BACHELOR OF SCIENCE IN NURSING

CARE OF MOTHER, CHILD, AND ADOLESCENT (WELL CLIENTS)

LABORATORY MODULE LABORATORY UNIT WEEK

1 5 5
PHYSICAL ASSESSMENT OF NORMAL PREGNANT CLIENT

✓ Read course and laboratory unit objectives

✓ Read study guide prior to synchronous
class attendance
✓ Read required learning resources;
refer to course unit terminologies for jargons
✓ Participate in weekly discussion board (Canvas)
✓ Answer and submit course unit tasks

At the end of this unit, the students are expected to:

1. Describe common physiologic changes that occur with pregnancy .

2. Assess a woman for the physiologic changes thru the verbalized data provided by the
patient that occur with her pregnancy.
3. Integrate knowledge of the physiologic changes of pregnancy with nursing process to
achieve quality maternal and child health nursing care.
 1. Computer
2. Internet connection
3. Headset
4. Maternal and Child Health Nursing Book
by Pillitteri and Silbert-Flagg
5. Other MCHN reference books

To facilitate the practice of students’ physical assessment skills o the following

rules must be implemented:

1. Attend to the synchronous or asynchronous class facilitated by instructors.

2. Use lecture guide attached in this RLE GUIDE.
3. Students must submit this accomplished worksheet through Canvas upload.

PHYSICAL ASSESSMENT

After the health assessment during the first prenatal visit, the next step is a physical
assessment. The pregnant woman must be advised to urinate first before the examination to:
(1) reduce bladder size and make the pelvic examination more comfortable, (2) allow easier
identification of pelvic organs, and (3) provide a urine specimen for laboratory testing, as
ordered.
A physical examination at a first prenatal visit typically includes inspection of major body
systems, with emphasis on the changes that occur with pregnancy or that could signal a
developing problem.
 1. VITAL SIGNS

NORMAL FINDINGS

BP: ≤ 135/85 mmHg

P: 60-90 bpm; may increase 10 bpm during
pregnancy
R: 12-22 cpm; pregnancy may induce a
degree of hypoventilation; thoracic breathing
predominant
T: 36.2 – 37.6 ºC

2. HEIGHT AND WEIGHT

Height: Depends on body build

Weight gain: 11.2 to 16.9 kg (25 to 35 lb) is
recommended as an average weight gain in
pregnancy

Recommended
Pregnancy Weight
Pre-Pregnancy BMI
Gain According to
CDC
Underweight : Less 28 to 40 pounds
than 18.5
Normal: 18.5 to 24.9 25 to 35 pounds
Overweight: 25 to 29.9 15 to 25 pounds
Obese: Over 30 11 to 20 pounds
 3. SKIN

Color: Consistent with racial background,

pink nail beds
Condition: Absence of edema (slight edema
of lower extremities is normal during
pregnancy)
Lesions: Absence of lesions; Spider nevi is
common in pregnancy
Moles
Pigmentation: Pigmentation changes of
pregnancy include linea nigra, striae
gravidarum, melasma
Café-au-lait spots

4. NOSE

Character of Mucosa: Redder than oral mucosa; in pregnancy, nasal mucosa is edematous
in response to increased estrogen, resulting in nasal stuffiness (rhinitis of pregnancy) and
nosebleeds.

5. MOUTH

May note hypertrophy of gingival tissue because of estrogen

 6. NECK

Nodes: Small, mobile, nontender nodes

Thyroid: Small, smooth, lateral lobes palpable on either side of trachea; slight hyperplasia by
third month of pregnancy

7. CHEST AND LUNGS

Chest: Symmetric, elliptic, smaller

anteroposterior (AP) than transverse diameter
Ribs: Slope downwards from nipple line
Inspection and Palpation: No retraction or
bulging of intercostal spaces during inspiration
or expiration; symmetric expansion; Tactile
fremitus
Percussion: Bilateral symmetry in tone: Low
pitched resonance of moderate intensity
Auscultation: Upper lobes – bronchovesicular
sounds above sternum and scapulas; equal
expiratory and inspiratory phases
Remainder of chest: Vesicular breath sounds
heard; inspiratory phase longer (3:1)

8. BREASTS

Supple: Symmetric in size and contour;

darker pigmentation of nipple and areola; may
have supernumerary nipples, usually 5-6 cm
below normal nipple line
Axillary nodes nonpalpable or pellet sized
Pregnancy changes:
1. Size increase noted primarily in first 20
weeks.
2. Become nodular.
3. Tingling sensation may be felt during
first and third trimester, women may
report feeling of heaviness.
 4. Pigmentation of nipples and areolas
darkens.
5. Superficial veins dilate and become
more prominent.
6. Striae seen in multiparas.
7. Tubercles of Montgomery enlarge.
8. Colostrum may be present after 12th
week.
9. Secondary areola appears at 20
weeks, characterized by series of
washed-out spots surrounding primary
areola.
10. Breasts less firm, old striae may be
present in multiparas.

9. HEART

Normal rate, rhythm, and heart sounds

Pregnancy changes:
1. Palpitations may occur due to
sympathetic nervous system
disturbance.
2. Short systolic murmurs that increase in
held expiration are normal due to
increased volume.
10. ABDOMEN

Normal appearance, skin texture, and hair

distribution; liver nonpalpable; abdomen
nontender
Pregnancy changes:
1. Purple striae may be present (or silver
striae on a multipara) as well as linea
nigra.
2. Diastasis of the rectus muscles late in
pregnancy
3. Size: Flat or rotund abdomen;
progressive and enlargement of uterus
due to pregnancy.
 10-12 weeks: Fundus slightly
above symphysis pubis.
 16 weeks: Fundus hallway
between symphysis and
umbilicus.
 20-22 weeks: Fundus at
umbilicus
 28 weeks: Fundus three finger
breadths above umbilicus.
 36 weeks: Fundus just below
xiphoid process.
4. Fetal heart rate: 110-160 bpm may be
heard with Doppler at 10-12 weeks’
gestation; may be heard with fetoscope
at 17-20 weeks.
5. Fetal movement palpable by a trained
examiner after the 18th week.
6. Ballottement: During fourth or fifth
month, fetus rises and then rebounds to
original position when uterus is tapped
sharply.
 10. EXTREMITIES

Skin warm, pulses palpable, full range of motion; may be some edema of hands and ankles
in late pregnancy; varicose veins may become more pronounces; palmar erythema may be
present

11. SPINE

Normal spinal curves: Concave cervical,

convex thoracic, concave lumbar
In pregnancy, lumbar spinal curve may be
accentuated
Shoulders and iliac crests should be even

12. REFLEXES

Normal and symmetric

 13. PELVIC AREA

External female genitalia: Normally formed

with female hair distribution; in multiparas,
labia majora loose and pigmented; urinary
and vaginal orifices visible and appropriately
located
Vagina: Pink or dark pink, vaginal discharge
odorless, nonirritating; in multiparas, vaginal
folds smooth and flattened; may have
episiotomy scar
Cervix: pink color, os closes except in
multiparas, in whom os admits tip
Pregnancy changes:
 1-4 weeks AOG: Enlargement in
anterior posterior diameter
 4-6 weeks AOG: Softening of cervix
(Goodell’s sign); softening of isthmus
of Hegar (Hegar’s sign); cervix takes
on bluish coloring (Chadwick’s sign)
 8-12 weeks AOG: Vagina and cervix
appear bluish violet in color
(Chadwick’s sign)
Uterus: Pear shaped, mobile; smooth surface
Ovaries: Small, walnut shaped, nontender
(ovaries and fallopian tubes are located in the
adnexal areas)

14. PELVIC MEASUREMENTS

Internal measurements:
 Diagonal conjugate at least 11.5 m
 Obstetric conjugate estimated by
subtracting 1.5-2 cm from diagonal
conjugate
 Inclination of sacrum
  Motility of coccyx; external
intertuberosity diameter greater than 8
cm

15. ANUS AND RECTUM

No lumps, rashes, excoriation, tenderness; cervix may be felt through rectal wall

RELATED VIDEOS TO WATCH:

https://www.youtube.com/watch?v=dAha5SSHbc4

https://www.youtube.com/watch?v=MH0CLlzL9gM

https://www.youtube.com/watch?v=VBE1I4W8x-0

Laboratory Task:

Conduct an interview to a pregnant woman about the physical assessments in

pregnancy. Because of the current situation, physical assessment will be noted as subjective
data. Formulate the questions to be asked in each system to be assessed. Transcribe the
response as verbalized by the patient

1. The class will be divided into three groups. Group 1 will be assigned to interview a
pregnant woman on the first trimester, Group 2 to a pregnant woman on the second
trimester, and Group 3 to a pregnant woman on the third trimester.
2. Consent and privacy of the patient must be dealt with utmost confidentiality.
3. Face-to-face interview may be done if the pregnant woman is residing in the same
house with the interviewer. Protocols set by the IATF shall be strictly followed.
4. Otherwise, interview shall be conducted thru video conferencing applications.
5. Findings as verbalized by the pregnant woman must be noted and transcribed.
6. Analysis and interpretation of the results must be reported to class.
7. Written report must be submitted using the following format.
 Nursing
Findings as Analysis and
Physical Responsibilities
Verbalized by the Interpretation of the
Assessment Based on the
Patient Findings
Findings

Send screenshot (email or Canvas) of the ‘submission confirmation screen’ to your instructor
along with this worksheet.

Date Completed:
Date Submitted:

Adele Pillitteri, JoAnne Silbert-Flagg. (2018). Maternal and Child Health Nursing: Care of the
Childbearing and Chilrearing Family. (8 th Ed.). Wolters Kluwer.

Michele Davidson, Marcia London, Patricia Ladewig. (2012). Old’s Maternal-Newborn Nursing
& Women’s Health across the Lifespan. (9th Ed.). Pearson.