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Performed my first pelvic exam, rectovaginal exam, and digital rectal exam today!

September 21, 2017

 

And boy am I still feeling the adrenaline of it all. You guys, I am really excited about my future career right now! As a part of the Family NP curriculum, we are all required to do gynecological and genitourinary exams on standardized patients. Today went basically from 9am-5pm and we spent the entire day learning from trained individuals how to perform breast exams, pelvic exams, rectovaginal exams, and genitourinary exam (including digital rectal exams). We got to do these exams in the NEW SIMULATION LAB at the new school of nursing. Top notch stuff. We were in simulated exam rooms. The standardized patients were HIGHLY trained and basically walked you through the entire process -- how to greet the patient, how to ask questions and give directions in a proper and respectful manner, and they let you know if you need to palpate deeper, move more to the right, to the left, further down, etc. etc. They definitely know their stuff when it comes to these focused exams. 

 

The next few sections here are kind of mainly for me to be able to look back on this experience and remember it all... but feel free to read and get a kick out of ! 

 

For the gynecological  exam we were split into groups of 3 and were in a room with two standardized patients. First, we practiced doing breast exams using the concentric circle method. Here's how the exam basically went -- 

1. Greeting the patient, asking how they would like to be addressed, asking when their last pelvic exam was 

2. Asking the patient to remove the top of their gown, inspecting and examining for the 3 S's -- shape (contour), symmetry, skin (texture, any puckering, dimpling, bulging) 

3. Lymph nodes examination. Feeling above the clavicle and below the clavicle for any lymph nodes. Asking the patient to rest their wrist on your wrist while you're standing to their side and feeling their lymph nodes in their under arm. 

4. Having the patient lie down and uncovering one of their breast. Hand above their head to center the breast tissue on the chest wall. 

5. Concentric circles from least invasive to most invasive (outer circles to inner circles), finishing with palpation of the nipple last

 

Throughout the process we would also be educating the patient about self breast exams, what we're looking for, letting them know if things are normal. 

 

The next part of the gynecological exam was the PELVIC EXAM! Basically my favorite part. The process was similar, basically telling the patient the steps that were going to happen and ensuring them that they would feel pressure, but should not feel pain at any moment. And if there was pain, to let us know. 

The basic 5 steps of the pelvic exam are -- 

1. Inspection of the external genitalia (mons pubic and hair distribution, labia majora, labia minora, vagina, urethra, prepuce, clitoris), looking at the anatomy and explaining to the patient about the anatomy if they would like. We also had a mirror the patient could hold to view their anatomy. 

2. One fingered glove into the vagina to feel for the glands (Bartholin's and Skene's) as well as muscle tone (by having the patient tighten their pelvic floor muscles and bear down) 

3. Insertion of the speculum for visualization of the cervix -- one fingered glove in first, then the speculum is inserted at a 45 degree angle and the fingered glove can come out once the speculum is pretty much in. FEELING AND SEEING THE CERVIX IS PRETTY COOL! We didn't actually perform pap smears today. 

4. Bimanual exam to feel for the health of the uterus and ovaries. Two fingers in the vagina touching the cervix. The other hand is used to palpate the fundus (top of the uterus) and to feel for the ovaries. 

5. Rectovaginal exam. Using the dominant hand, middle finger in the anus and index finger in the vagina. Nondominant hand is used to again palpate the fundus and you can feel the posterior side of the uterus this way on the middle finger in the anus. Super neat! Walking out of the gynecological exam, I'm thinking -- Yep, I think I can definitely picture myself doing this in my future career. Yep. Yep. Patient education, talking to the patient about reproductive health. Love it.

 

Genitourinary exam 

 

Not going to go into super detail with this since it was a lot quicker and not as dense as the gynecological exam. Basically we had a male patient. We would assess kidneys with palpation, CVA tenderness, felt for inguinal lymph nodes, percussed from the umbilicus down to pubic bone. We examined the penis, palpated the scrotum and felt for the vas deferens and spermatic cord on both testes, examined for any presence of indirect or direct hernias. Finally, we ended with a digital rectal exam with one fingered glove to feel for the prostate which is bi-lobed. 

 

 

All in all, what an amazing experience! Especially to be able to do this at the new simulation lab. I guess this is where our money goes into. Super thankful for the people who are so willing to help students like us. <3 

 

It was an exciting day, but also a tiring day. Your girl needs a nap. 

 

Sincerely,

 

Meagan

 

 

 

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