NCC EFM QUESTIONS AND ANSWERS 100% PASS

NCC EFM QUESTIONS AND ANSWERS 100% PASS LATE DECELERATIONS ARE MEDIATED PRIMARILY BY ✔✔CHEMORECEPTORS BASELINE ✔✔FHR IN A 10 MIN SEGMENT TACHYCARDIA ✔✔FHR >160 BRADYCARDIA ✔✔FHR = 10 MIN EARLY ✔✔GRADUAL ONSET >= 30 ...

NCC EFM QUESTIONS AND ANSWERS 100% PASS LATE DECELERATIONS ARE MEDIATED PRIMARILY BY ✔✔CHEMORECEPTORS BASELINE ✔✔FHR IN A 10 MIN SEGMENT TACHYCARDIA ✔✔FHR >160 BRADYCARDIA ✔✔FHR <110 VARIABILITY ✔✔VARIATIONS IN BASELINE ABSENT-0 MIN <=5 MOD 6-25 MARKED >25 NO DISTINCTION IS MADE BETWEEN SHORT TERM & LONG TERM VARIABILITY BECAUSE ✔✔THEY ARE VISUALIZED AS A UNIT ACCELERATION ✔✔ABRUPT INCREASE <30 SEC FROM BASELINE ACCELERATION IN 32+ WEEKS GESTATION ✔✔PEAK OF AT LEAST 15 BPM AND DURATION OF 15 SEC BUT < THAN 2 MINUTES ACCELERATION IN < 32 WEEKS GESTATION ✔✔PEAK OF AT LEAST 10 BPM AND DURATION 10 SEC BUT < THAN 2 MINUTES PROLONGED ACCELERATION ✔✔LASTS >= 2 MIN BUT < THAN 10 MIN BASE LINE CHANGE ✔✔ACCELERATION LASTING >= 10 MIN EARLY ✔✔GRADUAL ONSET >= 30 SECONDS W CONTRACTION >= TO NADAR. HEAD COMPRESSION...VAGAL RESPONSE LATE ✔✔GRADUAL ONSET >= 30 SECONDS TO NADAR OCCUR AFTER CONTRACTION VARIABLE ✔✔ABRUPT ONSET <30 SECONDS TO NADAR CATEGORY 1 ✔✔FHT INCLUDES ALL OF THE FOLLOWING: RATE: 110-160 MODERATE VARIABILITY ACCELERATIONS PRESENT OR ABSENT 0 LATE OR VARIABILE DECELERATIONS EARLY DECELERATIONS PRESENT OR ABSENT CATEGORY 2 ✔✔ALL FHT NOT CATEGORY 1 OR CATEGORY 3 CATEGORY 3 ✔✔FHT INCLUDES AT LEAST ONE OF THE FOLLOWING: ABSENT VARIABILITY WITH RECURRENT LATES ABSENT VARIABILITY WITH RECURRENT VARIABLES ABSENT VARIABILITY WITH BRADY FOR 10 MIN SINUSOIDAL PATTERN FOR AT LEAST 20 MIN SINUSOIDAL PATTERN ✔✔SAW TOOTH >= 20 MIN FEVER/INFECTION ✔✔TACHYCARDIA DECREASED VARIABILITY MEDICATIONS ✔✔DEPENDS ON MED BUT INCLUDES CHANGES: BASELINE FREQUENCY AND AMPLITUDE OF ACCELS VARIABILITY SINUSOIDAL PATTERN HYPERTHYROIDISM ✔✔TACHYCARDIA DECREASED VARIABILITY FETAL ANEMIA ✔✔SINUSOIDAL PATTERN TACHYCARDIA FETAL HEART BLOCK ✔✔BRADYCARDIA DECREASED VARIABILITY FETAL TACHYARRHYTHEMIA ✔✔VARIABLE DEGREES OF TACHYCARDIA DECREASED VARIABILITY CONGENITAL ANOMALY ✔✔DECREASED VARIABILITY DECELERATIONS PREEXISTING NEUROLOGIC ABNORMALITY ✔✔DECREASED VARIABILITY ABSENT ACCELERATIONS SLEEP CYCLE ✔✔DECREASED VARIBILITY REDUCED FREQUENCY AMPLITUDE OF ACCELERATIONS AUTONOMIC NERVOUS SYSTEM (CARRIES SIGNALS TO AND FROM SMOOTH MUSCLES AND GLANDS: SYMPATHETIC AND PARASYMPATHETIC) ✔✔REGULATES FHR IN RESPONSE TO FLUCTUATIONS IN PO2, PCO2, AND BP DETECTED BY CHEMORECEPTORS AND BARORECEPTORS (LOCATED IN AORTIC ARCH AND CAROTID ARTERIES) SYMPATHETIC NERVOUS SYSTEM ✔✔INCREASE FHR (FIGHT OR FLIGHT, Step on the gas) PARASYMPATHETIC NERVOUS SYSTEM ✔✔DECREASES FHR (REST AND DIGEST, Press on the break) INTERVILLOUS SPACE PERFUSION IS DEPENDENT ON ✔✔ADEQUATE UTERINE BLOOD FLOW OXYGEN IS TRANSFERRED FROM THE MOTHER TO THE FETUS VIA THE PLACENTA THRU ✔✔PASSIVE DIFFUSION MATERNAL-FETAL EXCHANGE IS BEST PROMOTED BY WHICH MATERNAL POSITION ✔✔EITHER RIGHT OR LEFT LATERAL OXYGEN DEPLETION CASCADE ✔✔AEROBIC METABOLISM->HYPOXEMIA- >TISSUE HYPOXIA->ANAEROBIC METABOLISM->LACTIC ACID BUILD UP- >METABOLIC ACIDOSIS PHYSIOLOGY OF LATE DECELLERATIONS ✔✔*DECREASED FH VARIABILITYFETUS HAS LESS AVAILABLE O2 *OVERTIME...ANAEROBIC METABOLISM (GLUCOSE HAS LESS O2 TO MIX WITH) *GLUCOSE BREAKS DOWN W/O O2 AND BECOMES LACTIC ACID *INITIALLY FETUS BRINGS IN BASE (NA BICARB) TO NEUTRALIZE ACID. WORKS FOR A BIT... *IF CONTINUES...BASE IS DEPLETED FETUS DEVELOPS METABOLIC ACIDEMIA *LEADS TO CELLULAR DEATH SYMPATHETIC BRANCH OF THE AUTONOMIC NERVOUS SYSTEM INFLUENCES THE FHR TO ✔✔INCREASE PARASYMPATHETIC BRANCH OF THE AUTONOMIC NERVOUS SYSTEM INFLUENCES THE FHR TO ✔✔DECREASE VARIABLE DECELERATIONS ARE MEDIATED PRIMARILY BY ✔✔BARORECEPTORS THE AVERAGE DIFFERENCE IN BASELINE FHR BETWEEN 30 AND 40 WEEKS GESTATION IS ✔✔10bpm RESPIRATORY ACIDEMIA ✔✔PH DECREASED <7.10 PCO2 INCREASED >60 HCO3 NORMAL METABOLIC ACIDEMIA ✔✔PH DECREASED <7.10 PCO2 NORMAL <60 HCO3 DECREASED <22 NON-ACIDEMIC FETUS ✔✔PH >7.10 PCO2 <60 HCO3 >22 THE FOLLOWING UMBILICAL ARTERY CORD BLOOD WAS OBTAINED PH 7.22 PCO2 50 HCO3 24 ✔✔NORMAL ACID BASE STATUS THE FOLLOWING UMBILICAL ARTERY CORD BLOOD WAS OBTAINED PH 7.04 PCO2 80 HCO3 22 ✔✔RESPIRATORY (INCREASED PCO2) THE FOLLOWING UMBILICAL ARTERY CORD BLOOD WAS OBTAINED PH 6.98 PCO2 49 HCO3 16 ✔✔METABOLIC ACIDEMIA (NORMAL PCO2 DECREASED HCO3) CELESTONE ✔✔DECREASE VARIABILITY 24-36 HOURS WHERE IS THE FETAL BLOOD MOST HIGHLY OXYGENATED ✔✔DUCTUS VENOSUS WHERE IS THE FETAL BLOOD LEAST OXYGENATED ✔✔DUCTUS ARTERIOSUS HOW DOES THE FETUS SURVIVE IN AN ENVIRONMENT WITH A PO2 EQUAL TO ADULT VENUS BLOOD ✔✔*FETAL HGB IS HIGHER THAT ADULT (51-56%) *FETAL HGB HAS A HIGHER AFFINITY THAN ADULT *FETUS HAS HIGHER CARDIAC OUTPUT AND HR THAN ADULT RESULTING IN RAPID CIRCULATION SYMPATHETIC INNERVATION ✔✔RELEASES NOREPINEPHRINE AND EPI...INCREASES FHR NOREPINEPHRINE (SYMPATHETIC NERVOUS SYSTEM) ✔✔*NEUROTRANSMITTER OR CATECHOLAMINE...A CHEMICAL RELEASED FROM NEURONS *REFERRED TO AS A STRESS HORMONE PARASYMPATHETIC INNERVATION (VAGUS NERVE) ✔✔*RELEASES ACETYLCHOLINE...DECREASES FHR *TRANSMITS VARIABILITY FHR GRADUALLY DECREASES WITH GESTATIONAL AGE ✔✔DIFFERENCE BETWEEN 30 AND 40 WEEKS IS ABOUT 8-10 bpm BARORECEPTORS ✔✔*LOCATED IN AORTIC ARCH WALL AND CAROTID WALL *PROTECT FETUS FROM INCREASED IN BP WHEN FETAL BP INCREASES ✔✔BARORECEPTORS ABRUPTLY DECREASE FHR DECREASE BP DECREASE CO *UMBILICAL CORD COMPRESSION-> *INCREASED FETAL BP-> *STIMULATION OF BARORECEPTORS-> *VARIABLE DECEL ✔✔ABRUPT RISE IN FETAL BP YOU WILL SEE A VARIABLE DECELERATION FETUS ABILITY TO REGULATE CARDIAC OUTPUT ✔✔BASED ON ALTERING HEART RATE ACTIVE REM SLEEP ✔✔*FREQUENT BODY MOVEMENTS *MOD VARIBILITY *ACCELS W FM *REACTIVE NST WHAT WE THINK OF AS AN AWAKE BABY BUT REALLY ACTIVE REM DURING AN ACUTE EPISODE OF FETAL HYPOXEMIA FETAL BLOOD FLOW IS REDISTRIBUTED PRIMARILY TO THE ✔✔BRAIN CHEMORECEPTORS RESPOND PRIMARILY TO ✔✔HYPOXEMIA NARCOTICS ✔✔DECREASE VARIABILITY, FREQUENCY OF ACCELERATIONS BUTORPHANOL ✔✔*TRANSIENT SINUSOIDAL FHR PATTERN *SLIGHT INCREASE IN BASELINE COCAINE ✔✔DECREASE INFHR CORTICOSTEROIDS ✔✔DECREASE IN FHR VARIABILITY FOR 24-36 HOURS WITH BETAMETHASONE, NOT DEXAMETHASONE MAGNESIUM SULFATE ✔✔*DECREASE IN FHR VARIABILITY *CLINICALLY INSIGNIFICANT DECREASE IN BASELINERATE *INHIBITION OF INCREASING ACCELERATIONS AS GEST AGE ADVANCES TERBUTALINE ✔✔INCREASE IN BASELINE RATE ZIDOVUDINE(HIV ANTIVIRAL) ✔✔NO CHANGE