PAMANTASAN NG CABUYAO

Bachelor of Science in Nursing

COURSE TITLE: Care of Mother, Child, Adolescent, Well Clients

COURSE CODE: NCM107
LEVEL OFFERING: Level 2, First Semester AY 2020
NUMBER OF UNITS: 3

COURSE DESCRIPTION:
This course deals with the concepts, principles, theories, and techniques in the nursing care of
individuals and families during childbearing and childrearing years toward health promotion, disease
prevention, restoration and maintenance, and rehabilitation. The learners are expected to provide safe,
appropriate, and holistic nursing care to clients utilizing the nursing process.

MODULE OVERVIEW:
This module is designed to develop your competencies in the maternal and child nursing. In
Module 1 presents a theoretical concepts of maternal and child health nursing, understanding of nursing
process, nursing research and nursing theory in the provision of quality care will be integrated in the
practice of nursing skills. The standards of maternal and child health nursing practice, the changing
discipline and varied roles assumed by nurses in maternal and child health nursing are also apply.
Moreover, needs to provide nursing care related to health promotion before and during pregnancy and
prevention of fetal exposure to teratogens. The next step that you need to learn after having gone through
the theoretical inputs is on the application of these principles and techniques in the nursing care of
individuals and families during childbearing and childrearing years. The related learning experience will be
catered to flexible clinical learning experiences through this self-instructed module.
In addition, this learning activity might not be a substitute for actual clinical experience due to
Covid- 19 pandemic. However, this will help you to direct through your nursing practice in providing nursing
care to your patient in the virtual platform. This module has the following RLE learning process:

RLE LEARNING PROCESS

1 • Module Overview
2 • Learning Map
3 • Small leap
4 • Big leap
5 • Conquering the heights
6 • Recapturing the trail
INTRODUCTION OF SELF TO CLASS

Name of Clinical Instructor:

Name:Girlie Mannphy
Emelita A. Lacambra
S. Pesigan RM MAN,
RN, RM, RN MAN MAED, PHD
Contact number: 09258468725
Contact number: 0927-1856048 Email add:
Email add: [email protected]
RLE schedule: MTW 8AM – 4PM (OB-OPD)
RLE schedule:
(time and day students can communicate with the respective clinical
instructor)

RLE Module in Hi-Flex Learning

RLE Focus: Care of Mother, Child, Adolescent, Well Clients Clinical Area: OB-OPD/Clinic
Date of Clinical Exposure: (as per RLE rotation)
Number of Hours: 48 hours

LEARNING MAP
At the end of this course, the students should be able to:
Apply concepts, theories and principles of sciences and humanities in the formulation and
application of appropriate nursing care during childbearing and childrearing years.
Provide safe, appropriate, and holistic care to individuals, families, population, groups and
community utilizing nursing process during childbearing and childrearing years.
Apply evidence-based practices in the care of mother and child.
 MODULE 1

V. Pre-natal Care (Fetal Heart Tone)

Introduction:
When a woman visits a health care facility for the first prenatal visit, an assertive effort should be made by
the nurse validate the pregnancy, determine the woman’s health status and initiate strategies that will
encourage the woman and her family to establish positive behavior patterns of health promotion during
pregnancy and throughout their lives. This allows a student to review the anatomic structures of the female
body and demonstrate knowledge on how to appropriately intervene to provide nursing care, education and
guidance from the visit throughout the mother’s pregnancy. A case study is included to help the student
integrate therapeutic communication skills through Comprehensive Obstetric Health History taking and
nursing actions when assisting the patient with her first visit that include demonstrating of skills like
measuring Fundic height, checking Fetal heart tone, palpating the abdomen by means of Leopold’s
maneuver.

Let’s first review your background of Assessing Fetal and Maternal Health: Prenatal Care
Assessing Fetal Heart Tone

Fetal heart tone (FHT) also referred to as fetal heart rate (FHR) are auscultated with a De Lee-Hillis
fetoscope or Pinard stethoscope. However, in the practice, the term auscultation is often used to refer to
the assessment of the fetal heart sounds by means of a hand-held Doppler device or ultrasound monitor.

The ultrasonic Doppler device is the primary tool for assessing fetal heartbeat. It may detect fetal
heartbeat at about 10 to 12 weeks’ gestation. The normal range for fetal heart tones (FHT) is 120–160
beats per minute (bpm). An ultrasound should be completed if the nurse is unable to auscultate between 10
and 12 weeks, because there may be a discrepancy of EDD, twins, or a missed abortion. In the case of
twins or the obese woman, it may be later before the fetal heartbeat can be detected.
Pinard Fetoscope

Doppler Device Stethoscope

FHT Locations on The Abdominal Wall indicating possible corresponding fetal positions and Usin
Fetoscope

Definition:
 This is a method of listening to the fetal heart tone periodically or intermittently to measures
the heart rate and rhythm of fetus.

Purpose:
 To evaluate fetal well-being through auscultation of the fetal heart rate to determine the rate
and rhythm.
Equipment:
 A stethoscope, a fetoscope and/or Doppler.
 Watch or clock with a second hand
 Water-base lubricant or KY Jelly
 Draping sheet

PROCEDURE RATIONALE
1. Explain to the client what you are going to do, why it is  To ensure correct procedure to right
necessary, and how she can cooperate. A patient.
 Explaining procedure reduces
anxiety and fear thus promoting
cooperation from the client.
 To ensure correct procedure to right
patient.
2. Wash hands and observe other appropriate infection  Reduces transmission of
control procedures. microorganisms.
3. Ask the client to empty her bladder.  To ensure the accuracy of the
 measurement.
 Promotes comfort and aids in the
performance of the procedure.
4. Prepare the client.  To ensure safety
5. Assist the client to lie down in bed.
6. Ask the client to bare her abdomen from the lower rib  Promotes comfort and aids in the
margin to the pubic bone. performance of the procedure.
7. Drape appropriately.  Maintain client’s privacy.
 To locate properly the fundus.
8. Stand at the woman’s side by palpation, determine the  To ease the procedure
following:  Ideal position to best hear the fetal
a. Fetal position heart tone
b. Fetal presentation
c. Fetal lie
9. Place the head of the stethoscope using the bell side  To auscultate properly and clearly.
on the abdomen over the back (or chest) of the  Avoid friction noises caused by
fetus. or fingers on the abdominal surface
Apply Lubricant gel on the transducer of the Doppler area.
and place on the abdomen over the back or chest of
fetus.
10. Palpate the maternal radial pulse to differentiate the  To identify accurately the correct
maternal heart rate from FHT. fetal heart sound.
11. Do the following:  Provides proper monitoring of the
a. Listen and count the beats for one full minute FHT.
b. Listen with an interval for 2-5 minutes for at least
twice or five times.
c. Compare counts to determine variability.
 12. Assess for variability of the fetal heart rate:  To assess properly if there is any
a. As it occurs spontaneously, and/or deviation.
b. As it occurs with fetal activity, and/or
c. As it occurs with palpation of the fetus
d. Note irregularity of heart rate or heart sounds
e. Any increases or decreases in the FHR.
f. Loudness of the heart tones relative to
the position of the fetus.
13. If the location of the fetal heart tones conflicts with  To ensure correct location of the
your assessment of #7 above, repeat # 7 to be sure FHT.
of
the fetal position, if necessary.
14. Explain the findings to the woman.  To promote participation in care and
understanding of the status.
15. Clean the Stethoscope with cotton swab or ball and  Ensures comfort for the client.
alcohol Although always clean equipment
Or between client to prevent transfer of
Clean the transducer and the mother’s abdomen with microorganisms.
clean tissue
16. Wash hands.  To reduce transfer of
microorganisms.
17. Document the results.  To provide accurate record of data
needed for further care or treatment.
 To serve as baseline data for health
care provider.

Reference:
1. Pilliteri, Adele, (2010). Maternal and child Health Nursing: Care of the Childbearing and Child Rearing
Family (6th ed). Philadelphia: Lippincott Williams and Wilkins.
2. https://youtu.be/jFWUYfuvUkQ
3. https://youtu.be/AuUzJH1ssIA
4. https://youtu.be/4YlVvP5Z4XM
5. https://nurseslabs.com/prenatal-visit/
6. https://www.youtube.com/watch?v=p6Ma0D-fN38
7. http://www.ofeverymoment.com/2014/09/how-many-days-are-in-this-month.html
8. https://nurseslabs.com/physiological-changes-pregnancy/
9. https://nurseslabs.com/fetal-development/
 Let’s begin with small leap.

RLE Activity 1: Review of Leopold’s Maneuver and Fetal Heart Tone

Instructions:
1. All questions apply to this activity pertains to the concepts and theories discussed. Your responses
should be detailed and direct to the point. When asked to provide several answers, list them in
order of priority or significance.
2. Please submit on or before , 2020 thru MS Teams and or to the designated place in your
barangay, and to be collected by PNC personnel.
You’re on your way!
A. Identification.
1) Normal fetal heart rate.
2) The four instruments use to hear the fetal heart tone.
3) (Answers No.2-4)
4)
5) Medical term for increase heart rate.
6) Medical term for decrease heart rate.
7) Four sounds that you can hear in the abdomen of the pregnant
woman.
8) (Answers No.7-10)
9)
10)

B. Write the number over the diagram where you would listen for the fetal heart tone according to the
fetal positions given below.

1. RMA
2. LOP
3. RSA
4. LST
5. LScT
 Now, try some big leap.

RLE Activity 2: Case Analysis

Instructions:
1. All questions apply to this activity pertains to the concepts and theories discussed. Your responses
should be detailed and direct to the point. When asked to provide several answers, list them in
order of priority or significance.
2. Please submit on or before , 2020 thru MS Teams and or to the designated place in your
barangay, and to be collected by PNC personnel.
Keep going.
You are now duty in the OB – Out-Patient Department of LPH-SPCDH. In this 24-hour duty, you are
expected to take care patients who is pregnant. Your focus on the following:
 History Taking
 Health teaching
 Nursing process

Case Analysis
Read the case scenario and apply your critical thinking.
Monique Nuque, 31 years of age, visits your clinic for her first prenatal check-up. She is in her first
trimester. She complaints vomiting and loose bowel movements for 2 days. Her blood pressure is 90/60
mmHg, heart rate 95 bpm, respiratory rate 24 and temperature 38.2°C. The fetal heart rate is 90 bpm, so
weak to hear even using the hand-held doppler device.
A. What role does fetal heart rate assessment play during pregnancy?

B. The FHT is 90bpm, what will be your nursing action?

C. Besides problem with the FHT, what else will be included in the care for Monique’s and her fetus
condition?

We’re ready to conquer the heights!

RLE Activity 3: Develop the nursing skills in demonstrating Fetal Heart Tone assessment.
Instructions:
1. All questions apply to this activity pertains to the concepts and theories discussed. Your responses
should be detailed and direct to the point. When asked to provide several answers, list them in
order of priority or significance.
2. Please submit on or before , 2020 thru MS Teams and or to the designated place in your
barangay, and to be collected by PNC personnel.

You’re doing fine! Carry on.

You are now duty in the OB – Out-Patient Department of LPH-SPCDH. In this 24-hour duty, you are
expected to perform Fetal Heart Tone assessment to pregnant woman. Use the checklist for below for your
return demonstration via video presentation and send via LMS. Be sure you are wearing your clinical
uniform and use the suggested supply and equipment. Your focus on the following:
 Therapeutic Communication Technique
 History Taking
 Aseptic technique
 Providing Privacy/Confidentiality
 Computations of EDD and AOG
 Prenatal Care
 Health teaching
 Documentation of Data
 PAMANTASAN NG CABUYAO
Cabuyao City COLLEGE
OF NURSING

Nursing Care Management – 107 RLE Checklist Evaluation

Auscultation of the Fetal Heart Tone

Name: Yr/Section/Grp: Rate:

Objective:
 Demonstrate the ability to count and assess the fetal heart tone using a stethoscope, a
fetoscope and/or Doppler.

Rating Scale:
5 = The student demonstrates the procedure with thorough in independent manner 4 =
Demonstrates the procedure with minimal guidance and supervision
3 = Demonstrates with thorough understanding of the skills/performances 2 =
Demonstrates some understanding of the skills/performances
1 = Demonstrates limited understanding of the skills/performances

Auscultation of the Fetal Heart Tone

Performance
Preparation Remarks
5 4 3 2 1
1. Assess:
The previous clinic visits.
Retrieve the record if old patient.
The Last menstrual period (LMP) and AOG.
The latest FHR.
2. Assemble equipment and supplies:
A stethoscope, a fetoscope and/or Doppler.
Watch or clock with a second hand
Water-base lubricant or KY Jelly
Draping sheet
Procedure
1. Explain to the client what you are going to do, why it is necessary,
and how she can cooperate.
2. Wash hands and observe other appropriate infection control
procedures.
3. Ask the client to empty her bladder.
4. Prepare the client.
5. Assist the client to lie down in bed.
6. Ask the client to bare her abdomen from the lower rib margin to the
pubic bone.
7. Drape appropriately.
8. Stand at the woman’s side by palpation, determine the following:
a. Fetal position
b. Fetal presentation
c. Fetal lie
9. Place the head of the stethoscope using the bell side on the
abdomen over the back (or chest) of the fetus.
Or
Apply lubricant on the transducer of the Doppler and place on the
abdomen over the back or chest of fetus.
10. Palpate the maternal radial pulse to differentiate the maternal heart
rate from FHR.
11. Do the following:
a. Listen and count the beats for one full minute
b. Listen with an interval for 2-5 minutes for at least twice or
five times.
c. Compare counts to determine variability.
12. Assess for variability of the fetal heart rate:
a. As it occurs spontaneously, and/or
b. As it occurs with fetal activity, and/or
c. As it occurs with palpation of the fetus
d. Note irregularity of heart rate or heart sounds
e. Any increases or decreases in the FHR.
f. Loudness of the heart tones relative to the position of
the fetus.
13. If the location of the fetal heart tones conflicts with your assessment
of #7 above, repeat # 7 to be sure of the fetal position, if necessary.
14. Explain the findings to the woman.
15. Clean the Stethoscope with cotton swab or ball and alcohol
Or
Clean the transducer and the mother’s abdomen with clean tissue
16. Wash hands.
17. Document the results.

To compute for the Total Score: Add each item’s rating. Total Score
----- 95
To compute for the Average: Divide the total SCORE by total number of Ave.
items, multiply by 100
 Comments:

Student’s Signature Over Printed Name CI’s Signature Over Printed Name

Recapturing the trail.

Reflection Point:

“As a nurse, we have the opportunity, to heal the mind, soul, heart and body of our
patients, their families and ourselves. They may forget your name, but they will never
forget how you made them feel” – Maya Angelou.
Having been drawn with concepts of maternal and child nursing, how would you
anticipate your clinical exposure from which you can connect this inspirational quote.

Module Evaluation:

ng, I appreciate to hear your feedback to this module. Kindly rate each component with a scale of 1 – 5; 1 as the lowest and 5 a

Component Rating
1. Contents are inclusive in the
course topics.
2. Contents are relevant.
3. Clarity of instructions.
4. Alignment of assessment tasks
to course learning outcomes
TOTAL

Comments/Suggestions:
 Congratulations for completing the module. May the learning you have gained from this course work
contribute, in developing your competencies in the clinical nursing practice. Carry on and continue
your journey in reaching greater heights!

“…observation and experience will teach us ways to maintain or to bring back the state of health.”
Florence Nightingale