CHECKLIST PAP SMEAR STEP / TASK GETTING READY Greeted the woman respectfully and with kindness.

Explained why cervical smear is recommended and described the procedure. Instructed her to empty the urinary bladder, undress and lie in the supine position on the examination bed Washed hands Put on examination gloves Procedure of cervical smear Inspected external genitalia and checked urethral opening for discharge. Inserted speculum and adjust it so that the entire cervix can be seen. Scraped the whole transformation zone and the ectocervix by the Ayres spatula Spread the specimen on a glass slide Introduced a cytobruch inside the endocervical canal and rotated it 180 degree Spread the specimen obtained from the endocervical canal on the same slide Fixed the smear immediately with cytological fixative After the procedure Took off the gloves, disposed of them in the proper container Washed hands Told the client when to return for results

CHECKLIST Wet SMEAR Getting Ready Greeted the woman respectfully and with kindness. Explained why vaginal smear is recommended and described the procedure. Instructed her to empty the urinary bladder, undress and lie in the supine position on the examination bed Washed hands Put on examination gloves Procedure Inspected external genitalia and checked urethral opening for discharge. Inserted speculum and adjust it so that the entire cervix can be seen. Collected samples of vaginal fluid by wooden spatula or a swab. Spread the sample on 2 slides for testing. mixed the first sample with normal saline mixed the second sample with KOH and Did Whiff test. Measured vaginal ph. Post Procedure Took off the gloves, disposed of them in the proper container Washed hands Told the client when to return for results

Checklist vaginal exam Getting Ready Greeted the woman respectfully and with kindness. Explained why vaginal exam is recommended and described the procedure. Instructed her to empty the urinary bladder, undress and lie in the supine position on the examination bed Asked for a third party (for example a nurse or midwife) to attend the examination. washed hands Put on examination gloves Lower abdominal and Groin examination Inspected and palpated the lower abdominal quadrants for masses and tenderness Inspected and palpated the groins for Lymph node enlargement Lower Genital Inspection and palpation Separated the labia majora gently with the index finger and thumb of one gloved hand Inspected and commented on the mons pubis, clitoris, labia majora, labia minora, vestibule, urethral orifice, perineum, anal and peri-anal area Instructed the patient to strain and cough Identified the Bartholin gland Outward massage the anterior vaginal wall and urethra to detect urethral discharge and discharge from Skene's glands Speculum Exam Selected a suitable sized speculum Held the closed blades of the bivalve speculum between the index and middle fingers of the right hand and placed the thumb on the upper posterior rim of the speculum Separated the labia majora with the index finger and thumb of the left-gloved hand to expose the vaginal introitus Placed the tip of the speculum at the vaginal introitus and gently advanced the blades of the speculum into the vagina bearing in mind its upward and backwards direction Opened the blades of the speculum and fixed it open Inspected and commented on the vaginal walls Closed the blades of the speculum and gently withdraw it from the vagina Bimanual Palpation Separated the labia majora with the index finger and thumb of the left gloved hand to expose the vaginal introitus Inserted the index finger of the right gloved hand into the vagina first; only inserted the middle finger as the patient relaxed the muscles around the vagina palpated the vaginal walls and cervix Placed the vaginal fingers in front of the cervix in the anterior fornix and moved the cervix down to antevert the uterus Placed the the left hand (abdominal hand) just below the umbilicus and gradually move it lower until the fundus is caught and pressed against the fingers in the anterior fornix and palpated the uterus Palpated the right and left adnexa Placed the fingers of the vaginal (right) hand in the posterior fornix and palpate the pouch of Douglas, Rectovaginal exam (when indicated) Inserted the index or middle fingers of the right gloved hand into the anal canal and the left hand on the lower abdomen and