Need Help with Physical Assessments

Nursing Students Student Assist

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Specializes in Pediatrics, ICU, ED.

I am an LVN and when I was in my LVN program, we briefly touched on physical assessments. I recently bridged over to an RN program and we do physical assessments for each patient during clinicals. I'm comfortable with taking vital signs and right now I'm in my maternity rotation and I'm having trouble with following:

1. Listening and obtaining heart rate for newborn and babies. Their heartbeats are so fast that I have trouble counting them.

2. Feeling for the mother's fundus. I can't seem to find it.:confused:

3. I keep forgetting to check something whether it be the pt's pedal pulses, etc.

Do any of you have any advice or tips on how I can do better on my assessments? I check my pt's respirations while taking the pt's temperature. Any other time saving advice?

Thanks in advance!

Hi live&love&heal,

I understand completely how you feel. I just finished my postpartum clinical. A lot of the nurses count the infants heart rate for 15 mins and multiply is by 4. The fundus is located one or two fingers below the umbilicus, sometimes it will be to the right and if so I was told to have the patient to void. I keep a small notebook in my pocket so that I can remember what to do, but I usually try to work head to toe. I hope this helps

Specializes in Oncology.

I tapped my foot while listening to the newborn heartbeat. It helped me to get a feel for the rhythm I needed to count with. I counted for 30 seconds then multiplied by 2 unless it was irregular.

I remember feeling for the fundus a little higher in the abdomen than 2 inches below the umbilicus but I am no expert in OB.

http://library.med.utah.edu/kw/human_reprod/mml/hrmaternal_L06.html

Here it is for pregnancy, not sure about how it would work for post-partum, but I thought it was 2 inches a day on average?

you can remember the fundus...for every day postpartum, think fundus is one cm (or one finger width down from umbilicus....) example, 1st pp day..u/1 2nd pp day u/2 all the way to 5....usually, that works. as for the infant heart rate...look at the clock and start to listen, then after you get the rhythm going, close your eyes to block out everything else and just keep on counting...opening your eyes every few seconds to make sure you dont pass a minute.

Specializes in Med/Surg, Academics.
1. Listening and obtaining heart rate for newborn and babies. Their heartbeats are so fast that I have trouble counting them.

Yeah, it's REALLY fast. I would give myself a moment to get the rhythm and tap my foot in time to the heartbeat. For some reason, that would help me count accurately. If the rhythm was irregular, I couldn't do that of course.

2. Feeling for the mother's fundus. I can't seem to find it.:confused:
My CI told me that you can't be afraid of pressing down into the abdomen for lady partsl deliveries. She also demonstrated using a rolling motion with the middle portion of four fingers held stiffly to find the fundus. It worked!

3. I keep forgetting to check something whether it be the pt's pedal pulses, etc.

This will just take practice. Maybe make yourself a checklist until it becomes more natural to you?

Specializes in Emergency Dept. Trauma. Pediatrics.

When we first were doing Vitals in class I kept getting 60's for pulses, realized it when I was staring at my watch my mind switched to the tick of the secondhand. So everyone was 60 beats per minute. When doing the kiddo heart beat another thing that helps is to just close you eyes and listen to the beat, open every few seconds to glance at clock.

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