Contents, Lecture notes of History

Download Contents and more Lecture notes History in PDF only on Docsity! 1 Contents CHECKLIST 1 – PERFORMING ANTENATAL HISTORY TAKING ............................................ 2 CHECKLIST 2 – PERFORMING ANTENATAL ABDOMINAL EXAMINATION, LEOPOLD MANEUVERS AND AUSCULTATION OF FETAL HEART ........................................................... 5 CHECKLIST 3 – PALPATING UTERINE CONTRACTIONS ........................................................ 9 2 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 (1 st 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 (1 st 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 5 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 7 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 8 Inspect abdomen for the following:  Scars, Diastasis reti, Hernia, Linea nigra, Striae gravidarum, Contour of the abdomen, State of umbilicus, Skin condition 6 STEP INTERVENTIONS RATIONALES 9 Determine the fundal height using the ulnar side of the palm (2.1) Identify fundus and provides an estimate whether fetal growth corresponds to gestational period  12 weeks – level of symphysis pubis  16 weeks – midway between symphysis pubis and umbilicus  20 weeks – 1 to 2 finger breadths below umbilicus  24 weeks – level of umbilicus  32 weeks – halfway between umbilicus and xiphoid process  36 weeks – at level of xiphoid process  40 weeks – 2 to 3 finger breadths below the xiphoid process if lightening occurs 10 Measure fundal height using measuring tape  Place zero line of the tape measure on the superior border of the symphysis pubis.  Stretch the tape across the contour of the abdomen to the top of the fundus along the midline. The number of centimeters measured should be approximately 22 to 24 weeks. PERFORMING LEOPOLD’S MANEUVERS Preferably performed after 24 weeks gestation when fetal outline can be already palpated. 11 Instruct the woman to relax her abdominal muscles by bending her knees slightly and do relaxation breathing. Reduces stretching and tensions of abdominal muscle during procedure. 12 Warms hands by rubbing both palmar surface of your hands. Cold hands can stimulate uterine contractions and cause discomfort. 13 Rest your hand on the woman’s abdomen lightly while reinforce explanation given earlier. Resting hands on woman’s abdomen would help her to become accustomed to your touch and dissipate muscle tightening. 14 Use flat palmar surface of fingers and not fingertips during palpation; and keep fingers of hands together. These techniques aid in gathering greatest amount of information with least discomfort to the woman. 15 Apply smooth and gentle deep pressure as firm as necessary. Provides accurate findings. 16 Perform 1 st Leopold’s Maneuver (Fig 2.2a) Determine fetal part lying in the fundus and presentation  Stand at the woman’s side and face the woman; and palpate the fundus using both hands. Can observe any discomfort and or pain experience by the woman during abdominal palpation. Determine fundal height.  Curve the fingers around the top of the uterus and feel for the fetal part lying in the fundus. Round, hard, readily, movable part, ballotable between the fingers of both hands is indicative of head. Irregular, bulkier, less firm and not well-defined or movable part is indicative of breech. Neither of the above is indicative of transverse lie. 7 STEP INTERVENTIONS RATIONALES  Use the palm, palpate for size, shape and consistency and mobility of the fetal part in the fundus. 17 Perform 2 nd . Leopold’s Maneuver (Fig 2.2b) 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. 18 Perform 3 rd . Leopold’s Maneuver (Fig 2.2c) 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. 19 Perform 4 th . Leopold’s Maneuver (Fig 2.2d) 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 4 th maneuver if fetus in breech presentation,. This maneuver is performed only in cephalic presentation This maneuver determines whether the fetal head is flexed FETAL AUSCULTATION USING PINARD STETHOSCOPE 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.