Health care is part of the vast medical field that involves the study of detention, cureand prevention

of illness, sickness, injuries and physical and mental abnormalities. Midwifery is part of the health care
industry that cares for the individuals, familiesand society to attain, maintain and recover optimum
health so that they enjoyabetter quality of living.

A health assessment is a plan of care that identifies

the specific needs of a person and how those needs will be
addressed by the healthcare system or skilled nursing
facility. Health assessment is the evaluation of the health
status by performing a physical examafter taking
a health history. It is done to detect diseases early inpeople that may look and
feel well.
Evidence does not support routine health assessments in otherwise healthy people.
Health assessment is the evaluation of the health status of an individual along thehealth continuum.The
purpose of the assessment is to establish where on the healthcontinuum the individual is because this
guides how to approach and treat theindividual. The health care approaches range from preventive, to
treatment, to palliative care in relation to the individual's status on the health continuum. It is not the
treatment or treatment plan. The plan related to findings is a careplanwhich is preceded by the specialty
such as medical, physical therapy, nursing, etc.

Health History

The health history is a current collection of organized information unique toanindividual. Relevant aspects
of the history include biographical, demographic, physical, mental, emotional, sociocultural, sexual, and
spiritual data.

Purpose

The health history aids both individuals and health care providers by supplyingessential information
that will assist with diagnosis, treatment decisions, andestablishment of trust and rapport between
lay persons and medical professionals. The information also helps determine an individual's baseline,
or what is normal andexpected for that person.

Every person should have a thorough health history recorded as a component of aperiodic physical
examination . These occur frequently (monthly at first) in infantsand gradually reach a frequency of once
per year for adolescents and adults.
Description

The clinical interview is the most common method for obtaining a health history. When a person or a
designated representative can communicate effectively, theclinical interview is a valuable means for
obtaining information.

The information that comprises the health history may be obtained froma person'sprevious records, the
individual, or, in some cases, significant others or caretakers. The depth and length of the history-taking
process is affected by factors such as thepurpose of the visit, the urgency of the complaint or condition, the
person'swillingness or ability to contribute information, and the environment in whichinformation is
sought. When circumstances allow, a history may be holistic andcomprehensive, but at times only a cursory
review of the most pertinent facts ispossible. In cases where the history-gathering process needs to be
abbreviated, thehistory focuses on a person's medical experiences.

Health histories can be organized in a variety of ways. Often an organization suchasa hospital or clinic will
provide a form, template, or computer database that servesas a guide and documentation tool for the
history. Generally, the first aspect coveredby the history is identifying data.

PARTS OF HEALTH HISTORY

A.1. Biographic data

A.2. Nutritional status

A.3. Medical history

A.4. Family history

A.5. Gynecologic history

A.6. Obstetric history

A.1. Biographic Data-includes,

∙ Age

∙ Cultural consideration

∙ Marital status

∙ Occupation

∙ Education

∙ Religion
A.2. Nutritional Status- adequate nutrition is especially vital during pregnancy. Take a 24hour diet history
(recall) during pre-natal assessment. A woman who was average weight before getting pregnant should gain 25
to 35 pounds after becoming pregnant. Underweight women should gain 28 to 40 pounds. And overweight
women may need to gain only 15 to 25 pounds during pregnancy.
A.3. Medical History- findings if patient is taking over the counter (OTC) drugs or anyprescriptions. Also about
smoking practices, alcohol use, and use of illegal drugs brushing upon current events… ask pt. about previous
and current medical problems that mayjeopardize the pregnancy e.g:
 1. Diabetes

2. Maternal HPN

3. Rubella

4. Genital herpes

Other Obstacles

Specific problems that should be asked to pregnant woman includes;

1. Cardiac Disorders

2. Respiratory Disorders such as TB

3. Reproductive Disorders such as STD’s and endometriosis

4. Reproductive Disorders

5. Phlebitis

6. Epilepsy

7. Gallbladder Disorders

Also ask the patient if she has history of UTI, Cancer, Alcoholism, Smoking, Drugaddiction or
psychiatric problems.
A.4. Family/History- ask family history of

1. Varicose vein

2. Pregnancy Induced Hypertension (PIH)

3. Multiple Births

4. Congenital Diseases of Deformities

5. Mental Disabilities

A.5. Gynecologic History

1. Menstrual History

- Menarche plays a part

- Cramping her style

2. Contraceptive History

- Contraceptive catastrophes

3. Calculating EDC

Naegel’s Rule - count backward 3 months from the first day of the last menstrual cycle plus
7 days.
A.6. Obstetric History

1. Chronological History- Past to present history

 GPTPAL - Gravidity - no. of pregnancies

Parity - no. of living children

Term - no. of babies delivered term (37 weeks to 40 weeks AOG)

Pre-term- no. of pre-maturely delivered babies( more than

20 weeks and below 37 weeks AOG)

Abortion - terminated pregnancy before it the ageof

viability whether therapeutic/

spontaneous

Live - no. of living children

Physical Assessment

- Includes evaluation of maternal and fetal well being

a. Rounding the baseline- weight/height/vital signs

b. Scheduled surveillance- monthly

c. Regular prenatal visit

Equipment Checklist

Depending on the type of assessment conducted, the nurse may need specific equipment, states
Zucchero.

Basic equipment includes:

∙ Gloves

∙ Thermometer
∙ Blood pressure cuff
∙ Watch
∙ Scale
∙ Height wall ruler

∙ Tape measure,

∙ Penlight
∙ Stethoscope

Additional equipment for more comprehensive examinations would include,

∙ Otoscope
 ∙ Ophthalmoscope
∙ Reflex hammer
∙ Tongue depressor
∙ Sterile sharp object (like toothpick or pin)
∙ Sterile soft object (like cotton ball)
∙ Something for the patient to smell (like an alcohol swab)

Physical assessment

⮚ a systematic data collection method that uses the senses of sight, hearing, smell and touch to detect
health problems.There are four techniques used in physical assessment and these are: Inspection,
palpation, percussion and auscultation. Usually history taking is
completed before physical examination Inspection

▪ It’s the use of vision to distinguishthe

normal from the abnormal findings.Body
parts are inspected to identify color, shape,
symmetry, movement, pulsation and
texture.
▪
Principles of inspection

▪ Availability of adequate light

▪ Position and expose body part to view all surfaces
▪ Inspect each area for size, shape, color, symmetry, Positionandabnormalities.
▪ If possible compare each area inspected with the same area on the oppositeside.
▪ Use additional light to inspect body cavities
Palpation

▪ It involves use of hands to touch body parts for

data collection.
▪ The nurse uses fingertips and palms to determine
the size, shape, and configuration of
underlying body structure and pulsation of blood
vessels.
▪ It help to detect the outline of organs such as thyroid, spleen or liver and mobility of masses.
▪ It detects body temperature, moisture, turgor, texture, tenderness, thickness,
anddistention.
Principles of palpation

▪ Help client to relax and be comfortable because muscle tension impairs effective assessment.
▪ Advise client to take slow deep breaths during palpation
▪ Palpate tender areas last and note nonverbal signs of discomfort.
▪ Rub hands to warm them, have short fingernails and use gentle touch. Percussion

It is the technique in which one or both hands are used

to strike the body surface to produce a sound called
percussion note that travels through body tissue.

▪ The character of the sound determines the

location, size and density of underlying
structure to verify abnormalities.
▪ An abnormal sound suggest a mass or
substance like air, fluid in an organ or cavity.

Auscultation

▪ It involves listening to sounds and a stethoscope is mostly used. ▪ Various body systems like
cardiovascular, respiratory and gastrointestinal have characterized sounds.
▪ Bowel, breath, heart and blood movement sounds are heard using thestethoscope.
▪ It is important to know the normal sound to distinguish fromabnormal.
Preparation for physical exam

▪ Infection prevention– Follow IP precaution through out procedure ▪ Environment– P/A requires
privacy and away from other destructorsthroughout
▪ Equipment– Get all the necessary equipment, other equipment needs tobewarmed before
being placed on the body e.g. rubbing diaphragmof thestethoscope briskly between hands.
▪ Patient preparation– Prepare the patient physically and make the patient comfortable throughout
the physical assessment for successful exam.Explain
to the patient everything to be done.
General survey

▪ The assessment of the patient/client begins on the first contact. ▪ It includes apparent state of
health , level of consciousness, and signs of distress.
▪ The general height, weight, and build can be noted including skin color, dressing, grooming, personal
hygiene, facial expression, gait, odor, postureand motor activity.
 NOTE: If there is a sign of acute distress comprehensive health assessment is deferred until when
patient is stable.

Skull, Scalp & Hair

▪ Observe the size, shape and contour of

the skull.
▪ Observe scalp in several areas by
separating the hair at various locations;
inquire about any injuries. Note presence of lice, nits, dandruff or lesions. ▪ Palpate the head by
running the pads of the fingers over the entire surfaceof skull; inquire about tenderness upon
doing so. (wear gloves if necessary) ▪ Observe and feel the hair condition.

Normal Findings:

Skull
▪ Generally round, with prominences in the frontal and occipital area. (Normocephalic).
▪ No tenderness noted upon palpation.
Scalp

▪ Lighter in color than the complexion.

▪ Can be moist or oily.
▪ No scars noted.
▪ Free from lice, nits and dandruff.
▪ No lesions should be noted.
▪ No tenderness or masses on palpation.
Hair

▪ Can be black, brown or burgundy depending on the race.

▪ Evenly distributed covers the whole scalp (No evidences of Alopecia) ▪ Maybe thick
or thin, coarse or smooth.
▪ Neither brittle nor dry.

Face
 1. Observe the face for shape.
2. Inspect for Symmetry.
▪ Inspect for the palpebral fissure (distance
between the eye lids); should be
equal in both eyes.
▪ Ask the patient to smile, There should be
bilateral Nasolabial fold (creases extending from the angle of the corner of the mouth). Slight
asymmetry in the fold is normal.
▪ If both are met, then the Face is symmetrical
3. Test the functioning of Cranial Nerves that innervates the facial structures

CN V (Trigeminal)

1. Sensory Function
▪ Ask the client to close the eyes.
▪ Run cotton wisp over the fore head, check and jaw on both sides of the face. ▪ Ask the client if
he/she feel it, and where she feels it.
▪ Check for corneal reflex using cotton wisp.
▪ The normal response in blinking.
2. Motor function

▪ Ask the client to chew or clench the jaw.

▪ The client should be able to clench or chew with strength and force.

CN VII (Facial)

1. Sensory function (This nerve innervate the anterior 2/3 of the tongue).

▪ Place a sweet, sour, salty, or bitter substance near the tip of the tongue. ▪ Normally, the
client can identify the taste.
2. Motor function

▪ Ask the client to smile, frown, raise eye brow, close eye lids, whistle, or puff the cheeks.
Normal Findings

▪ Shape maybe oval or rounded.

▪ Face is symmetrical.
▪ No involuntary muscle movements.
▪ Can move facial muscles at will.
▪ Intact cranial nerve V and VII.

Eyebrows, Eyes and Eyelashes

▪ All three structures are assessed using the modality of inspection.

Normal findings

Eyebrows

▪ Symmetrical and in line with each other.

▪ Maybe black, brown or blond depending on race.
▪ Evenly distributed.
Eyes

▪ Evenly placed and inline with each other.

▪ None protruding.
 ▪ Equal palpebral fissure.
Eyelashes

▪ Color dependent on race.

▪ Evenly distributed.
▪ Turned outward.
Eyelids and Lacrimal Apparatus

1. Inspect the eyelids for position and symmetry.

2. Palpate the eyelids for the lacrimal glands.

a. To examine the lacrimal gland, the examiner, lightly slide the pad of the index finger against the
client’s upper orbital rim.
b. Inquire for any pain or tenderness.
3. Palpate for the nasolacrimal duct to check for obstruction.

a. To assess the nasolacrimal duct, the examiner presses with the index finger against the client’s
lower inner orbital rim, at the lacrimal sac, NOT AGAINST THE NOSE. b. In the presence of blockage, this will
cause regurgitation of fluid in the puncta Normal Findings

Eyelids

▪ Upper eyelids cover the small portion of the iris, cornea, and sclera when eyes areopen.
▪ No PTOSIS noted. (Drooping of upper eyelids).
▪ Meets completely when eyes are closed.
▪ Symmetrical.
Lacrimal Apparatus
 ▪ Lacrimal gland is normally non palpable.
▪ No tenderness on palpation.
▪ No regurgitation from the nasolacrimal duct.
Conjunctivae

▪ The bulbar and palpebral conjunctivae are

examined by separating the eyelids widely and
having the client look up, down and to each side.
When separating the lids, the examiner should
exert NO PRESSURE against the eyeball; rather, the
examiner should hold the lids against the ridges of
the bony orbit surrounding the eye.
In examining the palpebral conjunctiva, everting the upper eyelid in necessary andis done as follow:

1. Ask the client to look down but keep his eyes slightly open. This relaxes the levator muscles, whereas
closing the eyes contracts the orbicularis muscle, preventing lideversion.
2. Gently grasp the upper eyelashes and pull gently downward. Do not pull the lashes outward or
upward; this, too, causes muscles contraction.
3. Place a cotton tip application about I can above the lid margin and push gently downward with the
applicator while still holding the lashes. This everts the lid. 4. Hold the lashes of the everted lid against
the upper ridge of the bony orbit, just beneath the eyebrow, never pushing against the eyebrow.
5. Examine the lid for swelling, infection, and presence of foreign objects. 6. To return the lid to its normal
position, move the lid slightly forward and ask the client to look up and to blink. The lid returns easily to its
normal position. Normal Findings:

▪ Both conjunctivae are pinkish or red in color.

▪ With presence of many minutes capillaries.
▪ Moist
▪ No ulcers
▪ No foreign objects
Sclerae

▪ The sclerae is easily inspected during

the assessment of the conjunctivae.

Normal Findings
 ▪ Sclerae is white in color (anicteric sclera)
▪ No yellowish discoloration (icteric sclera).
▪ Some capillaries maybe visible.
▪ Some people may have pigmented positions.
Cornea

▪ The cornea is best inspected by directing penlight obliquely fromseveral positions.

Normal findings
▪ There should be no irregularities on the surface.
▪ Looks smooth.
▪ The cornea is clear or transparent. The features of the iris should be fully visible through the
cornea.
▪ There is a positive corneal reflex.
Anterior Chamber and Iris

▪ The anterior chamber and the iris are easily inspected in conjunction with the cornea. The technique of
oblique illumination is also useful in assessing the anterior chamber. Normal Findings:

▪ The anterior chamber is transparent.

▪ No noted any visible materials.
▪ Color of the iris depends on the person’s race (black, blue, brown or green). ▪ From the side view, the
iris should appear flat and should not be bulging forward. There should be NO crescent shadow casted
on the other side when illuminated from one side.
Pupils

▪ Examination of the pupils involves several

inspections, including assessment of the size, shape
reaction to light is directed is observed for direct
response of constriction. Simultaneously, the other
eye is observed for consensual response of constriction.
The test for papillary accommodation is the examination for the change in papillarysize as it is
switched from a distant to a near object.

▪ Ask the client to stare at the objects across room.

▪ Then ask the client to fix his gaze on the examiner’s index fingers, whichisplaced 5 – 5
inches from the client’s nose.
▪ Visualization of distant objects normally causes papillary dilationandvisualization of nearer
objects causes papillary constriction and convergenceof the eye.
Normal Findings
 ▪ Pupillary size ranges from 3 – 7 mm, and are equal in size. ▪ Equally round.
▪ Constrict briskly/sluggishly when light is directed to the eye, both directly andconsensual.
▪ Pupils dilate when looking at distant objects, and constrict when lookingat nearer objects.
If all of which are met, we document the findings using the notation PERRLA, pupilsequally round,
reactive to light, and accommodate

Cranial Nerve II (optic nerve)

▪ The optic nerve is assessed by testing for visual

acuity and peripheral vision.
▪ Visual acuity is tested using a snellen chart, for
those who are illiterate and unfamiliar with
the western alphabet, the illiterate E chart, in
which the letter E faces in different directions, maybe used. ▪ The chart has a standardized
number at the end of each line of letters; thesenumbers indicates the degree of visual acuity
when measured at a distanceof 20 feet.
▪ The numerator 20 is the distance in feet between the chart and the client, or the standard testing
distance. The denominator 20 is the distance fromwhich the normal eye can read the lettering,
which correspond tothenumber at the end of each letter line; therefore the larger
thedenominator the poorer the version.
▪ Measurement of 20/20 vision is an indication of either refractive error or some other optic
disorder.
In testing for visual acuity you may refer to the following:

▪ The room used for this test should be well lighted.

▪ A person who wears corrective lenses should be tested with and without them to check fro the
adequacy of correction.
▪ Only one eye should be tested at a time; the other eye should be coveredbyan opaque card or
eye cover, not with client’s finger.
▪ Make the client read the chart by pointing at a letter randomly at eachline; maybe started from
largest to smallest or vice versa.
▪ A person who can read the largest letter on the chart (20/200) shouldbechecked if they can
perceive hand movement about 12 inches fromtheir eyes, or if they can perceive the light of the penlight
directed to their yes. Peripheral Vision or visual fields

▪ The assessment of visual acuity is indicative of the functioning of the macular area, the area of central
vision. However, it does not test the sensitivity of theother areas of the retina which perceive the more
peripheral stimuli. The Visual
field confrontation test, provide a rather gross measurement of peripheral vision.
▪ The performance of this test assumes that the examiner has normal visual fields, since that client’s
visual fields are to be compared with the examiners. Follow the steps on conducting the test:
 1. The examiner and the client sit or stand opposite each other, with the eyes at the same,
horizontal level with the distance of 1.5 – 2 feet apart. 2. The client covers the eye with opaque
card, and the examiner covers theeyethat is opposite to the client covered eye.
3. Instruct the client to stare directly at the examiner’s eye, while the examiner stares at the client’s
open eye. Neither looks out at the object approachingfrom the periphery.
4. The examiner hold an object such as pencil or penlight, in his handandgradually moves it in from
the periphery of both directions horizontally andfrom above and below.
5. Normally the client should see the same time the examiners sees it. Thenormal visual field is
180 degrees.
Cranial Nerve III, IV & VI (Oculomotor, Trochlear, Abducens)

▪ All the 3 Cranial nerves are tested at the same timebyassessing the Extra Ocular
Movement (EOM) or thesix
cardinal position of gaze.
Follow the given steps:

1. Stand directly in front of the client and hold a finger or a penlight about 1ft from the client’s eyes.
2. Instruct the client to follow the direction the object hold by the examiner byeye movements
only; that is with out moving the neck.
3. The nurse moves the object in a clockwise direction hexagonally. 4. Instruct the client to fix his
gaze momentarily on the extreme position ineachof the six cardinal gazes.
5. The examiner should watch for any jerky movements of the eye
(nystagmus). 6. Normally the client can hold the position and there
should be no nystagmus. Ears

1. Inspect the auricles of the ears for parallelism,

size position, appearance and skin color.
2. Palpate the auricles and the mastoid process for firmness of the cartilageof the auricles,
tenderness when manipulating the auricles and the mastoidprocess.
3. Inspect the auditory meatus or the ear canal for color, presence of cerumen, discharges,
and foreign bodies.
▪ For adult pull the pinna upward and backward to straiten the canal. ▪ For children pull the
pinna downward and backward to straiten the canal 4. Perform otoscopic examination of the
tympanic membrane, noting the color andlandmarks.

Normal Findings

▪ The ear lobes are bean shaped, parallel, and symmetrical.

▪ The upper connection of the ear lobe is parallel with the outer canthus of theeye.
 ▪ Skin is same in color as in the complexion.
▪ No lesions noted on inspection.
▪ The auricles are has a firm cartilage on palpation.
▪ The pinna recoils when folded.
▪ There is no pain or tenderness on the palpation of the auricles and mastoidprocess.
▪ The ear canal has normally some cerumen of inspection.
▪ No discharges or lesions noted at the ear canal.
▪ On otoscopic examination the tympanic membrane appears flat, translucent and pearly gray in
color.
Nose and Paranasal Sinuses

The external portion of the nose is inspected for the

following:

1. Placement and symmetry.

2. Patency of nares (done by occluding nosetril one at a time, and noting for difficulty in breathing)
3. Flaring of alae nasi
4. Discharge
The external nares are palpated for:

1. Displacement of bone and cartilage.

2. For tenderness and masses
The internal nares are inspected by hyper extending the neck of the client, the ulnar aspect of the
examiners hard over the fore head of the client, and using the thumbto push the tip of the nose upward
while shining a light into the nares.

Inspect for the following:

1. Position of the septum.

2. Check septum for perforation. (Can also be checked by directing the lightedpenlight on the side
of the nose, illumination at the other side suggests perforation).
3. The nasal mucosa (turbinates) for swelling, exudates and change in color. Paranasal Sinuses

▪ Examination of the paranasal sinuses is indirectly. Information about their condition is gained by
inspection and palpation of the overlying tissues. Only frontal and maxillary sinuses are accessible for
examination.
▪ By palpating both cheeks simultaneously, one can determine tenderness of themaxillary sinusitis, and
pressing the thumb just below the eyebrows, we candetermine tenderness of the frontal sinuses.
Normal Findings
 ▪ Nose in the midline
▪ No Discharges.
▪ No flaring alae nasi.
▪ Both nares are patent.
▪ No bone and cartilage deviation noted on palpation.
▪ No tenderness noted on palpation.
▪ Nasal septum in the mid line and not perforated.
▪ The nasal mucosa is pinkish to red in color. (Increased redness turbinates aretypical of allergy).
▪ No tenderness noted on palpation of the paranasal sinuses.
Cranial Nerve I (Olfactory Nerve)

To test the adequacy of function of the

olfactory nerve:

1. The client is asked to close his eyes and occlude.

2. The examiner places aromatic and easily distinguish nose. (E.g. coffee).
3. Ask the client to identify the odor.
4. Each side is tested separately, ideally with two different substances.

Mouth and Oropharynx Lips

Inspected for:

1. Symmetry and surface abnormalities.

2. Color
3. Edema
Normal Findings:

1. With visible margin

2. Symmetrical in appearance and movement
3. Pinkish in color
4. No edema
Temporomandibular

Palpate while the mouth is opened wide and then closed for:

1. Crepitous
 2. Deviations
3. Tenderness
Normal Findings:

1. Moves smoothly no crepitous.

2. No deviations noted
3. No pain or tenderness on palpation and jaw movement.
Gums

Inspected for:

1. Color
2. Bleeding
3. Retraction of gums.
Normal Findings:

1. Pinkish in color
2. No gum bleeding
3.No receding gums
Teeth

Inspected for:

1. Number
2. Color
3. Dental carries
4. Dental fillings
5. Alignment and malocclusions (2 teeth in the space
for 1, or overlapping teeth).
6. Tooth loss
7. Breath should also be assessed during the process.

Normal Findings:

1. 28 for children and 32 for adults.

2. White to yellowish in color
3. With or without dental carries and/or dental fillings.
4. With or without malocclusions.
 5. No halitosis.
Tongue

Palpated for:

1. Texture
Normal Findings:

1. Pinkish with white taste buds on the surface.

2. No lesions noted.
3. No varicosities on ventral surface.
4. Frenulum is thin attaches to the posterior 1/3 of the ventral aspect of the tongue. 5. Gag reflex is
present.
6. Able to move the tongue freely and with strength.
7. Surface of the tongue is rough.
Tonsils

Inspected for:

1. Inflammation
2. Size
A Grading system used to describe the size of
the tonsils can be used.

▪ Grade 1 – Tonsils behind the pillar.

▪ Grade 2 – Between pillar and uvula.
▪ Grade 3 – Touching the uvula
▪ Grade 4 – In the midline.

Neck

▪ The neck is inspected for position symmetry and

obvious lumps visibility of the thyroid gland and
Jugular Venous Distension
Normal Findings:

1. The neck is straight.

2. No visible mass or lumps.
3. Symmetrical
4. No jugular venous distension (suggestive of cardiac congestion).
The neck is palpated just above the suprasternal note using the thumb and the indexfinger.

Normal Findings:

1. The trachea is palpable.

2. It is positioned in the line and straight.
▪ Lymph nodes are palpated using palmar tips of the fingers via systemic circular movements. Describe lymph
nodes in terms of size, regularity, consistency, tenderness and fixation to surrounding tissues.
Normal Findings:
▪ May not be palpable. Maybe normally palpable in thin clients.
▪ Non tender if palpable.
▪ Firm with smooth rounded surface.
▪ Slightly movable.
▪ About less than 1 cm in size.
▪ The thyroid is initially observed by standing in front of the client and asking the client to swallow.
Palpation of the thyroid can be done either by posterior or anterior approach.
Posterior Approach:

1. Let the client sit on a chair while the examiner stands behind him. 2. In examining the isthmus of the
thyroid, locate the cricoid cartilage and directly below that is the isthmus.
3. Ask the client to swallow while feeling for any enlargement of the thyroid isthmus. 4. To facilitate
examination of each lobe, the client is asked to turn his head slightly toward the side to be examined to
displace the sternocleidomastoid, while the other hand of the examiner pushes the thyroid cartilage
towards the side of the thyroid lobe to be examined.
5. Ask the patient to swallow as the procedure is being done.
6. The examiner may also palate for thyroid enlargement by placing the thumb deeptoand behind the
sternocleidomastoid muscle, while the index and middle fingers areplaced deep to and in front of
the muscle.
7. Then the procedure is repeated on the other side.

Anterior approach:

1. The examiner stands in front of the client and with the palmar surface of the middleand index
fingers palpates below the cricoid cartilage.
 2. Ask the client to swallow while palpation is being done.
3. In palpating the lobes of the thyroid, similar procedure is done as in posterior approach. The client is
asked to turn his head slightly to one side and then the other of the lobe to be examined.
4. Again the examiner displaces the thyroid cartilage towards the side of the lobe tobeexamined.
5. Again, the examiner palpates the area and hooks thumb and fingers around the sternocleidomastoid
muscle.
Normal Findings:

1. Normally the thyroid is non palpable.

2. Isthmus maybe visible in a thin neck.
3. No nodules are palpable.
Auscultation of the Thyroid is necessary when there is thyroid enlargement. The examiner may hear
bruits, as a result of increased and turbulence in blood flowinanenlarged thyroid.

▪ Check the Range of Movement of the neck.

Breast

Inspection of the Breast

There are 4 major sitting position of the client used for

clinical breast examination. Every client should be
examined in each position.

1. The client is seated with her arms on her side.

2. The client is seated with her arms abducted over the head.
3. The client is seated and is pushing her hands into her hips, simultaneously eliciting contraction of the
pectoral muscles.
4. The client is seated and is learning over while the examiner assists in supporting andbalancing her.
▪ While the client is performing these maneuvers, the breasts are carefully observedfor
symmetry, bulging, retraction, and fixation.
▪ An abnormality may not be apparent in the breasts at rest a mass may cause the breasts, through
invasion of the suspensory ligaments, to fix, preventing themfromupward movement in position 2 and
4.
▪ Position 3 specifically assists in eliciting dimpling if a mass has infiltrated and shortened suspensory
ligaments.
Normal Findings:

1. The overlying the breast should be even.

2. May or may not be completely symmetrical at rest.
 3. The areola is rounded or oval, with same color, (Color va,ies form light pink to dark brown depending on
race).
4. Nipples are rounded, everted, same size and equal in color.
5. No “orange peel” skin is noted which is present in edema.
6. The veins maybe visible but not engorge and prominent.
7. No obvious mass noted.
8. Not fixated and moves bilaterally when hands are abducted over the head, or is learning forward.
9. No retractions or dimpling.
Palpation of the Breast
▪ Palpate the breast along imaginary concentric circles, following a clockwise rotary motion, from the
periphery to the center going to the nipples. Be sure that the breast is adequately surveyed. Breast
examination is best done 1 week post menses.
▪ Each areolar areas are carefully palpated to determine the presence of underlying masses.
▪ Each nipple is gently compressed to assess for the presence of masses or discharge. Normal
Findings:

▪ No lumps or masses are palpable.

▪ No tenderness upon palpation.
▪ No discharges from the nipples.
NOTE: The male breasts are observed by adapting the techniques used for female clients. However, the
various sitting position used for woman is unnecessary.

Abdomen

▪ In abdominal assessment, be sure that the client has

emptied the bladder for comfort. Place the client ina
supine position with the knees slightly flexed to relax
abdominal muscles.
Inspection of the abdomen

▪ Inspect for skin integrity (Pigmentation, lesions, striae, scars, veins, and umbilicus). ▪ Contour
(flat, rounded, scapold)
▪ Distension
▪ Respiratory movement.
▪ Visible peristalsis.
▪ Pulsations
Normal Findings:

▪ Skin color is uniform, no lesions.

▪ Some clients may have striae or scar.
 ▪ No venous engorgement.
▪ Contour may be flat, rounded or scapoid
▪ Thin clients may have visible peristalsis.
▪ Aortic pulsation maybe visible on thin clients.
Auscultation of the Abdomen

▪ This method precedes percussion because bowel motility, and thus bowel sounds, may be
increased by palpation or percussion.
▪ The stethoscope and the hands should be warmed; if they are cold, they may initiatecontraction of
the abdominal muscles.
▪ Light pressure on the stethoscope is sufficient to detect bowel sounds and bruits. Intestinal sounds are
relatively high-pitched, the bell may be used in exploring arterial
murmurs and venous hum.
Peristaltic sounds

▪ These sounds are produced by the movements of

air and fluids through the gastrointestinal tract.
Peristalsis can provide diagnostic clues relevant to
the motility of bowel.
Listening to the bowel sounds (borborygmi) canbe
facilitated by following these steps:

1. Divide the abdomen in four quadrants.

2. Listen over all auscultation sites, starting at the right lower quadrants, following thecross pattern of
the imaginary lines in creating the abdominal quadrants. This direction ensures that we follow the
direction of bowel movement.
3. Peristaltic sounds are quite irregular. Thus it is recommended that the examiner listen for at
least 5 minutes, especially at the periumbilical area, before concludingthat no bowel sounds
are present.
4. The normal bowel sounds are high-pitched, gurgling noises that occur approximatelyevery 5 – 15
seconds. It is suggested that the number of bowel sound may be as low as 3 to as high as 20 per
minute, or roughly, one bowel sound for each breathsound.
Some factors that affect bowel sound:

1. Presence of food in the GI tract.

2. State of digestion.
3. Pathologic conditions of the bowel (inflammation, Gangrene, paralytic ileus, peritonitis). 4. Bowel
surgery
5. Constipation or Diarrhea.
6. Electrolyte imbalances.
7. Bowel obstruction.
Percussion of the abdomen

▪ Abdominal percussion is aimed at detecting fluid in the peritoneum (ascites), gaseous distension, and
masses, and in assessing solid structures within the abdomen.
▪ The direction of abdominal percussion follows the auscultation site at each abdominal guardant.
▪ The entire abdomen should be percussed lightly or a general picture of the areas of tympany and
dullness.
▪ Tympany will predominate because of the presence of gas in the small and large bowel. Solid masses will
percuss as dull, such as liver in the RUQ, spleen at the 6thor 9th rib just posterior to or at the mid
axillary line on the left side.
▪ Percussion in the abdomen can also be used in assessing the liver span and size of the spleen.
.
Palpation of the Abdomen

Light palpation

▪ It is a gentle exploration performed while the client is in supine position. With theexaminer’s hands
parallel to the floor.
▪ The fingers depress the abdominal wall, at each quadrant, by approximately 1 cmwithout digging, but
gently palpating with slow circular motion.
▪ This method is used for eliciting slight tenderness, large masses, and muscles, andmuscle
guarding.
Normal Findings:

1. No tenderness noted.
2. With smooth and consistent tension.
3. No muscles guarding.
Deep Palpation

▪ It is the indentation of the abdomen performed by pressing the distal half of the palmar surfaces of the
fingers into the abdominal wall.
▪ The abdominal wall may slide back and forth while the fingers move back and forthover the organ
being examined.
▪ Deeper structures, like the liver, and retro peritoneal organs, like the kidneys, or masses may be
felt with this method.
▪ In the absence of disease, pressure produced by deep palpation may produce tenderness over the
cecum, the sigmoid colon, and the aorta.

Extremities
 Inspection

1. Observe for size, contour, bilateral symmetry, and

involuntary movement.
2. Look for gross deformities, edema, presence of trauma such as
ecchymosis or other discoloration.
3. Always compare both extremities.
Palpation

1. Feel for evenness of temperature. Normally it should be even for all the extremities. 2. Tonicity of
muscle. (Can be measured by asking client to squeeze examiner’s fingers and noting for equality of
contraction).
3. Perform range of motion.

Test for muscle strength. (performed against gravity and against resistance) ▪ Both
extremities are equal in size.
▪ Have the same contour with prominences of joints.
▪ No involuntary movements.
▪ No edema
▪ Color is even.
▪ Temperature is warm and even.
▪ Has equal contraction and even.
▪ Can perform complete range of motion.
▪ No crepitus must be noted on joints.
▪ Can counter act gravity and resistance on ROM.

Additional site for you to view: https://www.youtube.com/watch?v=gG8kh8MfnGY

Measuring Fundic Height

Measuring the height of the uterus above the symphisis pubis reflects the progress of fetal growth,
provides a gross estimate of the duration of pregnancy, and may indicateintrauterine growth retardation.
Excessive increase in fundal height could mean multiplepregnancy or hydramnios (an excess in amniotic
fluid).

To measure fundal height, use pliable (not stretchable) tape measure or pelvimeter tomeasure from
the notch of the symphisis pubis to the top of the fundus, without tippingback the corpus. During the 2
nd
and the 3
rd
trimesters, make the measurement more precise
by using the following calculation, known as McDonald’s Rule:

HEIGHT OF THE FUNDUSN (in CENTIMETER) x 8/7 = DURATION of PREGNANCY in WEEKS

▪ Estimation of pelvic size-the size and shape of woman’s pelvis can affect her abilityto deliver her
neonate vaginally.
▪ Clearly clearance count-internal pelvic measurements give actual diameters of theinlet and outlet
through which the fetus passes.

NOTE: The internal pelvis must be large enough to allow a patient togivebirth VAGINALLY
WITHOUT DIFFICULTY. Differences in pelvic contour develop mainly because hereditary factors.
However, such diseases as rickets may cause contraction of the pelvis and pelvic injury may
alsoberesponsible for PELVIC DISTORTION.
- Pelvic measurements can be taken at the initial visit or at visit later in pregnancy, when the
woman’s pelvic muscles are more relaxed.
- Combination of pelvimetry and fetal UTZ (Ultrasound)- if routine UTZis scheduled.
-Estimation of pelvic adequacy should be done by the 24
th
week of

pregnancy.

▪ Diagonal Conjugate

- Distance between the anterior surface of the sacral prominence and the anterior surface of the
inferior margin of the symphisis pubis.
- It is the most useful gauge of pelvic size because it indicates the anteroposterior diameter of the
pelvic inlet (the narrowest diameter).
NOTE: 5” (12.5 cm)

-Obtained measurement, pelvic inlet is considered suitable for childbirth because the diameter of the
fetal head that must pass that point.
AVERAGE: 3.5 (9cm)

∙ TRUE CONJUGATE- also known as “conjugate vera” is the measurement betweenthe anterior surface of
the sacral prominence and the posterior surface of the sacral prominence and the posterior of the
inferior margin of the symphisis pubis. This measurement can’t be made directly but estimated from
the measurement of thediagonal conjugate.

HERE’S HOW IT’S DONE:

∙ The usual depth of the symphisis pubis is (1/2 to 5/4”) or 1-2 cm is subtracted fromthe diagonal conjugate
 measurement.
∙ The distance remaining is the true conjugate, or the actual diameter of the pelvicinlet through which the
fetal head the must pass.

∙ 4” to 5” (10-11)- average true conjugate diameter.

ISCHIAL TUBEROSITY

- The transverse diameter of the pelvic outlet. This is the measurement is madeat the medial and the
lowermost aspect of the ischial tuberosities, at the level of the anus.

PELVICMETER

- Generally used to measure the diameter, although it can be measured usingaruler or by comparing
it with a hand span or a clenched fist measurement. Adiameter o 4.5” is considered adequate for
passage of the fetal head thoroughthe outlet.

LEOPOLS MANEUVER

The Leopold Maneuvers are used to help nurses AND MIDWIVES determine fetus’ presentation and
position. The maneuvers have 4 specific actions that nurses/midwives must perform. Nurses and midwives
use this process along withthe assessment of the maternal pelvis’ shape to determine if complications will
occur during the delivery and if the patient will require a Cesarean section.

Steps on How to Perform Leopold Maneuvers

Maneuver One: Fundal Grip

1. Using both hands and facing the patient, palpate the upper abdomen. Thenurse should use this
method to determine the shape, size, mobility, andconsistence of what he or she feels. The nurse
should feel that the limbs andshoulders contain little bone processes that move with the fetus’
trunk; thehead is firm, hard, round and moves separately from the trunk; andthebuttocks is
symmetric and feels soft.

Maneuver Two: Umbilical Grip

2. After the nurse identifies the form and palpates the upper abdomen, thelocation of the fetus’
back must be identified.

3. While still facing the patient, the nurse should apply deep pressure withthepalm of his or her hands
to palpate the abdomen gently. Performthis maneuver byplacing the right hand on one side of the
patient’s abdomen while using the left handto explore the woman’s uterus on the right side. Repeat
this step on the oppositeside using the opposite hand.

4. The nurse should observe that the fetal back is smooth and firm. Theextremities of the fetus should feel
like protrusions and small irregularities. The backshould connect with the form felt in the lower (maternal
inlet) and upper abdomen.

Maneuver Three: Pawlick’s Grip

5. During this step of the process, the nurses must identify the part of the fetusthat is above the inlet. The
nurse must use the fingers and thumb on the right handto grasp the lower abdomen area located above
the pubic symphysis. The findingsshould validate what is determined in the first maneuver.

6. The two- hand approach is an alternative that is more comfortable for thepatient. Nurses can perform
this approach by positioning the fingers of both hands ina lateral position on one side of the presented
part.
Maneuver Four: Pelvic Grip

7. This step should be done while facing the patient’s feet. The process involveslocating the fetus’ brow.
The nurse should gently move the fingers on both handstoward the pubis by sliding the hands over the
sides of the patient’s uterus, andtheside where the greatest resistance to the descending fingers is the
location of thebrow. A well-flexed fetal head is located on the opposite side of the fetal back. If thehead is
extended, the back of the head is felt on the side that the back is located. Ahead that cannot be felt has
likely descended.
Tips for Performing Leopold Maneuvers

∙ Instruct the female to empty her bladder before performing the maneuver sothat she will be
comfortable and the contour of the fetus is not obscured.

∙ Put the woman in a comfortable position with her knees flexed. Drapethepatient and place a pillow
under her head. Explain the procedure tothepatient and answer any questions that she may have.

∙ Make sure that the hands are warm before coming in contact withthepatient’s abdomen.
Rub the hands together vigorously to prevent uterinecontractions and use the palm of the
hand instead of the fingers.

∙ The nurse should stand with the body facing the patient during the first threemaneuvers and
facing the feet of the patient during the final maneuver.

Biophysical Monitoring

A fetal biophysical profile is a prenatal test used to check on a baby's well-being. The test combines fetal heart
rate monitoring (nonstress test) and fetal ultrasound to evaluateababy's heart rate, breathing, movements,
muscle tone and amniotic fluid level. Thenonstress test and ultrasound measurements are then each given a
score based on whether certain criteria are met.
Typically, a biophysical profile is recommended for women at increased risk of problems that could lead to
complications or pregnancy loss. The test is usually done after week 32of pregnancy, but can be done when
your pregnancy is far enough along for delivery tobe
considered — usually after week 24. A low score on a biophysical profile might indicate that you and your baby
need further testing. In some cases, early or immediate delivery might berecommended.

A biophysical profile is a noninvasive test that doesn't pose any physical risks to you or your baby. However,
it's not always clear that the test improves pregnancy outcomes. Findout what a biophysical profile involves
and whether this prenatal test might benefit your baby.

A biophysical profile combines five parameters ( fetal reactivity, fetal breathing, movements, fetal body
movement, fetal tone, and amniotic fluid volume).

The fetal heart rate and breathing record measure short-term central nervous systemfunction.

The amniotic fluid volume helps measure long-term adequacy of placental function.
A biophysical profile is more accurate in predicting well-being than any single assessment. Because of the
scoring system is similar to that of the Apgar score determined at birthoninfants, is is called fetal Apgar.

Biophysical profiles may be done as often as daily during high-risk pregnancy. If a fetus scoreon a complete
profile is 8-10, the fetus is considered to be doing very well. A score of 6is considered suspicious; a score of 4
denotes a fetus in jeopardy. For simplicity some centers only use amniotic fluid assessment and nonstress test
for assessment.

Biophysical Profile Scoring

Assessment Instrument Criteria for a score of 2

Fetal Breathing Ultrasound At least one episode of 30 sec of sustained fetal breathingmovements within 30
mins of observation.

Fetal movement Ultrasound At least 3 separate episodes of fetal limb or trunkmovementwithin 30 mins. Of
observation

Fetal tone Ultrasound The fetus must extend and then flex the extremities orspineatlest once in 30 mins.

Amniotic fluid
Ultrasound A range of amniotic fluid between 5 and 25 cmmust be
volume present

Fetal heart reactivity Nonstress

Two or more fetal heart rate accelerations of at least 15
test
beats/min above baseline and of 15 sec. Durationoccurwith
fetal movement over 20-min time period
FETAL HEART RATE (FHR) MONITORING
- Obtained by placing a fetoscope or Doppler stethoscope on the mother’s abdomen and counting fetal
heartbeats. Simultaneously palpating the mothers pulse helps you to avoid confusions between
maternal and the fetal heartbeat.

ULTRASONOGRAPHY- through the use of sound waves off of internal structures, UTZ allows visualization of the
fetus without hazards of X-rays. It allows patient to see her baby andeven produces image (called sonogram)
that she can show to friends and family.

Uses of ultrasonography:

1. Verify the due date and correlate with the fetus’ size
2. Determine the condition of the fetus when there’s a greater than average risk of an abnormality or a
greater than average concern
3. Rule our pregnancy by the 7
th
week if there has been a suspected false-positive
pregnancy test
4. Determine the cause of bleeding or spotting in early pregnancy 5. Locate an UID that
was in place at the time of conception 6. Locate the fetus before amniocentesis and
during CVS
7. Determine the condition of the fetus if no heartbeat has been detected by the14 th week with a
Doppler device or if no fetal movement has occurred by the22 nd week
 8. Diagnose the existence of multiple pregnancy, especially if the patient has takenfertility drugs of
the uterus is larger than it should be for the expected due date9. Determine if abnormally rapid
uterine growth is being caused by excessiveamniotic fluid
10. Determine the condition of the placenta when deterioration might beresponsible for fetal
growth retardation or distress
11. Evaluate the condition of the fetus through observation of fetal activity, breathing,
movements, and amniotic fluid volume
12. Verify presentation and uncommon fetal or cord position before delivery.

To prepare patient for abdominal UTZ, have her drink 1 qt (1L) of fluid 1.2 hrs thetest.

Instruct not to void before the test because a full bladder serves as a landmark todefine other pelvic
organs.

Transvaginal UTZ is another type of imaging. It’s well tolerated becauseit eliminates the needs
for full bladder and is usually used during the first trimester of pregnancy.

Fetal Activity Determination

The activity of a fetus (kick counts) determines its condition in utero.

Daily evaluation of movement provides an inexpensive, invasive wayassessing fetal well-being.

Decrease activity in a previously active fetus may reflect adisturb ace in placental function looking for
some fetal action…

MONITORING FOR FETAL DISTRESS

If the patient is performing a fetal activity determination, make that she rest during continuing
period. If she’s active, such as walking around or otherwisephysically moving, she may not feel the
movements as much as if she were at rest. If 2 hrs go by without 10 movements, she would promptly
contact her health careprovider. Absence of fetal activity doesn’t necessarily mean there’s a
problembut, in some case, it indicates fetal distress. Immediate action may be needed.

The NON-STRESS TEST (NST)- also called Fetal Activity Determination (FAD)- makes use of the
valuable relationship between fetal movement and fetal heart rate. When you run around the block,
your own heart begins to race. This is your body’s way speeding up the whole process of delivering
more oxygenated blood to areas of increased need, our muscles.

It’s a good thing everything works together like this, or many of us woulddrop dead just
chasing after the dog that got out again. In the same way, whenababy moves, which the mother
marks on a fetal heart rate. This tells us that everything is pretty much working right in the baby, too.

Biochemical Monitoring

1.MATERNAL URINALYSIS AND SERUM ASSAYS

MATERNAL U/A- urine specimen should be obtained fromthe patient during her regular
 day scheduled visit using a “CLEAN CATH TEACHNIQUE”.

Specimen is examined for bacteriora as well as proteinuria, ketonuria and glucosuria. U/A- can

detect problems such as infections, diabetes before the patient shows sign. MATERNAL SERUM

ASSAYS;

Includes:

A.Estrogen
3 MAJOR ESTOGEN
o Estron
An Estrogenic Hormone secreted by the ovary as well as
adipose tissue.
Estron is relevant to health and disease state because of its
conversion to estron sulphate, a long-lived derivative.
Estron Sulfate acts as a reservoir that can be convertedas
needed to be more active estradiol.
o Estradiol- is a sex hormone.
Estradiol is a predominant sex hormone present in females;
however, it is present in males, albeit at lower levels, as well.
It represents the major estrogen in humas.
o Estriol- is a type of estrogen made by the ovaries, it is oneof
the primary hormones a pregnancy and as a hormone
replacement therapy.
B.Human Placental Lactogen (HPL)
Also known as “HUMAN CHORIONIC SOMATOMAMMOTROPIN” Is a polypeptide placental hormone. Its structure
and function is similar to that of human growth hormone. It modifies the metabolic stateof the mother during
pregnancy to facilitate the energy supply of the fetus. HPL has anti-insulin properties.
It works with prolactin to prepare the breast for lactation. It alsoindirectly provides for maternal metabolism and
fetal nutrition. It facilitate the CHON synthesis and mobilization that are essentials for fetal growth.
Purpose of HPL Testing:
o Assess placental function and fetal well-being (combined
with measurements and estriol levels)
o Aid diagnosis of H-Mole and choriocarcinoma
o Aid diagnosis and monitor treatment of non-tropoblastic tumors that ectopically secretes HPL.
C.Human Chorionic Gonadotropin (HCG) are used in addition to U/Atomonitor the pregnant patient for
problems.
USED TO:
o Detect pregnancy
o Determine adequacy of hormonal production in high riskpregnancies.
o Aid in diagnosis of trophoblastic tumors such as H-Moles andchoriocarcinoma.
o Detects tumors that ectopically secretes HCG
o Monitor treatment for induction of ovulation and conception.

2. AMNIOCENTESIS- Sterile needle aspiration of fluid from the amniotic sac for
analysis.

Perform 16-18 weeks of pregnancy

Procedure is recommended when:

∙ Mother is older than 35 y/o.

∙ Couple has history of chromosomal abnormality
(Down Syndrome), and Metabolic Disorder (Hunter’s
Syndrome)- group of metabolic disorders causedby
the absence or malfunctioning of lysosomal
enzymes needed to breakdown molecules called
glycosaminoglycans- long chains of sugar carbohydrates in each of our cells that helpbuild bone, cartilage,
tendons, corneas, skin and connective tissues. Glycosaminoglycans (formerly called mucocolysachride) are also
found in the fluidthat duplicates our joints.
∙ Mother is carrier of X-link genetic disorder such as haemophilia
∙ Both parent is carriers of autosomal recessive inherited disorders, such as sickle cell anemia, Taysachs
Disease.

Uses of Amniocentesis

1. Detect Fetal Abnormalities, particularly chromosomal and nueral defects. 2. Detect

Hemolytic Disease of Fetus
3. Diagnose metabolic disorders, amino acid disorder, and
mocopolyssacharidosis
4. Assess fetal lung maturity.
5. Determine fetal age and maturity.
6. Detects the presence of meconium in the blood.
7. Measures amniotic levels of estriol and fetal thyroid hormone.
8. Identify fetal gender.

3. CHORIONIC VILLI SAMPLING

Performed between 8-10 weeks AOG. Involves aspirating chorionic villi

fromtheplacenta for prenatal diagnosis of genetic disorders.

4. PERCUTANEUS UMBILICAL BLOOD SAMPLING

In PUBS, a needle is inserted through the mother’s abdominal wall

and the uterine wall. Blood can be withdrawn from the umbilical veininserts goes into
the placenta. Blood may also be taken fromthe
umbilical vein on its way to the fetal liver. PUBA is a technique
usedboth for prenatal diagnosis and prenatal treatment of the fetus.

5. FETOSCOPY

is an endoscopic procedure during pregnancy to allow

access to the amniotic cavity, the umbilical cord, and

the fetal side of the placenta. A small (3-3 mm) incision

 is made in the abdomen, and an endoscope is inserted

through the abdominal wall and uterus into the amniotic cavity. Fetoscopy allows medical interventions
such as biopsy or a laser occlusion of abnormal blood vessels.

Note: The CDC recommends that all pregnant women tested for HIV, even if theydon’t think they are
at risk.
6. VDRL and RPR test

Venereal Disease Research Laboratories (VDRL), Rapid Plasma Reagin (RPR) are seologic test for syphilis.
Syphilis needs to be treated early in pregnancy, before fetal damage occurs.

7. ALPHA FETOPROTEIN TESTING

Sometimes called MSAFP test or maternal serum AFP test- usedtodetect neural tube
defects. AFP is a CHON that is secreted by the fetal liver and excreted in the mother’s
blood.

8. GLUCOSE TOLERANCE TESTING

This test is performed to rule out or confirmgestational

diabetes. Routinely done between 24-28 weeks of gestation

to evaluate insulin- antagonistic effects of placental

hormones but, in high-risk pregnancies, testing shouldn’t be

above 140mg/dl.

9. TRIPLE SCREEN BLOOD TEST

Routinely offered between the 15

th
-20th week of pregnancy

that measures 3 chemicals: AFP, UNCONJUGATED ESTRIOL,

HCG.

1.Blood Studies

A.Blood Typing- includes RH factor.

CBC-includes haemoglobin level, hematocrit, rbc index,
platelet, wbc.

*Haemoglobin and hematocrit help to determine the presence of anemia. RBC indexhelps to classify
anemia, if present. Platelet count estimates clotting ability, elevatedWBC count indicate an infection.
1. Antibody Screening Test- Rh compatibility (indirect combs test), rubella, andheap-B,
antibodies for vacirella (chickenpox) may also be assessed.

A. Indirect Combs Test- (screens maternal blood for RBC antibodies)

B. Rubella Titer- rubella (german measles) titer detects antibodies in maternal blood for the virus
that causes rubella. Rubella exposure during pregnancy canlead to blindness, deafness, and heart
defects in the fetus.
C. Hepatitis-B- another anti-body screening test, called “HEPATITIC ANTIBODYSURFACE
ANTIGEN (HbsAG) test, if used to determine if patient has heap-B.
2. HIV Testing- test uses enzyme-linked immunosorbent assay on a blood sampleto determine the
presence of HIV antibodies. If the HIV screening test returns positive results, findings are confirmed
with the 2
nd
test the WESTERN BLOT TEST.