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Obstetric Skills For

Nurses

Zabidah binti PutitHajjah Saptuyah Haji Baki

Rose ak Nanju Sengah ak Nawas

Universiti Malaysia SarawakKota Samarahan

Obstetric Skills For

Nurses

First Publication 2018

© Zabidah binti Putit, Hajjah Saptuyah Haji Baki,Rose ak Nanju,Sengah ak Nawas

All rights reserved. No part of this publication may be reproduced, stored in retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publisher.

Published in Malaysia by

UNIMAS Publisher,Universiti Malaysia Sarawak,94300 Kota Samarahan,

Printed in Malaysia by

PPKS Production Sdn. Bhd.(623666-M)

Jalan Canna Off, Jalan Alwi, Tabuan Jaya93350 Kuching, Sarawak, Malaysia

Perpustakaan Negara Malaysia Data Pengkatalogan-dalam-Penerbitan

Zabidah Putit Obstetric Skill For Nurses / Zabidah Putit, Hajjah SaptuyahHaji Baki, Rose ak Nanju, Sengah ak NawasISBN 978-967-2008-65-11. Obstetric--Handbooks, manuals, etc2. Labor ( Obstetrics)--Handbooks, manuals, etc.3. Government publications--Malaysia.I. Saptuyah Haji Baki. II. Rose NanjuIII. Sengah Nawas. I. Judul.618

v

CONTENT

Preface vii

Foreword ix

List of Figure xi

List of Table xiii

1 Admission of Antenatal mother (Hospital) 1

2 Physical Examination of Antenatal mother 7

3 Abdominal Examination 15

4 Measuring Fundal Height 29

5 Oral Glucose Tolerance Test for Gestational Diabetes 33

6 Manual Monitoring of Uterine Contraction. (TCM) 37

7 Prepare Mother for Abdominal Scanning 41

8 Preparation of Patient for Transvaginal Ultrasound 47

9 Cardiotocography (CTG) 51

10 Fetal Kick Charting 61

11 Vaginal Examination 65

12 Assist in Insertion of Vagina Pessaries/Medication 69

13 Prepare mother for delivery 73

14 Preparation of Delivery Trolley 79

15 Partogram/Partograph 81

16 Veno-Thromboembolism Assessment 85

17 Oral Suctioning of the Newborn 89

18 Assessment of Apgar Score 93

19 Examination of Placenta & Membranes 95

20 Top to Tail Cleaning 101

21 Physical Examination of A Newborn 103

22 Care of Umbilical Cord 111

23 Vulva Swabbing for Postnatal Mothers 115

References 121

Index 123

vii

Preface

The Obstetrics and Gynaecology Skills Handbook is a synthesis of the

writers’ vast experiences in the field of obstetrics and gynaecology,

theories, models and research compiled into a complete text for

Obstetrics and Gynaecology course in a degree, advance diploma and

diploma in nursing programme. The authors had clinical background and

academic qualification in this field, so we wanted a handbook that would

apply the theoretical concept of obstetrics and gynaecology into practice

where the student would find interesting, easy to follow and above

all, helpful during their study. While this book is targeted for students,

we recommend that the clinical teachers in the field of Obstetrics and

Gynaecology can use this book as guidelines in their teaching. We,

however sincerely welcome constructive comments from readers and

experts to help us enrich our knowledge for improvement.

ix

Foreword

The Obstetric and Gynaecological Nursing skills book is a compilation

of notes as a guideline for students and clinical teacher to refer for

a standardise procedures as practiced and taught in Obstetric and

Gynaecological Nursing. In this context, I appreciate the authors for their

initiative for compiling the procedure notes to help the students’ easy

understanding of the procedure taught in class, thereafter practice in the

clinical skill laboratory before they are allowed to hands-on experience

in the hospitals and clinics under supervision of the experts.

The authors have used their clinical management and expertise to bring

out contemporary thought into this book. To compile and to write this

kind of book, needs dedication and devotion of time and energy which

the authors have proven. This handy procedure book is written in simple

English for students’ easy understanding.

I recommend this book for all nursing students who are studying

the Obstetric and Gynaecological nursing course, likewise for clinical

instructors.

Thank you

Professor Dr. Ahmad Hata Rasit Dean of Faculty of Medicines and Health Sciences, Universiti Malaysia Sarawak.

xi

2.1 The Breast & Changes Through Pregnancy 92.2 The Breast & Changes Through Pregnancy 92.3 The Breast & Changes Through Pregnancy 102.4 The Breast & Changes Through Pregnancy 102.5 Colostrum 112.6 Tenderness 112.7 Leg examination for Edema 122.8 Varicose vein 133.1 Abdominal Shape 173.2 Lower Segment Caesarean Section(LSCS) 183.3 Classical Caesarean Section 183.4 Abdominal Infection/Rashes 193.5 Linea Nigra 203.6 Striae gravidarum 203.7 Measure fundal height 213.8 Fundal Palpation 223.9 Lateral Palpation 23

3.10 Pelvic Palpation 243.11 Pawlick’s grip 253.12 Doppler Fetal Monitor 263.13 Pinard Stethoscope 273.14 Antenatal Card 284.1 Measuring of fundal height 314.2 Comparison of primigravide and multigravide 324.3 Fetal Growth 327.1 Abdominal Ultrasound 42

List of FIGURE

xii

7.2 Image of fetal growth 438.1 Transvaginal Ultrasound 509.1 Cardiotocography Machine 529.2 External cardiotocography 539.3 Internal cardiotocography 549.4 CTG Tracing 55

11.1 Vagina Examination 6712.1 Vaginal Pessary 7117.1 Newborn suctioning 9119.1 Umbilical Cord 9619.2 The cotyledons 9719.3 The Fetal Surface 9819.4 The Maternal Surface 9820.1 Meconium stain/vernix on the body/skin 10221.1 Cephalo –Haematoma 10421.2 Caput succedaneum 10521.3 Cleft lip / cleft palate 10521.4 Web-fingers 10621.5 Pigeon chest 10621.6 Umbilical cord 10721.7 Umbilical Jelly cord 10721.8 Hypospadia / Epispadia 10721.9 Talipes 108

21.10 Extra digit 10821.11 Barlow’s Ortolani test 10821.12 Spinal Bifida 10921.13 Rectal Examination 10922.1 Umbilical Cord Care 114

xiii

List of Table

5.1 Oral Glucose Tolerance Test Result 345.2 Oral Glucose Tolerance Test Chart 356.1 Labour Chart 409.1 CTG Reading 59

10.1 Fetal Kick Chart Form 6315.1 Partograph Recording 8316.1 Veno-Thromboembilism Assessment Form 8718.1 Apgar Score Form 94

1

Admission of the Antenatal Mother (Hospital)

Overview

Admission of antenatal mothers to the hospital is usually for safe delivery and any other condition that needs close monitoring.

Purpose

To assist in planning and implementing care for the antenatal patient according to their needs.

Requirements

• Admission forms

• Vital signs chart (TPR chart)

• Hospital / ward attire for client

• Other forms required according to hospital / ward protocol

1

2

Obstetric Skills for Nurses

Procedure

No Steps Rationales

1 Follow admission procedure of the ward hospital.

To ensure standardisation of efficient admission procedure.

2 Greet patient and introduce yourself.

To establish rapport .

3 Assess mother’s general condition and stage of labour.

• onset of contraction

• any shows

• rupture of membrane and time

• colour of liquor

To assess whether mother is already in active labour or not so that appropriate action can be done.

4 Assist patient to change into hospital’s attire.

For identification as patient.

5 Appropriate orientation to the ward.

To reduce anxiety.

6 Test urine for sugar, albumin and ketones.

Testing is done to detect for diabetes mellitus, pregnancy induced hypertension and UTI.

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