Well Woman Exam 1 Flashcards
it is recommended that women between 20-39 should get breast exams how frequently?
40 and older?
20-39: every 1 to 3 years
40 and older: mammogram every year
a well women physcial exam should contain
vitals, general, cardiovascular, respiratory, breast, abdomen (looking for scars), pelvic exam, extremities, neuro
when should pelvic exams begin?
they should begin at age 21
breast examination:
sit upright: palpate all 4 quadrants, push toward chest wall
inspect breast and compare size contours, nipple skin, tissue (dense/firm/elastic)
supine position with hand behind head and repeat exam, allows for tissue to dissipate and have deeper palpation
palpate the nipple: compress the nipple between thumb and index finger
review them with how to conduct a self breast exam and importance of it
if in a breast examination a mass or a lump is identifies it should be characterized by?
by location, size, shape, mobility, and retraction
patients first pelvic exam: show her the instruments and inform her of the importance of testing
- set head of bed up to _ degrees
- position:
- speculum/supplies:
adjust _
put on _
inspect _ and _ and examine _ genitalia thoroughly
30 degrees
dorsal lithotomy position
warm up supplies (can drape patient while getting supplies and until you’re ready for exam
adjust light
put on gloves
vulva and perineum
external genitalia thoroughly
pediatric speculum
narrow blades; for children
pederson speculum
narrower blade for nulliparous females (first pap)
graves speculum
wider blades; multiprous females
parts of the speculum
upper and lower blades
thumb screw
thumb hinge
handle screw
handle
how do you insert a speculum
make sure bottom is barely off the end of table
warm speculum with warm water
hold speculum in dominant hand (place on her inner thigh so you can assess temperature)
take other hand and separate labia minora and majora exposing the introtus
direct speculum at a 45 degree angle into the vaginal vault
insert all the way in (normal vagina is 10cm)
open speculum in a smooth controlled fashion
you may have to adjust angle of speculum depending on if the patient has _
prolapse
if the cervix is not in view
angle the superior or inferior becuase it may be int he anterior or posterior fornix region
DO NOT PULL SPECULUM OUT IF YOU CANT SEE IT
if you still cannot find the cervix after readjustmnt you should?
remove speculum and preform bimanual exam and review surgical history (has she had a hysterectomy)
nulliparous cervix
multiparous cervix
nulliparous- conical
multiparous- transverse
pregnant cervix
chadwicks sign (blueish hue)
trichomonas cervix
yellowish green discharge, punctuate hemorrhages on ectocervix
BV cervix
yeast vagnitis cervix
BV cervix: foul smelling, thin gray homogeneous discharge; amine odor
yeast vagnitis cervix: adherent white discharge
always screen cervical discharge: chlamydia and gonorrhea testing
swab inserted into cervical os for 45 seconds
_ is used to gently scrape the ectocervix
spatula
_ is used after the spatula to obtain endocervical cells
cytobrush
cervical cytology: slide
1/2 slide wipe with spatula
1/2 slide with cytobrush
***gives cytology only
cytology: thin prep
remove tip of swab and place in media
***used for cytology, HPV testing, ASCUS. Gonorrhea and chlamydia
one specimens are obtained from a pap smear unlock or remove the speculum being sure to not pinch the labia or the cervix, dont forget to look at the vaginal _ during your exam as you retract the speculum. Place disposable speculum in?
place metal speculums in?
ruggae
hazardous red bag
in designated area
internal bimanual exam you place your fingers into the vagina and press _ and wait for the muscles to relax then you will place your other hand on the _ region
downward
suprapubic region
you can use 1 or 2 fingers
what are you looking for in a internal bimanual exam
in an IBE locate the cervix with _ surface of the finger and examine around the _
move the cervix gently side to side and observe patient expresion or discomfort; cervical motion tenderness can suggest _
check cervical _ ; no pregnant feel firm while pregnant feels softer
palpate the uterus by placing your left hand above the patients _ _ and the right intravaginal fingers in the _ _ behind the cervix
with the abdominal hand press down firmly and with the vaginal hand lift the uterus up thus entrapping the uterus; asses the uterus for size, _ , countour, and mobility
in pregnancy the uterine consistency becomes softer and you make be able to palpate between the cervix and fundus; this is known as ?
palpate vaginal valls looking for any masses, be careful where you place your thumb.
palmar
fornices
PID (chandelier sign)
consistency
pubic symphysis
posterior fornix
shape
hegars sign
in an IBE how do you palpate the ovaries
you place fingers of the abdominal hand on the right lower quadrant with the intravaginal hands in the right lateral fornix and then press them upward toward the abdominal hand
your abdominal hand should press inwardly and obliquely
rectovaginal exam is preformed with _ finger in the vagina and _ finger in the rectum
a rectovaginal exam is used to assess _ _ , __ and for _ _ nodularity
index
middle
anal sphincter, rectal walls, and uterosacral nodularity
tight anal sphincter:
lax anasphincter:
absent sphincter:
tight: scarring, fissurs, inflammation
lax: neurologic defecit
absent: improper repair from a 3rd/4thh degree laceration in childbirth
the rectal walls should feel _
when feeling the anal walls you should have the patient ?
check rectal wall for?
smooth
bear down
masses, polyps, strictures
conclusion of the well exam
cover patient
get out of lithotomy position
extend a hand and help her sit up
hand her some tissues or wipes, inform where the trashcan is
have her get dressed while you step out of the room and inform her to open the xam door when she is redy for you to come back in
then go back it to review: talk about the exam, prescription, mammograms, immunizations, future appointments, verablize understanding and get all questions answered.
