Michelle Murray PhD RNC - Essentials of Fetal Monitoring

ESSENTIALS OF
FETAL MONITORING

FOURTH EDITION

Michelle L. Murray, PhD, RNC-OB, is an international educator, author, and expert in obstetric nursing. She has taught nursing students and nurses in the United States, Canada, and Bahrain. Dr. Murray has spent the majority of her career as a labor and delivery nurse and obstetric nursing educator. She was appointed by the provost at the University of New Mexico as a clinical associate professor. Dr. Murray's company, Learning Resources International, Inc., produces clinical and educational products and seminars for nurses and midwives. Since 1986, more than 50,000 obstetric care providers, including nurses, midwives, and physicians, have participated in Dr. Murray's classes and seminars. Her work has been published in journals such as Birth: Issues in Perinatal Care; the American Journal of Maternal Child Nursing; the Journal of Perinatololgy; the Journal of Nursing Care Quality; and the Journal of Obstetric, Gynecologic, and Neonatal Nursing. Dr. Murray was also a contributor to the Association of Women's Health, Obstetric and Neonatal Nurses publication Nursing Management of the Second Stage of Labor. Her best-selling books include Antepartal and Intrapartal Fetal Monitoring, Essentials of Fetal Monitoring, and Labor and Delivery Nursing: A Guide to Evidence-based Practice. Her books and products are available at www.fetalmonitoring.com and www.OBCEUs.com.

Gayle Huelsmann, BSN, RNC-OB, C-EFM, is certified in inpatient obstetrics and holds a certificate of advanced qualification in electronic fetal monitoring from the National Certification Corporation. She has been an antepartal nurse and a labor and delivery nurse for more than 30 years. She is also a maternal air transport nurse with Lifeguard Air Emergency Services in Albuquerque, New Mexico. She is a recipient of the PRIDE nurse award from Presbyterian Hospital in Albuquerque. Gayle is the coauthor of Essentials of Fetal Monitoring and Labor and Delivery Nursing: A Guide to Evidence-based Practice. Ms.Huelsmann has also published in the Journal of Obstetric, Gynecologic, and Neonatal Nursing.

Nanci Koperski, RNC-OB, LNCC, MBA, MHSA, is certified in inpatient obstetrics and legal nurse consulting with two master's degrees: one in business administration and one in health care administration. She has been a labor and delivery staff nurse, a patient care coordinator in women's health, a quality improvement coordinator, a labor and delivery nurse specialist, nursing supervisor, health care administrator, and vice president of operations at a major health care institution in the southwest. Ms. Koperski was selected as a reviewer of the new book, Labor and Delivery Nursing: A Guide to Evidence-based Practice. She currently works in an attorney's office in Omaha, Nebraska, reviewing and summarizing medical records in medical malpractice, personal injury, and drug/device cases. Ms. Koperski also prepares experts and clients for deposition and trial testimony.

ESSENTIALS OF
FETAL MONITORING

FOURTH EDITION

MICHELLE L. MURRAY, PHD, RNC-OB

GAYLE HUELSMANN, BSN, RNC-OB, C-EFM

NANCI KOPERSKI, RNC-OB, LNCC, MBA, MHSA

NEWYORK

Copyright 2011 Springer Publishing Company, LLC

All rights reserved.

No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Springer Publishing Company, LLC

The information, guidelines, and techniques of practice included in this book are not intended to dictate a plan of care. Publication should not be construed as excluding other acceptable approaches to clinical management. Medication dosages are provided in this book, but it is possible they may change. The reader is urged to review the formulary or manufacturer's package information prior to drug administration.

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ISBN: 978-0-8261-0637-7
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Library of Congress Cataloging-in-Publication Data

Murray, Michelle (Michelle L.)

Essentials of fetal monitoring / Michelle L. Murray, Gayle Huelsmann, Nanci Koperski 4th ed.

p. ; cm.

Includes bibliographical references and index.

ISBN-13: 978-0-8261-0637-7

ISBN-10: 0-8261-0637-4

1. Fetal heart rate monitoring. 2. Fetal monitoring. I. Huelsmann, Gayle. II. Koperski, Nanci. III. Title.

[DNLM: 1. Fetal Monitoring. 2. Heart Rate, Fetal. WQ 209]

RG628.3.H42M87 2011
618.320754dc22

2010052917

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I have found it helpful to recover a sense of my work
not as a career but as a calling.

D. H. Smith (June 1994)
How to Be a Good Doctor in the 1990s: Stand and Deliver
American Journal of Obstetrics and Gynecology, 170(6), 17241728, p. 1725.

DISCLAIMER

This book is not intended to replace the manufacturer's fetal monitor manual. You are encouraged to read the manual before using the fetal monitor.

This book does not include directions on setting the monitor clock, disabling the logic feature, or specific features that are unique to only one or two monitors. Therefore, you are encouraged to work with a skilled clinician who will assist you in setting the clock and using the unique features of your monitor. Since clocks are battery-backed, you should only have to set the clock when there is a change in daylight savings time. If you plug in the monitor and there is a message to set time/date, the battery must be replaced. Tag the fetal monitor with a note to replace the clock battery and notify the biomedical department.

Also, the content of the book is based on references from Antepartal and Intrapartal Fetal Monitoring, Third Edition, research, and common knowledge in the field of obstetrics and fetal monitoring. Any questions or concerns about content should be sent to Springer Publishing Company, LLC.

CONTENTS

INTRODUCTION

The fetal heart rate (FHR) pattern may be evaluated to predict fetal oxygenation and acid-base status at that time. Choosing auscultation or the electronic fetal monitor to evaluate the FHR depends on maternal and fetal risk factors, the nurse-to-patient ratio, and protocol. If you use the fetal monitor, you will be expected to identify FHR pattern components and determine the significance of the FHR and uterine activity patterns. Although interpretation is subjective and a reflection of the user's knowledge base, no one can argue with the absence of any sign of fetal well-being. This book should prepare you to identify the signs of fetal well-being and the more common signs of fetal compromise or the absence of fetal well-being.