FEMALE GENITOURINARY AND RECTAL CHECKLIST

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					                      FEMALE GYN (PELVIC) EXAMINATION
                                  Checklist
                                  2011-2012



                                                                      Need to       Feel
                                                                      Practice   Comfortable

1. Patient in lithotomy position on exam table with feet
   supported in stirrups. Examiner seated at end of table with
   light source over right shoulder.

External Examination
2. Inspects mons pubis, labia, perineum, noting swelling,
   erythema, or lesions.


3. With gloved hand, uses thumb and first finger to inspect
   labia minora, clitoris, urethral orifice, introitus, and Skene’s
   glands.


4. Assesses vaginal output support by separating labia with
   thumb and index finger and asking patient to bear down.

Internal Examination
5. Chooses appropriate speculum for patient; lubricates and
   warms it with warm water. Makes sure that speculum is in a
   closed position.


6. With gloved right hand, places two fingers at the introitus
   and gently presses down on the perineal body.


7. With left hand, inserts speculum at 45o angle downward.


8. Holds blades obliquely and exerts pressure toward posterior
   vaginal wall.


9. Rotates speculum to horizontal position, maintaining
   posterior pressure.
                      FEMALE GYN (PELVIC) EXAMINATION
                                  Checklist
                                  2011-2012


                                                                     Need to       Feel
                                                                     Practice   Comfortable

10. When speculum is fully inserted, slowly open blades for
    complete cervix visualization.

11. When cervix is in complete view, tightens thumb screw to
    stabilize speculum.


12. Inspects cervix and its os, noting color, position ulceration,
    nodules, masses, bleeding, discharge, and contour.


13. Uses endocervical swab method to obtain cervical cytology
    specimen. * Please note that cervical cytology specimens
    are not obtained in this exam.


14. Performs cervical scrape to obtain cervical cytology
    specimen.


15. Obtains cervical cytology specimen from vaginal pool.


16. Loosens thumb screw and removes speculum.

Bimanual Palpation Examination
17. Patient remains in lithotomy position. Examiner stands.


18. Inserts index and middle fingers into vagina.


19. Abducts thumb and flexes third and fourth fingers into
    palm.


20. Presses posteriorly, assessing tenderness or nodules in
    vaginal wall.
                       FEMALE GYN (PELVIC) EXAMINATION
                                   Checklist
                                   2011-2012


                                                                  Need to       Feel
                                                                  Practice   Comfortable

21. Palpates fornix.


22. Places other hand on the abdomen and presses toward the
    pelvic floor.


23. Assesses uterus, noting size, shape, consistency, mobility,
    masses, and tenderness.


24. Moves abdominal hand to the right lower quadrant and
    pelvic hand to the fornix area.


25. Using abdominal hand to stabilize ovary, palpates it with
    pelvic hand.


26. Repeats steps 26 and 27 for left ovary.

Examination of posterior wall of uterine surface:
27. Using lubricated, gloved fingers, insert index finger into
    vagina and middle finger into rectum as patient bears down.


28. Inform patient that she may feel as though she must move
    her bowels, but that she will not.


29. Assesses region posterior to cervix, noting masses,
    tenderness, nodules and swelling.


30. Test fecal material for blood.

Rectal Examination
31. Inspects external anus.

*Please Note that the Rectal Examination is NOT performed on patients during this
exercise*
                      FEMALE GYN (PELVIC) EXAMINATION
                                  Checklist
                                  2011-2012



                                                                 Need to       Feel
                                                                 Practice   Comfortable

32. Uses index finger of right hand to examine rectum (digital
    palpation technique).


33. Uses gentle, firm motion while patient bears down.


34. Instructs patient to relax after finger passes external
    sphincter.


35. Palpates rectum walls (right and left lateral surfaces,
    posterior and anterior surfaces).

				
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posted:10/31/2011
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