wait until a baby is crying till bringing into breastfeed if see baby is starting to wake up teach her sleeop wake states so she can get comfortable and get ready for breast feeding or feeding in the nursery a baby is starting to get hungry if arms start to move up from mouth a babys whos arms are down on their side are full as arms move up to mouth may start getting fist to mouth may hear smacking with thumb in mouth may start in their sleep to route reflex searching for food and turn their mouth toward the source of food they are looking for a mom who is breast feeding can have a few drops of colostrum babies smell it taste it turn towards it stroke baby from inner aspect to lip out to lip the way you want the baby to turn give clear cues ELECTRONIC FETAL MONITORING CLINICAL ORIENTATION NOTES Internal vs External Monitoring External Fetal Monitoring Non Invasive Ultrasound Transducer picks up FHR Tocotransducer picks up uterine activity You can only assess FHR long term variability you must palpate to assess contraction intensity and uterine resting tone Advantages Patients can ambulate decreased risk for infection doesn t require ROM cervical dilation Internal Fetal Monitoring Invasive Fetal Scalp electrode picks up FHR Intrauterine Pressure Catheter picks up uterine activity Pt must be ruptured dilated You can assess short term variability contraction intensity and uterine resting tone Advantages Internal monitoring measures exact uterine contraction intensity uterine resting tone which is great for the use of Pitocin VBAC etc Recordings are also not affected by maternal obesity or fetal movement External noninvasive advantages internal invasive membranes must be ruptured gives us more detailed info about the fetus disadvantage is increased risk for infection Uterine Activity 1 Contraction Frequency beginning of the next and it s recorded in minutes This is measured from the beginning of one contraction to the When timing frequency of contractions between each dark line is one minute if looking at frequency don t use the number 1 use begin or 0 at 1 minute 2 minute 3 minute charting is done in 15 minute intervals because we don t know what will happen in the future recorded in minutes end of the same contraction and it s recorded in seconds This is measured from the beginning of one contraction to the 2 Contraction Duration How long does each contraction last measured in seconds example 70 120 seconds 3 Contraction Intensity With Internal Fetal Monitors IUPC this can be measured and recorded in mmHG or as MVU s With External Fetal Monitors EFM this is measured by palpation and recorded as mild moderate and strong How strong the contractions are if doing external fetal monitoring there is no way we can exactly tell the intestity just based on the fetal monitoring one can look weak but if palpate contractions can perceive it is strong the only true delineation of strength of contraction is if we need to put an internal pressure catheter gives exact mm of contractions know exactly how strong they are more dependent on nurses palpations compared to fetal monitoring our firm 3 contractions feel like forehead it s like tetany on the postpartum uterus Mild Easily indent fingers into fundus chin Feel more like nose Moderate Some tension felt able to indent fundus slightly with pressure tip of nose feel more like chin Strong Unable to indent fundus with fingers forehead 4 Uterine Resting Tone With Internal Monitors this can be measured recorded in mmHg This is usually less than 25 mmHG With External Fetal Monitors EFM this is measured by palpation and recorded as soft hard Make sure adequate rest no hyperstimulation of the uterus adequate rest between intermittent contractions get this info more from internal fetal monitoring bc numbers give us amount of pressure Uterine Hyperstimulation This occurs when one or more of the following is present Uterine resting tone greater than 25 mmHG Contraction frequency is less than 2 minutes 5 contractions in 10 minutes Contraction duration is greater than 2 minutes Fetal Heart Rate Baseline This is the average FHR over a 10 minute duration and it s recorded as a range This should be obtained between contractions Normal range is 110 160 bpm Very fast Newborn and fetal heart rate are the same look at overtime what the baseline fetal heart rate is squiggles in line are variability moderate variability is the normal fetal heart rate variability gives us info to the wellness of the child means adequate 02 sat good autonomic reserve when begins to flatten out may become for hypoxic mom could have had narcotics or baby might be sleeping Intensity of contraction is the firmness of contraction if done by internal we could know the mm of pressure otherwise do hand palpation moderate fetal heart rate variability is normal When there is an increase in hr called acceleration that is a good thing indicates the baby has moved and fetal movement is a sign of well being No signs of movement less variation in pulse when typically thin line three causes for a decrease in variability for moderate minimal fetal hypoxia maternal iv narcotic pain med or epidural baby may be in sleep cycle watch a baby like this for one half hour if still getting variability that is minimal try to wake the baby up to make sure safe try to get moro response put hands on top of fundus and then take two fingers where the head and neck ought to be and give a little shake if no moro response further testing and notify HCP bc means baby is hypoxic can scratch scalp and when you do scalp stimulation you should get a moro response the baby should startle and move if don t get a response to those get vibra acoustic stimulator lastly battery operated put close to abdomen and makes loud buzzing sound should make fetus jump various ways to respond to data the baby is giving us Meconium is the first bowel movement the baby has dark green black tarry if rectal sphincter relaxes