Leopolds Maneuver is preferably performed after 24 weeks gestation when fetal outline can be already palpated. Preparation: 1. 2. 3. 4. 5. 6.

Instruct woman to empty her bladder first. Place woman in dorsal recumbent position, supine with knees flexed to relax abdominal muscles. Place a small pillow under the head for comfort. Drape properly to maintain privacy. Explain procedure to the patient. Warms hands by rubbing together. (Cold hands can stimulate uterine contractions). Use the palm for palpation not the fingers. Purpose Procedure Findings

First Maneuver: To determine fetal Using both hands, Head is more firm, hard and round Fundal Grip part lying in the feel for the fetal that moves independently of the fundus. part lying in the body. To determine presentation. fundus. Breech is less well defined that moves only in conjunction with the body. Fetal back is smooth, hard, and resistant surface Knees and elbows of fetus feel with a number of angular nodulation

Second Maneuver: Umbilical Grip

To identify location of fetal back. To determineposition.

One hand is used to steady the uterus on one side of the abdomen while the other hand moves slightly on a circular motion from top to the lower segment of the uterus to feel for the fetal back and small fetal parts. Use gentle but deep pressure. Using thumb and finger, grasp the lower portion of the abdomen above symphisis pubis, press in slightly and make gentle movements from side to side. Facing foot part of the woman, palpate fetal headpressing downward about 2

Third Maneuver: Pawliks Grip

To determine engagement of presenting part.

The presenting part is notengaged if it is not movable. It is not yet engaged if it is still movable.

Fourth Maneuver: Pelvic Grip

To determine the degree of flexion of fetal head. To determine attitude or

Good attitude if brow correspond to the side (2nd maneuver) that contained the elbows and knees. Poor atitude if examining fingers

habitus.

inches above the will meet an obstruction on the inguinal ligament. same side as fetal back Use both hands. (hyperextended head) Also palpates infants anteroposterior position. If brow is very easily palpated, fetus is at posterior position (occiput pointing towards womans back)

A /G = albumin/globulin ratio ABG = arterial blood gases AC = before eating ACE = angiotensin converting enzyme ACL = anterior cruciate ligament ACLS = advanced cardiac life support ACTH = adrenocorticotropic hormone ad lib = as much as needed ADH = anti-diuretic hormone ADL = activities of daily living AFB = acid-fast bacilli AFP = alpha-fetoprotein AGA = appropriate for gestational age AI = aortic insufficiency AIDS = acquired immune deficiency syndrome AKA = above knee amputation ALD = alcoholic liver disease ALL = acute lymphocytic leukemia ALP = alkaline phosphatase ALT = alanine transaminase, alanine aminotransferase ATN = acute tubular necrosis AU = both ears AV = atrioventricular B.S. = Bachelor of Science B/K = below knee BM = bowel movement or breast milk BX = biopsy c = with C/O = complaining of CA = calcium, cancer, carcinoma CAA = crystalline amino acids CABG = coronary artery bypass graft

CAD = coronary artery disease CAPD = continuous ambulatory peritoneal dialysis CAT = computerized axial tomography CBC = complete blood count CBD = common bile duct CBG = capillary blood gas CBI = continuous bladder irrigation CBS = capillary blood sugar CC = chief complaint CCK = cholecystokinin CCPD = continuous cyclic peritoneal dialysis CCU = clean catch urine or cardiac care unit CCV = critical closing volume CF = cystic fibrosis CHF = congestive heart failure CHO = carbohydrate CI = cardiac index CLT = Clinical Laboratory Technician CML = chronic myelogenous leukemia CN = cranial nerves CNS = central nervous system CO = cardiac output COPD = chronic obstructive pulmonary disease CP = chest pain, cleft palate CPD = cephalo-pelvic disproportion CPK = creatinine phosphokinase CPP = cerebral perfusion pressure CPR = cardiopulmonary resuscitation CRCL = creatinine clearance CRF = chronic renal failure CRT = capillary refill time CSF = cerebrospinal fluid CT = computerized tomography CVA = cerebral vascular accident, costovertebral angle CVP = central venous pressure D5W = 5% dextrose in water DAT = diet as tolerated DC = (dc) discontinue DIC = disseminated intravascular coagulopathy DKA = diabetic ketoacidosis DM = diabetes mellitus DNA = deoxyribonucleic acid

DNR = do not resuscitate DOA = dead on arrival DOE = dyspnea on exertion DPT = diphtheria, pertussis, tetanus DTR = deep tendon reflexes DVT = deep venous thrombosis DX = diagnosis EAA = essential amino acids EBL = estimated blood loss EBV = Epstein-Barr Virus ECF = extracellular fluid, extended care facility ECG = electrocardiogram ECT = electroconvulsive therapy EENT = eye, ear, nose and throat EFAD = essential fatty acid deficiency EMG = electromyogram EMV = eyes, motor, verbal response (Glasgow coma scale) ENT = ears, nose, and throat EOM = extraocular muscles ESR = erythrocyte sedimentation rate ESRD = end stage renal disease ET = endotracheal tube ETT = endotracheal tube EUA = examination under anesthesia FBS = fasting blood sugar FDA = Food & Drug Administration FEV = forced expiratory volume FFP = fresh frozen plasma FNP = Family Nurse Practitioner GB = gallbladder GC = gonorrhea GERD = gastroesophageal reflux disease GFR = glomerular filtration rate GI = gastrointestinal GSW = gun shot wound GTT = glucose tolerance test GU = genitourinary HB = hemoglobin HBP = high blood pressure HCG = human chorionic gonadotropin HCO3 = bicarbonate

Side A 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. @ abd ad lib AROM ADL A/O amb. adm amt. Approx.

Side B at abdomen, abdominal as desired active range of motion activities of daily living alert and oriented ambulate, ambulatory admit, admission amount approximate 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.

Side A aa ABO AAROM a.c. ax AKA amp A.M. ant A&P

Side B of each The main blood group system Active Assisted Range of Motion before meals axillary above knee amputation amputation morning anterior anterior and posterior