Speculum Exam
Description:
The sterile speculum exam is used to assist the practitioner to determine if amniotic membranes have ruptured.Amniotic fluid contains a high amount of a salt called sodium chloride. If drops of the fluid are spread on a glass slide, allowed to dry, and examined through a microscope, a characteristic palm leaf pattern can be seen. This is why it is sometimes called ”arborization” or the fem test.
Materials/ Equipment Needed:
Sterile speculum Bright light source
Nitrazine paper or Amniotest® kit Microscope slides
Microscope, if read on unit Sterile cotton tip swabs
Sterile sponge forceps
Procedure:
1. Prepare your supplies:
a. If you are alone, open the package containing the sterile speculum in such a way that you can grasp the handle for removal after you have put on a sterile glove. Prepare a piece of nitrazine paper or open the amniotest package before donning sterile gloves.
b. It is helpful to have someone assist you and support the woman throughout the examination.
2. Preparing the woman:
a. Tell her in term she can understand what you are going to be doing.
b. Ask the woman to empty her bladder.
c. Have the woman remove her underclothing and lie on the examining table or in bed, using an inverted bedpan covered by towels to raise her lips. Assist her to relax with her legs bent, feet resting flat on the table or in the stirrups. Place a pillow under her head and ask that she rest her hands across her abdomen or at her sides.
3. Position the light source so that the perineum is well lit.
4. Select the appropriate sterile speculum (medium or large).
5. Sit down on the stool and ask the woman to separate or spread her legs. Do not try to use force or even gently separate her legs.
6. Assist the woman in relaxing. If she knows a relaxation and breathing technique learned previously. Have her use it. If not. Have her do slow, deep, relaxed breathing.
Ask her to let herself go limp, to think of herself as a rag doll.
7. If the woman becomes upset of tense during the examination, stop whatever you are doing. Do not remove your fingers; simply hold your hand still. Find out what is bothering her. Try to distinguish between discomfort as a result of pressure, fear, or actual pain. Wait until she has regained control, helping her to relax.
8. Tell her what you are doing as you touch her inner thigh with the back of your gloved hand, which is not holding the speculum.
9. Using this same hand, place two finger just inside the introitus and gently press down on the base of the vagina.
10. With your other hand, introduce the closed speculum past your finger at approximately a 45-degree angle downward. Keep a moderate downward pressure on the blades to avoid upward pressure on the sensitive bladder and to vaginal wall. If a lubricant is needed for the speculum examination, use only sterile water. Many people use no lubricant.
11. After the speculum is in the vagina, remove your fingers from the base of the vaginal opening. Turn the blades of the speculum into a horizontal position, all the while keeping a moderate downward pressure.
12. Tell the woman she might feel pressure. Move your thumb to the piece and press to open the blades so that the cervix is in view.
13. Sweep the blades slowly upward by gently pressing on the handle. If this does not bring the cervix into view, close the blades; withdraw the speculum a little. Warn the woman of the extra pressure she might feel. Then, while pressing down firmly, move the blades toward the back of the vagina again. Sometime the tip of the blades needs to be directed more anteriorly or posteriorly, depending on the position of the cervix.
14. When the cervix is in view tighten the thumbscrew to keep the blades open.
15. If membranes are ruptured, fluid will be seen seeping from the cervical opening.
Diagram/ Illustrations:
Nursing Responsibilities:
Before Procedure:
Completing the competency and
Obtaining a provider’s order
Explain the procedure to the patient
Ask patient to empty bladder
Do hand washing
Prepare the necessary equipments
Provide privacy
During Procedure:
Identify the specimen as to cervical or vaginal.
Take a patient label and attach it to the packet. Label the
specimen with date/time/initials.
Make sure lab order is placed on the computer and send
Specimen to lab with computer requisition completed.
Handle other specimens according to established procedure.
After Procedure:
Prepared specimens are labeled and sent to the lab.
Patient is assisted back to her room.
Note the color and the odor. Deep yellow probably indicates the release of meconium approximately 1-2 days previously. Greenish- brown color indicates fresh meconium staining of amniotic fluid. Use this to determine bleeding and abnormalities.
Sources:
18 November 2009 ___________________________
Date Clinical Instructor’s Initials
Categories:
Procedures