LEOPOLD’S MANEUVER (ABDOMINAL EXAMINATION) Leopold’s Maneuvers are a systematic method of observation and palpation to determine fetal position

, presentation, lie and attitude. It is preferably performed after 24 weeks gestation when fetal outline can be palpated Keen observation of abdomen should give data about: 1. longest diameter in appearance (longest diameter (axis) is the length of the fetus) 2. location of apparent fetal movement (the location of the activity most likely reflects the position of the feet) PREPARATION
(1) CARDINAL RULE: Instruct woman to empty bladder first. This will promotes

comfort and allows for more productive palpation because fetal contour will not be obscured by a distended bladder (2) Place woman in dorsal recumbent position, supine with knee flexed to relax abdominal muscles. Place a small pillow under the head for comfort (3)Drape properly to maintain privacy (4)Explain procedures to gain patient’s cooperation (5) Warm hands first by rubbing them together before placing them over the woman’s abdomen to aid comfort. Cold hands may stimulate uterine contractions (6) Use the palm for palpation not fingers (7) During the first three maneuvers, stand facing the patients. For the last maneuver, stand facing patient’s feet THE FOUR MANEUVERS FIRST MANEUVER: Fundal Grip: What fetal pole or part occupies the fundus? -palpation of the fundal area to determine which fetal part is located in the uterine fundus

-to determine the presenting part or presentation (part of the fetus lying over the inlet) PROCEDURES (1)Nurse stands at the side of the bed, facing the client (2)Using both hands, feel for the fetal par lying in the FINDINGS -The nurse-midwife should ascertain what is lying at the fundus by feeling the upper abdomen (fundus) with tips of both hands. Generally, she will find there is a mass, which will either be the head or the buttocks (breech) of he fetus. The nursemidwife must decide which pole of the fetus; it is by observing three points:
1.

fundus

Relative consistency- the head is harder/ firmer than the breech

Shape- if the head, it will be round and hard, and the transverse groove of the neck may be felt. The breech has no groove and usually feels more angular 3. Mobility- the head will move independently of the trunk; but the breech moves only in conjunction with the body -If the nurse-midwife feels the head, the fetus is in breech presentation; if the nursemidwife feels the buttocks, it means the fetus is in vertex presentation
2. • SECOND MANEUVER: Umbilical Grip: Which side is the fetal back? -to locate/identify the fetal back in relation to the right and left sides of the mother

-to determine the fetal position (the relationship of the presenting part to one of the quadrants of the mother’s pelvis PROCEDURES (1)The nurse-midwife places the palmar surfaces of either side of the abdomen. (2)With left palm stationary on the left side of the steady the uterus the right palpates the right side of circular motion from top to lower segment of the gentle but deep pressure to palpate the fetal outline parts (3)The nurse-midwife then reverses her hands. FINDINGS -Small fetal parts (knees and elbows) feel nodular with numerous angular nodulations -Fetal back feels smooth, hard, like a resistant surface THIRD MANEUVER: Pawlik’s Grip: What fetal part lies above the pelvic inlet? -determine if the presenting part has entered the pelvis (engagement of presenting part)

both hands on abdomen to the uterus on a uterus applying and small fetal

-to find the head at the pelvis and to determine the mobility of the presenting part PROCEDURES (1)Nurse-midwife stands at the side of the bed, facing (2) It should be conducted by gently gras ping the of the abdomen, just above the symphisis pubis, thumb and the two fingers of one hand and then together slightly and make gentle movements from FINDINGS the client lower portion between the pressing side to side

-If the presenting part moves, round, balottable and easily displaced it is not yet engaged. If the presenting part is not movable felts as relatively fixed, knoblike part, it is engaged. -If it is firm, it must be the head. If soft, it could be breech

Weeks of pregnancy: Fundal height (cms) x 8/7 Ex. 2007 McDonald’s Rule: Ht fundus/4 (AOG wks)  1. the head is extended Age of Gestation  Nagele’s Rule: -3 calendar months and +7 days Ex. Fundal Height = 14 cms Lunar Month: 14cms x 2 = 28 / 7 = 4 months Weeks Pregnant: 14 cms x 8 = 112 / 7 = 16 weeks AOG Bartholomew’s Rule: based on position of fundus in abdominal cavity  3rd month = above symphysis 5th month = umbilical level 9th month = below xiphoid process) Fetal Length: pole of the 2 inches above . LMP= May 15.3 + 7 EDC: 2 22 or February 22. Information about the infant’s anteioposterior position may also be gained from this final maneuver PROCEDURES (1)The nurse-midwife faces the feet of the client (2)Place one hand each on either side of the lower uterus (3)Palpate the fetal head by pressing downward about the inguinal ligament (4)Use both hands FINDINGS -If descended deeply. head and extremities. Lunar months: Fundal Height (cms) x 2/7 3. only a small portion of the fetal head will be palpated. Measure in cms the length from the symphysis to the level of fundus 2. 2006 or 5-15-06 LMP: 5 15 Formula: . -If cephalic prominence or brow or the baby is on the same side of the small fetal parts. or the relationship of fetal parts to ach other) -to determine the fetal descent -should only be done if fetus is in cephalic presentation. the head is flexed -If the cephalic prominence is on the same side of the fetal back.FOURTH MANEUVER: Pelvic Grip: Which side is the cephalic prominence? Cephalic prominence is part of the fetal head that prevents the deep descent with one hand • -to determines the degree of fetal head flexion or extension -to determine the attitude or habitus (degree of flexion of the fetal body.

is at the junction of the 2 parietal bones and the two fused frontal bones . making the parietal bones or the space between the fontanelles and the presenting part 2.diamond-shaped .normally closes by age of 2 months . Lambdoidal suture – is the line of junction of the occipital bone and the 2 parietal bones Closed – anterior fontanelle (diamond) 12-18 months posterior fontanelle (triangular) Fontanelles 1. Vertex – head is sharply flexed.720 g STRUCTURE OF THE FETAL SKULL Fetal skull – is the largest anatomical pary of the fetus through the birth canal.measures approximately 2 cm across its widest part FETAL PRESENTATION .determined by fetal lie. Coronal suture – is the line of the junction of the frontal bones and the 2 parietal bones 3. the rest of the body can be delivered Consists of 7 bones 2 frontal – presenting part 2 parietal – presenting part 2 temporal – not a presenting part 1 occipital Suture lines of the skull 1.normally closes at age 12-18 months measures 2 cm to 3 cm and 3 cm to 4 cm in length 2. the presenting part is the brow . Cephalic presentation – means that the head is the body part that 1st contacts the cervix and it is the most frequent type of presentation 4 Types of Cephalic Presentation 1.Haase’s Rule: 1st half of pregnancy – square number of months Example : 2 months = 2x2 = 4 cm 2nd half of pregnancy – number of months multiplied by 5 Example: 7 months x 5 = 35 cm Fetal Weight: Johnson’s Rule: Fundic Ht – n x k ( k=155. Anterior fontanelle (Bregma) . n = 11 not engaged/12 engaged) Example for a not engaged fetus Fundic Height given = 35 cms n = 11 (standard for not engaged fetus) k= 155 gms. Brow – head moderately flexed. (9 standard) Solution: 35 cms – 11 = 24 x 155 =3. usually if the head can pass.denotes the body parts that will first contact the cervix or deliver first . Posterior fontanelle . or the degree of flexion or the attitude or habitus 3 Types of fetal presentation 1. Sagittal suture – a membranous interspace. and occipital bones triangular-shaped . joins the 2 parietal bones of the skull 2.is at the junction of the parietal bones.

term used to describe the degree of flexion the fetus assumes or the relation of fetal parts to each other Four types 1. Complete extension (face presentation/incomplete footling) .the spinal column is bowed forward. the presenting part are both the buttocks and tightly flexed feet 2. Leopold’s maneuver – method of palpating the maternal abdomen to determine information about the fetus such as presentation. presenting part is the face 4.is determined by locating the presenting part in relation to the pelvis Means of assessing fetal position 1. the presenting part is the sinciput 2. Complete flexion (normal fetal position) . Breech presentation . Shoulder presentation 2. LOT – LLQ 3. hand ATTITUDE / DEGREE OF FLEXION . face – head is extended.is the relationship between the long axis of the featl body and the long axis of the woman’s body 1. Longitudinal lie – fetus is lying vertically POSITION . sinciput) 3. 3. Transverse lie – fetus is lying horizonally.presents the brow of the head to the birth canal 4.presents the face and the back is arched. Complete – thighs tightly flexed on the abdomen. presenting part is the foot .single footling breech – one foot is present . Ex. Moderate flexion (military position) sinciput . the head is nor flexed.means either the buttocks or feet are the first body parts to contact the cervix 3 Types of breech presentation 1. Auscultation of FHT 4.is the relationship of the fetal presenting part to the maternal bony pelvis . presenting part is the shoulder acromion process – iliac crest.double footling breech – both feet is present 3.3. the presenting part is the buttocks alone. arms are flexed and folded on the chest. Frank – the hips are flexed but the knees are extended to rest on the chest. sinciput – the head is completely hyperextended. the neck is entended FETAL LIE . Footling – (incomplete breech presentation) neither the thigh nor the lower legs are flexed. Shoulder presentation . LOP – FHT heard in LLQ 2. elbow. thighs are flexed on the abdomen and the calves of the legs are pressed against the posterior aspect of the thighs 2. the head is flexed forward.the chin is not touching the chest (frank. engagement and rough estimate of fetal size 2. Sonography – diagnostic tool that is helpful in assessing a fetus for general size and structural disorders or internal organs and limbs 6 Most Common Fetal Positions 1. Vaginal examination 3. Partial extension (brow presentation) . the chin touches the sternum. LOA – LLQ .fetus is lying horizontally in the pelvis so that its long axis is perpendicular to that of the mother.

vaginal / rectal examination / cervical examination GRAVIDA >the # of pregnancies including the present & abortion NULLIGRAVIDA =woman who has never been pregnant PRIMIGRAVIDA =woman w/ first pregnancy MULTIGRAVIDA = woman w/ 2nd pregnancy or more PARITY > refers to past pregnancies (not the # of babies) that reached viability whether or not born alive (abortion & miscarriages not included) NULLIPARA = woman who has not carried a pregnancy to viability PRIMIPARA = woman who carried one pregnancy to viability MULTIPARA = woman who had 2 or more pregnancy that reached viability GRANDMULTIPARA= woman who has had 6 or more viable pregnancies .occiput of the fetus is parallel to the right maternal pelvis Position measured in numeric terms: Station. Left occipito anterior (LOA) .occiput of the fetus points to the right side of the maternal pelvis. right occipito posterior .occiput of the fetus points to the right side of the maternal pelvis and toward the rear or face up 6. Right occipito transverse (ROT) .occiput of the fetus points to the left side of the maternal pelvis and towards rear or face up 3.largest diameter / widest diameter of the presenting part .is the relationship of the presenting part of the fetus to the level of the ischial spines 0 station – presenting part is at the level of the ischial spines (engagement) -1 to –4 cm – presenting part is above the ischial spines +1 to +4 cm – presenting part is below the ischial spines +3 to +4 cm – presenting part is at the perineum (crowning) Other terms to denote station: High – presenting part not engaged Floating – presenting part freely moveable in inlet Dipping – entering pelvis Fixed – no lnger moveable in inlet but not engaged Engaged – bipareital plane is passed through the pelvic inlet Engagement .4. Left occipito transverse . ROP – RLQ 5. towards front face down 5. Right occipito anterior .occiput of the fetus points to the left side of the maternal pelvis and towards front. ROA – RLQ Most Common Fetal Position 1.occipot of the fetus is parallel to the left maternal pelvis 4. left occipito posterior (LOP) .maybe assessed by Leopold’s maneuver. ROT – RLQ 6.refer to the settling of the presenting part of the fetus (midpoint of the pelvis) .usually take place two weeks before labor . face down 2.

pelvic outlet diameters e. size of the fetal head b.myometrial contractions of labor are painful that is why pains is used to describe labor B.is the last few hours of human pregnancy characterized by thunderous uterine contractions that affect dilatation of the cervix and the force of the fetus through the birth canal . passenger – refers to the fetus and its ability to move through the passageway which is based on the following: a. preparation for childbirth. Up > post-term NORMAL LABOR a. experiences and coping strategies . available support system. Intra-partum care . power – refers to the frequency. Below > considered abortion 20-37 wks. fetal presentation c. > preterm 38-40 wks.refer to the medical and nursing care given to a pregnant woman and her family during labor and delivery Intra-partum period . pelvic inlet diameters d. fetal attitude d.extends from the beginning of contractions that cause cervical dilatation to the 1st 1-4 hours after delivery of the newborn and placenta Labor / parturition . duration. Factors affecting labor / components of labor 1. fetal position 3.GTPALM SYSTEM: G > the # of pregnancies including the present TERM > the # of full term birth born @ 38-40 wks. type of pelvis b. Psyche – refers to the client’s psychological state. > term 42 wks.is the process by which the fetus and products of conception are expelled as the result of the regular. strength of uterine contractions to cause complete cervical effacement and dilatation 4. placental factors – refers to the site of placental insertion 5. passageway – refers to the adequacy of the pelvis and birth canal in allowing fetal descent Factors include: a. Gestation ABORTION > the 3 of abortion LIVING > the # of living children MULTIPLE > the # of multiple pregnancy 20 wks. progressive and strong uterine contractions . ability of the uterine segment to distend the cervix and dilate and the vaginal canal and introitus to distend 2. Gestation PRETERM > the # of preterm birth born @ 20-37 wks. structure of pelvis c.

ripening and effacement of the cervix that will cause expulsion of the mucous plug (bloody show) 4. Contractions disappear while sleeping 7. Burst of energy or increased tension and fatigue may occur right before the onset of labor 6. “bloody show” usually not present.either no effect or decreases contractions 4. Discomfort in lower abdomen and groin Characteristics of true labor 1. contractions located chiefly in the abdomen . Braxton Hicks contractions are irregular. usually brownish in color 5. Signs and symptoms of impending labor / premonitory signs of labor 1. Cervical changes include softening.intervals remain long 3. Rupture of amniotic membranes may occur before the onset of labor. Lightening – is the descent of the fetus and uterus into the pelvic cavity 2-3 weeks before the onset of labor 2. Contractions continue while sleeping 6. she should contact her OBGyne and go to the labor suite immediately so that she may be examined for prolapsed cord – a threatening condition for the fetus * Premature rupture of membranes 5. Walking (activity) intensifies contractions 4. becomes uncomfortable and produce a drawing pain in the abdomen groin 3. Contractions occur at regular intervals 2. “Bloody show” present (pink-tinged mucus released from the cervical canal and as labor starts) 5. Walking does not intensify contractions and often gives relief . longer intervals between contractions 2.increased intensity and duration or progressive . Sedation decreases or stops contractions 8. Discomfort begins in the back and radiates to the abdomen Length of labor a. There is no cervical changes 6. -progressive thinning and opening of the cervix 7. Contractions start at the back and sweep around to the abdomen .intensity remains the same or variable . Cervix becomes effaced and dilated. intermittent contractions that have occurred throughout the pregnancy. If present.C. Contractions are irregular. occur at irregular intervals – decreased frequency and intensity. If the woman suspects that her membranes have ruptured. 1st stage nullipara – 8-12 hrs multipara 6-8 hrs b. Sedation does not stop contractions 8. 2nd stage nullipara 1-2 hrs multipara 30 minutes .shortened intervals between contractions 3. Weight loss of about 1 – 3 lbs may occur 2-3 days before the onset of labor Characteristics of false labor 1.

Transition phase . 3rd stage nullipara 5-60 minutes multipara 5-60 minutes Separation of placenta – 5 to 6 minutes Cardinal movements of normal delivery (DFIERE) 1. longer and more painful c.walking is recommended . descent 2.contractions lasts 60-90 seconds -intervals of 2-3 minutes 2. more frequent.effacement and dilatation 1 to 3 cm .contractions becomes stronger.frequency of vaginal exam: once every 4 hours 3 Phases of the 1st stage of labor a.intensity. shortened and more frequent lasting for abour 20 to 40 seconds occurring approximately 3-5 minutes intervals . flexion 3. 1st stage of labor . contractions are severe at 2-3 minutes intervals. internation rotation 4.contraction interval 3-5 minutes (frequency) b.C.this phase begins with the complete dilatation of the cervix and ends with delivery of the newborn -woman feels the urge to bear down a. restitution (external rotation) 6. newborn exits into the birth canal with the help of the mechanism of normal labor or cardinal movements . frequency and duration of contractions peak and there is an irresistible urge to push lasting for about 60-90 seconds -dilatation 8-10 cm . Latent phase – this phase begins with the onset of regular contractions and effacement and dilatation of the cervix to 1 to 3 cms. with a duration of 50 seconds or less .A.begins with the onset of regular contractions which cause progressive cervical dilatations and effacement and it ends when the cervix is completely effaced and dilated N. expulsion STAGES OF LABOR 1.contractions last for 20-40 seconds (duration) . including episiotomy) .the culmination of the 1st stage of labor is the transition phase during which the cervix dilates from 8 to 10 cm . – due vaginal examination to detect if there is cervical dilatation . Active phase .membranes rupture spontaneously b.dilatation from 4 – 7 cm -contractions lasts 40 – 60 seconds . extention 5. 2nd stage of labor (expulsive stage. Contractions become increasingly stronger.

perineal skin and vaginal mucous membrane but not the underlying faschia and muscle 2. pressure of the amniotic fluid b. Flexion – a movement which the chin is broight about into more intimate contact with the fetal thorax 3. 3rd degree – extends to the skin. allows head to be born by extension 5. cold packs to the perineum 2. The cord is but between 2 clamps placed 4 to 5 cms from the fetal abdomen and later on an umbilical cord clamp is applied 2-3 cm from the fetal abdomen MECHANISMS OF NORMAL LABOR / CARDINAL MOVEMENTS 1. infections 2. Complications: fecal incontinence and fistulas 4. sitz bath 3.p. brought about by one or more four forces: a. Clamping the umbilical cord. contraction of the abdominal muscles d. extension and straightening of the fetal body 2. surgical incisions reduces laceration 2. 2nd degree – skin and mucous membrane. 1st degree – involves the fourchette. Extension – back of neck pivots under s. shortens the 2nd stage of labor Side effects of episiotomy 1. usually can be sutured under local anaesthesia 3. Internal rotation – turning of the head in such a manner that the occiput gradually moves from its original position anteriorly toward the symphysis pubis 4. Descent – 1st requisite for birth of the infant. the faschia and muscle of the pernial body but not the rectal spinchter thus forming triangular injury. protects infants head from pressure exterted by resistance 4. direct pressure of the fundus upon the breech c. mucous membrane and perineal body and involved the anal spinchter can be sutured by an expert obstetrician. presents smallest diameter of shoulders to outlet 6. Expulsion – borth of neonate completed (3rd stage) EPISIOTOMY – a surgical procedure or an incision performed to facilitate the delivery of the infant Rationale: 1. may be done to facilitate delivery and avoid laceration of the perineum e. Episiotomy – surgincal incision of the perineum. heals more easily than lacerations 3. using medication . gives sufficient progress of delivery 6. 4th degree – extends to the rectal mucosa to expose the lumen of the rectum and it bleeds profusely Health teachings 1. Restitution (external rotation) – head returns to normal alignment with shoulders.c. “crowning” occurs when the newborn’s head or presenting part appears at the vaginal opening d. longer healing time Types / degree of lacerations / perineal tear / birth canal 1. protect infants from signs of fetal distress 5.

The maternal organs undergo initial readjustment to the nonpregnant state d.this phase begins with the delivery of the newborn and ends with the delivery of the placenta. This stage lasts from 1-4 hours after birth of the newborn b.500 ml blood loss 4. anatomical results excellent occasionally faulty 5. Crede’s maneuver is performed by the doctor or nurse by gentle pressure over the contracted uterine fundus 3. Placenta is deliver by natural bearing down effort of the mother 2. appears shiny and glistening from the fetal membranes (fetal side) -NSD blodd loss = 500 ml to less than 1. blood loss less more 6. K) 3. intervention in hemolytic problems of the newborn (vit. Duncan placenta / mechanism – as the placenta separates. 4th stage of labor (recovery or bonding stage) a. Schultze’s placenta / mechanism – concealed behind the placenta and membranes until the placenta is delivered. Some bleeding is inevitable during this stage. The mother and newborn recover from the physical process of birth c. Sudden gush of blood from the vagina 3.5-6 minutes gap before placenta comes out . surgical repair easy more difficult 2.Two types of episiotomy 1. Midline 2.00 ml -CS blood loss = 1.order oxytocin 10 in (IM) or IV push . the blood from the implantation site may escape into the vagina immediately. maternal side Hysterectomy – 3. Mediolateral Comparison Characteristics Midline Mediolateral 1.000 – 3.400 ml 4. prevent eye infection 6. “Calkin’s Sign” 2. The newborn body systems begin to adjust to extrauterine life and stabilize . Lengthening of the imbilical cord. 1-5 minutes after delivery of the infant 4. dyspareunia rare occasional 7. identify infant 5.increased blood loss if placenta comes out after 30 minutes a) Signs of placental separation 1.000 ml to 1. meaty. Uterus becomes globular or firmer. ensure patent airway 2. post-operative pain minimal common 4. maintain body tempterature 4.edges. It occurs in two phases . everted. It looks raw and red in color . faulty healing rare more common 3. 3rd Stage of labor “Placental Stage” . extensions common* uncommon * only disadvantage of midline NURSING MANAGEMENT OF THE NEWBORN IMMEDIATELY AFTER BIRTH 1. It is the earliest sign to appear. facilitate prompt identification 7. suction with bulb syringe 3. Fundus rises up in the abdomen b) Placental expulsion 1.

Promote perineal self-care Postpartum warning signs to report to the physician 1. Feeling of full bladder accompanied by inability to void 6. Administer sitz bath 6. . or 2. Provide perineal care 7. enlarging hematoma 7 feeling restless 8. feeling of apprehension. pain greater than expected 4. when the infant is weaned from the breast. Provide pain relief for afterpains 2. reflex irritability and color of the infant are each rated 0. Sexual intercourse should not resume until vaginal bleeding has stopped and the episiotomy has healed 3. This assessment is done at the first 1 minute and 5 minutes after birth. Give episiotomy care 4. Score interpretation as follows:  A newborn whose total sore is less than 4 is in serious danger and needs resuscitation. Heart rate. rapid HR.e.  A score of 4-6 means that the infant’s condition is guarded and the baby may need clearing of the airway and supplementary oxygen. The uterus contracts in the midline of the abdomen with the fundus midway between the umbilicus and symphysis pubis NURSING CARE OF THE WOMAN IN THE 1ST 24 HOURS POSTPARTUM 1. newborns are observed and rated according to an Apgar score.4 F 5. bright red vaginal bleeding anytime after birth 3. sexual intercourse may be resumed at 2-3 weeks after birth 2. pale. clots or passage of tissue 2. muscle tone. cold blue or blue skin color Postpartum sexual activity 1. respiratory effort. 1. indicating that the infant scored as high as 70% to 90% of all infants at 1 to 5 minutes (A score of 10 is the highest score possible).the contraceptive meethid of choice should be used as directed. chest pain. at the initiation of sexual Activity APGAR SCORING One of the standardized assessments done to evaluate the newborn quickly at birth is the Apgar Scoring. Increased bleeding. pain. difficulty breathing. Promote perneal exercises 5.  A score of 7-10 is considered good. redness and warmth accompanied by a firm area in the calf 9. Relieve muscular aches 3. sex drive will usually return to normal 6. the five score are then added. cough. sexual arousal may cause milk to leak from the breast 4 longer periods of foreplay will encourage lubrication 5. temperature elevation to 110. an assessment scale used since 1958.

although rapid.  Muscle tone. however. strong cry Well flexed No response No response Cough or sneeze Cry or withdrawal of foot Normal skin coloring (completely pinkish) Blue.  Respiratory effort. One of two possible is used to evaluate reflex irritability in a newborn: response to suction catheter in the nostrils and response to having the soles of the feet slapped. All infants appear cyanotic at the moment of birth. irregular. Auscultating a newborn heart rate with a sensitive stethoscope is the best way to determine heart rate. There is a high correlation between a 5-minute Apgar scores and mortality and morbidity. which makes the color of the newborns correspond to how well they are breathing. Respirations are counted by watching respiratory movements. A baby whose mother was heavy sedated will probably demonstrate a low score in this category. simulating their intrauterine position. Extremities blue (acrocyanosis) The following points should be considered in obtaining Apgar rating:  Heart rate.  Reflex irritability. They grow pink with or shortly after the first breath. . Mature newborns hold their extremities tightly flexed. particularly neurologic morbidity. he or she maintains regular. By 1 minute. APGAR SCORING CHART SIGN Heart rate Respiratory effort Muscle tone Reflex irritability Response to catheter in nostril or Slap to sole of foot Color 0 Absent Absent Flaccid 1 Slow(<100) Slow.The Apgar score standardizes infant assessment at birth and serves as the baseline for future evaluation. A mature newborn usually cries and aerates the lungs spontaneously at about 30 seconds after birth. Muscle tone is tested by observing their resistance to any effort to extend their extremities. weak cry Some flexion of extremities Grimace Grimace 2 >100 Good. Acrocyanosis (cyanosis of the hands and feet) is common in newborns that a score of 1 in this category can be thought of normal. pale Body normal pigment (pinkish). Difficulty with breathing might be anticipated in a newborn whose mother received a large dose of analgesia or a general anesthesia during labor or birth. heart rate also may be obtained by observing and counting the pulsations of the cord at the abdomen if the cord is still uncut. respirations.  Color.

I&O 6.NURSING MANAGEMENT OF THE NEWBORN AFTER DELIVERY a. location and tone of fundus .identify infant .prevent eye infection .comfort measures 1. 2 times or until stable . hemolytic jaundice 5.suction with bulb syringe . ineffective breathing pattern related to CNS depression secondary to intrauterine hypoxia and prematurity 3. urine . maternal position – supine 2. interactions between parents.hemorrhage .maintain body temp . 4 times.uterine atony Nursing care plan . impaired skin integrity related to cord stump 6.general physical appearance b. fluid volume deficit related to birth trauma. assessment .midline . vital signs 2.facilitate prompt identification / vigilance for potential neonatal complications 1. pad change 3.to monitor response to physiologic stress of labor / birth 1. then every 30 minutes. rate of IV. high risk for injury related to impaired thermoregulation (incubation & drop light) 7. history of delivery . ice pack to perineum as ordered . signs of bonding 7. history of pregnancy 2. newborn.every 15 minutes. oropharynx .firm & slightly lower than the umbilicus 3. ineffective thermoregulation related to environmental condition c. perineum – edema / rectal pain 4.mucus in nasopharynx.fullness of bladder 5. bladder – initial nursing action is to alternate warm & cold packs .# of vessels in the umbilical stump . analysis / ND 1 ineffective airway clearance related to excessive nasopharyngeal mucus 2.facilitate prompt identification / intervention in hemolutic problems of the newborn NURSING ACTIONS DURING THE 4TH STAGE OF LABOR a.note and record apgar score . NCP / implementation .passage of meconium stool. impaired gas exchange related to respiratory distress 4.ensure patent airway . assessment . perineal care 4. assess for signs of postpartal emergencies .

cervical mucus..4 F 6. or @ the level of the umbilicus. 4-6 weeks . feeling of full bladder accompanied by inability to void POSTPARTUM (puerperium) . pain greater than expected 5. passage of large clots 3. temp elevation at 110. cervical mucus & microorganisms odor – strong odor 3.promote bonding . leukocytes & fragments of decidus odor – characteristic odor 2.sometimes called as “4th trimester of pregnancy” Uterus – contracts firmly. leukocytes. increased vaginal bleeding. after birth / delivery . decidus.one firngerbreath (1 cm) below the umbilicus 3.health teachings .signs to report to physician 1. non-palpable abdominally 5. enlarging hematoma 7. locahia serosa color – pinkish to brownish duration 3-10 days after delivery composition – blood. reducing its size by more than half Lochia – discharge from the uterus during the first 3 weeks of delivery 3 types of lochia = “RSA” 1. size & consistency of firm grapefruit 2. nausea. day 1 (first 12 hours) . dizziness (Kegel exercise – eliminate urination) 4.fundus is palpated halfway between the umbilicus & symphysis pubis.palpated behind symphysis pubis. lochia alba color – colorless to creamy yellowish duration – 10 days to 3 weeks after composition – leukocytes.nutritional hydration – offer oral fluid.six weeks after delivery or beginning with the termination of labor and ending with the return of the reproductive organ to its non-pregnant state . erythrocytes. epithelial cells. cholesterol crystals & bacteria odor – no odor Fundal height & consistency after delivery 1. erythrocytes. fat. decidus. descends by 1 fingerbreath daily until day 10 4. uterine cramps 2. Lochia rubra color – dark red duration – 1-3 days after delivery composition – blood. day 10 to 14 . 4-6 hours -urinary elimination .returns to its non-pregnant size . epithetial cells.

perianal and pernienal tissues 4. promote the new born’s successful integration into the family unit 8.mother typically passive & dependent .begins 2-3 days after delivery & resolving pain within 1-2 weeks . taking-in phase 2.6. time for a new role .strives to master newborn care skills Letting go phase .to heal site of placental attachment GOALS of post-partum care 1 promote normal involution & return to the non-pregnant state .UTI . letting go phase Taking-in phase . increased understanding of physiologic & psychological changes 6.profuse bleeding -puerpera infection . provide effective discharge planning including appropriate referral for home-care follow up Post-partum psychological adaptation 3 phases of puerperium 1.adapt to the demands of newborn dependency . promote comfort & healing of pelvic.time for initiating action . assist in restoration of normal body function 5.sub-involution 3.thrombophebitis .time of family reorganization. support parenting skills & parent-newborn attachment 9. prevent or minimize post partum complications .a “let down” feeling after giving birth related to the magnitude of the birth experience & doubts about the ability to cope effectively with the demands of childrearing . 6-7 weeks .expressed little interest in caring for her child .post partum depression most commonly occur during this phase Post partum depression .extending 2-4 days after delivery .this phase generally occirs after the new mother returns home .involution of the uterus – pregressive changes of the uterus after delivery 2. taking-hold phase 3.time for reflection – talkative .assumes responsibility for newborn care .occurring 1-2 days after delivery .mastitis . facilitate new born care & self-care of the mother 7.review her labor & delivery experience frequently Taking-hold phase .

in which the infant remains in the mother’s room for part of the time Type Isotonic Intravenous Solution Dextrose 5% in water (D5W) 0. feelings of inadequacy. partial .serious depression.due to hormonal changes .evidenced by tearfulness. anorexia & sleep disturbance . moody.implies that the mother & the child are together 24 hours a day 2.also known as “baby blues” . postpartal psychosis – requiring formal counseling or psychiatric care Rooming-in .the infant stays in the room with the mother rather than staying in the central nursery Two types of rooming-in .Post-partum blues . • Lower GI don’t use with renal fluid loss failure patients • Acute blood • Don’t use with liver .9% sodium chloride (Normal Saline) (NaCl) Isotonic Isotonic Lactated Ringer’s (LR) Fluid Comparison Uses Special Considerations • Fluid loss • Dehydration • Use cautiously in renal • and cardiac patients Hypernatremia • Can cause fluid overload • Shock • • Can lead to overload Hyponatremia • Use with caution in • Blood patients with heart failure transfusions or edema • Resuscitation • Fluid challenges • DKA • Dehydration • Burns • Contains potassium.

Moisture introduced to unprotected IV sites through washing or bathing substantially increases the infection risks. or burns • Use only when blood sugar falls below 250 mg/dL • Don’t use n cardiac or renal patients Hypertonic Dextrose 5% in ½ normal saline Dextrose 5% in normal saline Hypertonic Hypertonic Dextrose 10% in water • Monitor blood sugar levels Risks of intravenous therapy Infection Any break in the skin carries a risk of infection. Symptoms are warmth. skin-dwelling organisms such as Coagulase-negative staphylococcus or Candida albicans may enter through the insertion site around the catheter. causing easily visible swelling. Phlebitis Phlebitis is inflammation of a vein that may be caused by infection. the infection is called septicemia and can be rapid and life-threatening. Infection of IV sites is usually local. the mere presence of a foreign body (the IV catheter) or the fluids or medication being given. as it can deliver bacteria directly into the central circulation. and redness around the vein. An infected central IV poses a higher risk of septicemia. Although IV insertion is an aseptic procedure. swelling. If bacteria do not remain in one area but spread through the bloodstream. can’t metabolize lactate • Use with caution • May cause cardiovascular collapse or increased intracranial pressure • Don’t use with liver disease. or bacteria may be accidentally introduced inside the catheter from contaminated equipment. trauma. The IV device must be removed and . pain.Hypotonic 0. redness.45% sodium chloride (1/2 normal saline) loss • Hypovolemia due to third spacing • Water replacement • DKA • Gastric fluid loss from NG or vomiting • Later in DKA treatment • Temporary treatment for shock if plasma expanders aren’t available • Addison’s crisis • Water replacement • Conditions where some nutrition with glucose is required disease. and fever.

The peripheral veins of intravenous drug addicts. because of brittle veins in very elderly patients). in which case the incident is known as extravasation. this is called embolism. Embolism . Electrolyte imbalance Administering a too-dilute or tooconcentrated solution can disrupt the patient's balance of sodium. It is treated by removing the intravenous access device and elevating the affected limb so that the collected fluids can drain away.if necessary re-inserted into another extremity. It is characterized by coolness and pallor to the skin as well as localized swelling or edema. This occurs more frequently with chemotherapeutic agents and people who have tuberculosis. if delivered all at once. or directly (e. Air bubbles of less than 30 milliliters are thought to dissolve into the circulation harmlessly. It is usually not painful. but ongoing studies hypothesize that these "micro-bubbles" may have some adverse effects. Hospital patients usually receive blood tests to monitor these levels. Fatality by air embolism is vanishingly rare. as well as an air bubble. Possible consequences include hypertension. can cause lifethreatening damage to pulmonary circulation. in part because it is also difficult to diagnose. Infiltration Infiltration occurs when an IV fluid accidentally enters the surrounding tissue rather than the vein. A larger amount of air. The risk is greater with a central IV. sometimes forming a hard “venous cord”. become sclerotic and difficult to access over time. and pulmonary edema. A blood clot or other solid mass. because the needle has punctured the vein and the infusion goes directly into the arm tissue). Small volumes do not result in readily detectable symptoms. either by leakage (e. if extremely large (3-8 milliliters per kilogram of body weight). since large solid masses cannot travel through a narrow catheter. Air bubbles can leave the blood through the lungs. A patient with a heart defect causing a right-to-left shunt is vulnerable to embolism from smaller amounts of air. Extravasation Extravasation is the accidental administration of IV infused medicinal drugs into the surrounding tissue which are caustic to these tissues. One reason veins are preferred over arteries for intravascular administration is because the flow will pass through the lungs before passing through the body. Infiltration is one of the most common adverse effects of IV therapy and is usually not serious unless the infiltrated fluid is a medication damaging to the surrounding tissue. can be delivered into the circulation through an IV and end up blocking a vessel. heart failure. Fluid overload This occurs when fluids are given at a higher rate or in a larger volume than the system can absorb or excrete. or.g.g. and other electrolytes. and it is nearly impossible to inject air through a peripheral IV at a dangerous rate. scar tissue can build up along the vein. potassium. magnesium. Peripheral IVs have a low risk of embolism. Due to frequent injections and recurring phlebitis. and of cancer patients undergoing chemotherapy. can stop the heart.

How much solution will contain the ordered dose. Young’s Rule: Child’s Dose = Adult dose x age ______________ Age + 12 3.05 mg: 1 ml 0.5 cc OF THE STOCK= 100.000 U 2. Clark’s RuLE : Child’s dose = Adult dose x weight ( lbs.000 X = 500. 100. Lanoxin is available in a solution with 0. A patient is to receive 100.000 X= 1. Ideal Body weight ( ages 2-10 years) Weight ( lbs. How much do u prepare? 0. A bottle containing 300.000 U: x cc = 300. 000x = 500.08 mg: x ml = 0.) = age in years x 5 +18 4.000 U of an oral suspension of Penicillin QID.Celsius to Fahrenheit: 0F = (9/5 X 0C ) + 32 EXAMPLE: 1.05x = 0.08 X = 0.) _____________________ 150 2.08 mg.DRUG COMPUTATION Formulas: 1. The doctor orders Lanoxin for patient.08 .000 U: 5 cc 3000. Ideal body weight ( ages 2-10 years ) Height ( inches) = age in years x 2 + 32 5.000 U penicillin in 5 cc of solution is to be used to prepare the ordered dose. The dose ordered is 0.000 _______ 300.05 mg. Fahrenheit to Celsius: 0c = 5/9 x ( 0F – 32 ) 6./ml.

: x mg = 1 gr. The vial reads : “ Atropine 0. : 60 mg. 3. = 1 grain 1/300 gr. 1/300 IM preop.625 cc X 15 minims _____________ 3125 625 9. The doctor orders insulin 25 U OD.6 ml of the stock = 0./ml” How much should the nurse administer? First step: 60 mg.08 mg.4 mg.375 = 10 minims 4.625 cc 1 cc = 15 – 16 minutes . = 1/300 gr. How much insulin should be drawn up in a minim? Formulas: 25 U : x cc = 40 U : cc 40 x = 25 X = 25 ___ 40 X = . The doctor orders atropine so4 gr.2 mg._____ 0.05 X = 1. Second step: . The available stock is 40 U/cc. X mg = 1/300 x 60 X mg = 60/300 X mg = 0.

The doctor orders ASPIRIN 150 mg. You have on hand aspirin 1 tab = 11/4 gr. The drop factor of the mini dropper is 60/ml.2 X = 0..4 mg : 1 ml 0.2 : x ml = . QID PRN. 6 mcgtts/min = 42 ______________________________________ 24 x 60 = 1.25 x 60 = 75 mg. 1/300 5. : 60 mg. X = 1. The nurse should regulate the IV to run at? Total ml. A patient is to receive 5 % dextrose and LR.2/0.4x = 0. 1. = 1 gr. 1000 ML IV in 24 hrs. How many tablets should you give? First step: 60 mg =1 gr. Second step: 150 mg : x tabs = 75 mg. = 1 ¼ gr. : 1 tab Formulas: 75 x = 150 X = 150/75 X = 2 tablets of the 150 mg. : x mg. To be infused x drop factor Total time to infuse ( in minute ) 1000 x 60 = 6000 = 41.4 X = 0. Stock 6.440 .25 gr.5 ml of the stock = gr.