Leopold’s Maneuver Rationale 5 4 3 2 1

1. Explain the procedure to the patient.

2. Let patient empty her bladder.

3. Screen

4. Place the patient in supine position with knees slightly

flexed.
5. Do the first maneuver. While facing the mother, the
examiner palpates the fundus using the fingertips to
identify first the fetal part that occupies the fundus of the
uterus.
7. Second Maneuver: Palpation of the fetal back and small
parts. Still facing the mother, the examiner’s palmar surface
of the hand is placed on the one side of the abdomen to
steady the uterus. While the other hand palpates the other
side in a slightly circular motion of the fingers from the top
to lower segment of the uterus to feel the fetal outline.
8. The third maneuver: The maneuver should next
determine with the right hand (if right handed) which fetal
part presenting over the inlet. This is to confirm the first
maneuver. Still facing the mother. This is done by gently
grasping the lower pole of the uterus between the thumb
and fingers and pressing in slightly. If the presenting part is
not engaged, the next step is to determine the attitude of the
head.
9. Finally, the degree of descent is estimated. To do this, the
examiner faces the woman’s feet and uses both hands. The
sides of the uterus just below the umbilical level are
grasped snugly between the palms of the hands; the fingers
held close together pointing downward and inwards. If the
hands are placed correctly, the first points at the little
fingers will be on level with the anterior iliac spine and the
outstretched thumbs will meet above the level of the
umbilicus. When the presenting part has descended deeply,
only the small portion of it may be outlined. Palpation of the
anterior shoulder will aid in assessment of descent of the
vertex.
10. Able to auscultate the FHB by using Doppler or
stethoscope, locate fundus. Begin listening halfway between
the fundus and the pubis. Work outward in widening circles
until a beating sound is heard. Compare the beating with the
maternal pulse. If it is different, count beats for a full
minute.

11. Chart

Total Score

Equivalent Grade

Signature of C.I.

Signature of Student
 ng Exercises, Coughing and Splinting Rationale 5 4 3 2 1

1. Check the patient’s chart for the type of surgery and

review the medical orders.
2. Gather the necessary supplies and bring to the bedside
stand or over bed table.

3. Perform hand hygiene and put on PPE, if indicated.

4. Identify the patient.

5. Close curtains around bed and close the door to the

room, if possible. Explain what you are going to do and
why you are going to do it to the patient.
6. Identify the patient’s learning needs. Identify the
patient’s level of knowledge regarding deep breathing
exercises, coughing, and splinting of the incision. If the
patient has had surgery before, ask about this experience.
7. Explain the rationale for performing deep breathing
exercises, coughing and splinting of the incision.
8. Provide teaching about deep breathing exercises.
a. Assist or ask the patient to sit-up
(semi-or-high-Fowler’s position) and instruct the patient
to place the palms of both hands along the lower anterior
rib cage.

b. Instruct the patient to exhale gently and completely.

c. Instruct the patient to breathe in through the nose as
deeply as possible and hold breath for 3 seconds.
d. Instruct the patient to exhale through the mouth,
pursuing the lips like when whistling.

e. Have the patient practice the breathing exercise three

times.

f. Instruct the patient that this exercise should be

performed every 1 to 2 hours for the first 24 hours after
surgery.
9. Provide teaching regarding coughing and splinting
(providing support to the incision).
a. Ask the patient to sit up (semi-Fowler’s position) and
apply a folded bath blanket or pillow against the part of
the body where the incision will be (e.g., abdomen or
chest).

b. Instruct the patient to inhale and exhale through the

nose three times.

c. Ask the patient to take a deep and hold it for 3 seconds

and then cough out three short breaths.

d. Ask the patient to take a breath through the mouth and

strongly cough again two times.
e. Instruct the patient that he or she should perform these
actions every 2 hours when awake after surgery.
10. Validate patient’s understanding of information. Ask
the patient to give a return demonstration. Ask the
patient if he or she has any questions. Encourage the
patient to practice the activities and ask questions, if
necessary.

11. Remove PPE, if used. Perform hand hygiene.

Total Score

Equivalent Grade

Signature of C.I.

Signature of Student
 Collecting Specimens Rationale 5 4 3 2 1

1. Check for a written doctor’s order for such examination.

2. Bring necessary equipment to the bedside stand or over

bed.

3. Perform hand hygiene and put on PPE, if indicated.

4. Identify the patient. Explain the procedure to the patient.

If the patient can perform the task without assistance after
instruction, leave the container at bedside with
instructions to call the nurse as soon as specimen is
produced.
5. Check specimen label with the patient’s identification
bracelet. Label should include patient’s name and
identification number, time specimen was collected, route
of collection, identification of the person obtaining the
sample, and any other information required by agency
policy.
6. Close curtains around bed and close the door to the
room, if possible.
7. Put on disposable gloves. Collect specimen. Close lid to
container.

8. Remove gloves. Perform hand hygiene.

9. Fill up laboratory request and bring request and

specimen to the laboratory.
Total Score

Equivalent Grade

Signature of C.I.

Signature of Student
Providing Range of Motion (ROM) Exercises Rationale 5 4 3 2 1

1. Review the physician’s orders and nursing plan of

care for patient activity. Identify any movement
limitations.
2. Perform hand hygiene and put on PPE, if indicated.
3. Identify the patient. Explain the procedure to the
patient.
4. Close curtains around bed and close the door to the
room, if possible. Place the bed at an appropriate and
comfortable working height, usually elbow height or the
caregiver. Adjust the head of the bed to a flat position or
as low as the patient can tolerate.
5. Stand on the side of the bed where the joints are to be
exercised. Lower side rail on that side, if in place.
Uncover only the limb to be used during the exercise.
6. Perform the exercises slowly and gently, providing
support by holding the areas proximal and distal to the
joint. Repeat each exercise two to five times, moving
each joint in a smooth and rhythmic manner. Stop
movement if the patient complains of pain or if you
meet resistance.
7. While performing the exercises, begin at the head and
move down one side of the body at a time. Encourage
the patient to do as many of these exercises by him-or
herself as possible.
8. Move the chin down to rest on the chest. Return the
head to a normal upright position. Tilt the head as far as
possible toward each shoulder.
9. Move the head from side to side, bringing the chin
toward each shoulder.
10. Start with the arm at the patient’s side and lift the
arm forward to above the head. Return the arm to the
starting position at the side of the body.
11. With the arm back at the patient’s side, move the
arm laterally to an upright position above the head, and
then return it to the original position. Move the arm
across the body as far as possible.
12. Raise the arm at the side until the upper arm is in
line with the shoulder. Bend the elbow at a 90-degree
angle and move the forearm upward and downward,
then return the arm to the side.
13. Bend the elbow and move the lower arm and hand
upward toward the shoulder. Return the lower arm and
hand to the original position while straightening the
elbow.
14. Rotate the lower arm and hand so the palm is up.
Rotate the lower arm and hand so the palm of the hand
is down.
15. Move the hand downward toward the inner aspect
of the forearm. Return the hand to a neutral position
even with the forearm. Then move the dorsal position of
the hand backward as far as possible.
16. Bend the fingers to make a fist, and then straighten
them out. Spread the fingers apart and return them
back together. Touch the thumb to each finger on the
hand.
17. Extend the leg and lift it upward. Return the leg to
the original position beside the other leg.
18. Lift the leg laterally away from the patient’s body.
Return the leg back toward the other leg and try to
extend it beyond the midline.
19. Turn the foot and leg toward the other leg to rotate
it internally. Turn the foot and leg outward away from
the other leg to rotate it externally.
20. Bend the leg and bring the heel toward the back of
the leg. Return the leg to a straight position.
21. At the ankle, move the foot up and back until the
toes are upright. Move the foot with the toes pointing
downward.
22. Turn the sole of the foot toward the midline. Turn
the sole of the foot outward.
23. Curl the toes downward, and then straighten them
out. Spread the toes apart and bring them together.
24. Repeat these exercises on the other side of the body.
Encourage the patient to do as many of these exercises
by him- or herself as possible.
25. When finished, make sure the patient is comfortable,
with the side rails up and the bed in the lowest position.
26. Remove gloves and any other PPE, if used perform
hand hygiene.
Total Score
Equivalent Grade
Signature of C.I.
Signature of Student
 Pouring Sterile Solutions Rationale 5 4 3 2 1

1. Wipe the bottle cap with a tissue solution or paper

towel.

2. Loosen cap with thumb and index finger.

3. Remove the cap with small finger and side of the

palm. Hold the bottle with the label upward.

4. Pour a small amount of solution away from the

label into the sink or waste container to cleanse tip
of bottle.
5. Pour the needed amount of solution into the
provided container, catching the last drop with the
slightly twist.

6. Recap the bottle.

Total Score

Equivalent Grade

Signature of C.I.

Signature of Student