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CHECKLIST 2 – PERFORMING ANTENATAL ABDOMINAL EXAMINATION, LEOPOLD. MANEUVERS AND AUSCULTATION ... LEOPOLD MANEUVERS AND AUSCULTATION OF FETAL HEART. Purpose.
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CHECKLIST 1 – PERFORMING ANTENATAL HISTORY TAKING
Purpose
To assess the antenatal woman’s general health and wellbeing To provide essential information about previous pregnancies To manage medical complications (if any) To screen for risk factors that may have a bearing on the progress of the pregnancy and its outcome To conduct antenatal care first visit/booking To provide health education and counseling; and advice and preparation of childbirth
Equipment
Antenatal card Antenatal record form
STEP INTERVENTIONS RATIONALES 1 Gather equipment 2 Reviewed any available medical files/records of woman 3 Greet the woman and introduce yourself 4 Draw curtains around the bed Provide privacy for the woman and show concerns the woman’s cultural and religious background 5 Place woman in relaxed reclining or sitting position Promotes comfort during booking 6 Explain to the woman what will be done and how she may cooperate
Reduces anxiety and promotes relaxation during the procedure 7 Listen to the woman’s problems and concerns attentively; and respond to her questions
This data yields information about woman’s overall condition. Often, best database is drawn from observation 8 Fill the woman’s antenatal card with all the relevant information you gathered from the pregnant woman
Details information of woman’s obstetrical and other related conditions 9 Perform history taking Ask/Check all relevant information on the Antenatal Card of the woman
Information obtained will ease antenatal care and management of woman during pregnancy a. Personal history (1st^ Visit) i. Woman’s name, age, occupation, husband’s name, address and duration of marriage, potential harmful habits (i.e. smoking)
Demographic characteristic is needed for further obstetric diagnosis, management and care b. Details of presenting complaints (1st^ and Subsequent Visits) Fever Vomiting Vaginal discharge/itching/leaking of watery fluid Vaginal bleeding Severe headache/blurring of vision Difficulty of breathing, palpitations, easy fatigability Severe pain in the abdomen Decreased/absent fetal movement within the last day Generalized swelling of the body, puffiness of the face
To find out how exactly symptoms began, in what setting they arose, and how symptoms have evolved since initial onset
Knowing mother’s symptoms and obstetrical disorder/complication is necessary in assisting the nurse to provide the most effective teaching strategies, client education and nursing care
Diabetes mellitus Hypertension Cardiac problem Multiple pregnancies (Twins) Congenital anomalies Other medical disorder
Because certain diseases and conditions run in families, such as breast and colon cancer, heart disease, type 2 diabetes, depression, and thrombophilia (blood clotting conditions). Such information can better help nurses managed and care for the woman, prevent or minimize the problem. g. Medical Surgical History Medical: Any chronic disease like diabetes mellitus, hypertension, urinary tract infections, heart diseases, viral infection and drug allergies
Surgical: C-section, forceps delivery, breech delivery
Provides information about what medical surgical problems the woman has had in the past and potential problems that might be in the woman’s present pregnancy (if any).
Many medical problems affect pregnancy; and these conditions/illness require careful evaluation and counseling h. Gynecology History Dilatation and curettage (D & C) Vaginal repair Caesarean section (C-section) Cervical cerclage Non-Gynecologic operations
Provides information about what gynecological problems the woman has had in the past and potential problems that might be in the woman’s present pregnancy (if any) i. Family Planning History Establish history of recent contraceptive use j. Immunization History
Woman’s tetanus immunization status Anti-Tetanus Toxoid (ATT) injection given 16 – 18 weeks gestation after quickening is felt ATT 2 nd. dose is given at 34 weeks gestation.
Information of immunization status past and present is essential to plan for further immunization for pregnant woman.
Benefit of vaccination among pregnant women can protect the mother from disease and protect the neonate from disease with passive maternal antibodies.
Failure to maintain an immune status to diseases such as tetanus, can result in serious consequences. k. Other History of allergies (drugs, foods or others) Blood transfusion Rh incompatibility X-ray exposure
Provides information of other problems the woman has had (if any)
Below 28 weeks – once a month 28 – 35 weeks – every two weeks 36 weeks and above – every week
More visits may be necessary depending on mother’s condition and needs
CHECKLIST 2 – PERFORMING ANTENATAL ABDOMINAL EXAMINATION, LEOPOLD MANEUVERS AND AUSCULTATION OF FETAL HEART
Purpose
To provide information about fetal presentation, position, presenting part, lie, attitude and descent To determine fundal height To aid in location of the fetal heart sounds To determine the fetal heart rate To determine single versus multiple gestation To detect any deviation from normal
Equipment
Pinard stethoscope Measuring tape Antibacterial Hand Cleaner Sanitising Gel Drawsheet
STEP INTERVENTIONS RATIONALES 1 Check the order for procedure and nursing care plan. Obtains specific instruction and or information. 2 Gather equipment. Provide good organization of intervention. 3 Greet the woman and introduce yourself. 4 Explain procedure to the woman and the rationale for each step as it performed
Awareness of the procedure may reduce anxiety and promotes cooperation during the procedure. 5 Instruct the woman to empty the bladder. An empty bladder contributes to the woman’s comfort during examination. 6 Draw curtains around the bed. Provide privacy for the patient 7 Perform hand hygiene. Prevents transmission of microorganisms. INSPECTION
Position the woman for examination. Place woman in dorsal recumbent position, supine with knees flexed
Promotes relaxation of abdominal muscles. Place a pillow under the head for comfort Place a small pillow or folded towel under woman’s right hip
Uterine displacement prevents aorto-caval compression, which could reduce blood flow to the placenta. Have her arms by her sides. Drape the woman with a drawsheet. Maintain privacy Expose her abdomen from below the breasts to the symphysis pubis.
Enables visualization of the abdomen
Inspect abdomen for the following: Scars, Diastasis reti, Hernia, Linea nigra, Striae gravidarum, Contour of the abdomen, State of umbilicus, Skin condition
Use the palm, palpate for size, shape and consistency and mobility of the fetal part in the fundus.
Perform 2nd. Leopold’s Maneuver (Fig 2. 2 b) Identify location of fetal back and to determine position. Place your hands on either side of woman’s abdomen about midway between the symphysis pubis and the fundus. Move your hands to the sides of the abdomen With one hand in place to steady the uterus, use the other hand to palpate the opposite side of the uterus with firm, circular motions
A firm convex, continuously smooth and resistant mass extending from breech to neck is indicative of fetal back. Small knobs, irregular mass, which move when pressed is indicative of the fetal small parts/limbs. Repeat the maneuver of opposite side of the abdomen
Confirm findings.
Perform 3rd. Leopold’s Maneuver (Fig 2. 2 c) or Pawlik’s Grip
Determine engagement of presenting part.
Continue facing the woman, grasp the portion of the lower abdomen immediately above the symphysis pubis between the thumb and middle finger of one of your hands.
If the fetal head is above the pelvic brim, it will be readily movable and ballotable.
Perform 4th. Leopold’s Maneuver (Fig 2. 2 d) Determine the degree of flexion of fetal head and attitude. Face the woman’s feet and place the palmar surface of your hands on each side of the woman’s abdomen Use both hands and palpate fetal head using pressing downward gently with your fingertips about 2 inches above the inguinal ligament
If the hands converge around the presenting part, the head is not engaged.
If the presenting part is engaged, there will be no mobility. This is indicative of an engaged head.
Omit the 4th^ maneuver if fetus in breech presentation,.
This maneuver is performed only in cephalic presentation
This maneuver determines whether the fetal head is flexed
20 Place the pinard over the convex portion of the fetus closest to the anterior uterine wall.
Fetal heard sounds heard best over fetal back at scapula region in vertex and breech presentation. Over chest in face presentation. 21 Listen by pressing in firmly and very gently; and count a full minute without holding the pinard while the other hand feel for the mother’s radial pulse. 22 Inform the woman the findings. 23 Tidy the woman’s unit. 24 Wash hands. 25 Document findings and remarks if any.
Figure 2. 1 Fundal Height by Weeks Figure 2. 2 Leopold Maneuvers
