Basic Fetal Heart Monitoring

About Basic Fetal Heart Monitoring

Basic Fetal Heart Monitoring is a comprehensive introductory course; hence, candidates do not require experience to attend this class. Experienced RN’s, on the other hand, are recommended to attend an Intermediate or Advanced FHM course. In summary, participants will learn the skills needed to perform fetal surveillance through electronic Fetal Monitoring.

To begin with, students will overview the role of the nurse during the antepartum period; as well as how to properly acquire the information needed to conduct appropriate antenatal tests. Further, different methods of uterine and fetal monitoring will be discussed. In particular, students will learn how to determine if a patient requires internal versus external fetal monitoring.

In addition, this course will define the etiologies related to characteristics of the baseline fetal heart rate, variability, plus fetal heart deceleration’s. Similarly, students will learn how to identify and respond to category II and III fetal heart strips. Nursing interventions for non-reassuring patterns will be also deliberated. Last but not least, students will have the opportunity to practice assessments of FHR strips.

Why you should choose NEO for Basic Fetal Heart Monitoring

Nurses Educational Opportunities holds a genuine passion for women’s and children’s health. Most notably, Maternal mortality rates in the United States have steadily increased; in view of this fact, we have sought to improve maternal outcomes by preparing nurses on how to adequately perform maternal child care. Accordingly, our instructors will ensure that learners feel ready to prepare mothers for a successful outcome. Lastly, upon completion of the Basic Fetal Heart Monitoring class, students will acquire the skills to carry-out appropriate nursing interventions.

Course Information

Course Fee: $150.00

Textbook Included

Awarded 6 Contact Education Hours

Schedule online or call us at 866-266-2229

Orange County

San Diego

Online Webinar

Basic Fetal Heart Monitoring for Labor and Delivery nurses, new grads and nursing students

NEO Blog

The Baby Friendly Initiative History

Congratulations Southern California Nurses, for your efforts in promoting the Baby Friendly Initiative. Hospitals and Maternal-Child Health departments have set a powerful example for women nationwide. To summarize, in 2007 only 29% of USA hospitals used breastfeeding measures. By 2013, this percentage increased to 54%. Additionally, in California, rates increased to as much as 94% for some breastfeeding and 70% for exclusive breastfeeding. Indeed, the attainment of Baby Friendly designation has proven to be a strenuous, but worthwhile journey. More than one million infants die worldwide every year because they are not breastfed exclusively for 6 months.  If 90% of babies were breastfed exclusively for 6 months, 911 lives could be saved. In addition, $13 billion could be saved in healthcare costs.  What is the Baby Friendly Initiative? The Baby Friendly Initiative was launched worldwide in 1992 in collaboration with WHO and UNICEF as a quality improvement project. This initiative is a global effort that encourages governments to develop and implement a policy on infant feeding. To clarify, hospitals who provide a positive environment for breastfeeding receive the coveted Baby Friendly recognition.  This process is not easy! Hospitals, must work rigorously to implement strict standards as outlined by the Ten Steps to Successful Breastfeeding. Secondly, healthcare staff must ensure that breastfeeding rates remain above a certain percentage to retain Baby Friendly status.  Most notably, the goal is to empower healthcare workers with appropriate education to provide effective breastfeeding counseling. What does it mean to be a Baby Friendly Hospital? Baby Friendly designation means that maternal child health departments have successfully implemented the Baby Friendly Initiative’s Ten Steps to Successful Breastfeeding. In short, these steps include: providing appropriate education to enable mothers to make informed decisions about infant nutrition; also, encouraging skin-to-skin immediately following birth; and offering Lactation Specialist services throughout and beyond the hospital stay. Not only does this initiative help to reestablish optimal infant nutrition, but it has also proven to improve health outcomes in developed countries. In summary, the risks of formula feeding for infants include: an elevated risks of childhood obesity; type 1 and type 2 diabetes; leukemia; and sudden infant death syndrome. Moreover, in women, the lack breastfeeding increases the incidence of: pre-menopausal breast cancer, as well as, ovarian cancer; retained gestational weight gain; type 2 diabetes; myocardial infarction; and metabolic syndrome. Southern California hospitals who implemented the Baby Friendly Initiative It is essential for California obstetrical nurses to continue protecting breastfeeding and maternal-child bonding. The percentages of breastfeeding varied among all California hospitals. Below is a summarized list of Southern California hospitals who have: successfully implemented the Baby Friendly Initiative and Ten Steps to Successful Breastfeeding; or, met the Healthy People 2020 Breastfeeding Objectives; including, hospitals who promote the International Code of Marketing of Breast-Milk Substitutes. California hospital feeding rates are acquired from Genetic Newborn Screenings collected within 24 hours after birth. This data does not accurately reflect ongoing breastfeeding after 24 hours of birth. Alternatively, this data does indeed demonstrate that the proponents of Breastfeeding have been successful in their efforts to communicate the value of Breastfeeding to the community. For more information on breastfeeding rates visit the California’s Department of Public Health website. Hoag Hospital Some breastfeeding = 96% Exclusive breastfeeding = 75% St. Jude Medical Center Some breastfeeding = 93% Exclusive breastfeeding = 63% St. Joseph Hospital Some breastfeeding = 94% Exclusive breastfeeding = 80% UC Irvine Medical Center Some breastfeeding = 91% Exclusive breastfeeding = 70% Community Hospital of  San Bernadino Some breastfeeding = 90% Exclusive breastfeeding = 65% Arrowhead Regional Medical Center Some breastfeeding = 88% Exclusive breastfeeding = 77% Loma Linda University Medical Center Some breastfeeding = 92% Exclusive breastfeeding = 71% Kaiser, San Diego Some breastfeeding = 97% Exclusive breastfeeding = 79% Palomar Medical Center Some breastfeeding = 96% Exclusive breastfeeding = 72% Paradise Valley Hospital Some breastfeeding = 96% Exclusive breastfeeding = 72% Scripps Memorial Hospital, Ecinitas Some breastfeeding = 97% Exclusive breastfeeding = 91% Scripps Memorial Hospital, La Jolla Some breastfeeding = 98% Exclusive breastfeeding = 87% Scripps Mercy Hospital, Chula Visa Some breastfeeding = 96% Exclusive breastfeeding = 83% Scripps Mercy, San Diego Some breastfeeding = 96% Exclusive breastfeeding = 85% Sharp Chula Vista Some breastfeeding = 95% Exclusive breastfeeding = 73% Sharp Grossmont Some breastfeeding = 94% Exclusive breastfeeding = 72% Sharp Mary Birch Hospital Some breastfeeding = 92% Exclusive breastfeeding = 81% Tri-city Medical Center Some breastfeeding = 96% Exclusive breastfeeding = 74% UC San Diego Medical Center Some breastfeeding = 96% Exclusive breastfeeding = 75% The history of breastfeeding The history of breastfeeding is a fascinating topic. In the beginning breast milk was the only available food for infants. Wet nurses served as alternatives when mothers became ill or passed away. Subsequently, the industrial revolution took place and the need to work caused women to separate from their infants. Wet nurses became a commodity and thus desired or required by many people. As a result, the cost of their services increased. As a matter of fact, early in the 20th century, the attainment of a wet nurse served as a status symbol for the wealthy. For disadvantaged mothers, “dry nurses” irrupted. However, dry nurses often fed newborn infants pablum, an inadequate form of nutrition for infants less than six months of age. Furthermore, the proliferation of American Hospitals in the late 1800’s to early 1900’s further caused a divide between mothers and their own breast-milk. During this time hospital’s advertised their environment as a safer and cleaner place to deliver infants compared to midwives. Anti-midwife and wet nurse propaganda further antagonized their reputation. Articles and posters such as these left a bad taste in people’s mouths. Consequently, society began to shift away from longstanding maternal care practices. In addition, advances to formula feeding further led to the substitution of artificial feeding. As a result, formula milk became known as scientifically superior to breast milk and formula companies were born. The Maternalist Movement The Maternalist movement began with a group of women who wanted to “clean up the environment.” Overall, these reformers encouraged wives and mothers to make the world a safer and cleaner place to live in. Technology provided that possibility in regards to infant nutrition. Well-off mothers could take pride in providing the latest nutritional technology for their babies, whereas underprivileged women could not afford bottles or formula milk. Over time, breastfeeding became associated with uneducated and low income women. On the other hand, formula feeding became affiliated with more civilized, well-off, and conscientious mothers, Additionally, maternalists were enthusiastic about scheduling. They encouraged women to run their home in a clean, organized manner with a passion for scheduling babies. In fact, their motto was “A good mother is a scheduling mother.” According to the standards of the movement, Breastfeeding was to occur only during certain hours of the day. For example, they encouraged four hours of rest between feedings and not at all during nighttime hours. Lastly, this movement unknowingly supported formula milk by causing lactation insufficiency, therefore prompting mothers to turn to formula feedings. Formula promotion In the 1960’s and 1970’s aggressive formula promotion led to wide-spread abandonment of breastfeeding. In addition, companies enlisted hospitals and healthcare professionals to distribute formula by providing free samples. Being that formula was expensive, mothers often diluted the compound to make it last longer. Consequently, many infants died of malnutrition and infections. Moreover, the rapid increase of infant mortality rates in 1974 inspired the United Kingdom to publish “The Baby Killer,” which documented the horrific results of formula feeding. In particular, this booklet exhibited graphic images of malnourished infants and starving infants. Even more, in the past, the United States government went to extreme measures to support formula manufacturers and lobbyists; for the reason that it preserved the US economy. The national battle between Breast Milk and Formula Milk Most noteworthy, in response to the associated risks of formula milk the World Health Organization developed the Who Code, also known as International Code of Marketing of Breast-milk Substitutes. To summarize, WHO’s international health policy declares that the advertisement of formula products are unethical and causes harm to infants. Therefore, formula milk sales or free handouts should be legally restricted. Other proposals of the WHO code include: Restriction of free formula samples given by the hospitals Removal of misleading labels that suggest formula is healthier than breast milk Prevention of marketing through healthcare providers that idealize bottle feeding. Furthermore, the Carter administration, which governed from 1977-1981, was pro-code. In contrast, the Reagan administration opposed the policy due to the fact that it would impact American Corporations. In 1981, under the Reagan administration, the U.S cast the only vote against the WHO code. Formula lobbyists were behind the decision to reject the code. As a result, the U.S. became the leader in restricting formula marketing strategies. During this time Nestle was the largest manufacturer of formula products. The international battle between Breast Milk and Formula Milk Each nation had the option to implement or reject The WHO Code. The results were: 118 countries adopted the code. 3 countries abstained 1 country voted against the Code – that was the U.S. Most notably, the United States government argued the WHO code by using the prospect of antibiotics and clean water supplies to continue making safe and viable formula. The U.S. stands alone as the one modern democracy that has not found a way to reconcile its financial, political, and philosophical concerns. The Code does not restrict manufacturing, sales and use of formula, it is only about marketing. Currently, most nations have legislation to enforce the code, while the U.S. does not. In addition, all major formula companies claim to be Code compliant, but according to a watch dog group (IBFAN), none are. How formula makers get around the law Direct marketing through healthcare facilities with free samples is still legal and commonly seen. In actuality, it is not really free. Formula companies simply increase the cost of formula powder to offset the “free samples.” Other examples include: Similac sponsors the web site Enfamil sponsors WebMD Nestle sponsors “World Breastfeeding Week” and all materials are adorned with formula company logos. Moreover, when disasters occur the American Red Cross arrives with formula sponsored by companies to save the day. This cost of formula milk Formula feeding and all that needs to be purchased can consume 25-50% of the family income. These include: The purchase of formula The purchase of bottles and nipples The healthcare cost of childhood conditions that breast milk could have prevented Also, breastfeeding contributes to natural birth spacing which can decrease unwanted pregnancies. Global strategies to improve breastfeeding rates The Global Strategy urges that hospital routines and procedures remain fully supportive of the successful initiation and establishment of breastfeeding through the Baby Friendly Initiative. Including: Reassessment of Baby Friendly designated facilities. Expanding the Baby Friendly Initiative to include clinics, health centers, and pediatric hospitals. Furthermore, all governments should develop and implement a comprehensive policy on infant and young child feeding; in the context of national policies for nutrition, child and reproductive health, and poverty reduction. All mothers should have access to skilled support to initiate and sustain exclusive breastfeeding for 6 months. In addition, healthcare workers should ensure the timely introduction of adequate and safe complementary foods, certainly, with continued breastfeeding for up to two years or beyond. Healthcare workers should be empowered to provide effective feeding counseling. Additionally, their services should be extended in the community by trained lay or peer counselors. Also, governments should review progress in national implementation of the International Code of Marketing of Breast Milk Substitutes. Similarly, new legislation or additional measures should be created to protect families from adverse commercial influences. Last but not least, governments should enact imaginative legislation protecting the breastfeeding rights of working women, to include, establishing a means for its enforcement in accordance with international labor standards. So far, the best strategy for improving breastfeeding rates has been the Baby Friendly Initiative. Although other strategies exist and…

Klebsiella pneumoniae and Healthcare Acquired Infections

Do you know why Healthcare Acquired Infections are on the rise? One reason is Klebsiella pneumoniae. Actually, Klebsiella pneumoniae CAN be a friendly bacterium, especially to our environment and GI tract; but nurses don’t turn your back! These little capsule wearing, sticky suckers can cause serious havoc to the fragile lungs. To put it briefly, Klebsiella pneumoniae can be an opportunistic bacterium. In fact, it can cause a dangerous form of bacterial pneumonia in children, the elderly and immunocompromised individuals. Contact with feces allows people to serve as reservoirs and transmit the bacteria from person to person. Under those circumstances, these individuals can become severely ill or die from complications. So, Nurses wash your hands because we are running out of antibiotics! Although the percentage of total infections are a mere 8%, the percentage of its resistance to antibiotics is an alarming 29%. In the past, the drug carbapenem treated bacterial pneumonia caused Klebsiella pneumoniae. Yet, as of recent times there has been major difficulties in treating bacterial infections with antibiotics due to RESISTANCE. Similar to Methicillin-resistant Staphylococcus aureus or MRSA, Klebsiella pneumoniae developed a resistance to carbapenem. Meaning, Klebsiella is becoming harder to kill! Also, we cannot deny the fact that we are truly running out of antibiotics. Moreover, Carbapenem, already being a highly potent, broad spectrum, last-line-of-defense antibiotic is no longer effective against the resistant form. So the question is if most antibiotics are not working then what else do we have? In fact, not all persons infected with Klebsiella pneumoniae have the resistant form of the infection. That’s a relief! Nurses don’t let this resistant form spread! Help prevent Healthcare Acquired Infections According to the Centers for Disease Control, the key in treating antibiotic resistant Klebsiella pneumoniae is to identify the resistant strain. Next, applying strict contact precautions can further prevent the spread of infection. Most cases of carbapenem resistant pneumonia caused by Klebsiella pneumoniae were attributed to transmission from patient to patient in the hospital setting. Either carelessness from the healthcare provider or lack of guidelines or strict regulations for patient safety are attributed to the spread of carbapenem resistant Klebsiella pneumoniae. In conclusion, strict surveillance of the disease combined with strict adherence of hospital protocol can help prevent healthcare acquired infections caused by Klebsiella pnemoniae, among many others. So Nurses, Gear up- Gloves, Gowns, and Face-mask (if needed), and don’t forget to wash your hands thoroughly! To further prove our point regarding the rapid spread of antibiotic resistant bacteria check out Stanford’s video on the Evolution of Bacteria on a “Mega-Plate” Petri Dish. References: Case, C.L., Funke, B.R., Tortora, G.J. (2019). Microbiology: An introduction (13th). United States of America. Pearson Education Inc. Guidance for Control of Infections with Carbapenem-Resistant or Carbapenemase-Producing Enterobacteriaceae in Acute Care Facilities. (2009). Centers for Disease Control and Prevention. Retrieved from  

How to do NRP Skills Step by Step

This article provides healthcare providers with a step-by-step guide on how to successfully accomplish your NRP skills session as well as the E-sims portion of the AAP NRP exam. Initial Neonatal Resuscitation is all about being ready. If you are not ready, your resuscitation will be inefficient. This is why it’s essential to have your American Academy of Pediatrics NRP certification combined with your NRP skills. At NEO, we highly recommend that our students purchase the American Academy of Pediatrics Neonatal Resuscitation Program NRP 7th Edition Textbook. Preparation for a delivery is a must. You certainly don’t want a doctor standing beside you “blowing wind tunnels” waiting for you to rummage through the drawers looking for something! There is a long list of supplies and equipment in your NRP text. Click here to view our blog on Preparing for the Neonatal Resuscitation Program NRP Skills. All equipment is usually stored in the drawers of the radiant warmer. You just need to know which drawer!! All steps of resuscitation must be performed quickly and efficiently. Prior to beginning your NRP skills session the healthcare provider must be aware of the conditions that may cause an infant to require neonatal resuscitation. Click here to view our blog on anticipating neonatal resuscitation. In addition, healthcare providers must be aware on how to prepare the proper equipment needed to assist an apneic infant or neonates requiring chest compression’s and epinephrine. The initial steps of neonatal resuscitation include drying, stimulation, and perhaps suctioning. You must dry the infant with a towel then throw the towel away from the infant. If you leave a wet towel on the infant, the infant will get cold and your resuscitation will be inefficient. Next, you must stimulate gently. There is no need to stimulate vigorously. In addition, you are required to suction the mouth and then the nose if there are copious secretions. If you suction the nose before the mouth your resuscitation will be inefficient. In fact, suctioning the nose first causes the infant to snort and pull secretions from his/her mouth into the lung and your resuscitation will be inefficient. If the infant is apneic or gasping, you must provide positive pressure ventilation (PPV) that causes the chest to rise and fall. Bag Mask ventilate at a rate of 1 breath every 3 to 5 seconds. Most importantly, if there is no rise and fall of the chest with Positive Pressure Ventilation your resuscitation will be inefficient. If there is no rise and fall of the chest, you must: Mask Reposition Suction the mouth then the nose. Open the mouth Increase the pressure. Maintain or secure the airway MR SOPA What’s the point of providing positive pressure ventilation if air does not enter the lungs! Do not provide PPV too rapidly – slow down. For instance, I like to say “bag the baby” during PPV so that I don’t deliver PPV too rapidly.  If you “bag the baby” too rapidly, you will cause a pneumothorax and your resuscitation will be compromised. Moreover, do not provide PPV too aggressively with too much pressure. To much pressure will cause a pneumothorax and your resuscitation will be compromised. Have someone place a pulse oximeter on the right hand as soon as possible. It takes time to place the pulse oximeter and if it’s not attached as soon as possible, your resuscitation will be inefficient. If you place the pulse oximeter any other place than the right hand, you will get post-ductal saturation and not preductile saturation. Thus, your resuscitation will be inefficient. You want to know the saturation of the blood as it initially enters the heart and not what comes out of the heart. Have someone get a heart rate using your stethoscope. If you palpate the umbilical cord for the pulse you may be mistaken and your resuscitation will be inefficient. You must calculate the heart rate in 6 seconds and multiply that number by 10. For example if you auscultate or palpate 10 beats in 6 seconds multiply 10 x 10. The correct answer is 100 bpm. If the heart rate is less than 60 bpm, you must call for intubation. Keep providing PPV until the doctor is ready to establish an advanced airway. If you begin chest compression’s before intubation, your resuscitation will be inefficient. The reason being newborns have poor ventilation and not poor circulation. After the Intubationist arrives and takes over the bag/mask, move to the left of the Intubationist and prepare the instruments. The laryngoscope blade size is 0 for the preterm infant and 1 for the term infant. If you have the wrong size laryngoscope, your intubationist will have difficulty intubating and your resuscitation will be inefficient Next check the light source. If you do not have a light source your resuscitation will be inefficient. Put the blade in a locked position. The Intubationist will lower his/her head to view the glottis. At this point He/she is no longer looking at you. You must hand the laryngoscope into the LEFT hand of the Intubationist. If you hand the laryngoscope to his right hand, the light source of the laryngoscope will be directed outward and the intubationist will not be able to view the glottis and your resuscitation will be inefficient. You must have the right size ET tube for the gestational age of the infant. A 25 weeker requires a 2.5 ET tube A 30 weeker requires a 3.0 ET tube A 35 weeker requires a 3.5 ET tube A 40 weeker requires a 4.0 ET tube The Intubationist will then raise his/her right hand for you to place the ET tube into the right hand. Push the ET tube between the fingers of the Intubationist. Remember, he/she is not looking up. If the intubationist has to take his/her eye off the target, your resuscitation will be inefficient. The ET tube is inserted to the desired depth. 6 plus the weight of the infant in Kg. That’s the intubationist responsibility! The laryngoscope blade is then removed. The stylet is then removed if one is used. A CO2 detector is then placed on the end of the ET tube. If you don’t have one handy, your resuscitation will be inefficient. It comes out of the package all purple. When it turns gold, it indicates the presence of CO2. “Gold is Good.” Next, check for stomach gurgling during PPV. If epigastric gurgling is present this is a bad sign because the stomach was intubated. Take out the ET tube and try again. If you check the lung sounds before abdominal sounds, your resuscitation will be inefficient. Then check for bilateral breath sounds. If you don’t check both sides, your resuscitation will be inefficient. Using a stethoscope, check the neonates heart rate If the heart rate is less than 60 bpm, begin chest compression’s at a ration of 3 chest compression to 1 breath. Prepare for chest compression’s by: Placing a 3-lead ECG on the infant’s chest. If you don’t use the 3-lead ECG, you may not get an accurate heart rate and your resuscitation will be inefficient. Increase the FiO2 to 100% If you do not increase the FiO2 to 100%, your resuscitation will be inefficient. Chest compression’s and Ventilation’s are required with a 3:1 ratio. Do 3 compression’s and then pause for 1 ventilation. This cycle should take only 3 seconds. If you do not do this rapidly, your resuscitation will be inefficient Compress the chest 1/3 the anterior to the posterior depth of the chest. If you do not compress deeply, your resuscitation will be inefficient. Continue chest compression’s with ventilation’s for 60 seconds. Then check the heart rate again. This can be accomplished with the 3-lead ECG. If the heart remains less than 60 bpm, prepare for the administration Epinephrine. If you do not have Epinephrine ready, your resuscitation will be inefficient. The Endotracheal route is the route to be used initially. It’s not the best way, but the fastest way. The dose for Epinephrine through the ET tube is: 5 mg – 1.0 mg/kg It may be easier for you to use the 0.5 mg/kg to determine the dose. For a 3 kg infant, the dose would be 1.5 ml. The dose is administered rapidly and PPV follows. Wait 60 seconds to check the heart rate. Someone should be delegated to begin flushing the UVC. Attach a stop-cock If you don’t have a stop-cock handy, your resuscitation will be inefficient. Flush with Normal Saline. If the heart rate remains less than 60 bpm, the UVC is inserted just far enough the get blood return. The Epinephrine is then administered through the UVC. The dose of Epinephrine via the UVC is 0.1 mg/kg – 0.5 mg/kg It may be easier for you to use 0.1 mg/kg for the UVC access.. For an infant weighing 1 kg the dose becomes 0.1 ml. (if you are using the 0.1 mg/kg dose.) Flush the UVC with normal saline. Wait 60 seconds and check the heart rate. If you do not wait 60 seconds, you may be apt to repeat the Epinephrine too soon. You may decide to give a fluid bolus of 10 ml/kg of body weight. This may be given via the UVC. A fluid bolus is given to increase fluid volume. You must administer this fluid volume with a slow push. If you administer the fluid too rapidly, it will cause Intra-ventricular Hemorrhages, and you will compromise the infant. If the heart rate increases, you have been successful. Prepare to transfer to the NICU. Be sure and use a preheated transfer isolette. If you have not preheated your transfer isolette, your transfer will be compromised. Continue to provide PPV during the transport. Continue to provide O2 saturation during the transport. Nurses Educational Opportunities offers the most recognized and stress free NRP skills course in Southern California. We offer a flexible course schedule for healthcare providers. You can be assured that if there is no class scheduled to meet your needs we will schedule an NRP skills course according to your available times. Click on the link below to view our current calendar and additional course information. Click here to view NEO’s NRP Skills Schedule    

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by Allison on Nurses Educational Opportunities
Awesome Class!
Instructor: Jane

This class was great! I loved how easy to understand Jane made the course. It goes very in depth but Jane helps you get the big picture concepts.