Download Procedure 26-2 - Skills Commons

Name______________________________________________ Date _____________ Score _____________
COMPETENCY ASSESSMENT
Procedure 26-2: Assisting with Pelvic Examination and Pap Test
(Conventional and ThinPrep® Methods)
Task:
To assist the provider in collecting cervical cells for laboratory analysis for early
detection of malignant cells of the cervix and to assess the health of the reproductive
organs to detect diseases, leading to early diagnosis and treatment.
Conditions: • Nonsterile gloves
• Vaginal speculum, disposable or nondisposable
• Warm water or warming light
• Light source
• Drape sheet
• Patient gown
• Tissues
• Vaginal lubricant
• Lab requisition
• Urine specimen container
• Urine testing supplies
• Biohazard specimen bag
• Biohazard waste container
• Adjustable stool for provider
Supplies for the Pap test according to the method used for ThinPrep® Pap:
• Cervical spatula
• Brush and broom
• ThinPrep® container with solution
For conventional Pap test:
• Microscope slides
• Fixative and/or specimen bottles
• Cervical spatula
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Ch 26-1
• Cytology brush
Standards: Perform the Task within 25 minutes with a minimum score of points, as determined by
your instructor.
Time began: ___________
Time ended: ___________
No.
Step
1
Wash hands and follow Standard Precautions.
2
Paying attention to detail, assemble
equipment.
3
Introduce yourself to the patient. Identify
patient.
4
Explain the procedure, speaking at the
patient’s level of understanding.
5
Request that patient empty her bladder.
(Instruct patient to save urine specimen and
provide specimen container if ordered by
provider.)
6
Being courteous and respectful, provide
patient with gown and request her to
completely undress, being sure to protect
patient’s personal boundaries.
7
Instruct patient to sit at end of table when
ready for pelvic examination. Drape patient
for privacy. If performing conventional Pap
test, label the frosted end of the slide with a
marking pencil. Include patient’s name on
slide. Indicate site from where specimen is
collected: c = cervix, v = vagina, e =
endocervical.
8
Assist patient into lithotomy position.
Patient’s knees should be relaxed and thighs
rotated out as far as comfortable. Drape for
privacy and warmth.
Ch 26-2
Points
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Total time: ___________
Check #1 Check #2 Check #3
No.
Step
9
Encourage patient to breathe slowly and
deeply through the mouth during examination.
10
Warm vaginal speculum with either warm
water or under heat lamp or place on a heating
pad.
11
Hand speculum and spatula, cytology brush,
and broom to the provider as needed.
12
Apply gloves.
13
For conventional Pap test, hold slides for
provider to apply smear of exfoliated cells,
one for vaginal smear (v), one for cervical
smear (c), and one for endocervical smear (e),
in that order. If spraying Pap fixative, spray it
over the slide within 10 seconds at a distance
of about 6 inches. Allow to dry for at least 10
minutes. If using Pap fixative in a bottle, place
slide directly into bottle. If using ThinPrep®,
swish the cytology broom vigorously in the
ThinPrep® solution until the entire specimen
has been deposited. Dispose of the brush into
biohazard container.
14
For ThinPrep® Pap testing, hand the speculum
and cytology broom to the provider. Open the
ThinPrep® solution container. When the cells
have been obtained, take the broom and
vigorously swish it into the container of
solution until all the cells have been
deposited. Replace the cap and label. Dispose
of the broom into biohazard waste container.
15
Place lubricant on provider’s gloved fingers
without touching the gloves, for bimanual and
rectal examinations. The provider will insert
the index and middle fingers into the vagina.
The other hand is placed on the lower
abdomen. The size, shape, and position of the
uterus and ovaries are palpated.
16
The provider will insert one gloved finger into
the rectum to check the ovaries and the tone
Points
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Check #1 Check #2 Check #3
Ch 26-3
No.
Step
Points
of the rectal and pelvic muscles. Hemorrhoids,
rectal fissures, or other lesions may be
palpated.
17
Provide the patient tissues to wipe genitalia
and rectum.
18
After the examination, assist the patient to a
sitting position, allowing her to rest a while.
Check her pulse and skin color.
19
Apply disposable gloves. Discard disposable
supplies per OSHA guidelines. If stainless
steel speculum was used, soak in cool water.
Sanitize and sterilize as soon as convenient.
20
Remove gloves and wash hands.
21
Assist patient down and off the table if
necessary, attending to any special needs of
the patient.
22
Assist the patient to dress; provide privacy.
Escort the patient to provider’s office for
discussion of examination results.
23
Prepare laboratory requisition (cytology
request) form. Include provider name and
address, date, source of specimen, patient’s
name and address, date of LMP, and hormone
therapy, if any. Place slides in slide container
or ThinPrep® container into biohazard
specimen bag. Place requisition into outer
pocket of bag and send to laboratory.
24
Wash hands.
25
Accurately document procedure in patient’s
chart or electronic medical record.
Student’s Total Points
Ch 26-4
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Check #1 Check #2 Check #3
No.
Step
Points
Check #1 Check #2 Check #3
Points Possible
Final Score (Student’s Total Points/Possible
Points)
Instructor’s/Evaluator’s Comments and Suggestions:
CHECK #1
Evaluator’s Signature:
Date:
CHECK #2
Evaluator’s Signature:
Date:
CHECK #3
Evaluator’s Signature:
Date:
Work Documentation Form(s)
*Progress Note Template and Laboratory Requisition Form can be downloaded from the Premium Website
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Ch 26-5
ABHES Competencies: MA.A.1.9.c Take vital signs; MA.A.1.9.i Use standard precautions; MA.A.1.9.k
Prepare and maintain examination and treatment area; MA.A.1.9.l Prepare patient for examinations and
treatments; MA.A.1.9.m Assist physician with routine and specialty examinations and treatments
CAAHEP Competencies: I.P.1 Obtain vital signs; I.P.10 Assist physician with patient care; I.A.1 Apply
critical thinking skills in performing patient assessment and care; 1.A.2 Use language/verbal skills that enable
patients’ understanding; III.P.2 Practice Standard Precautions; III.P.4 Perform handwashing; III.A.1 Display
sensitivity to patient rights and feelings in collecting specimens; III.A.2 Explain the rationale for performance
of a procedure to a patient; IV.P.6 Prepare a patient for procedures and/or treatments; IV.P.8 Document patient
care; IX.P.7 Document accurately in the patient record
Ch 26-6
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