Vaginal Exam for nurses are being discussed in this article.There are normally three types of vaginal exam.This is complete pelvic exam of women’s pelvic organ. We have jotted down previous articles about nursing procedure.
During pregnancy :
- For diagnosis of pregnancy.
- To detect any abnormality in pelvic cavity.
- Assessment of pelvis and cephalic-pelvic disproportion.
- Abnormal presentation.
- Diagnosis of onset of labour.
- For early rupture of membrane to occlude cord prolapse.
- Arrested progress of labour.
- As routine procedure done at the end of sixth week ta assess involution of uterus.’
- Disease of vagina.
- Disease of cervix.
- Disease of Bartholin gland.
- Certain disease conditions of uterus.
- For laboratory examination of vaginal discharge.
Being A Nurse You Must Know About Principles for Vaginal Exam For Nurses
- Ask the women to breath deeply.The patient should be asked to urinate and empty the bladder just immediately before the examination. Usually a female patient empties bladder before the examination. Usually a female patient empties bladder before she leaves home for a doctor or nurse. Nurse should insist to empty bladder as during waiting or travelling quite considerable amount of urine gets collected. A bladder with some urine will always give incorrect finding for vaginal examination.
- A heavily loaded colon will also give a false impression of a pelvic tumour during vaginal examination. If such doubt appeared while palpitating left for nix the patient to come erupting bowel after laxative aer: day.
- It is always advisable to keep a second person may be female attendant or relative while doing vaginal examination, specially if done by a male doctor. A nurse may not, require such attendant.
- The patients consent should always be taken before doing a vaginal examination. For minor girls parents consent should be obtained.
- The procedure should always be done by putting on a glove over hands. All other equipments should be available and antiseptic measures should be adopted.
- Reasons for Inadequate Findings by Vaginal Examination
- An obese or fatty patient whose abdominal wall is inpermeable to the finger of external hand.
- An extremely nervous patient whose abdominal wall becomes rigid due to tension and excitement.
- An intact virgin who becomes very sensitive to such examination.
- Sometimes some doubtful cases of suspected extra-uterine pregnancy.
Sterile gloves. 2. Sterile lubricant. 3. Vaginal speculum. 4. Sponge holding forceps, 5. Swabs. f>. Adjustable light or torch.
Explain the procedure to the patient.
- Take her consent.
- Put a bed side screen for privacy or take to a separate examination room.
- Ask her to lie on her back with her legs bent at knee. Keep her covered and expose only perineal part.
- Ask her to urinate prior to lying on bed.
- Place a macintosh covered with a cloth under patients.
- Swab the vulva and perineum with antiseptic solution.From above downwards with the help of sponge holding forceps
- Ask the women to breath deeply.
- Stand at right side of patient.
- Separate the labia widely with the non-examination hand i.e. left hand fingers.
- Take little savlon with glove on examining fingers index and middle fingers of right hand.
- First put index finger and later on two fingers when the patient accommodates the index finger.
- Usually a nurse requires to do vaginal examination during delivery. So wait until the pain or contraction has passed, before inserting the fingers. Avoid any contact with anus.
- Estimate amount of dilatation of external cervical os in terra of fingers as follows.
- Tip of finger One Finger Two Fingers Three Fingers Four Fingers
- More fingers to feel the Fontanelle and sutures to confirm the position of head.
- In case of cord presentation, it can be felt as a slippery*, twisted pulsating cord about the thickness of a small finger.
- Remove the examination finger from vagina and remove gloves.
- Again swab down the vulva.
- Reassure the patient.
- Record the findings in chart.
External Bimanual Compression of Uterus
- This procedure is followed for controlling post partum haemorrhage (PPH) by using two hands externally. This procedure is indicated in following conditions.
- When the placenta has been expelled.
- The uterus is soft and not contracting despite massage.
- Drugs have already been given to produce uterine contraction.
- Explain the patient what you are going to do.
- Use the left hand to grasp the fundus of the uterus and pull it up towards the patient’s chest.
- Nursing for Women
- Release the fundus and place the left hand behind the uterus, so that the organ is cupped by the hand with fingers pointing in the direction of cervix.
- Make a fist with right hand and press the flat portion (not the knuckles) very hard deep into the abdominal cavity just above symphysis pubis until the uterus begins to contract regularly. If an injection of metheglin has been given this should be done for about 10 minutes.
- Maintain the bimanual compression until the uterus begin to contract.
- Continue the bimanual compression of uterus till haemorrhage is stopped.
- Take TPR of the patient and access the general condition.
- Note the procedure in chart.
Haemorrhage without signs of placental separation
When the bleeding continues without signs of placental separation the method applied to expel placenta and simultaneously to control haemorrhage is known as CREDE’S METHOD. This method is tried at once without anaesthesia. The advantage of this method is that it can be followed immediately. It is reasonably safe and successful.
- Fundus is massaged till the uterus is made firmly contracted. If massage or rubbing fails then metheglin 0.5 mg is given intravenously.
- Contracted uterus is grasped per jabdomes fey pacing four fingers behind and the thumb in front of the uterus firmly squeezed to expel out the placenta from its attachment.
- The contracted uterus is further pushed c sunward and back towards to expel out the separated placenta if the expulsion of placenta is possible.
- In certain cases Crede’s method becomes ineffective and produces shock. However this method is never attempted in a shocked patient.Packing the Vagina In PPHIndication
- The uterus is hard and contracting properly.
- The flow of blood is steady with heavy trickle.
- The placenta has been expelled.
- The bleeding can not be controlled by applying pressure to perineum.
- Allow the patient to lie on her back with thighs and knee flexed.
- Wash your hand thoroughly with soap and water.
- Put on sterile gloves.
- Remove cloth from vagina using sterile swabs.
- Separate the labia with left hand to pull back the perineum.
- Dip the sterile pad or sterile cloth in lubricant solution.
- Use the right hand to pack the vagina tightly.
- Support the pad by applying one or more pad to vulva and
- Explain the procedure to the patient regarding what you are going to do.
- Ask her to empty the bladder.
- Put a bed side screen if required for privacy.
- Collect all material ready for use on a table at bed side, make The bleeding can not be controlled by injection of methergine.