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    De Leon, Austine Sydney D.
    This document outlines the physical assessment of a normal pregnant client. It discusses the frequency of prenatal visits based on trimester, equipment needed, positions for examination, and components of the general, head and neck, chest, heart, breast, abdominal, extremities, and genitalia examinations. Assessment techniques include inspection, palpation, percussion, and auscultation. It also reviews rules to estimate gestational age, fetal weight, and fetal position. The assessment concludes with reviewing findings, answering questions, and documenting the visit.

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    De Leon, Austine Sydney D.
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    This document outlines the physical assessment of a normal pregnant client. It discusses the frequency of prenatal visits based on trimester, equipment needed, positions for examination, and components of the general, head and neck, chest, heart, breast, abdominal, extremities, and genitalia examinations. Assessment techniques include inspection, palpation, percussion, and auscultation. It also reviews rules to estimate gestational age, fetal weight, and fetal position. The assessment concludes with reviewing findings, answering questions, and documenting the visit.

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    This document outlines the physical assessment of a normal pregnant client. It discusses the frequency of prenatal visits based on trimester, equipment needed, positions for examination, and components of the general, head and neck, chest, heart, breast, abdominal, extremities, and genitalia examinations. Assessment techniques include inspection, palpation, percussion, and auscultation. It also reviews rules to estimate gestational age, fetal weight, and fetal position. The assessment concludes with reviewing findings, answering questions, and documenting the visit.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    112 views25 pages

    Ssss

    Uploaded by

    De Leon, Austine Sydney D.
    This document outlines the physical assessment of a normal pregnant client. It discusses the frequency of prenatal visits based on trimester, equipment needed, positions for examination, and components of the general, head and neck, chest, heart, breast, abdominal, extremities, and genitalia examinations. Assessment techniques include inspection, palpation, percussion, and auscultation. It also reviews rules to estimate gestational age, fetal weight, and fetal position. The assessment concludes with reviewing findings, answering questions, and documenting the visit.

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    of 25

    PHYSICAL

    ASSESSMENT OF
    NORMAL
    PREGNANT CLIENT
    COLLEGE OF NURSING
    OUR LADY OF FATIMA UNIVERSITY
    FREQUENCY OF PRENATAL VISIT

    TRIMESTER FREQUENCY OF VISIT


    1ST (1-12 wks AOG) At least once
    DOH
    2nd (13-27 wks AOG) At least once
    3rd (28-40 wks AOG) At least twice

    AGE OF GESTATION FREQUENCY OF VISIT


    WEEK 4 - 27 1 PER MONTH
    Pillitteri WEEK 28 - 36 1 EVERY TWO WEEKS
    WEEK 37 - 40 1 EVERY WEEK
    PREPARATION BEFORE ASSESSMENT:
    �Make sure to always provide comfort and
    sense of privacy
    �Have the needed equipment readily at
    hand
    �Provide gown and drapes for abdominal
    examination
    �Instruct the client to empty her bladder
    prior to examination
    EQUIPMENT

    �The examiners hand are


    the “primary equipment”
    for assessment
    �Tape measure
    �Stethoscope/ fetal
    Doppler
    �Water-soluble gel
    �Clean gloves (if needed)
    POSITION

    �Sitting position
    �Supine position
    with pillow under
    the legs
    GENERAL EXAMINATION
    �Appearance – inspection of the overall health,
    nutritional status, emotional state, neuromuscular
    coordination
    �Weight, height
    �BMI (prepregnant state)
    �Vital signs

    2
    HEAD AND NECK
    � Hair: note for texture, moisture, and distribution, dryness,
    oiliness
    � Eyes: anemia of pregnancy may cause pallor
    � Nose: nasal congestion is common among pregnant women
    and nose bleeds
    � Mouth: inspect for gums and teeth, gingival enlargement with
    bleeding is common
    � Thyroid: symmetrical enlargement may be expected
    � Skin pigmentation changes: Chloasma/melasma gravidarum
    – irregular brownish patches of varying size appear on the
    face and neck, “mask of pregnancy”
    � Spider telanggieactasia – a vascular stellate marks resulting
    from high level of estrogen. Typically develop in face, neck,
    upper chest and arm
    THORAX AND LUNGS
    � Inspect thorax for the pattern of breathing

    HEART
    � Palpate for the apical impulse. Sometimes it may be slightly
    higher than normal due to higher diaphragm
    � Auscultate the heart; soft blowing are common, reflecting
    the increased blood flow in normal vessels

    BREAST
    � Inspect breast and nipple for symmetry and color, nipple and
    areola become bigger and darker
    � Compress nipples with finger and thumb, may express colostrum
    ABDOMEN
    � Inspect for skin changes: presence of Linea Nigra –
    darkening of the linea alba
    � Inspect for Striae gravidarum “stretch mark” due to
    stretching of the abdomen, reddish or purplish in color and
    becomes silvery after delivery
    � Associated risk factors are weight gain during pregnancy,
    younger maternal age, and family history
    � Palpate for the fetal movement “quickening” 10-12 fetal
    kicks per hour
    � Braxton hick’s contraction – abnormal painless contraction
    � Auscultation of fetal heart tone 120-160bpm
    � Can be detected through stethoscope by 18 weeks AOG
    � Can be detected through fetal Doppler at 10 – 12 weeks AOG
    ABDOMEN
    �Mc Donald’s rule: used
    to determine the age of
    gestation
    �Length of the fundus in
    cm x 8/7 = AOG in
    weeks
    �Length of the fundus in
    cm x 2/7 = AOG in
    months
    ABDOMEN
    �Bartholomew’s Rule – to
    determine the age of
    gestation by fundic
    location
    �3 months – just above the
    symphysis pubis
    �4 months – midway
    between symphysis pubis
    and umbilicus
    �5 months – at the level of
    the umbilicus
    JOHNSON’S RULE
    �For estimation of fetal weight
    �Fetal weight in grams = (fundic
    height in cm) - n x 155
    �n = 12 if the fetus is not
    engaged
    �n = 11 if the fetus is engaged

    �Example:
    28cm – 11 = 17
    17 x 155 = 2635gms
    ABDOMEN
    �Haase’s Rule – to
    determine the length of
    the fetus in centimeter
    �First half of pregnancy (1
    – 5 months) --- months ²
    �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 hands
    �Fetal head should be
    round and hard
    �Buttocks soft and round
    LM 2 (UMBILICAL/ LATERAL GRIP)

    �To determine which


    side is the fetal back,
    usually feels like a hard,
    resistant, convex
    structure
    �Fetal extremities feels
    nodular and irregular
    �Fetal back is smooth
    and broad (FHT)
    LM 3 (PAWLIK’S GRIP)

    �Suprapubic palpation
    using thumb and fingers
    just above the symphysis
    pubis to determine
    degree of engagement
    and ballotment
    �To confirm fetal
    presentation
    LM 4 (PELVIC GRIP)

    �Palpation of the
    bilateral lower
    quadrants to
    determine fetal
    attitude
    �Only done when
    the mother is near
    her EDD/EDC/EDB
    FETAL ATTITUDE
    EXTREMITIES
    �Inspect hands and legs for
    edema
    �Palpate for pre-tibial, ankle
    and pedal edema
    �Physiologic edema is more
    common in women who stands
    a lot
    �Pathologic edema is often
    grade 3+ and often associated
    with PIH
    �Check for leg varicosities
    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 vagina
    due 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
    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
    REFERENCES
    Pillitteri, Adele (2014).Maternal and Child Health Nursing: Care of the Childbearing and
    Childbearing Family, 7thedition, vol 1.
    Philadelphia: Lippincott Williams and Wilkins.
    618.20231 P64 2014, v1, c102.

    Pillitteri, Adele (2014).Maternal and Child Health Nursing:


    Care of the Childbearing andChildbearing Family, 7edition, vol 2.
    Philadelphia: LippincottWilliams and Wilkins.618.20231 P64 2014, v1, c10

    Hockenberry, Marilyn J. (2015).Wong’s Nursing Care of Infants and Children, Vol. 1.


    Singapore: Elsevier. 610.736 H65 2016 v1, c6

    Hockenberry, Marilyn J. (2015).Wong’s Nursing Care of Infants and Children, Vol. 2.


    Singapore: Elsevier. 610.736 H65 2016 v1, c6

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