Gyno Pelvic Exam

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dcmommy13
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235526
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Gyno Pelvic Exam
Updated:
2013-09-18 22:59:24
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  1. The Pelvic Exam... 7 steps.
    (Plus a bonus for women over 40) 
  2. 1) Preparation: (6)
    • 1. Empty bladder.
    • 2. Position pt.
    • 3. Drape (cover knees).
    • 4. Explain steps.
    • 5. Warm speculum.
    • 6. Watch for discomfort/pain.
  3. 2) Equipment: (5)
    • 1. Good light source.
    • 2. Gloves. 
    • 3. Drape.
    • 4. Speculum.
    • 5. Materials for culture & pap smear.
  4. 3) Inspect external genitalia: (6)

    • 1. Labia majora: for swelling.
    • 2. Labia minora: for swelling.
    • 3. Urethral opening.
    • 4. Vaginal opening.
    • 5. Skene's glands: high. 
    • 6. Bartholin’s glands: low.
  5. 4) Palpate external genitalia: have the patient bear down. (2) 
    • 1. Skene’s glands: high.
    • 2. Bartholin’s: low.
  6. 5) Speculum exam: seated. (3)
    • 1) Inspect cervix: color, position, ulcerations, nodules, masses, bleeding, discharge, carcinoma, parous vs. nulliparous os.
    • 2) Pap smear:
    •     i.   Endocervical: @ os w/ Q-tip.
    •     ii.  Cervical scrape.
    •     iii. Vaginal pool: below cervix.
    • 3) Observe vagina: (while withdrawing speculum) color, inflammation, discharge, ulcers & masses.
  7. What are the 3 steps for the speculum exam?

    • 1. Inspect Cevix
    • 2. Pap smear
    • 3. Observe Vagina
  8. What are the 3 steps for the pap smear?
    • 1. Endocervical: @ the os w/ q-tip. 
    • 2. Cervical scrape.
    • 3. Vaginal pool: below cervix.
  9. 6) Bimanual exam: standing. (3) 
    *Hand gloved & lubed, then insert first 2 fingers.  
    VCA

    • 1) Palpate Vaginal wall: tenderness & nodules.
    • 2) Palpate Cervix: position, shape, consistency, mobility, tenderness & fornix.
    • 3) Palpate via Abdomen: hand midway between umbilicus & symphysis pubis, press down w/ pelvic hand. (Pelvic hand horizontal w/ slight cephalic pressure).
    •     i.  Uterus: size, shape, mobility, tenderness & masses.
    •     ii.  Ovary: size, shape, masses, mobility. (Normal ovary IS tender, size of thumb pad).
    •     iii. Fallopian tubes: not normally palpable. (Size of ½ diameter of pencil).
  10. What are the 3 steps of the bimanual pelvic exam done through the abdomen?
    Uof ][V][
    • 1. Uterus.
    • 2. Ovary.
    • 3. Fallopian tubes.
  11. 7) End of exam: (1) 
    *Refer to Gyno or GP if necessary. 
    1. Offer something to wipe with.
  12. 8) Bonus: Bimanualabdominal-pelvic-rectal exam (4)


    • 1. Re-glove. 
    • 2. Repeat w/ abdominal hand middle finger in rectum.
    • 3. Palpate behind cervix.
    • 4. Palpate posterior uterine surface.
    • *40 YO+ 
  13. 7 overall steps...
    PEIPSBE
    • 1. Preparation. 
    • 2. Equipment. 
    • 3. Inspect external genitalia. 
    • 4. Palpate external genitalia. 
    • 5. Speculum exam. 
    • 6. Bimanual exam.
    • 7. End of exam.

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