Procedure 1.

1 : The First Physical Examination during pregnancy

Preparation
1. Equipment
 Stethoscope
 Light measuring device
 Thermometer
 Sphygmomanometer
 Tongue depressor
 Weighing scale
 Urine testing facility
 Client record

Procedure Rationale

1. Prepare equipment Assembling the equipment’s needed for the

assessment beforehand would be necessary to run
things smoothly or it will economize time and effort
of the nurse and of the patient. Organization
facilitates accurate skill performance.
2. Welcome the woman To establish rapport and warmth so that the patient
will be comfortable during the examination.
3. Instruct her to evacuate the bladder and collect a midstream Urinate first for a comfortable examination and collect
midstream in urine so that any bacteria present around
specimen of urine the urethra and on the hands do not contaminate the
specimen and to confirm the diagnosis of a urine
infection.
4- Test urine for sugar ,protein and Ketone To assess bladder or kidney infections, diabetes,
dehydration, and preeclampsia.
5- Measure accurately woman’s weight without shoes To serve as a baseline data for future comparison.
6- Measure accurately woman’s height without shoes To serve as a baseline data for future comparison.

7- Measure correctly her blood pressure Because hypertension is one of the most common
medical disorders complicating pregnancy.
8- Measure correctly her pulse To assess if the pregnant woman has bradycardia or
tachycardia.
9- Please the woman on the examination couch on her back So that the mother is comfortable and feel secure and
safety in the assessment.

10- Explain the procedure to her As a nurse, you need to introduce yourself first, and
explain the procedure so that the patient will be
aware on the procedure and providing information
fosters cooperation.
11- Drape the woman and keep the doors and curtains Close the doors, window, and curtains and draping
the patient to provide a secure environment for
closed
patient which reinforces confidence in health care
and emphasize the importance of respect for patient
dignity.
12- Wash your hand Observing appropriate infection control is necessary
to avoid spreading microorganisms that can cause
diseases.
13- Stand at the right side of the woman To have an easy access and give a full access view.
14- Examine the head – to check for any lumps, lice and dandruffs.
 Check hair for lice and nits It may cause skin irritation and can be uncomfortable
to the mother.
 Check the face for pallor ,edema and facial expression To assess the appearance of the pregnant women to
check for normal and abnormal findings and edema in
upper extremities is an abnormal sign of pregnancy.

 Check conjunctiva for degree of redness Conjunctivitis is a common condition in pregnant

 Note any pigmentation on forehead and cheeks
 Examine mouth for condition of gums and teeth
women it should be checked to properly cure and give
the medical intervention that is appropriate for the
mother.
To make sure if that pigmentation is normal due to
pregnancy or is there any underlying skin condition
such as vitiligo, chloasma and psoriasis.
To make sure that there’s no tooth decay or impacted
tooth and healthy gums should be pink and firm to
touch, there shouldn’t be a sign of gums disease
which is known as gingivitis. No dental carries and
swelling. Because some pregnant women has
impacted tooth due to inadequate amount of calcium.

15- Examine the neck: - to ensure that there is no abnormalities.

 Palpate the nodes below the posterior angle of the Smooth, non-tender and small cervical nodes
may be palpable and normal but when it is hard
jawbone and tender it may indicate infection or cancer.
Check the neck for the thyroid gland Slight enlargement of thyroid is normal but
marked enlargement of thyroid gland indicate
thyroid disease.
16- Examination the chest – to ensure that there is no abnormalities.
Assist with examination of the heart and lung by Using the stethoscope and through auscultation
we can hear the rhythm of the heart progressive
preparing the woman dyspnea can indicate cardiovascular disease.
Listen to the patient’s breathing if there are any
audible sounds.
Examination the breast ,nipple and areola Breast sized is increased and more sensitive to
touch and hyperpigmentation of the areola and
nipples is more evident. Localized redness, pain
and warmth could indicate mastitis.
17- Examine the abdomen Stiae gravidarum and linea nigra are normal the
size of the abdomen may indicate gestational
age and the shape of the uterus may suggest
fetal presentation and position.
18- Examine the extremities
Check the color of the palms and nails Check if leukonychia is present this occur
when pregnant women takes drugs and the palm
is should not be yellowish which is a sign of
jaundice which causes liver dysfunction or
cyanosis is a bluish discoloration of the skin,
mucous membranes, tongue, lips, or nail beds
and is due to an increased concentration of
reduced hemoglobin in the circulation.
Is Check swelling of fingers If there is no swelling, stiffness and pain which
can be associate to arthritis.
Examine the legs ,ankles and feet for shape and Note for any tenderness, swelling and edema
and for leg length discrepancy.
unequal length
Check edema over the tibia, ankle and feet Edema in lower extremities is normal but we
should include it to make sure if it is a normal
edema or a pitting edema.
Observe legs for dilated veins Varicose veins are a common, usually harmless
part of pregnancy for some women but if the
veins feel hard, warm, or painful, or the skin
over them looks red it is not normal.
19- Assist with pelvic examination - To evaluate the size of the pelvis and cervix and look for abnormalities and infections
20- Check the woman for danger signs of pregnancy To help women to make the right decisions and
take appropriate healthcare seeking actions.
21- Assist the woman to get down from examination table and redress To make the pregnant woman comfortable and
not shivering/cold.
her clothes
22-. Record findings and woman’s reaction For future purposes for referrals if the patient
will visit the hospital or clinic for other
concerns and continuity of acre and it is legal
and a doctor’s guide.
23- Replace equipment’s For safety purposes.
24- Wash hands To avoid spreading microorganisms that can
cause diseases.
25- Give the woman the necessary instruction and date So pregnant women know when her next visit
for the follow up check-up is.
of the next visit
26- Refer abnormal case So that the appropriate health care provider can
take action immediately. And the pregnant
women can be aware on her condition.
 Procedure# 1. 2 : Abdominal Examination
Purpose :
1. To detect any abnormality of the abdominal organs
2. To confirm pregnancy
3. To estimate the period of gestation
4. To determine presentation ,lie .position and engagement of the presenting part
5. To detect any deviation from normal

Preparation

1. Equipment
 Tape measure
 Pinard fetoscope or sonic fetal heart sound device
Client record

Procedure RATIONALE

1. Prepare equipment Assembling the equipment’s needed for the

assessment beforehand would be necessary to run
things smoothly or it will economize time and effort
of the nurse and of the patient. Organization facilitates
accurate skill performance.
2. Welcome the woman To establish rapport and warmth so that the patient
will be comfortable during the examination.
3. Preparing mother So that the mother is well oriented and can cooperate
throughout the whole procedure.
4- Instruct her to evacuate the bladder To be comfortable and it is heard to palpate if the
bladder is full.
5- Positioning mother on her back on a firm bed or So that the mother is comfortable and feel secure and
safety in the assessment.
examination table
6- Standing at the side of bed, facing the mother during the first three To have an easy access and give a full access view
maneuver but in the last one the nurse reverses her position and and a good assessment of Leopold’s maneuver.
faces her feet.
7- First Maneuver
 Ascertaining the fundus and determined its level Gently The soft mass is the fetal buttocks and the fetal head
palpate the fundus with the tips of the Fingers of both hands feels round and hard.
in order to define which fetal part is present in the fundus

8- Second Maneuver
Applying the palm of the hands on either side of the mother abdomen
gentle but deep pressure is exerted to locate the back of the fetus in
relation to the right and left sides of the mother.
On one side of the abdomen round nodules is
palpable these are the fist and feet of the fetus.
Kicking and movement are expected to be felt. The
other side of the abdomen feels smooth this is the
fetus back.

9-. Third Maneuver

Employing the thumb and fingers grasping the lower portion of the
maternal abdomen, just above symphasis pubis to determine if the
presenting part is engaged or not
10- Fourth Maneuver
- Facing the mother’s feet, using the tips of the first three fingers of
each hand, making deep pressure in the direction of the axis of the
pelvic inlet to ascertain presenting part of the engaged head.
- Identifying the fetal position correctly.
- Identifying which best place to hear the fetal heart tone.
The unengaged hand is round, firm and ballotable,
whereas the buttocks are soft and irregular. A soft
presenting part at the symphisis pubis indicates
breech presentation.
The fetal head has not descended into the maternal
pelvic inlet if the hands move together and if do not
move together and stop to resistance the fetal head
is engaged into the pelvic inlet.
The purpose of finding the fetal lie is to identify
whether there are any danger signs that could make
labor and delivery difficult and put the mother and
baby at risk.

- Hearing the fetal heart tone and count. Fetal heart rate decelerations could indicate poor
placental perfusions. The fetal heartbeat is quiet and
quick usually 120 to 160 beats a minute.

11-. * Auscultation
- Place the pinard fetal stethoscope at right angles about 5 cm above the It is used to auscultate the heart sounds of the
embryo in the womb. Fetal heart rate monitoring is
head on the side of abdomen where the back was felt, keep the ear in especially helpful if you have a high-risk
firm contact with the pinard, don't touch it while listening. Listen pregnancy.
carefully and count for 60 seconds.
 Procedure #1. 3: Assessing pitting edema
Procedure RATIONALE
1. Explain the procedure & its purpose to the mother. This is the very first and important step before doing
any kinds of assessment we need to explain to your
client why you need to do that in order for them to
cooperate and be able to have a background on what
are you going to do while the assessment of the eyes
and ears are ongoing. Take note that we should greet
the patient politely to establish rapport so that the
patient will participate and make patient comfortable
2. Screen the mother’s bed. Prepare the bed so that the mother is comfortable
through the whole assessment.
3- Ask the women & family members if the women's To assess the swollen area if it is associated with
preeclampsia, allergy, or any medical condition.
face or hands appear swollen.
4- Inspect the women's face, extremities and sacral area To check for any sign of pitting edema and to scale it
for signs of pitting edema
5- Press each area firmly with thumb or index finger for To know if the it is pitting edema or non-pitting
edema and if it go back after pressing the area.
several seconds & release.
6- Evaluate the Extensiveness of edema, Depth of To give an exact grade or scale of the edema
depression & Length of time it takes to clear.
7- Grade the pitting edema according to the following scale The grading of edema is determined by pit depth and
1+ =minimal edema of lower extremities recovery time from grade 0-4. The scale is used to
2+ =marked edema of lower extremities rate the severity
3+ =edema of the lower extremities, face & hands
4+ =generalized, massive edema

8- Record your findings & compare your findings with Documentation is important to assess client’s data
gathered and to provide clear data of the entire
those previously recorded assessment for the physician and to ensures an
accurate medical record so that the nurse practitioner
can perform a proper nursing intervention.