NUCAMA46N – PRELIM are assembled together to create a 3-D
reconstruction of the body.
WHAT IS MAMMOGRAPHY?
• Mammography is specialized medical imaging
that uses a low-dose X-ray system (ionizing
radiation) to see inside the breast. A
mammography exam, called mammogram, aids
in the early detection and diagnosis of breast
diseases in women.
• Mammograms are used as a screening tool to
detect early breast cancer in women
experiencing no symptoms. They can also be
used to detect and diagnose breast disease in
women experiencing symptoms such as a lump,
pain, skin or dimpling or nipple discharge.
2 Purposes of Mammography
1. Screening Mammography
• A screening mammogram is used to detect
breast changes that could be cancerous in
people who have no signs or symptoms. The
goal is to detect cancer when it is small, and
treatment may be less invasive.
2. Diagnostic Mammography
• A diagnostic mammogram is used to investigate
suspicious breast changes, such as new breast
lump, breast pain, an unusual skin appearance,
nipple thickening or nipple discharge. It is also
used to evaluate unexpected findings on a
screening mammogram. A diagnostic
mammogram includes additional mammogram
images.
3 Recent Advances in Mammography
1. Digital Mammography – also called full-field
digital mammography (FFDM), is a
mammography system in which the X-ray film is
replaced by electronics that convert X-rays into
mammographic pictures of the breast. These
systems are similar to those found in digital
cameras and their efficiency enables better
pictures with a lower radiation dose. These
images of the breast are transferred to a
computer for review by the radiologist and for
long term storage. The patient’s experience
during a digital mammogram is similar to having
a conventional film mammogram.
2. Computer-Aided Detection (CAD) – systems
search digitized mammographic images for
abnormal areas of density, mass, or calcification
that may indicate the presence of cancer. The
CAD system highlights these areas on the
images, alerting the radiologist to carefully
assess this area.
3. Breast Tomosynthesis – also called three-
dimensional (3-D) mammography and Digital
Breast Tomosynthesis (DBT), is an advanced
form of breast imaging where multiple images of
the breast from different angles are captured
and reconstructed “Synthesized” into a three-
dimensional image set. In this way, 3-D breast
imaging is similar to Computed Tomography
(CT) imaging in which a series of thin “Slices”
• Although the radiation dose for some Breast
Tomosynthesis systems is slightly higher than
the dosage used in standard mammography, it
remains within the FDA-approved safe levels for
radiation from mammograms. Some systems
have doses very similar to conventional
mammography.
• Large population studies have shown that
screening with Breast Tomosynthesis results in
improved breast cancer detection rates and
fewer “Call-backs”, instances where women are
called back from screening for additional testing
because of a potentially abnormal finding.
Breast Tomosynthesis may also result in:
• Earlier detection of small breast cancers that
may be hidden on a conventional mammogram.
• Fewer unnecessary biopsies or additional tests.
• Greater likelihood of detecting multiple breast
tumors.
• Clear images of abnormalities within dense
breast tissue.
• Greater accuracy in pinpointing the size, shape,
and location of breast abnormalities.
Risk and Limitations:
• Mammograms expose you to Low-Dose
Radiation.
• Having a mammogram may lead to additional
testing.
• Screening mammography can’t detect all
cancers.
• Not all of the cancers found by mammography
can be cured.
Procedure & Rationale:
1. Check and confirm the doctor’s order.
2. Perform hand don gloves.
- Hand washing prevents the spread of
microorganisms/infection.
3. Before the procedure:
a. Inform the patient not to wear deodorant,
talcum powder or lotion under the arms or
on the breasts on the day of the exam.
- These can appear on the mammogram as
calcium spots.
b. Instruct the patient to describe any breast
symptoms or problems to the technologist
performing the exam.
c. Ask the patient to obtain prior
mammograms for comparison with the
current exam.
4. During the exam:
a. Ask the patient to remove neck jewelry and
patient’s gown from waist up.
b. Inform the patient to stand in front of an X-
ray machine specially designed for
mammography/mammography machine.
c. Assist the technician to place one of the
patient’s breasts on a platform the
technician will raise or lower the platform to
match the patient’s height. (The patient’s
head, arms, and torso are positioned in
 order to allow an unobstructed view of the
breast).
The patient’s breast is gradually pressed
against the platform by a clear plastic plate.
Pressure is applied for a few seconds to
spread out the breast tissue. (The pressure
isn’t harmful, but it can cause some
discomfort).
d. Inform the patient to verbalize if the
discomfort becomes too much.
5. After the procedure:
a. Assist the patient to change from patient’s
gown to her previous clothing.
b. Instruct the patient to wait while the
technician checks the quality of the images.
If the views are inadequate for technical
reasons, the patient may have to repeat the
part of the test.
6. Performing handwashing.
7. Document the procedure done.
- The entire procedure usually takes less than
30 minutes. Afterward, the patient may
resume the usual activities.
WHAT IS AMNIOCENTESIS?
• It is a prenatal test that can diagnose genetic
disorders (such as Down Syndrome and Spina
Bifida) or Congenital Disabilities (Sometimes
called Birth Defects) and other health issues in
a fetus. A provider uses a needle to remove a
small amount of amniotic fluid from inside the
uterus, and then a lab tests the sample for
specific conditions.
Why is it done? (reasons) few
• Genetic Testing – testing the DNA from the
cells for diagnosis of certain conditions such as
Down Syndrome, Tay-Sachs disease, Neural
Tube defects such as Spina Bifida or
Anencephaly.
• Diagnosis of Fetal Infection – occasionally, it
is used to look for infection or other illness in
the baby.
• Treatment – can be done to drain amniotic fluid
from the uterus if too much has built up (call as
the polyhydramnios).
• Fetal Lung Testing – if delivery is planned
sooner than 39 weeks, amniotic fluid might be
tested to help out whether a baby’s lungs are
mature enough for birth. This is rarely done.
• Rh Disease – this is a potentially serious
condition where the mother and the fetus have
different blood Rh types.
Who gets Amniocentesis?
A healthcare provider will consider recommending
Amniocentesis when:
• Ultrasound Testing detects a fetal abnormality
or having an unusual finding.
• A Prenatal Screening Test detects an Increased
risk for a chromosome disorder. Certain Genetic
disorders (such as Sickle Cell Disease or Cystic
Fibrosis) run in your family, or you test positive
as a carrier of a genetic disorder.
• You’re older than 35 at the time of delivery. This
is because individuals over 35 have a higher
chance of having a baby with chromosomal
disorder.
When is Amniocentesis Performed?
• Between 15 and 20 weeks AOG (2nd Trimester).
• But if the purpose is to check fetal lung
development or treat polyhydramnios, it will
take place during the third trimester (as
ordered/requested by the physician).
**having an amniocentesis earlier in pregnancy
poses more risks, such as miscarriage though it is
very uncommon.
Risk/Complications:
• Cramping
• Bleeding or Leaking Amniotic Fluid
• Injury or Infection
• Loss of the Pregnancy/Miscarriage
• Premature Labor
Rh Sensitization (baby’s blood cells enter the
pregnant person’s bloodstream: Rh+ & Rh-,
therefore given injection of a blood product).
Infection Transmission (Hepatitis C, Toxoplasmosis
or HIV/AIDS)
***Complications from Amniocentesis are rare. In
less than 1% of cases, Amniocentesis leads to
miscarriage or early delivery. About 2% of people
have spotting or camping after Amniocentesis.
After Amniocentesis
• Patient may rest for the rest of the day then
resume to her regular activities not allowed to
do strenuous activities/lift heavy objects.
• Contact your health care provider if you have:
- Bleeding or loss of amniotic fluid through
the vagina.
- Severe uterine cramping that lasts more
than a few hours.
- Fever
- Redness where the needle was inserted.
- Fetal activity that is different than usual or
no fetal movement.
Procedure: Assisting in Amniocentesis
Materials/Equipment
1 Ultrasound machine
1 water soluble lubricant (KY Jelly)
1 sterile glove (for the physician)
1 clean glove (for nurses)
1 Povidone iodine/antiseptic solution
1-2 gauze
Drapes
Amniocentesis needle
1 pc 20ml syringe without
1 pc 20 ml syringe without needle/2 pcs 10 ml
syringe without needle.
bandage (optional)
1 condom/clean transparent gloves (optional)
Procedure & Rationale:
1. Check and confirm doctor’s order necessary for
any procedure.
2. Secure Consent
3. Gather all necessary equipment.
 - To save time and energy.
4. Explain the procedure to your patient.
- Promotes cooperation & knows what to
expect.
5. Perform hand washing.
- To prevent the spread of
microorganisms/infection.
6. Don gloves
7. Position the patient in a lying position, exposing
the abdomen.
8. Assist the physician during the procedure:
- If needs covering of the probe, provide the
physician with condom/transparent clean
gloves/any covering approved by the
institution hand over an ample amount of
water-soluble lubricant for ultrasound &
provide gauze for removing.
• Hand over the skin prep povidone
Iodine.
• Place the drape with hole over the
location chosen by the physician.
• If the amniocentesis needle does not
have the syringe for aspiration, connect
it to the syringe without needle (20mL).
- Aspirate 20 mL of amniotic fluid then detach
the syringe from the amniocentesis needle.
• Provide bandage if necessary/as
requested by the physician. (The
Physician will continue to perform the
UTZ to monitor the baby’s heart rate and
well-being).
9. Remove gloves and perform handwashing.
10. Observe for any reaction.
11. Document the procedure done.
WHAT IS A TRANSVAGINAL ULTRASOUND?
• A Transvaginal UTZ is an imaging procedure
that allows your provider to see your pelvic
cavity and the organs inside your pelvis. These
organs include your Cervix, Uterus, Fallopian
Tubes and Ovaries. A Transvaginal UTZ can
show abnormal structures or a growth in your
pelvic area that may indicate a condition or
disease. Your provider may also order a
Transvaginal UTZ to confirm or monitor your
pregnancy.
What is the Difference Between an UTZ and a
Transvaginal UTZ?
• Transvaginal UTZ are sometimes called
“endovaginal ultrasound” because the device
that records images of your pelvic cavity
(transducer) is inserted inside your vagina. The
process is different from a traditional
Abdominal Ultrasound, where your provider
moves the transducer across your belly to
record images.
Considerations:
• If a provider recommends a special kind of
transvaginal utz called Saline Infusion
Sonohysterography, or Sonohysterogram (a
small amount of fluid is used to distend the
cavity of the uterus to allow a good imaging
view of the lining), the patient must not be
pregnant or having Pelvic Inflammatory
Disease (PID).
• If the patient is menstruating, will she still be
allowed to have transvaginal utz? – yes, as
long as the physician assessed the patient and
has requested to continue the procedure.
A Transvaginal UTZ allows your provider to
identify:
• Cysts.
• Tumors
• Fibroids
• Polyps
• Signs of Pelvic Infection
• Signs of Cancer
• Signs of Ectopic Pregnancy or Miscarriage
• Potential Causes of Fertility Issues
• If an Intrauterine Device (IUD) is in the correct
position.
• Your provider may order a transvaginal during
pregnancy, especially during the first trimester
(weeks 1-12). Your provider may order a
transvaginal UTZ to:
- Confirm your pregnancy.
- Determine how far along you are in your
pregnancy.
- Monitor your baby’s heartbeat.
- Identify warning signs of miscarriage or
early delivery.
- Identify conditions that will affect your
pregnancy plan, like having a low-lying
placenta (placenta previa).
A Transvaginal UTZ can also help your provider
plan for surgery.
Preparation:
• Most of the time, there is nothing needed for
TVS (Transvaginal Sonography)/Transvaginal
UTZ, though physician may provide the patient
with series of instructions before the
appointment, especially if the patient will need
to drink something beforehand.
• Partially full-bladder – drink 30 minutes before
the appointment.
• Empty Bladder – void before the procedure.
Materials:
• Transvaginal UTZ Machine
• Plastic Sheath/Condom
• Lubricating gel
• Tissue
• Clean Gloves (Nurses)
• Sterile Gloves (Sonographer)/Specially Trained
Technician)
Procedure & Rationale:
1. Check & confirm physician’s order.
2. Secure Consent.
3. Cover the Transducer with clear
Sheath/Condom (depending on the institution
practice)
- To protect the instrument and to prevent
contamination.
4. Explain the procedure to the patient.
- To gain patient’s cooperation.
5. Perform handwashing and don gloves.
- To prevent the spread of
microorganism/infection.
6. Instruct the patient to wear the hospital gown
and remove her underwear. (If menstruating,
remove the tampon before the procedure).
7. Let the patient follow her physician’s
instructions about when to drink fluids and let
her void. (empty, partially full, or full bladder).
- Having a full bladder affects the way the
patient’s organs appear on an UTZ.
8. Assist the patient to lie on an examination table
with knees bent, and feet on the stirrups.
9. Provide the physician with warm lubricating gel
for the transducer (covered with condom).
10. As soon as the sonographer is done, assist the
patient to sit/stand and provide a tissue to let
them wipe their vagina since there could be a
slight vaginal discharge from the lubricating gel
used during the procedure.
11. Inform the patient to change clothes and put the
used lab gown/hospital gown at the hamper
provided.
12. Perform handwashing.
13. Document the procedure done.
ASSISTING IN NEWBORN HEARING TEST
What is the NBH test for?
• The newborn hearing test is a routine health
check that will be offered to your baby soon
after birth. The newborn hearing test is used to
help detect hearing loss in babies. Your baby
needs to hear to learn speech and language
skills. If your baby has hearing loss from birth
(congenital hearing loss) it’s important to
diagnose this soon after birth. Early detection
can help you and your health team take steps to
improve your child’s language, as well as
encourage their social and emotional
development.
When does the Hearing Test happen?
• The hearing test should ideally be performed
before your baby leaves hospital after the birth.
The test is usually done within 2 days and can
be done as early as 6 hours after birth. If for
some reason you go home before the test your
baby can still have their hearing tested as an
outpatient or during a home visit by an
appropriately qualified early discharge nurse.
The test should be done within 1 month of birth
for healthy babies or by 3 months for sick or
premature babies.
2 types of Newborn Hearing Screening Test:
1. Otoacoustic Emissions Test (OAEs)
• A miniature earphone and microphone are
placed in the ear, sounds are played, and a
response is measured.
• If a baby hears normally, an echo is reflected
back into the ear canal and is measured by the
microphone.
• When a baby has a hearing loss, no echo or a
reduced echo can be measured on the OAE
test.
2. Auditory Brainstem Response Test (ABR)
• Auditory Brainstem Response (ABR) testing is
the best test available for newborns and infants
up to 6 months of age that can provide
information about the softest level of sound the
ear can hear.
• Sounds are played to the baby’s ears and band-
aid like electrodes are placed on the baby’s
head to detect responses. Sounds are
presented to the ears using small earphones.
The electrodes pick up responses from the
hearing nerve and a computer measures the
responses to identify babies who have a
hearing loss.
How long does it take to get the results?
• The results of the test will be given to you
immediately after the screen. Some babies will
need to do a second test if the results of the first
one are not clear.
What happens if there is a problem?
• If your baby does not pass the hearing test the
first time, the test will be done. The repeat test
is usually done 12 to 24 hours after the first test.
• If your baby does not pass the second test, they
will be referred for a diagnostic audiology
assessment. This assessment is done by an
audiologist (hearing specialist), ideally when
your baby is 4 to weeks of age so your baby
can get support if hearing loss is diagnosed.
Equipment:
• OAE/ABR
• Clean gloves
Procedure:
1. Check and confirm physician’s order.
2. Explain the procedure to the guardian.
- To gain cooperation from the
guardian/mother.
3. Perform handwashing.
- To prevent the spread of
microorganism/infection.
4. Don gloves (if necessary: depending on the
institution)
5. Placed comfortably the newborn (sitting on the
lap, while carried on or even lying the bed).
6. Assist the screener/hearing test personnel.
7. Remove gloves & perform handwashing.
8. Document the procedure.
PEDIATRIC ASSESSMENT: WEIGHT, HEIGHT,
BMI, IMMUNIZATION RECORD
Pediatric Assessment: WEIGHT
• The measurement of weight is the most reliable
criteria of assessment of health and nutritional
status of children.
• The periodic recording of weight on a growth
chart is essential for monitoring the growth of
under five children.
 end and crosspiece. It is used to measure the
length of long bones.
BMI
What is BMI?

• BMI (Body Mass Index) – is a measure of

weight in relation to height. This number helps
doctors understand if a person’s weight is in
category such as underweight, overweight or
obese that may be putting their health at risk.

Beam Type Weighing Balance

• Electronic weighing scales for infants and

children.
• Bathroom type of mechanical scale (very
unreliable).
• Salter spring machine (in field conditions).
HEIGHT:
What is Height Assessment?

• This is a noninvasive, readily obtainable

measurement that can help identify children at
risk of malnutrition or obesity. However, a need
for universal and accurate measurement of
height remains.
Commonly Used Instruments for Measuring
Height:
1. Measuring tape
2. A Horizontal Length Scale (HLS) – is a flexible
horizontal scale used to measure an infant’s
recumbent length.
3. Infantometer – The infantometer measures the
recumbent length of an infant with greater
Interpretation:
accuracy by securely holding the infant in
position. • Ideally, children should fall in the target ranges
4. Anthropometer Rod – the anthropometer rod between the 5th and 85th percentiles. Percentiles
consists of four equal rods and can be used to outside this range can put kids at higher risk for
measure height up to a range of 2 meters. health risk for health problems.
5. Stadiometer – consists of a ruler and a sliding • Children below the 5th percentile could have a
horizontal headpiece which can be fixed above nutritional shortfall either not taking in enough
the head to measure height. calories or burning up more calories than they
6. Osteometric Board – it is an anthropometric are getting, or both. Likewise, children above
instrument consisting of a flat board with fixed the 85th percentile may have problems with how
their bodies balance energy intake and output.
 This may be tied to a variety of factors:
Nutrition, the way their bodies handle calories
or the body functions, a lack of physical activity
or a combination of these. There are also
medical conditions and medications that can
cause kids to gain or lose weight more easily.
Most children have multiple contributing factors
to their body weight.
IMMUNIZATION RECORD
What is an Immunization Record?
• An immunization record is a comprehensive
timeline of all vaccinations a patient has
received. Good record-taking will ensure a
patient can provide accurate immunization
records required for certain jobs, travel, or
school enrollment.
Finding your immunization record
• Makes sure to ask your doctor or nurse to
record each vaccine given on your or your
child’s immunization record and write down the
name of the doctor’s office or clinic. If you don’t
have a complete record of your immunizations,
you try to contact these organizations:
Child’s Doctor or Public Health Clinic: keep in
mind doctor’s offices and clinics may only keep
immunization records for a few years.
State Health Department: you can request a copy
of your child’s immunization record. Or you can find
your child’s immunization record is in an
Immunzation Information System (IIS).
Child’s School: keep in these records generally
are kept for only a year or two after the student
graduates, transfers to another school, or leaves
the school system. After a student leaves the
school system, records are sent to storage and
may not be accessible unless the record is stored
in an IIS.
College Medical or Student Health Services:
Family Baby Books: look around the house or ask
parents or grandparents.
Military Records: a form for requesting health
information from the Veteran’s Administration is
available uchinc if you cannot find a complete
immunization record, you can have your blood
tested for antibodies to determine the immunity to
certain diseases. However, these tests may now
always be accurate, so your doctor may peeler the
revaccinate you or your child for best protection.
Talk to your child’s doctor to determine the safety of
revaccination.
How can an Electronic Health Record help?
• An Electronic Health Record, or EHR – is set
up to ensure that immunization records are
complete and accurate. With good EHR
software and EHR systems, health care
providers will be alerted to any miming,
incomplete, or possibly inaccurate immunization
records.
• Check out Practice Fusion’s EHR system to
guarantee complete and accurate immunization
records and cloud-based storage for easy
access.
MMDST
What is MMDST?
Metro Manila Developmental Screening Test
(MMDST)
• This is a screening test to note for normalcy of
the child’s development and to determine any
delays as well in children 6 ½ years old and
below. (2 weeks to 6 ½ years old).
• This is a simple and clinically useful tool to
determine early serious developmental delays
by Dr. William K. Frankenburg and is modified
and standardized by Dr. Phoebe D. Williams
DDST (Denver Developmental Screening Test)
to MMDST.
• It is not an intelligence test; this is a screening
instrument to determine if child’s development
is within normal.
4 Aspects/Sectors of Development:
1. Personal-Social – tasks which indicate the
child’s ability to get along with people and to
take care of himself.
2. Fine-Motor Adaptive – tasks which indicate
the child’s ability to see and use his hands to
pick up objects and to draw.
3. Language – tasks which indicate the child’s
ability to hear, follow directions and to speak.
4. Gross-Motor – tasks which indicate the child’s
ability to sit, walk and jump.
MMDST KIT:
• MMDST manual
• Test Form
• Bright red yarn pom-pom
• Rattle with narrow handle.
• Eight 1-inch-colored wooden blocs (red, yellow,
blue, green)
• Small clear glass/bottle with 5/8-inch opening.
• Small bell with 2% inch-diameter month.
• Rubber ball 12 ½ inches in circumference.
• Cheese curls
• Pencil
Age & the Age Line
• The exact age is computed by subtracting the
child’s birth date with the test date. After
computing, draw the age line in the test form.
• Example #1:
Birthdate: September 12, 2020
Date of test: December 22, 2020
 • No opportunity (NO)
• *Failure of an item that is completely to the left
of the child’s age line is considered as a
developmental delay and is therefore referred in
MMDST as a delay.
Test Items

• There are 105 test items but not all are

ADJUSTMENT FOR PREMATURITY
• Prematurity may affect the ability of the child to
perform or demonstrate items that other normal
children pass the same age.
• Make adjustments if the child is 2 years or
younger. Subtract the number of weeks of
prematurity.
• If more than 2 years, it is no longer necessary
to compensated for prematurity.
• No adjustment should be made for children
born later than expected.
ACTUAL AGE – number of weeks of Prematurity =
Adjusted Age
Example:
administered. The examiner prioritizes items
that the age line passes through. It is however
imperative to explain to the parent or caregiver
that the child is not expected to perform all the
tasks correctly. If the sequence were to be
followed, the examiner should start with
personal-social then progressing to the other
sectors. Items that are footnoted with “R” can
be passed by report.
• Age is marked in months for 1-24, and in years
from 2% to 6%.
Test Form
• The BAR representing the item is located
between the age scale to show when 25%, 50%
(indicated by the hatch mark), 75% and 90% of
the normal children are able to pass the item.

A child born 5 weeks premature has an actual age

of 13 months.
Actual Age = number of weeks of prematurity =
Adjusted age
13 months-5weeks – 11 ¾ months
Therefore, the actual age of the child is 11 ¾
months.
Selecting Items to be Administered

• Items to be administered first are those through

which the child’s chronological age line passes.
• If a failure occurs in any of these items, proceed
to administer items to the left of the age line
until you obtain 3 passes, then stop.
• In items passed, continue testing to the right
where the items become progressively more
difficult until the child fails three times in that
sector.
Remember:
1. All items crossing the age line should be
administered.
2. The child should have a minimum of 3 passes
to they left of any failure.
3. Each sector should have at least three passes
and three failures.
Selecting Items to be Administered:

• The number of items to be administered will

vary with the age and ability of the child.
• Normally, a child is tested on only 20 simple
tasks or items.
• The child may accomplish some of the tasks on
his own without being asked.
Test Scores:

• Passed (P)
• Failed (F)
• Refused (R)