Leopold’s Maneuver

Planning/Implementation:

First Maneuver:

With the examiner standing on the right side facing on the client, palpate side of the fundus with both palms, fingertips to determine which fetal pole is in the uterine fundus. For cephalic presentation: a hard, movable, regular mass is palpated whine a breach presentation, would be smooth, irregular, and slightly movable. With the fingers of the left hand, start from the umbilicus, count the number of finger breadths to the height of the fundus. This width approximate age of gestation (1 fingerbreadth to 1 month gestation)

Second Maneuver:

Place hands on the sides of abdomen downward to determine position of anterior shoulder, back and extremities.

Third Maneuver:

Grasp lower uterine segment between thumb and fingers of right hand to determine presentation and engagement.

Fourth Maneuver:

Examiner faces the foot part of the client. Palpate with both hands the sides of the fundus to confirm findings during the maneuver. Whether cephalic or breech presentation or how far engagement has occurred.

Administering an Intradermal Injection

Assessment:

Appearance of injection site. Specific drug action and expected response. Client’s knowledge of drug action and response.

Planning:

Assemble equipment and supplies, such as: Vial or ampule of the correct medication. Sterile 1 ml syringe calibrated into hundredths of a milliliter and a 25 to 27 gauge needle that is ¼ to ⅝ inch long. Alcohol swabs. 2” x 2” sterile gauze square, nonsterile gloves, band-aid, and epinephrine on hand. Check the MAR (medication Administration Record); Physician’s order. Check the label on the medication carefully against the MAR to make sure that the correct medication is being prepared. Follow the three  checks for administering medications. Read the label1 on the medication: When it is taken from the medication cart, before withdrawing the medication and after withdrawing the medication. Organize the equipment.

Implementation:

Wash hands and observe other appropriate infection control procedures. Prepare the medication from the vial or ampule for drug withdrawal. Prepare the client. Check the client’s identification band. Explain to the client that the medication will produce a small wheal, sometimes called a bleb. Provide for client privacy. Select and clean the site. Select a site. Avoid using sites that are tender, inflamed, or swollen, and those that have lesions. Put on gloves. Cleanse the skin at the site using a firm circular motion, starting at the center and widening the circle outward. Allow the area to dry thoroughly. Prepare the syringe for injection. Remove the needle cap while waiting for the antiseptic to dry. Expel any air bubbles from the syringe. Grasp the syringe in your dominant hand, holding it between thumb and forefinger. Hold the needle almost parallel to the skin surface, with the needle bevel up. Inject the fluid. With the nondominant hand, pull the skin at the site until it is taut. Insert the tip of the needle far enough to place the bevel through the epidermis into the dermis. The outline bevel should be visible under the skin surface. Stabilize the syringe and needle, and inject the medication carefully and slowly, so that it produces a small wheal on the skin. Withdraw the needle quickly at the same angle that it was inserted. Apply a band-aid, if indicated. Do not massage the area. Dispose of the syringe and needle safely. Remove gloves. Circle the injection site with ink to observe for redness or induration per agency policy. Document all relevant information. Record the testing material given, the time, dosage, route site, and nursing assessments.