1|MATERNAL AND CHILD NURSING RLE

LESSON 1: LABOR AND DELIVERY

PRENATAL ASSESSMENT AND HISTORY TAKING
- LMP
- EDD
- AOG
- G_T_P_A_L_
- G_P_
- Fetal Heart Rate

NAEGELE'S RULE, derived from a German obstetrician,

subtracts 3 months and adds 7 days to calculate the
estimated due date (EDD).
FUNDAL HEIGHT, OR MCDONALD'S RULE, is a measure
of the size of the uterus used to assess fetal growth and
development during pregnancy. It is measured from the B. DELIVERY STAGE
top of the mother's uterus to the top of the mother's
- Second stage of labor: Begins when the
pubic symphysis.
mother's cervix is fully dilated until the baby is
delivered.
AGE OF GESTATION
Normal Mechanism of Labor
- McDonald’s Rule ✓ Engagement
➢ Use fundal height measurement, ✓ Descent
measure from the symphysis to the top ✓ Flexion
of the fundus ✓ Internal Rotation
➢ Months= measure cm. x2/7 ✓ Extension/Crowning
➢ Weeks= measure cm. x8/7 ✓ Restitution
- Mrs. Andrew’s fundal height is 7cm. How far ✓ External Rotation
along is she? ✓ Expulsion
SAMPLE QUESTION: C. PLACENTAL STAGE
1. A 30-year-old female pregnant came to the - Third stage of labor: The part of labor that lasts
clinic with twins. She has 5 living children. Four from the birth of the baby until the placenta and
of the 5 children were born at 39 weeks fetal membranes are delivered
gestation and one child was born at 27 weeks
gestation. Two years ago, she had a SIGNS OF PLACENTAL SEPARATION
miscarriage at 10 weeks gestation. She stated
- The most reliable sign is the lengthening of the
her LMP was August 22, 2021. Answer for the
umbilical cord as the placenta separates and is
following using the date today: GTPAL, G P,
pushed into the lower uterine segment by
EDD, AOG.
progressive uterine retraction. ...on a more
➢ LMP August 22, 2021
globular shape and becomes firmer. ...
➢ EDD 5 - 29 – 22
- The uterus rises in the abdomen. ...
➢ AOG approx. 24 - 25 weeks
➢ G7 - T4 - P1- A1 - L5 - A gush of blood occurs.
➢ G7 - P5 ➢ Duncan presentation
➢ Shultz presentation
➢ Brandt Andrew Maneuver
FETAL HEART RATE
➢ Crede Maneuver
- The average fetal heart rate is between 110 and
160 beats per minute. It can vary by 5 to 25
D. RECOVERY STAGE
beats per minute. The fetal heart rate may
change as your baby responds to conditions in - Birth of placenta to 4 hours post-partum
your uterus. - WOF bleeding (check bleeding)
- V/S Monitoring
LABOR AND DELIVERY
- Stages of Labor

A. CERVICAL STAGE
- First stage of labor: Begins at the onset of labor
until the mother's cervix is fully dilated
➢ Latent Phase
➢ Active Phase
➢ Transition Phase

MATERNAL, CHILD, ADOLESCENT RLE BY: CORPUZ, ROCE LEANNE A.

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LESSON 2: EINC
ESSENTIAL INTRAPARTUM AND NEWBORN CARE
(EINC)
- A package of evidence-based practices
recommended by the Department of Health
(DOH), Philippine Health Insurance
- PURPOSE: EINC is a series of time-bound and
evidence-based interventions for newborn
babies and their mothers that ensure the best
care for them.

UNANG YAKAP
- part of Essential newborn Care that is adopted
by the DOH to address the increasing mortality AT THE TIME OF DELIVERY
rate of neonates, and to save lives until first - Encouraged the woman to push as desired
week of life. - Draped the clean, dry linen over the mother’s
abdomen or arms in preparation for drying the
FOUR (4) TIME-BOUND INTERVENTIONS IN EINC baby
- immediate and thorough drying, - Applied perineal support and did controlled
- early skin-to-skin contact followed by, delivery of the head
- properly timed clamping and cutting of the cord - Called out time of birth and sex of the baby
after 1 to 3 minutes, and. - Informed the mother of outcome
- non-separation of the newborn from the mother
for early breastfeeding initiation and rooming-in.

PRIOR TO WOMAN’S TRANSFER TO THE DR

- Ensured that mother is in her position of choice
while in labor
- Asked mother if she wishes to eat/drink or void
- Communicated with the mother – informed her
of progress of labor, gave reassurance and
encouragement

WOMAN ALREADY IN THE DR

- Checked temperature in DR area to be 25-28C,
eliminated air draft
- Asked woman if she is comfortable in the semi FIRST 30 SECONDS
upright position - Thoroughly dried baby for at least 30 seconds,
- Ensured the woman’s privacy starting from the face and head, going down to
- Removed all jewelry then washed hands the trunk and extremities while performing a
thoroughly observing the WHO 1-2-3-4-5 quick check for breathing
procedure
- Prepared a clear, clean newborn resuscitation 1-3 MINUTES
area. Checked the equipment if clean, - Removed the wet cloth
functional and within easy reach. - Placed baby in skin-skin contact on the
- Arranged materials/supplies in a linear mother’s abdomen and chest
sequence - Covered baby with the dry cloth and the baby’s
- Gloves, dry linen, bonnet, oxytocin injection, head with a bonnet
plastic clamp, instrument clamp, scissors, 2 - Excluded a 2nd baby by palpating the abdomen
kidney basins. In a separate sequence for after in preparation for giving oxytocin.
the 1st breastfeed: eye ointment, (stethoscope - Used wet cloth to wipe the soiled gloves. Give
to symbolize PE), vit K, hep B and BCG IM Oxytocin within one minute of baby’s birth.
vaccines (plus cotton balls) Disposed of wet cloth properly
- Cleaned the perineum with antiseptic solution - Removed 1st set of gloves and decontaminated
- Washed the hands and put on 2 them properly
- pairs of sterile gloves aseptically (if same - Palpate umbilical cord to check for pulsations
worker handles perineum and cord) - After pulsations stopped, clamp cord using the
plastic clamp or cord tie at 2cm from the base
- Place the instrument clamp 5 cm from the base
- Cut near plastic clamp

MATERNAL, CHILD, ADOLESCENT RLE BY: CORPUZ, ROCE LEANNE A.

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PERFORMED THE REMAINING STEPS OF THE AMTSL:

(ACTIVE MANAGEMENT OF THE THIRD STAGE OF LABOR)
- Waited for strong uterine contractions then
applied controlled cord traction and counter
traction on the uterus, continuing until placenta
was delivered
- Massage the uterus until it is firm
- Inspected the lower vagina and perineum for
lacerations and repaired lacerations/tears as
necessary
- Examined the placenta for completeness and
abnormalities
- Cleaned the mother. Flushed perineum and
applied perineal pad/napkin
- Checked baby’s color and breathing; checked
that mother was comfortable, uterus is
contracted
- Disposed of the placenta in a leak proof
container or plastic bag
- Decontaminated instruments before cleaning,
decontaminated 2nd pair of gloves before
disposal, stating that decontamination lasts at
least 10 mins.
- Advised mother to maintain skin-skin contact.
Baby should be prone on mother’s chest
between the breasts with head turned to one
side.
15-90 MINUTES
- Advised mother to observe for feeding cues
- Supported mother, instructed her on positioning
and attachment
- Waited for full breastfeed to be completed
- After a complete breastfeed, administered eye
ointment (first) did thorough physical
examination, then did vit K, hep B and BCG
injections (simultaneously explained purpose of
each rationale)
- Advised OPTIONAL/DELAYED bathing of baby
(AND was able to explain the rationale)
- Advised breastfeeding per demand
- In the first hour: checked baby’s breathing and
color; and checked mother’s vital signs and
massaged uterus every 15 minutes
- In the second hour, checked mother-baby dyad
(share an intimate biological, social and
psychological relationship) every 30 minutes to
1 hour
- Completed all records
VACCINATION
- Eye Ointment- erythromycin- to prevent pink
eye in the first month of life” ophthalmia
neonatorum”. Common cause is chlamydia, a
sexually transmitted infection.
- HEPATITIS B- given to newborn baby’s
“insurance policy” against being infected with
the hepatitis virus. Within 12 hours
- VITAMIN K- given to form blood clots and to stop
bleeding. Vitamin deficiency bleeding (VKDB).
(0.5mg-weighing below 1,500g & 1.0mg-
weighing above 1,500mg).
- BCG-BACILLE CALMETTE-GUERIN- vaccine
given to baby to protect them from serious
forms of tuberculosis (TB) such as TB
meningitis (infection of the brain).

MATERNAL, CHILD, ADOLESCENT RLE BY: CORPUZ, ROCE LEANNE A.

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ANTHROPOMETRIC
- LENGTH-48CM-50 CM
LESSON 3: APGAR SCORE
- WEIGH- 2.5KG- 3.5KG
- HEAD CC- 33 CM-35 CM APGAR SCORE
- CHEST CC-30CM-33CM - The Apgar score is a scoring system doctors
- ABDOMINAL CC-33CM-35CM and nurses use to assess newborns one minute
and five minutes after they're born.
- THIGH CC-12-16CM
- the first test given to a newborn to determine its
- ARM CC-8-9CM
physical condition (occurs right after birth).
- recorded at 1 and 5 minutes after birth
SUMMARY - calculated by adding points, either 2,1, or 0 •
✓ Lays out material in linear manner. - best possible score is out of 10
✓ Wears sterile gloves. (Double gloving) - points given for muscle tone, skin color, heart
✓ Supports the perineum. rate, respiratory effort, and response to
✓ Calls out the time of birth and sex of the baby. stimulation
✓ Dries thoroughly the baby for full 30 seconds WHAT DO SCORES MEAN?
using the 1st towel. - after the 1-minute Apgar evaluation, if the
✓ Performs a rapid assessment of the baby’s newborn scores between a 7 and 10, it will
breathing. receive normal care from there on out.
✓ Initiates immediate skin-to skin contact. - if the newborn scores between a 4 and 6, they
✓ Positions the newborn prone on the mother’s may need help breathing anything lower than a
abdomen. 4, would mean that the infant needs extreme
✓ Covers the newborn’s back with a dry blanket. measures to save it's life
✓ Covers the newborn’s head with a bonnet.
✓ Removes the 1st set of gloves prior to cord DR. VIRGINIA APGAR
clamping and cutting. - created the system in 1952 and used her name
✓ Clamps and cuts properly timed cord between as a mnemonic for each of the five categories
1-3 minutes. that a person will score. Since that time,
✓ Injects oxytocin 10 IU to the mother’s deltoid. medical professionals across the world have
✓ Checks the mother’s condition and delivers the used the scoring system to assess newborns in
placenta. their first moments of life.
✓ Initiates breastfeeding for the 1st 30-60 minutes. - Medical professionals use this assessment to
✓ Administer ointment, Vit K, Hep B and BCG quickly relay the status of a newborn's overall
after the baby completes her breastfeeding. condition. Low Apgar scores may indicate the
✓ Performs anthropometric measurements. baby needs special care, such as extra help
with their breathing.
INDICATOR 0 PT 1 PT 2 PTS
ACTIVITY absent Flexed arms and Active
(muscle tone) legs
PULSE absent Below 100 bpm Above 100
(Heart rate) bpm
GRIMACE Floppy Minimal Prompt
(Reflex response to response to
irritability) stimulation stimulation
APPEARANCE Blue/ Pink body w/
(Skin color) pale blue extremities Pink
RESPIRATION absent Slow & irregular Vigorous cry
(breathing)

ACTIVITY
- Baby’s movement
- 0- no movement, almost limp (call for help)
- 1- some flexing in arms/ legs
- 2- active, arms and legs flex resist to extend

PULSE
- 0- no pulse (call for help)
- 1- less than 100 bpm (call for help)
- 3- higher or equal to 100 bpm

GRIMACE
- 0- no response
- 1- only facial expression
- 3- pulse away, cries, sneezes, etc

MATERNAL, CHILD, ADOLESCENT RLE BY: CORPUZ, ROCE LEANNE A.

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APPERANCE TAKES INTO ACCOUNT 2 THINGS:

- 0- Blue everywhere (call for help) - NEUROMUSCULAR MATURITY
- 1- Blue everywhere but torso (call for help) ➢ Posture
- 2- pink, normal ➢ Square window test
➢ Arm recoil
RESPIRATIONS ➢ Popliteal angle
- 0- Absent breathing (call for help) ➢ Scarf sign
- 1- slow, weak, irregular ➢ Heal to ear test
- 2- Strong cry, normal effort and rate - PHYSICAL MATURITY
➢ Skin
➢ Lanugo
EXAMPLE 1: ➢ Plantar surface
You’re collecting the 1-minute APGAR on a male ➢ Breast
newborn. You note the heart rate of 140 bpm. The ➢ Eye/ ears
baby’s cry is strong and regular, and body is pink with ➢ Genitals
slightly blue hands. There is some flexion of arms and - NEUROLOGICAL SIGNS ARE MORE RELIABLE
legs. While assessing, the newborn moves and cries. THAN PHYSICAL
What is your patients APGAR SCORE.
APGAR SCORE

EXAMPLE 2:
You’re assessing the five-minute APGAR. On
assessment, you note the following: HR 97pbm, no
response to stimulation, flaccid, absent respiration,
cyanotic throughout. What is the newborn APGAR
SCORE and your nursing interventions based on the
score.
APGAR SCORE

NEW BALLARD SCORE

- Developed by Dr. Jeanne L. Ballard, MD (1979)
- Used by healthcare professionals to determine
gestational age
- Estimation of postnatal maturation for an infant
born after 20 weeks of gestation.
- Based on the infant's external characteristics. –
- Covers 12 categories of neuromuscular
maturity and physical maturity.
- Each category is scored between 0 and 5.
Lowest score is 0 and highest is 54.
- For example: Score of 45 = 42 weeks; 20, = 32
weeks.

MATERNAL, CHILD, ADOLESCENT RLE BY: CORPUZ, ROCE LEANNE A.

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NEUROMUSCULAR MATURITY 5. SCARF SIGN

- Tests the passive tone of the flexors about the
1. POSTURE (AT REST) shoulder girdle
- As maturation progresses → increasing - The point on the chest to which the elbows
passive flexor tone move easily prior to significant resistance is
- Increasing passive flexor tone- centripetal noted
direction - Landmarks noted in order of increasing maturity
- Lower extremities slightly ahead of upper ➢ Full scarf at level of neck (-1)
extremities (caudo cephalad) ➢ Contralateral axillary line (0)
➢ Contralateral nipple line (1)
➢ Xyphoid process (2)
➢ Ipsilateral nipple line (3)
➢ Ipsilateral axillary line (4)

2. SQUARE WINDOW TEST

- Tests wrist flexibility and/or resistance to
extensor stretch 6. HEEL TO EAR
- At term and post term, the infant has maximum - Measure passive flexor tone about the pelvic
passive flexor tone and minimum passive girdle by testing for passive flexion or
extensor tone resistance to extension of posterior hip muscles
- Note location of the heel where significant
resistance
- Landmarks noted in order of increasing maturity
include resistance felt when the heel is at or
near
➢ Ear (-1)
➢ Nose (0)
➢ Chin level (1)
3. ARM RECOIL ➢ Nipple line (2)
- Focuses on passive flexor tone of biceps ➢ Umbilical area (3)
muscle ➢ Femoral crease (4)
- Briefly flex the elbow → extend briefly →release

4. POPLITEAL ANGLE
- This maneuver assesses maturation of passive
flexor tone about the knee joint by testing for
resistance to extension of the lower extremity.

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LEOPOLD MANEUVER STEPS

LEOPOLD’S MANEUVER
A. STEP 1: FUNDAL GRIP
- Leopold maneuvers are a systematic four-step - Here, you palpate the uppermost part of the
physical examination performed to evaluate the abdomen. This maneuver answers the question
fetal lie, presentation, and position of the fetus “What fetal part (i.e., head or buttocks)
in the uterus. occupies the fundus (i.e., top of the uterus)? “
- These obstetric maneuvers are performed after - Hence, you will know the fetal lie by performing
26 weeks of gestation. It is when the fetus is fundal grip or first Leopold maneuver.
matured enough that when you palpate the Additionally, at this step, fundal height is also
abdomen its outline can be easily distinguished. measured.
- According to studies, the accuracy of the - Fundal height will give you information about
Leopold maneuvers varies between 94% to gestational age. It can be measured using a
95% in a cephalic presentation when compared measuring tape – McDonald’s rule or just by
with ultrasonography. However, when the fetus palpating with finger breadths.
is not in a cephalic presentation, the clinician’s - Purpose of the first Leopold maneuver or the
ability to correctly determine the fetal position fundal grip is to determine fetal lie and fundal
significantly decreases. height.
HOW TO PERFORM:
HISTORY OF LEOPOLD MANEUVERS ➢ Stand client’s right side facing towards her
- The four classic obstetric grips known as face
Leopold maneuvers were first described and ➢ Warm-up both the hands
named after a German Gynecologist Dr. ➢ Place both the hands over the fundal area
Christian Gerhard Leopold (1846–1911). ➢ Then, palpate from one hand while applying
- Since then, it has become an essential clinical steady firm pressure with the other hand to
skill to assess the presentation, lie, and position make it easier to identify fetal parts
of the baby within the uterus. FINDINGS
- If you feel broad, firm, irregular soft mass
PURPOSE OF LEOPOLD MANEUVER indicates fetal buttocks is in the fundus. It
- The purpose of Leopold maneuvers are to means presentation is cephalic and the lie is
determine: longitudinal. This is the normal findings which
a. FETAL POSITION (fetal position is promotes normal vaginal delivery.
described as fetal presentation in relation - If you feel smooth, globular mass which is
to mother’s pelvis. For example, right ballotable [bounces between the palpating
occiput anterior [ROA], left occiput anterior hands – because head can move
[LOA], left sacrum anterior [LSA], and independently from its body] indicates fundus
more…) occupies the fetal head. It means presentation
b. FETAL LIE (fetal lie is described as where is breech – a malpresentation which must be
the fetus lies in relation to the mother’s documented and confirmed with
back. For example, longitudinal lie, ultrasonography for planning the safest mode of
transverse lie, and oblique lie) delivery for the mother and baby.
c. FETAL PRESENTATION (first fetal part that - If you feel the upper pole is empty, indicates a
presents into the maternal pelvis) transverse lie.
d. FETAL ATTITUDE (fetal attitude can be
determined after head is engaged) B. STEP 2: LATERAL OR UMBILICAL GRIP
e. FETAL MALPOSITION (occiput posterior - The second step answers “On which maternal
and occiput transverse positions) side does the fetal back is located?” The fetal’s
f. Approximate fetal weight and amount of back is the best location to auscultate its heart
amniotic fluid sound.
- Hence, the aim of this step is to locate the fetal
PREREQUISITES BEFORE THE PROCEDURE back and limbs. Additionally, you can determine
- Explain the Leopold maneuvers and their the position (i.e., ROA, LOA, etc.) of the fetus at
purpose to the pregnant mother this step.
- Obtain verbal consent HOW TO PERFORM
- Ask the client to empty her bladder ➢ Stand facing the client as the first maneuver
- Position patient in supine and legs partially ➢ Place both hands on either side of the
flexed from knees abdomen between flanks and umbilicus
- Ensure the patient is comfortable and relaxed ➢ Then, while steadily supporting with the right
- Expose the tummy (from the xiphoid process to hand, palpate with the left hand. Palpate using
pubic symphysis) and cover lower part of the deep gentle pressure in slightly circular motion
body with a sheet to provide privacy – It will help to easily identify the fetal parts.
- Ensure your hands are warm prior to palpation ➢ Repeat the steps on the other side as well
- How to position the patient for performing using opposite hands
Leopold maneuvers

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FINDINGS - Additionally, you can determine the degree of

- If you feel continuous smooth structure engagement. Hence, confirming the findings of
indicates its fetal back. It is the best place to the third maneuver.
monitor fetal heart rate. You may use a
fetoscope, stethoscope, or doppler to monitor HOW TO PERFORM
fetal heart rate (FHR). - In this step, stand facing towards client’s feet.
- If you feel irregular multiple knoblike structures This is the only maneuver performed facing
indicates its fetal limbs towards the woman’s feet.
- Also, you will be able identify fetal body parts - Place hands below the umbilicus, parallel to
from amniotic fluids and the fetal position, inguinal, and walk fingers around presenting
whether its ROA, LOA, and more part towards the midline and symphysis pubis.
- If the lie is transverse, head or breech may be - Fourth Leopold Maneuver
palpable from one of the sides of maternal
torso. FINDINGS
- If the fingers of both hands meet (converge)
C. STEP 3: PAWLIK’S GRIP below presenting part indicates presenting part
- answers the question “what is the presenting is floating (i.e., not engaged yet)
part? “ This step was modified by Czech - If the fingers of both hands diverge below the
Gynecologist Karel Pawlík (1849–1914). presenting part indicates presenting part is now
Hence, named Pawlik’s grip. engaged.
- Sometimes the third Leopold maneuver is also - In vertex presentation, if cephalic prominence is
referred as the first pelvic grip. felt on the opposite side of the back indicates
- The aim of this maneuver is to evaluate that the fetal head is well flexed.
presenting part into the pelvis and engagement. - If the head is deflexed or extended as in brow
and face presentation – you can palpate
HOW TO PERFORM cephalic prominence on the same side as the
➢ Stand facing the client’s face same as the first back, but you will feel a groove between the
and second maneuvers cephalic prominence and fetal back.
➢ Wide open your right hand – thumb on one side - You should be able to confirm the findings od
and four fingers on the other side, grasp the Pawlik’s grip
lower pole of the uterus just above the
symphysis pubis. Use your left hand to grasp CONTRAINDICATION
the fundus at the same time. - Leopold maneuvers should not be performed
➢ Then, try to move presenting fetal part between during uterine contractions.
your thumb and four fingers.
➢ This maneuver usually causes some discomfort COMPLICATIONS
to the mother. So, be gentle and cautious during - Leopold maneuvers do not have any significant
this step. complications. It may cause mild discomfort to
the mother especially during the third
FINDINGS maneuver. And some very rare cases, it may
- If the lie is longitudinal and presentation is trigger uterine contractions.
vertex, and head not engaged – you will feel the
head of the fetus between your fingers. And it CONCLUSION
will be ballotable. - Leopold maneuvers are a systematic method of
- If the presenting part is engaged (i.e., palpating a pregnant woman’s abdomen to
presenting part has already descended into the assess fetal position in utero. It helps determine
pelvic inlet), you will feel the less distinct mass. presentation, lie, position, and attitude.
- If the presenting part is breech, the mass will - Leopold maneuvers are an easy and cost-
feel much softer and smaller. Also, it won’t effective method of assessing pregnant
move independently of the body. women. However, the accuracy of the findings
- If the lie is transverse, like the empty fundus, is heavily dependent on the skills and
the lower pole of the uterus will also be empty. competency of the examiner.
Hence no fetal parts will be palpable.

D. STEP 4: PELVIC GRIP

- A.K.A deep pelvic grip. This final step of the
Leopold maneuver answers the question “Is the
fetal head engaged in the pelvis and what is the
attitude?”
- This step will help you to confirm the presenting
part of the fetus and its descent into the pelvis.
If the presentation is vertex, you can determine
the relation of the cephalic prominence to the
fetal back to evaluate the fetal attitude.

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DEFINITION OF LEOPOLD’S MANEUVERS IMPLEMENTATION WITH RATIONALE

- Are a common and systematic ways to PREPARATIONS
determine the position of a fetus inside the 1. Prepare the client
woman's uterus through observation and 2. Explain the procedure
palpation to determine fetal presentations and ➢ Explanation reduces anxiety and enhances
positions. cooperation
3. Instruct the client to empty her bladder.
OVERVIEW AND RATIONALE ➢ Doing so promotes comfort and allows for
- The maneuvers consist of four distinct actions, more productive palpation because fetal
each helping to determine the position of the contour will not be obscured by a distended
fetus. bladder
- The maneuvers are important because they 4. Position the woman supine with knees slightly
help determine the position and presentation of flexed.
the fetus which in conjunction with correct 5. Place a small pillow or rolled towel under one
assessment of the shape of the maternal side
- The examiner's skill and practice performing the ➢ Flexing the knees relaxes the abdominal
maneuvers are the primary factor in whether muscles. Using a pillow or towel tilts the
the fetal lie is correctly ascertained, and so the uterus off the vena cava, thus preventing
maneuvers are not truly diagnostic. supine hypotension syndrome.
- Actual position can only be determined by 6. Wash your hands using warm water
ultrasound performed by a competent ➢ Hand washing prevents the spread of
technician or professional. possible infection. Using warm water aids in
client comfort and prevents tightening of
PURPOSES abdominal muscle.
- These maneuvers help identify the ff: 7. Observe the woman’s abdomen for longest
✓ Number of fetuses diameter and where fetal movement is apparent
✓ Presenting part, fetal lie and fetal ➢ The longest diameter (axis) is the length of
attitude the fetus. The location of activity most likely
✓ Degree of the presenting part’s descent reflects the position of the feet.
into the pelvis
✓ Expected location of the point of THE FIRST MANEUVER (FUNDAL GRIP)
maximal impulse (PMI) of the fetal - Upper pole
heart tones on the woman’s abdomen - This maneuver determines whether fetal head
or breech is in the fundus
EQUIPMENT - To determine what part of the baby lies in the
- Examination table upper part of the uterus.
- Rolled Towel - Palpating, with both hands, the uterine fundus
- Top Sheet linen to determine PRESENTATION ("the presenting
- Pillow part"): that portion of the fetus in closest
- Basin and warm water (for hand washing) proximity to the birth canal, i.e., cephalic,
breech, shoulder presentations.
NURSING CONSIDERATIONS: 1ST M: 3 QUESTIONS TO BE ASKED
1. Patient should empty her bladder • relative consistency – the head is harder
2. Examiner’s hand should be warm than the breech.
3. Explain the procedure to the patient • shape – head is firm, round and hard.
4. Provide privacy Breech is softer and feels more angular.
5. Position patient in dorsal recumbent. 6 • Mobility - head will move independently of
6. Gentle yet firm touch the trunk but the breech only with the trunk.
NURSE ALERT: If it is hard, round, and movable, it is
NURSE ALERT: likely the head (indicating a breech presentation) and if
- The clinician notes the presence and rate of it is softer, more triangular, and not movable, it is
fetal heart sounds, as well as location for probably the buttock (indicating a cephalic presentation)
auscultation.
- Preliminary estimates of the strength, a. Stand at the foot of the client, facing her, and
frequency, and duration of contractions are also place both hands flat on her abdomen.
recorded. ➢ Proper positioning of hands ensures accurate
- A helpful mnemonic device for evaluation is the findings
3 Ps: b. Palpate the superior surface of the fundus.
✓ powers (contraction strength, Determine consistency, shape, and mobility.
frequency, and duration) ➢ When palpating, a head feels firmer than the
✓ passage (pelvic measurements) breech. A head is round and hard; the breech
✓ passenger (e.g., fetal size, position, is well defined. A head moves independently
heart rate pattern). of the body; the breech moves only in
conjunction with the body.

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THE SECOND MANEUVER (UMBILICAL GRIP) e. Facing the client, gently grasp the lower portion of
- Sides of maternal abdomen the abdomen just above the symphysis pubis
- To determine in which side of the uterus of the between the thumb and index finger and try to
baby’s back is located. press the thumb and finger together. Determine
- Palpating, with both hands simultaneously, the any movement and whether the part is firm or soft.
sides of the uterus to locate the fetal back and ➢ If the presenting part moves upward so an
determine (with about 99% certainty) examiner’s hands can be pressed together,
POSITION: the relationship of a given landmark the presenting part is not engaged (not firmly
on the fetus to the mother's right and left settled into the pelvis). If the part is firm, it is
(Therefore there are two basic positions = Rt. the head; if soft, and then it is breech
And Lt.). Knowing where the back is (Rt. and NURSE ALERT: The examiner grasps the lower
Lt.) tells you the position 99% of the time. abdomen just above the symphysis pubis, between the
- Cephalic landmarks: occiput (vertex); sinciput thumb and fingers of the hand as Pawlicks grip. If the
(brow); mentum (face). presenting part is not engaged, it will be movable.
- Breech landmark: sacrum
- Shoulder landmark: acromion process of the THE FOURTH MANEUVER (PELVIC GRIP)
scapula - Presenting part evaluation
- LIE: the relationship of the long axis of the baby - This maneuver determines fetal attitude and
to the long axis of the mother, i.e., longitudinal, degree of fetal extension into the pelvis
transverse and oblique lies. - Should only be done if fetus is in cephalic
presentation. Information about the infant’s
c. Face the client and place the palms of each hand antero-posterior position may also be gained
on either of the abdomen from this final maneuver.
➢ Proper positioning of hands ensures accurate - To determine the location of the cephalic
findings. prominence or the brow.
- With the fingers of each hand on the sides of
d. Palpate the sides of the uterus. Hold the left-hand the uterus suprapubicly, exerting deep pressure
stationary on the left side of the uterus while the in the direction of the axis of the pelvic inlet to
right hand palpates the opposite side of the uterus reinforce the impression of engagement or lack
from top to bottom. Then hold the right hand thereof and to determine the ATTITUDE: the
steady and repeat palpation using the left hand on relationship of the long axis of the fetal head to
the left side. the long axis of the fetal trunk (neck flexed,
➢ This method is most successful to determine neutral or extended)
the direction the fetal back is facing. One - CEPHALIC PROMINENCE: that portion of the
hand will feel a smooth, hard, resistant baby's headfirst encountered with the Fourth
surface (the back), while on the opposite side; Maneuver; enabling the examiner to determine
number of angular nodulations (the knees which fetal landmark to use to ultimately
and elbows of the fetus) will be felt. determine position.
NURSE ALERT: If you feel a smooth, curved resistant • When the cephalic prominence is on the
plane in one side, you have located the back and on the side opposite the baby's back, the occiput
other side, you feel smaller lumps, irregular parts, those (vertex) is presenting.
are the the knees and elbows of the fetus. • When the cephalic prominence is on the
same side as the baby's back, the mentum
THE THIRD MANEUVER (PAWLIK’S GRIP) (face) is presenting.
- Lower pole • When the cephalic prominence seems the
- This maneuver determines the part of the fetus same on both sides, the sinciput (brow) is
at the inlet and its mobility. presenting.
- to determine what occupies the lower uterine • (When there is NO cephalic prominence,
segment and to determine whether it is the head may be way down in the pelvis, or
engaged or not. the breech may be presenting.)
- Pawlik's grip - grasping with the thumb and
fingers of one hand, the lower portion of the f. Facing the foot part of the client, place fingers on
maternal abdomen just above the symphysis both sides of the uterus approximately 2 inches
thus confirming the impressions of the First above the inguinal ligaments, pressing downward
Maneuver as well as providing information and inward in the direction of the birth canal. Allow
- ENGAGEMENT: when the biparietal diameter fingers to be carried downward.
of the fetal head reaches or passes the plane of ➢ The fingers of one hand will slide along the
the pelvic inlet. uterine contour and meet no obstruction,
- Standing to the mother's side and facing the indicating the back of the fetal neck. The
mother's feet other hand will meet an obstruction an inch or
so above the ligament- this is the fetal brow.
The position of the fetal brow should
correspond to the side of the uterus that
contained the elbows and knees of the fetus.

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➢ If the fetus is poor attitude, the examining

finger will meet an obstruction on the same PARTOGRAPH
side as the fetal back. That is, the fingers will
touch the hyper extended head. If the brow is - A tool to help in management of labor
very easily palpated (as if it lies under the - Guides birth attendant to identify women whose
skin), the fetus is probably in a posterior labor is delayed and therefore decide
position (the occiput is pointing toward the appropriate action
woman’s back).
NURSE CAUTION:
- Leopold's maneuvers are intended to be
performed by health care professionals, as they
have received training and instruction in how to
perform them.
- That said, as long as care is taken not to
roughly or excessively disturb the fetus, there is
no real reason it cannot be performed at home
as an informational exercise.
- It is important to note that all findings are not
truly diagnostic It is important to note that all
findings are not truly diagnostic, and as such
ultrasound is required to conclusively determine
fetal lie.

OBJECTIVES
- To understand the concept of the WHO
partograph
- To explain to mothers the significance of the
graph
- To record the observations accurately on the
graph
- To interpret the recorded findings, recognize
deviation from the norm, and decide on timely
referral
Monitor during labor…
- Progress of labor
- Cervical dilatation
- Contraction pattern
- Maternal well being
- Pulse, temperature, blood pressure
- Urine voided
- Fetal well being
- Fetal heart rate and pattern
- Color of amniotic fluid
- Vaginal bleeding

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CONDITIONS THAT DO NOT NEED THE USE OF PARTOGRAPH

- Antepartum hemorrhage
- Severe pre-eclampsia and eclampsia
- Fetal distress
- Previous cesarean section
- Multiple pregnancy
- Malpresentation
- Very premature baby
- Obvious obstructed labor

RECORDING THE FINDINGS IN THE PARTOGRAPH

- Start by labeling the record with pertinent
patient identifying information.

PLOTTING THE PROGRESS OF LABOR

- Plot only the CERVICAL DILATATION using
the symbol “X”
- Start when woman is in ACTIVE LABOR (4 cm
or more) and is contracting adequately (3-4
contractions in 10 minutes)

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EXAMPLES

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DISTINGUISHING NORMAL FROM ABNORMAL LABOR What to do if partograph passes alert line
PATTERN - Reassess woman and consider criteria for
referral.
- Alert transport services.
- Empty bladder.
- Ensure adequate hydration but omit solid foods.
- Encourage upright position and walking if
woman wishes.
- Monitor intensively. If referral long, reassess in
2 hours and refer if no progress.
- If partograph passes action line, refer urgently
to an EmOC facility unless imminent delivery.

If plotting reaches the action line…

- the patient must be already in an EmOC facility,
a decision made about the cause of slow
progress, and appropriate action taken

OTHER FINDINGS TO NOTE (AND RECORD) DURING IE

- Status of membranes, write “I” if intact
- If ruptured, note color of amniotic fluid, write
➢ “C” if clear
➢ “M” if meconium stained
➢ “A” if absent
➢ “B” if bloody
- Monitor every 4 hours* and record the findings
➢ Blood Pressure
➢ Pulse rate
➢ Temperature
➢ Urine voided (yes or no) * More
frequently, if indicated
- Monitor more frequently and record the findings
➢ Number of contractions in 10-minute
period
➢ Fetal heart rate in 1 full minute

➢ If woman is admitted in LATENT

PHASE of labor (less than 4 cm dilated)
– record only other findings (BP, FHT
etc).
➢ If she remains in latent phase for next
8 hours (labor is prolonged), transfer
her to hospital.

If plotting passes alert line …

- Reassess woman and consider referral if
facilities are not available to deal with obstetric
emergencies, unless delivery is imminent
- Alert transport services
- Monitor intensively

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- A G4P2 was referred at 5 pm. The midwife said

that the patient is at 4 cm cervical dilatation. At
9 pm, your IE showed 6 cm dilated cervix. At 1
am, another IE done showed 8 cm dilated
cervix, 50% effaced, station -1, intact BOW.

RECAP
- Significance and use of the partograph
- Parts of the partograph and information
contained in it
- Recording or plotting of clinical observations
- Interpretation of the recorded findings and
decision on referral

- A G2P1 was admitted at 2 am, IE showed a

4cm dilated cervix. The patient was still smiling,
and she was hesitant to be admitted. At 6 am,
another IE was done … 8 cm dilated cervix,
80% effaced, station 0. At 8 am, fetal head was
bulging at the perineum.

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STERILE GAUZE
ASSISTING DELIVERY - Used as surgical sponge
DUTIES AND RESPONSIBILITIES IN PERFORMING
ACTUAL DELIVERIES
PURPOSES:
- To provide encouragement and support to the
woman.
- To support the woman's pain management.
- To prepare the place of birth.
- To assess the fetal heart sounds and the labor
progress.
STERILE GLOVES
EQUIPMENT - Used to maintain sterile procedure or free from
- Prepare DR table, instruments needed in cross contamination or infection
delivery
MULTI PARA:
- 1 MAYO SCISSOR- use to cut the umbilical
cord
- 1 KELLY CLAMP (curve) –use to clamp the
cord toward the baby.
- KELLY CLAMP (straight ) – use to clamp the
cord toward the placenta.
- Other Equipments: MAYO TABLE
➢ Sterile gauze - Used to lay out the instruments
➢ Sterile towel
➢ Pair of gloves
➢ Mayo Table

MAYO SCISSORS
- Use to cut tough tissue and sutures
- For episiotomy

MAYO TABLE COVER

- Used cover the table and maintain sterility of the
equipment
KELLEY CURVE FORCEPS/CLAMP
- Use to clamp the umbilical cord towards the
baby.

KELLEY STRAIGHT FORCEPS & DISPOSABLE CORD CLAMP

- Use to clamp the umbilical cord toward the
placenta STERILE TOWEL
- Used as drape for the mayo table

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ADDITIONAL EQUIPMENTS: (if there is episiotomy) 2. Use pick up forceps to unwrap sterilize hypo
- 1 needle holder- use to hold the needle towel
• pick up sterile instruments and equipment
• To maintain sterility

- 1 tissue forceps - use to hold the skin for

suturing

- 1 suture (chromic 2-0): For episiorraphy and

repair of perineal laceration
3. Open and spread the hypo towel on the tray
exposing the sterile part
• use to lay materials needed during delivery

- 1 syringe (10 cc with g23 needle): Xylocaine 2%

(10 cc) used as anesthesia during 4. Unwrap autoclave instruments into the tray
episiorrhaphy • to expose the sterilized equipment

5. Lay the instruments in linear position

• to easy accessibility
PROCEDURE
1. Do hand washing
• To prevent the spread of microorganism

6. After care of instruments

• wash used instruments and soaked to cidex
• Cidex is used to disinfect instruments.

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DUTIES AND RESPONSIBILITIES IN ASSISTING DELIVERIES ➢ To reduce embarrassment and anxiety.

1. Transfer the client in the delivery room if cervix
is fully dilated and if client is primigravida. In
multigravida, transfer if the client is on 8cm
dilation
➢ to prevent precipitate labor

ACTUAL SETTING OF DELIVERY ROOM IN ITRMC

5. Placed the deflated kelly pad under the client’s

buttocks and direct the tip to a pail
➢ To maintain the area clean ad dry

6. Raise both legs on stirrups

➢ To promote safety in bearing down

2. Assist client in the delivery room

➢ to promote safety of the patient 7. Drape the legs exposing only the genital area
➢ to prevent the spread of microorganism causing
infection

3. Placed mother in semi upright position.

➢ to provide comfort and to facilitate easy delivery

4. Ensured the mother’s privacy.

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UNIVERSAL PRECAUTIONS
- Universal precautions are infection control
guidelines designed to protect people from
diseases spread by blood and certain body
fluids.
- Always assume that all "blood and body fluids"
are infectious for blood- borne diseases such as
HBV (Hepatitis B Virus), HCV (Hepatitis C
Virus) and HIV (Human Immuno-deficiency
Virus).
- These precautions are written in accordance
with guidelines established by the Center for AN INFECTIOUS AGENT/ETIOLOGIC AGENT:
Disease Control (CDC) and OSHA. • These - Pathogen/ Microorganisms
apply to all personnel. Universal Precautions - Capable of producing an infectious process
- standard preventive measures that are
normally taken by professional and health RESERVOIR
persons when they are handling sick people
- Source
with communicable diseases.
- anything (a person or animal or plant or
- This is for the purpose of preventing the spread
substance) in which an infectious agent
of a certain disease through infection
normally lives and multiplies
BODY FLUIDS WHICH REQUIRE UNIVERSAL PRECAUTIONS
PORTAL OF EXIT/ FROM
- Blood
- through sneezing, coughing, talking; open
- Anybody fluid with visible blood
wound; drainage.
- Wound secretions
- Vaginal secretions and semen
MODE OF TRANSMISSION
WHAT ARE BLOODBORNE PATHOGENS? - Way that the causative agent can be
transmitted to another reservoir or host where it
1. HEPATITIS B – HBV
can live by:
• Extremely contagious.
- Contact-Direct or indirect
• About 10% of those infected become - Airborne-droplet or droplet nuclei
carriers. Can live outside the body for up to - Vector- insects or animals
2 weeks. - Vehicle- food, water, blood medication
2. HEPATITIS C PORTAL OF ENTRY TO SUSCEPTIBLE HOST
• Very contagious.
- Refers to the method by which the pathogen
• Can live outside the body for 3-4 days. enters the body
- It can be through skin, GIT, respiratory tract,
3. HIV – AID – genito urinary tract
• HIV attacks the immune system, eventually
destroying the body’s ability to fight SUSCEPTIBLE HOST
infection.
- One whose biologic defense mechanisms are
• Note: There is no vaccine and no cure!! weakened in some way
Body Fluids which DO NOT require Universal
Precautions but are still a potential source of many
other types of infection.
- Urine
- Feces or stool (with no visible blood)
- Saliva (with no visible blood)
- Sputum/mucous (with no visible blood)
- Vomit (with no visible blood)
- Sweat
- Tears

HOW ARE GERMS TRANSMITTED? FIVE MODES:

- Airborne (Legionaires Disease)
- Droplets (Cold, Influenza, TB)
- Blood and Body Fluids (STD’s,HBV,HIV)
- Skin to Skin (Pinkeye, Ringworm)
- Oral/Fecal (Hepatitis A, Food Poisoning, e-coli)

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PRINCIPLES IN THE PREVENTION OF INFECTION HOW TO DON GLOVES

- Consider every person (patient or staff) - Don gloves last
infectious. - Select correct type and size
- Wash Hands- the most practical procedure for - Insert hands into gloves
cross-contamination (person to person). 3 - Extend gloves over isolation gown cuffs
- Wear gloves before touching anything wet-
broken skin, mucous membranes, blood or HOW TO SAFELY USE PPE
other body fluids (secretions and excretions) or - Keep gloved hands away from face
soiled instruments. - Avoid touching or adjusting other PPE
- Use physical barriers (protective goggles, face - Remove gloves if they become torn; perform
masks and apron) if splashes and spills of any hand hygiene before donning new gloves
body fluids are anticipated - Limit surfaces and items touched
- Use safe work practices, such as not recapping
or bending needles, dispose properly. “CONTAMINATED” AND “CLEAN” AREAS OF PPE
- Isolate patient only if secretions(airborne) or - Contaminated – outside front
excretions (urine and feces) cannot be ➢ Areas of PPE that have or are likely to have been
contained in contact with body sites, materials, or
- Decontaminate process for instruments and environmental surfaces where the infectious
other items by sterilizing. organism may reside
- Clean – inside, outside back, ties on head and
TYPES OF PPE USED IN HEALTHCARE SETTINGS back
➢ Gloves- protect hands ➢ Areas of PPE that are not likely to have been in
➢ Gowns/aprons- protect skin and/or clothing contact with the infectious organism
➢ Masks and respirators- protect mouth/nose
➢ Respirators – protect respiratory tract from SEQUENCE FOR REMOVING PPE
airborne infectious agents - Gloves
➢ Goggles- protect eyes - Face shield or goggles
➢ Face shields- protect face, mouth, nose, and - Gown
eyes - Mask or respirator

FACTORS INFLUENCING PPE SELECTION WHERE TO REMOVE PPE

a. Type of exposure anticipated - At doorway, before leaving patient room or in
• Splash/spray versus touch anteroom*
• Category of isolation precautions - Remove respirator outside room, after door has
b. Durability and appropriateness for the task been closed*
c. Fit
HOW TO REMOVE GLOVES (1)
SEQUENCE* FOR DONNING PPE - Grasp outside edge near wrist
- Gown first - Peel away from hand, turning glove inside-out
- Mask or respirator - Hold in opposite gloved hand
- Goggles or face shield
- Gloves HOW TO REMOVE GLOVES (2)
- Slide ungloved finger under the wrist of the
HOW TO DON A GOWN remaining glove
- Select appropriate type and size - Peel off from inside, creating a bag for both
- Opening is in the back gloves
- Secure at neck and waist - Discard
- If gown is too small, use two gowns
✓ Gown #1 ties in front REMOVE GOGGLES OR FACE SHIELD
✓ Gown #2 ties in back - Grasp ear or head pieces with ungloved hands
- Lift away from face
HOW TO DON A MASK - Place in designated receptacle for reprocessing
- Place over nose, mouth and chin or disposal
- Fit flexible nose piece over nose bridge
- Secure on head with ties or elastic Adjust to REMOVING ISOLATION GOWN
fit - Unfasten ties
- Peel gown away from neck and shoulder
HOW TO DON EYE AND FACE PROTECTION - Turn contaminated outside toward the inside
- Position goggles over eyes and secure to the - Fold or roll into a bundle
head using the earpieces or headband - Discard
- Position face shield over face and secure on
brow with headband
- Adjust to fit comfortably

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REMOVING A MASK
- Untie the bottom, then top, tie HANDWASHING
- Remove from face
- Discard - The most effective means of preventing
disease transmission
REMOVING A PARTICULATE RESPIRATOR - It should be done
- Lift the bottom elastic over your headfirst ✓ At the start of the day or when soiled.
- Then lift off the top elastic ✓ Before contact with food.
- Discard ✓ After using toilet facilities or assisting
with personal hygiene.
HAND HYGIENE ✓ After coming into contact with any
- Perform hand hygiene immediately after Potential Infectious Material, *even if
removing PPE. gloves were worn. *
➢ If hands become visibly contaminated during ✓ After handling or feeding pets.
PPE removal, wash hands before continuing to ✓ After working or playing outside.
remove PPE DO HAND WASHING PROPERLY...
- Wash hands with soap and water or use an - Wash hands thoroughly with soap and water for
alcohol-based hand rub 5 minutes. Rinse under running water. Dry
- *Ensure that hand hygiene facilities are hands.
available at the point
STEPS IN DOING HAND WASHING:
WHAT TYPE OF PPE WOULD YOU WEAR? 1. Wet hands before applying liquid soap.
a. Giving a bed bath? Generally, none 2. Rub palm to palm. 3
b. Suctioning oral secretions? Gloves and 3. Right palm over left dorsum and left palm over
mask/goggles or a face shield – sometimes right dorsum.
gown 4. Palm to palm with fingers interlaced.
c. Transporting a patient in a wheelchair? 5. Back of fingers to opposing palms with fingers
Generally, none required interlocked.
d. Responding to an emergency where blood is 6. Rotational rubbing of the right thumb clasped in
spurting? Gloves, fluid-resistant gown, left palm, and vice versa.
mask/goggles, or a face shield 7. Rotational rubbing backwards and forwards
e. Drawing blood from a vein? Gloves with tops of fingers and thumb of right hand to
f. Cleaning an incontinent patient with diarrhea? left, and vice versa.
Gloves w/wo gown 8. Rinse hands under running water.
g. Irrigating a wound? Gloves, gown, 9. Dry hands using paper towels. Dry palms and
mask/goggles, or a face shield back of hands.
h. Taking vital signs? Generally, none
MANAGING EXPOSURE INCIDENTS
USE OF PPE FOR EXPANDED PRECAUTIONS - Immediately wash hands and other skin
- Contact Precautions – Gown and gloves for surfaces that are contaminated.
contact with patient or environment of care - Mucous membranes or eyes must be flushed
(e.g., medical equipment, environmental with clear water.
surfaces) In some instances these are required - Allowing puncture wounds to bleed for a short
for entering patient’s environment period prior to washing will help to clean the
- Droplet Precautions – Surgical masks within 3 wound from the inside
feet of patient - All exposure incidents must be reported to your
- Airborne Infection Isolation – Particulate supervisor or the On- call supervisor as soon as
respirator it is safe to do so.
*Negative pressure isolation room also required - This includes:
✓ Staff to Staff,
✓ Individual to Individual
✓ Staff to Individual
✓ Individual to Staff.
- In addition to an Incident Report, an Exposure
Incident Report must be filled out and given to
your supervisor by the end of your shift.
- All employees who have been identified as
having potential exposure will be offered the
HBV vaccine.
- Receive prophylaxis

STANDARD PRECAUTIONS USE IN THE CARE OF ALL

HOSPITALIZED PERSONS REGARDLESS OF THEIR
DIAGNOSIS OR POSSIBLE INFECTION STATUS.

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ISOLATION- refers to measures design to prevent the

spread of infections or potentially infectious
BAG TECHNIQUE
microorganisms to health personnel's.
a. Specific Isolation precaution-strict isolation, COMMUNITY/PUBLIC HEALTH BAG
contact isolation, enteric isolation, - An essential and indispensable equipment of a
drainage/secretions isolation, blood and body public health nurse which she must carry along
fluid precaution during her home visits.
b. Disease –specific isolation precaution –for
specific diseases. BAG
c. Transmission –Based Precaution: Use in - It is a flexible, or dilated sac or pouch designed
addition to standard precaution, for clients with to contain needed article to carry from one
known or infections that are spread in one of place to another place to do the health-related
three ways: by airborne, droplet transmission or services to the people.
contact.
BAG TECHNIQUE
- Skills and expertise in preparing and using the
supplies and equipment in the Community
Health Bag to provide efficient nursing care to
clients while conserving time and effort.
- For the following purposes bag technique is
employed:
✓ to assess the need of the individual and
family
✓ to provide emergency first aid services
in case of minor ailments and
accidents-to provide primary medical
care in case of acute and
communicable diseases
✓ to provide antenatal, postnatal and
intranatal care to mothers
✓ to provide essential care to infants and
children to provide follow up services in
case of chronic illness
✓ to demonstrate nursing procedures- to
provide appropriate health educations.

COMPARTMENTS /CONTENTS OF THE PUBLIC HEALTH BAG:

Planning Supply/ Equipment's:
A. Outside pocket
➢ Top:
• Extra paper for making waste bag
• Plastic/linen lining
• Plastic lining
• 1 pair of sterile gloves
• Apron
➢ Front:
• Thermometer (oral/rectal)
• 2 test tubes
• Test tube holders
➢ Center:
• Cotton balls
• Baby’s scale
• Tape measure
• Sterile dressing
• Micropore plaster
• 2 pairs of scissors (surgical and bandage)
• 2 Pairs of forceps (curved and straight)
• Cord Clamp
• Disposable syringes with needles (g. 23 &25)
• Hypodermic needles (g.19,22,23,25)
• Alcohol lamp

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IMPORTANT POINTS TO CONSIDER IN THE USE OF THE

BAG TECHNIQUE
1. Handwashing is the single most important way.
• To prevent the spread of disease. To
prevent spread bacteria from the
environment of the patient to the patient
himself.
2. The bag should contain all necessary articles,
supplies and equipment that will be used. 2.
The bag and its contents should be cleansed
very often, supplies replaced and ready for use
anytime.
3. The bag and its contents should be well-
protected from contact with any article in the
patient’s home.
4. Consider the bag and its contents clean and
sterile, while articles that belong to the patients
as dirty and contaminated.
5. The arrangement of the contents of the bag
should be the one most convenient for the user,
to facilitate efficiency and avoid confusion.

SPECIAL CONSIDERATIONS
B - Bag and its contents must be free from any
contamination.
A - Always perform handwashing.
G - Gather necessary equipment to render effective
nursing care.

PRINCIPLES OF BAG TECHNIQUE

1. Minimize, if not prevent the spread of infection.
2. Saves time and effort of the nurse.
3. Should show effectiveness of total care given to
an individual or family.
4. Can be performed in a variety of ways

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PROCEDURE AFTER CARE

1. Cleans and alcoholizes all articles before
ASSESSMENT keeping in the bag.
1. Check bag and contents before home visit 2. Get the bag from the table,
2. Choose a work area where the bag can be • folds the paper lining (and inserts)
placed without risk of contamination. • and places in between the flaps and cover
(Verandah, etc.) the bag.

PLANNING EVALUATION AND DOCUMENTATION

1. Prepare a clean upper surface 1. Records all relevant findings about the client
2. Check the bag according to the sequence of and members of the family.
procedure before hand washing. 2. Takes note of the environmental factors which
affect the clients/family health
IMPLEMENTATION 3. Includes quality of nurse-patient relationship.
1. Upon arriving at the client's home, a. place the 4. Assess effectiveness of nursing care provided.
bag on the table or any flat surface lined with
paper lining, clean side out (folded part
touching the table). Puts the handle or strap
beneath the bag.
2. Asks for a basin of water if faucet is not
available.
3. Places this outside the work area
4. Opens the bag,
• takes the linen/plastic lining and spread
over the work field or area.
• the paper lining, clean side out (folded part
out)
5. Takes out hand towel, soap dish and apron and
places them at one corner of the work area
(within the confines of the linen/plastic lining)
6. Performs hand washing,
• wipes hands with dry towel.
• Leaves the plastic wrappers of the towel in
soap dish in the bag
7. Wears an apron:
• right side out and wrong side with crease
touching the body
• slides the head into the neck strap
• ties the straps neatly at the back.
8. Puts out things most needed for the specific
care (e.g., thermometer, kidney basin, cotton
ball, wastepaper bag) and places at one corner
of the work area.
9. Places wastepaper bag outside of work area.
10. Closes the bag.
11. Proceeds to the specific nursing care or
treatment.
12. Cleans and alcoholizes the things after
completing nursing care or treatment.
13. Performs hand washing again.
14. Opens the bag and put back all the cleaned
materials.
15. Removes apron folding away from the body,
with soiled side folded inwards, and the clean
side out and places it in the bag.
16. Folds the linen/plastic lining and places in the
bag and close.
17. Makes post visit conference on matters relevant
to health care, taking anecdotal notes
preparatory to final reporting.
18. Makes appointment for the next visit (either
home or clinic), taking note of the data, time and
purpose.

MATERNAL, CHILD, ADOLESCENT RLE BY: CORPUZ, ROCE LEANNE A.