First Exam in Maternal child health is done!! I didn’t think it was murder like some of my classmates say but it was difficult. I think I did alright though. The grades have not been posted yet. I did make the mistake of rounding up on a gtts/min calculation but whatever. I got the other 4 calculations and the Leopold Maneuver correct.
My first day at clinical at Arnold Palmer was low key. I was up on 6 tower with a very nice nurse and her preceptee. Many of us ate lunch at Winne Palmer (for women and babies) and the cafeteria was amazing! I can’t really talk about specifics of cases that I was involved in because that would be a big HIPPA violation but I saw some interesting things. I was able to witness a PICC line on a child and I thought that Child Life coming in to distract the child during the procedure was great. This is what a real pediatric hospital should be like. I would even consider working there after I graduate.
Ovarian Torsion
(from medical dictionary and uptodate.com)
Ovarian torsion refers to the twisting of the ovary on its ligamentous supports, often resulting in impedance of its blood supply. It is the fifth most common gynecologic emergency and affects females of all ages.
First Maneuver: Fundal Grip – To determine fetal part lying in the fundus.To determine presentation.
- Using both hands, feel for the fetal part lying in the fundus.
- The Head is more firm, hard and round that moves independently of the body.
- Breech -is less well defined that moves only in conjunction with the body.
Second Maneuver:Umbilical Grip -To identify Fetal Back to determine position
- One hand is used to steady the uterus on one side of the abdomen while the other hand moves slightly on a circular motion from top to the lower segment of the uterus to feel for the fetal back and small fetal parts. Use gentle but deep pressure.
- Fetal back is a smooth hard and resistant surface.
- knees and elbows of the fetus feel with a number of angular nodulation
Third Maneuver: Pawlik’s Grip – to determine engagement of presenting part.
- Using thumb and finger, grasp the lower portion of the abdomen above symphisis pubis, press in slightly and make gentle movements from side to side.
- The presenting part is engaged if it is not movable. It is not yet engaged if it is still movable.
Fourth Maneuver: Pelvic Grip -To determine the degree of flexion of fetal head. To determine attitude or habitus.
- Facing foot part of the woman, palpate fetal head pressing downward about 2 inches above the inguinal ligament. Use both hands.
- Good attitude – if brow correspond to the side (2nd maneuver) that contained the elbows and knees.
- Poor atitude – if examining fingers will meet an obstruction on the same side as fetal back (hyperextended head).Also palpates infant’s anteroposterior position. If brow is very easily palpated, fetus is at posterior position (occiput pointing towards woman’s back)
