This document outlines the procedures for conducting a physical assessment of a normal pregnant client. It describes assessing the client's general appearance, vital signs, weight, and body mass index. It then provides details on examining each body system, including the head/neck, thorax, heart, breasts, abdomen, extremities, and genitalia. Assessment techniques like Leopold's maneuvers are explained to evaluate fetal position, presentation, and attitude. Guidelines are given for preparing the client and equipment as well as concluding the visit.
This document outlines the procedures for conducting a physical assessment of a normal pregnant client. It describes assessing the client's general appearance, vital signs, weight, and body mass index. It then provides details on examining each body system, including the head/neck, thorax, heart, breasts, abdomen, extremities, and genitalia. Assessment techniques like Leopold's maneuvers are explained to evaluate fetal position, presentation, and attitude. Guidelines are given for preparing the client and equipment as well as concluding the visit.
This document outlines the procedures for conducting a physical assessment of a normal pregnant client. It describes assessing the client's general appearance, vital signs, weight, and body mass index. It then provides details on examining each body system, including the head/neck, thorax, heart, breasts, abdomen, extremities, and genitalia. Assessment techniques like Leopold's maneuvers are explained to evaluate fetal position, presentation, and attitude. Guidelines are given for preparing the client and equipment as well as concluding the visit.
This document outlines the procedures for conducting a physical assessment of a normal pregnant client. It describes assessing the client's general appearance, vital signs, weight, and body mass index. It then provides details on examining each body system, including the head/neck, thorax, heart, breasts, abdomen, extremities, and genitalia. Assessment techniques like Leopold's maneuvers are explained to evaluate fetal position, presentation, and attitude. Guidelines are given for preparing the client and equipment as well as concluding the visit.
PREGNANT CLIENT ➢ Sitting position FREQUENCY PRENATAL VISIT ➢ Supine position with pillow under the legs DOH GENERAL EXAMINATION TRIMESTER FREQUENCY OF VISIT ➢ Appearance – inspection of the overall 1st (1-12 wks AOG) At least once health, nutritional status, emotional state, neuromuscular coordination 2nd (13-17 wks At least once ➢ Weight, height AOG) ➢ BMI (prepregnant state) 3rd (28-40 wks AOG) At least twice ➢ Vital signs
PILLITERI AGE OF FREQUENCY OF The Body Mass Index Formula GESTATION VISIT
Week 4-27 1 PER MONTH Metric Units - BMI = Weight(kg) / Height
(m)]2 Week 28-36 1 EVERY TWO English Units - BMI = 703 (Conversion factor WEEKS for lbs/in2 to kg/m2) x Weight(lbs) / Height(in)]2 Week 37-40 1 EVERY WEEK
PREPARATION BEFORE ASSESSMENT:
UNDERWEIGHT - Less than 18.0 ➢ Make sure to always provide comfort NORMAL WEIGHT - 18.0 - 24.9 and sense of privacy OVERWEIGHT - 25.0 - 29.9 ➢ Have the needed equipment readily at OBESE - 30 or more hand ➢ Provide gown and drapes for abdominal examination ➢ Instruct the client to empty her bladder prior to examination
EQUIPMENTS: ➢ The examiners hand are the “primary equipment” for assessment ➢ Tape measure ➢ Stethoscope/ fetal Doppler ➢ Water-soluble gel ➢ Clean gloves (if needed) HEAD AND NECK ABDOMEN
➢ Hair: note for texture, moisture, and ➢ Inspect for skin changes: presence of distribution, dryness, oiliness Linea Nigra – darkening of the linea ➢ Eyes: anemia of pregnancy may cause alba pallor ➢ Inspect for Striae gravidarum “stretch ➢ Nose: nasal congestion is common mark” due to stretching of the abdomen, among pregnant women and nose bleeds reddish or purplish in color and becomes ➢ Mouth: inspect for gums and teeth, silvery after delivery gingival enlargement with bleeding is ➢ Associated risk factors are weight gain common during pregnancy, younger maternal age, ➢ Thyroid: symmetrical enlargement may and family history be expected ➢ Palpate for the fetal movement ➢ Skin pigmentation changes: “quickening” 10-12 fetal kicks per hour Chloasma/melasma gravidarum– ➢ Braxton hick’s contraction – abnormal irregular brownish patches of varying painless contraction size appear on the face and neck, “mask ➢ Auscultation of fetal heart tone of pregnancy” 120-160bpm ➢ Spider telangiectasia – a vascular ➢ Can be detected through stellate mark resulting from high levels stethoscope by 18 weeks AOG of estrogen. Typically develop in face, ➢ Can be detected through fetal neck, upper chest and arm Doppler at 10 – 12 weeks AOG
THORAX AND LUNGS Mc Donald’s Rule - used to determine the age
of gestation ➢ Inspect thorax for the pattern of ➢ Length of the fundus in cm x 8/7 = AOG breathing in weeks ➢ Length of the fundus in cm x 2/7 = AOG HEART in months
➢ Palpate for the apical impulse. Bartholomew’s Rule – to determine the age of Sometimes it may be slightly higher gestation by fundal location than normal due to higher diaphragm ➢ 3 months – just above the symphysis ➢ Auscultate the heart; soft blowing are pubis common, reflecting the increased blood ➢ 4 months – midway between symphysis flow in normal vessels pubis and umbilicus ➢ 5 months – at the level of the umbilicus BREAST NOTE: Fundal height is measured in ➢ Inspect breast and nipple for symmetry centimeters from the pubic symphysis to the top and color, nipple and areola become most portion of the uterus. bigger and darker ➢ Compress nipples with finger and thumb, may express colostrum JOHNSON’S RULE - For estimation of fetal LM 3 (PAWLIK’S GRIP) weight ➢ Suprapubic palpation using thumb and ➢ Fetal weight in grams = (fundal height fingers just above the symphysis pubis in cm) - n x 155 to determine degree of engagement and ➢ n = 12 if the fetus is not engaged ballottement ➢ n = 11 if the fetus is engaged ➢ To confirm fetal presentation
● Example: 28cm – 11 = 17 17 x LM 4 (PELVIC GRIP)
155 = 2635gms ➢ Palpation of the bilateral lower quadrants to determine fetal attitude HAASE’S RULE – to determine the length of ➢ Only done when the mother is near her the fetus in centimeter EDD/EDC/EDB ➢ First half of pregnancy (1 – 5 months) --- months ² FETAL ATTITUDE ➢ Second half of the pregnancy ( 6 – 10 months) month x 5
LEOPOLD’S MANEUVER ★ Are a common and systematic way to determine the position of a fetus inside the woman's uterus ★ Named after the gynecologist Christian Gerhard Leopold. ★ Also used to estimate term fetal weight.
LM 1 ( FUNDAL GRIP) ➢ Palpation of the fundus to determine which fetal part occupies the fundus ➢ Use finger pads and ulnar surface of EXTREMITIES hands ➢ Inspect hands and legs for edema ➢ Fetal head should be round and hard ➢ Palpate for pretibial, ankle and pedal ➢ Buttocks soft and round edema ➢ Physiologic edema is more LM 2 (UMBILICAL/ LATERAL GRIP) common in women who stands ➢ To determine which side is the fetal a lot back, usually feels like a hard, resistant, ➢ Pathologic edema is often grade convex structure 3+ and often associated with ➢ Fetal extremities feels nodular and PIH irregular ➢ Check for leg varicosities ➢ Fetal back is smooth and broad (FHT) PITTING EDEMA CONCLUDING THE VISIT
➢ Once the examination is completed
instruct the client to get dressed ➢ Review findings ➢ Answer client’s questions ➢ Advise necessary laboratory procedures that are needed ➢ Reinforce the importance of regular check up ➢ Record findings in the chart of the client
GENITALIA
➢ Inspect for the hair distribution and
color ➢ Scar from previous episiotomy or perineal laceration ➢ Inspect the anal area for varicosities (hemorrhoids) ➢ Inspect for vaginal discharge ➢ Inspect for warts, foreign body and smell ➢ Chadwick’s sign – bluish to purplish color of the vaginadue to increased vascularity ➢ Goodell’s sign – cyanosis and softening of the cervix, may occur as early as 4 weeks AOG ➢ Hegar’s sign – softening of the uterine isthmus and can be observed by 6th to 8th week AOG
