Pelvic cue card checklist.qxd 4/10/2008 12:42 PM Page 1 PELVIC EXAMINATION Checklist PELVIC EXAMINATION Checklist Bimanual Rectovaginal Examination: Preparation: Check all materials and equipment Reglove and apply lubricant to index and Wash hands in the presence of the patient middle fingers Position patient: Alert patient that the rectovaginal exam will offer pillow begin raise table back drape appropriately Place middle finger on anus and ask patient place patient's feet in foot rests to bear down have patient move buttocks to end of table Adjust the light and drape Insert middle finger into rectum and index finger into vagina Put on gloves Explain in advance each step of the examination Repeat the palpation and characterization of and warn patient when you begin the cervix, and other structures from this position External Examination: Sweep posterior pelvic wall with rectal finger Inspect and palpate the mons pubis, labia majora and perineum Palpate rectovaginal septum between fingers Separate the labia and inspect: labia minora Remove fingers smoothly clitoris urethral meatus Help patient assume sitting position vaginal opening Skene's glands Bartholin's glands Inspect the anus Ask patient to bear down to assess for cystocele/ rectocele if indicated Pelvic cue card checklist.qxd 4/10/2008 12:42 PM Page 2 PELVIC EXAMINATION Checklist PELVIC EXAMINATION Checklist Speculum Examination and Pap Test: Bimanual Pelvic Examination: Alert patient that speculum examination is about Apply lubricant to index and middle fingers of to begin gloved hand Warm and lubricate speculum with water Alert patient that you are about to begin Insert speculum: Introduce index and middle fingers into vagina Hold speculum at 45 degree angle Insert both fingers slightly into vagina and turn Open labia with opposite hand and introduce hand to palm up position speculum into vagina avoiding urethral meatus Palpate vaginal rugae and cervix Insert blades gently and slowly into the vagina, pointing downward Starting at the umbilicus, press on outer abdomen Rotate at full insertion so that handle is vertical with the pads of the fingers of the outside hand and move towards pubis Open speculum slowly, exposing cervix Tighten screw to hold in open position Palpate uterus between vaginal and abdominal hands Observe cervical size, color, outer os configuration, Move vaginal fingers into one lateral fornix noting any erosion, cyst, polyp, tumor, eversion, etc. With abdominal hand, attempt to palpate the ovary and parametrial tissues and check for pelvic Obtain and fix cervical specimens according to masses manufacturer's recommendations for performing pap smears and handling specimens Repeat on other side Remove fingers from vagina Hold blades open and release screw Withdraw speculum.