VEAL CHOP Nursing Interventions
VEAL CHOP Nursing Mnemonic
A mnemonic is a technique or helpful device used to remember information; mnemonics are frequently a sequence of letters. Nurses utilize mnemonic devices to help them remember crucial concepts and procedures.
VEAL CHOP, generally known as veal chop nursing mnemonic, is used during birth to recognize variations in fetal heart rate patterns. Significant increases (acceleration) or decreases (deceleration) in the heart rate of a fetus can be indicative of an underlying problem.
VEAL CHOP nursing mnemonic enables nurses to determine what the newborn feels and whether intervention is necessary. VEAL CHOP nursing mnemonic functions as a whole, with each letter in the first word correlating to the matching letter in the second word (V to C, E to H, A to O, and L to P):
- Variable — Cord compression
- Early — Head compression
- Accelerations — Okay
- Late — Placental insufficiency
Furthermore, It is critical to keep an eye on the baby’s heart rate and breathing during the third trimester of gestation and delivery. According to the research of Johns Hopkins Medicine Health Library, the fetus’s heart rate should be around 110 and 160 beats per minute throughout the final trimester and labor.
Doctors may also use interior or exterior devices to evaluate the fetal heart rate. Fetal heart rate is most commonly assessed using ultrasound imaging. The doctor may also connect an internal monitoring system directly to the fetus’ head to track and measure the baby’s heart rate more precisely.
The doctor will also evaluate heart rates alterations, including accelerations and decelerations. They will monitor for any heart-related abnormalities, as these are frequently indicators that either the baby or the mother is in danger. Such warning indications may lead the doctor to take early measures to ensure the fetus and mother’s wellbeing.
On the other hand, measuring fetal heart rate is simple, but internal monitoring can be uncomfortable for the patient. Since there are few dangers connected with this procedure, it is routinely performed on all women during labor and delivery.
Patients were encouraged to consult with their doctor, midwife, or labor nurse if they had any concerns about the fetus’ heart rate during labor. However, patients should be reminded that a variety of factors other than heart rate can indicate how well the baby’s condition is inside the mother’s womb.
8 Components of VEAL CHOP Mnemonics
1. V: Variable Decelerations
Variable deceleration is more severe than late decelerations because it is unpredictable and it causes frequent drops in fetal heart rate. When the baby’s umbilical cord is temporarily tightened, variable deceleration occurs. Variable decelerations occur in the majority of pregnancy labors.
The infant relies on continuous blood supply through the umbilical cord to get oxygen and other vital nutrients. If variable decelerations occur repeatedly, it may indicate that the fetus’s blood supply is limited. A pattern like this can be detrimental to the infant.
Causes of Variable Decelerations
Here are some of the possible reasons for variable decelerations:
- Compression of the intrauterine umbilical cord due to the following:
- Positioning of the mother and fetus
- Oligohydramnios or insufficient amniotic fluid
- Entanglements in the nuchal cord or other cords
- True knot or short umbilical cord
- Tachysystole of the uterus
- Efforts to push during the second stage of labor
- Increased fetal acidemia
- Prolapse of the umbilical cord
- Rupture of the uterus
Management of Variable Decelerations
- Nursing interventions for variable decelerations include adjusting maternal posture to alleviate the pressure on the umbilical cord and minimizing fetal head compression.
- Administering an IV bolus may boost the volume of blood and its circulation, as well as fetal heart rate.
- Examine the cervix for a prolapsed cord or a change in labor progress.
- Regularly monitor FHR to evaluate the current situation and detect any variations in FHR patterns.
- If necessary, administer oxygen.
- Report observations to the doctor and keep a record of them.
- Prepare for the possibility of cesarean birth. Take the interventions mentioned above.
2. E: Early Decelerations
Early deceleration refers to the proportional decreases and subsequent restoration of the normal fetal heart correlated to uterine contractions. In this condition, the heart rate progressively slows down.
Early decelerations occur before the contraction reaches its maximum. When the baby’s head is compressed, early deceleration might occur.
This situation is expected in the later stages of labor when the baby descends into the delivery canal. They can also happen during premature labor if the baby is preterm or transverse. During contractions, the uterus squeezes the head of the baby as a result. Generally, early decelerations are not detrimental.
Causes of Early Decelerations
- Rather than hypoxia, the fetus’s head compression is one of the causes.
- Early deceleration may occur in the late stages of labor when the baby descends via the birth canal.
- The heart rate slows down due to uterine contractions, resulting in early decelerations.
Management of Early Decelerations
- Electronic fetal monitoring technology; cardiotocography (CTG). Cardiotocography (CTG) is an electronic fetal monitoring tool that allows the clinician to watch the fetus’s early decelerations or other FHR disparity.
- Changing one’s body position is one intervention of early deceleration. To relieve compression on the big vein, have the patient lie down in the left lateral, knee-chest, or correct lateral posture (or vena cava). This method increases the flow of deoxygenated blood to the heart and the rest of the body, along with the uterus and placenta.
- Early decelerations do not require immediate medical attention because they are not related to poor fetal oxygenation or metabolic acidosis. However, it is critical to continue monitoring FHR tracings during labor to identify any abnormalities that may be concerning related to changes in the fetus’ acid-base state.
3. A: Accelerations
During labor, doctors will watch for any signs of acceleration. Accelerations are temporary increases in heart rate of at least 15 beats per minute that last at least 15 seconds. Accelerations are both natural and healthy.
Accelerations inform the doctor that the infant has an appropriate quantity of oxygen, which is crucial. The majority of fetuses have spontaneous accelerations at various times during the labor and delivery process.
If the doctor is worried about the baby’s wellbeing and does not notice accelerations, he or she may try to generate accelerations. They may experiment with a variety of approaches to create accelerations. These are some examples:
- Rocking the mother’s abdomen gently.
- Putting a finger through the cervix on the baby’s head
- Delivering a brief burst of sound (vibroacoustic stimulation)
- Supplying the mother with food or fluids
- Contraction of the uterus
- Compression of the umbilical vein
If these approaches cause fetal heart rate accelerations, it indicates that the baby is healthy.
4. L: Late Accelerations
Late decelerations do not commence until a contraction reaches its peak or after the uterine spasm has ended. They are smooth, brief drops in heart rate that mimic the pattern of the contractions.
Late decelerations are sometimes not a serious concern as long as the baby’s heart rate also exhibits accelerations (this is known as variability) and a quick rebound to normal heart rate range.
Late decelerations can be a warning that the infant is not getting sufficient oxygen in some situations. Late decelerations with a rapid heartbeat (tachycardia) and slight fluctuation indicate that the contractions may harm the baby because of depleting oxygen.
If late decelerations and other signs suggest that the baby is in danger, the doctor may decide to perform an immediate (or emergent) cesarean surgery.
Causes of Late Accelerations
- Insufficiency of the uteroplacental (depleted oxygen for the fetus)
- Amniotic fluid infection, which might occur as a result of too prolonged labor
- Maternal blood pressure is low.
- Consequences of epidural or spinal anesthesia
- Hyperactive uterine activity
- Placenta previa or abruption.
Management of Late Accelerations
- Present findings to the doctor and keep a record.
- Keep the maternal position on the left side.
- Use a face mask to deliver oxygen at a rate of 7–10 L/min.
- Check the mother’s blood pressure and pulse.
- Increase the IV fluids.
- Analyze the labor progress.
- Start preparing for an emergency cesarean birth.
- Explain the treatment strategy to the woman and her spouse.
- Assist the doctor with fetal blood sampling.
5. C: Cord Compression
Compression is a typical cause of umbilical cord problems. When pressure partially or fully prevents the blood circulation through the umbilical cord, this is referred to as compression.
Fetuses can survive short durations of umbilical cord compression, but if the baby’s blood circulation is not restored, the newborn may suffer catastrophic birth complications. This condition is harmful since babies require nutrition and oxygen to develop correctly.
Thus, as measured by a reduction in movement, or an irregular heartbeat, as detected by fetal heart monitoring, reduced activity from the baby are both signs of umbilical cord compression.
Causes of Cord Compression
Below are some of the most typical causes of umbilical cord compression:
- Nuchal cords. A nuchal cord is a clinical definition for when an umbilical cord wraps multiple times around the baby’s neck within the womb.
- True knots. The true knot is the clinical terminology for when the umbilical cord twists into a knot like a rope. This condition can occur merely from the baby’s activity within the mother’s womb.
- Prolapse of the umbilical cord. A prolapse occurs when the umbilical cord moves down the delivery canal ahead of or alongside the infant. The umbilical cord should ideally accompany the baby down the delivery canal. A perilous condition can emerge if the cord moves ahead of or beside the infant, resulting in delivery hypoxia, Hypoxic-Ischemic Encephalopathy, and other birth complications.
Management of Cord Compression
- Amnioinfusion is a popular treatment for umbilical cord compression. Amnioinfusion is a procedure that includes infusing a room temperature saline solution into the uterus during childbirth to alleviate the pressure that could lead to the umbilical cord getting compressed.
- Boost the mother’s oxygen levels to improve blood circulation through the umbilical cord.
- A C-section may be required to preserve the baby’s health if the infant shows signs of discomfort or if the baby’s heart rate abruptly showed some signs of brief fluctuations in the heart rhythm.
- Changing positions: Changing the mother’s position (for example, from lying on the right to lying on the left side) might assist relieve compression and increasing blood circulation to the baby.
6. H: Head Compression
Head compression injuries can occur when a baby’s head is subjected to increased pressure during labor and delivery, causing brain injury. This condition can happen even if there is no visible external head trauma, apparent evidence of oxygen insufficiency, or birth asphyxia.
Causes of Head Compression
Here are some of the possible factors that contribute to head compression:
- During uterine contractions, mainly when they are pretty severe towards birth.
- The most common cause of head compression during pregnancy or labor is a lack of oxygen to the fetal brain.
- Obstinate maternal pushing during labor
Management of Head Compression
- Change the posture of the mother.
- Assure that the mother is adequately hydrated.
- Ensure that the mother receives enough oxygen
- Educate the mother on the proper technique for maternal pushing during labor.
7. O: Oxygenated (Fetal Oxygenation)
Fetal oxygenation is the transmission of oxygen and nutrients from the mother’s blood throughout the placenta to the fetus via the umbilical vein. This enhanced blood travels into the baby’s organs through the umbilical cord.
There, it travels through a shunt known as the ductus venosus. Adequate oxygenation enables some blood to be sent to the liver.
Signs of Normal Fetal Oxygenation
- Normal heart rates. Babies developing typically in the womb will have stable and robust heartbeats.
- Increased fetal movement
- Reduced maternal cramping
- Reduced bleeding
- Adequate amniotic fluid
8. P: Placental Insufficiency
The placenta does not always function correctly. As a result, the baby will not receive the necessary oxygen and nutrition. If the mother has placental insufficiency, the baby may not grow properly or experience problems during labor.
The condition can cause issues for both the mother and the infant. It has been connected to pre-eclampsia and spontaneous abortion when the placenta pulls away from the uterine wall.
It can also prevent the baby from developing typically in the womb, a condition known as intrauterine growth restriction (IUGR). There may be significant issues for the infant, such as a shortage of oxygen during the birth, preterm labor, hypoglycemia, inadequate calcium in the blood, excessive red blood cells, and, in rare cases, miscarriage.
Causes of Placental Insufficiency
- Placental insufficiency occurs when the placenta fails to grow correctly or is destroyed.
- Sometimes, the placenta may not grow enough, such as if the mother is carrying twins or more. It can have an irregular form or fail to connect adequately to the uterine wall.
- The way of living can potentially harm the placenta.
- Using illegal substances while pregnant may develop placental insufficiency.
- Diabetes, pre-eclampsia, and blood clotting disorders all trigger the risk.
Management of Placental Insufficiency
- If the healthcare professional suspects placental insufficiency, they will closely monitor the baby’s growth. The mother will be asked to keep records of the baby’s motions and notify the medical team if any changes occur.
- The stage of the pregnancy will determine the treatment. If the mother is less than 37 weeks pregnant, the doctor might recommend maintaining the baby in the womb as long as possible while keeping the observation.
- If the mother is already full term or indicators that the baby is in distress, the doctor may choose to induce labor or perform a cesarean section.
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