18 Essential Procedures Used during Pregnancy

Alpha-feto Protein Levels

Purpose: To assess the presence of neural tube defects and Down's syndrome.
Nursing alert: An elevated alpha-feto protein level indicates neural tube defects and a decreased level indicates Down's syndrome.
- maternal serum screens for open neural tube defects
- alpha-feto protein is glucoprotein produced by fetal yolk sac, GI tract and liver
- test is done between 16 and 18 weeks of gestation


Purpose: To assess the fetal growth and maturity, and to determine the genetic disorders and sex of the fetus.
Nursing alert: If done between 14 and 16 weeks of gestation, the purpose is to assess for chromosomal aberration or other disorders. If done after 35 weeks of gestation, the purpose is to assess the fetal lung maturity.
Instruct the client to void before the procedure, if gestation is greater than 20 weeks. Position the client on supine.
A lecithin/sphingomyelin (L/S) ratio of 2:1 indicates fetal lung maturity.

Advise the client to report:
- fetal hyperactivity or hypoactivity
- vaginal bleeding
- chills and fever
- fluid leakage
- vaginal discharge
Complications: placental, cord and bladder puncture.

Assessment of Lochia

Purpose: To detect the presence of infection and bleeding.
Nursing alert: The normal color of lochia is as follows:
- Lochia rubra (reddish) - 1-3 days post-partum
- Lochia serosa (brownish or pinkish) 4-10 days post-partum
- Lochia alba (whitish) 10-14 days post-partum
- The longest possible time for the client to have lochial discharge (alba) can be up to three weeks to sixty days post-partum.

Biophysical Exams

Purpose: To collect data on fetal breathing movement, body movements, muscle tone, reactive heart rate and amniotic fluid volume; to identify fetuses at risk for asphyxia.
Nursing alert: A score of 0-2 is given in each category and the total is interpreted by the physician.

Chronic Villi Sampling (CVS)

Purpose: To determine the chromosomal or genetic disorders in the fetus. It is the earliest test possible on fetal cells.
Nursing alert: Sample obtained by slender catheter passed through the cervix to the implantation site.

Creatinine Level

Purpose: To estimate the fetal renal maturity and function.
Nursing alert: It uses amniotic fluid. Monitor abnormal levels. The mother's blood creatinine level should be known before the amniotic fluid creatine value is interpreted.

Contractions Stress Test (CST)

Purpose: Based on the principle that a healthy fetus can withstand decreased oxygen during contraction, but a compromised fetus cannot.
Nursing alert: Types of Contraction Stress Test
- Nipple-stimulated CST: Massage or rolling of one or both the nipples to stimulate uterine activity and check the effect FHR.
- Oxytocin challenge test (OCT): Infusion of calibrated dose of IV oxytocin "piggy backed" to main IV line. This is controlled by infusion pump and the amount infused increased every 15-20 minutes until three good uterine contractions are observed within 10-minute period.
- CST is never done unless a mother is willing to deliver the fetus.

Fetal Movement Count

Purpose: Teach the mother to count 2-3 times daily, 30-60 minutes each time.
Nursing alert: There should be 5-6 movements per coming time. Mother should notify the caregiver immediately of abrupt change or absence of movement.

Fetal Heart Monitoring

Purpose: To assess the fatal heart rate abnormalities.
Nursing alert:
- Early decelerations indicate fetal had compression; reflects mirror image in the monitor, no treatment required.
- Late decelerations indicate placental insufficiency; reflects reverse mirror image in the monitor. Change the client's position to left lateral recumbent and administer oxygen.

Guthrie Capillary Blood Test

Purpose: To screen for phenylketonuria.
Nursing alert: Normal level is 2 mg/dl, provide the client a high protein diet, 24-48 hours before the test.


Purpose: To determine patency of the fallopian tube and to detect pathology in the uterine cavity.
Nursing alert: Involves X-ray examination and administration of a radiopaque dye into the urine cavity. It should be done in the pre-ovulatory phase of the cycle. Contraindicated in pregnancy.

Leopold's Maneuver

- to estimate the fetal size
- to locate parts
- to determine presentation, position, engagement and attitude

Preparation of client:
- place in the dorsal recumbent position to relax the abdominal muscle.
- palate with warm hands because cold hands cause muscle contraction.
- use palm not fingers because it will tickle the client.

1st maneuver: Facing the head part, palpate for fetal part found in the fundus (a hard, smooth ballotable mass in the fundus means breech presentation).
2nd maneuver: Palpate sides of the uterus to determine location of fetal back.
3rd maneuver: Grasp lower portion of the abdomen just above symphysis pubis to determine the degree of engagement.
4th maneuver: Facing the feet of the client. Cross fingers downward on both sides of the uterus above the inguinal ligaments to determine attitude.

Lecithin-Sphingomyelin (L/S) Ratio

Purpose: To ascertain fetal lung maturity.
Nursing alert: Lung surfactants include lecithin and sphingomyelin. At 35-36 weeks, L/S ratio of 2:1 is achieved, the newborn is less likely to develop respiratory distress syndrome. Phosphatidylglycerol (PG) is found in amniotic fluid after 35 weeks of gestation.

Non-stress Test (NST)

Purpose: To assess the fetal activity and well-being.
Nursing alert:
- Reactive test: acceleration of fetal heart rate of more than 15 beats per minute above baseline FHR lasting 15 seconds or more.
- Non-reactive test: acceleration of fetal heart rate of less than 15 beats per minute above baseline FHR. May indicate fetal jeopardy.
- Acceleration in heart rate accompany normal fetal movement.
- In high risk pregnancies, NST may be used to assess FHR on a frequent basis in order to ascertain fetal well-being.
- Non-invasive

Pelvic Ultrasound

Purpose: To detect abnormalities of the organs in the abdomen.
Nursing alert: Increase the fluid intake 30 minutes to 1 hour before the test in order to distend the bladder, as it is necessary to promote visualization of the organs. The client would, therefore, need further teaching if she voids before the test.

Percutaneous Umbilical Blood Sampling (PUBS)

Purpose: To locate the umbilical cord with the help of ultrasound and to detect chromosomal abnormalities.
Nursing alert: Cord blood aspirated and tested. Used during second and third trimesters. The mother should be made to understand why she should not void before the test.

Sweat Chloride Test

Purpose: To detect cystic fibrosis.
Nursing alert: Normal chloride level is 90-100 mg/dl (serum), 10-35 mEq/L (sweat). Serum reading of 140 mg/dl and sweat reading of >60 mEq/dl may reflect cystic fibrosis. Pulsations is administered to induced sweating.


Purpose: To identify intrabody structures.
Nursing alert: Useful in early pregnancy to identify gestational sac(s). Later uses include assessment of fetal viability, growth patterns, anomalies and adnexal masses. Used as an adjunct to amniocentesis; safe for fetus (no ionizing radiation).

IMCI: Ear Problem

IMCI: Ear Problem
No Ear Infection
Color Code: Green

- No ear pain
- No pus draining from the ear

IMCI: Fever High Malaria Risk

IMCI: Fever High Malaria Risk

The cold has fever if there is febrile history or feels hot or with a temperature 37.5 °C or above. There is Malaria risk, if the mother of care taker tells you any of these: the child lived, traveled to, or stayed overnight in an area with High-Malaria cases in the past 4 weeks.

IMCI: Malnutrition

IMCI: Malnutrition

Not Very Low Weight

Color Code: Green


Not very low weight for age
No other signs of malnutrition

IMCI: Measles now or within the last 3 months

IMCI: Measles


Color Code: Green


- Measles now or within the last 3 months


- Give Vitamin A
- Advice mother to check for signs indicating that the child's condition is worsening such as:

Pulmonary Tuberculosis: Medications and Nursing Management

Pulmonary Tuberculosis IMCI
Over 15,000 cases of Tuberculosis (TB) are reported annually and according to WHO, an estimated 1.6 million deaths resulted from TB in 2005.

IMCI: Diarrhea - Integrated Management of Childhood Illness

IMCI: Diarrhea

No Dehydration

Color Code: Green

Manifestation of No Dehydration

Signs to classify as severe or some dehydration.

Pneumonia: Management of Childhood Illness

Pneumonia is an inflammation of the lung parenchyma cause by various microorganisms, including bacteria, mycobacteria, fungi, and viruses. Viruses are the most common cause of pneumonia in infants and children. In integrated management of childhood illness, pneumonia is classified into three: no pneumonia (cough or cold), pneumonia and severe pneumonia.

COPAR Process and its Process


COPAR is a social development approach that aims to transform the apathetic, individualistic and voiceless poor into dynamic, participatory and politically responsive community.
COPAR means community organizing-participatory action research.

Home Visit

Home visit

Home visit is a family-nurse contact which allows the health worker to assess the home and family situations in order to provide the necessary nursing care and health-related activities.

15 Ways to Prevent Infection in the Client with an Indwelling Catheter

Indwelling urinary catheter
Indwelling urinary catheter is a passage especially to promote drainage with the used of an implanted tube. A client should be catheterized only if necessary, because catheterization commonly leads to UTI.

Types of Therapeutic Diets and their Examples

types of therapeutic diets
Diet is a food or drink prescribed for a special reason. The diet is essentially normal one, except that the amount of food and their distribution in meals are controlled from day to day. Here are the five types of therapeutic diets and their subtypes: