NAME: _______________________________________________ DATE: ____________________

INSTRUCTOR/EVALUATOR: _______________________________ SECTION: __________________

NURSING PROCEDURE: PELVIC EXAMINATION

DEFINITION:

PURPOSE:

PRINCIPLE/S:

EQUIPMENT/SUPPLIES NEEDED:

Rate:

STEP by STEP PROCEDURE_Rating:

5-excellent 4-very satisfactory 3-satisfactory 2-needs improvement 1-poor

1. Secure the patient's consent and explain the procedure to the patient.

Rationale:
 2. Advise the patient to urinate before positioning the client to a lithotomy position. (as
shown in your module)

Rationale:

3. Help position a woman with her buttocks just over the edge of the table and drape
appropriately

Rationale:

4. Examine the vulvar region for erythema and other rashes.

Rationale:

5. Insert a warm-lubricated vaginal speculum and instruct the woman to take a deep
breath while inserting the speculum.
(as seen in your module)

Rationale:

6. Open the speculum and adjust until the cervix is in sight and lock open.

If planned, conduct pap smear and STD testing, cytobrush is inserted.

Rationale:

7. Insert index finger and possibly additional finger (with lubricant) in vaginal canal with
non-dominant hand to palpate the abdomen.

Rationale:

8. Place lubricant on the index and middle finger of the dominant hand then insert
the index finger into the vaginal canal.
Rationale:

9. Insert middle finger into rectum, asking patient to bare down and insert fingers
as far possible
Rationale:

TOTAL SCORE: ______ / ____

COMMENTS/SUGGESTIONS:

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