Ghising, Astak

Bimanual Pelvic Examination:

a) Apply lubricant to index and middle fingers of gloved hand

b) Alert patient that you are about to begin
c) Introduce index and middle fingers into vagina
d) Insert both fingers slightly into vagina and turn hand to palm up position
e) Palpate vaginal rugae and cervix
f) Starting at the umbilicus, press on outer abdomenwith the pads of the fingers of the outside
hand and move towards pubis
g) Palpate uterus between vaginal and abdominal hands
h) Move vaginal fingers into one lateral fornix
i) With abdominal hand, attempt to palpate the ovaryand parametrial tissues and check for
pelvic masses
j) Repeat on other side
k) Remove fingers from vagina

Speculum Examination and Pap Test:

a) Alert patient that speculum examination is about to begin

b) Warm and lubricate speculum with water
c) Insert speculum:
d) Hold speculum at 45 degree angle
e) Open labia with opposite hand and introduce speculum into vagina avoiding
urethral meatus
f) Insert blades gently and slowly into the vagina, pointing downward
g) Rotate at full insertion so that handle is vertical
h) Open speculum slowly, exposing cervix
i) Tighten screw to hold in open position
j) Observe cervical size, color, outer os configuration,noting any erosion, cyst, polyp,
tumor, eversion,etc.
k) Obtain and fix cervical specimens according to manufacturer's recommendations for
performing pap smears and handling specimens
l) Hold blades open and release screw
m) Withdraw speculum

GRAM STANING

1. Apply a smear of bacteria on to a slide. Air dry and then heat fix by passing it
through a flame a few times. Make sure you air dry the bacteria before heat fixing.

2. Add about 5 drops of Hucker’s Crystal Violet to the culture. Let stand for one
minute. Bacteria will stain purple. Wash briefly with water and shake off excess.
3. Add about 5 drops of iodine solution to the culture. Let stand for 30 seconds, wash
briefly with water and shake off excess.

4. 4.    Tilt slide and decolorize with solvent (acetone-alcohol solution) until purple
color stops running. Be careful not to over-decolorize. Wash immediately (within
5 seconds) with water and shake off excess.

5. Add about 5 drops of Safranine O. Let stand for one minute, wash briefly with water
and shake off excess.

6. Examine under microscope at both 400x and 1,000x oil immersion.