Assignment: Gynecological Exam
You are about to perform a well-visit gynecological exam on a 22-year-old woman who has never had a Pap smear or vaginal exam. How will you make this patient understand and be comfortable with the exam? How will you explain the tests required? Defend your answer by citing one or two articles from nursing research journals that you have found from the Bradley Library.
Use as an Example of Assignment
You are about to perform a well-visit gynecological exam on a 22-year-old woman who has never had a Pap smear or vaginal exam.
- How will you make this patient understand and be comfortable with the exam?
First, I would ensure that the conversation takes place in a private, quiet environment while the patient is fully clothed and sitting eye level. A private, quiet environment reduces distractions and increases the likelihood of the patient providing honest answers. Sitting eye level with the patient shows that I am engaged and actively listening. Next, I would ask the patient how she is feeling. Doing so would help distinguish if the patient is nervous, scared, or if she experienced past trauma (e.g., sexual abuse). Obtaining this information would allow me to alleviate her concerns (if applicable). Then, I would explain the exam process to the patient and show her the medical supplies I would use (i.e., speculum and collection kits). After that, I would ask the patient if she has any other questions or concerns. Doing so would alleviate additional concerns (if applicable) and ensure that the patient feels comfortable and fully understands the procedure before the physical exam. Finally, I would tell the patient she could stop the exam at any time if needed.
2. How will you explain the tests required? Defend your answer by citing one or two articles from nursing research journals that you have found from the Bradley Library.
I would tell the patient that a gynecological well-visit includes obtaining a comprehensive health history (i.e., medical, sexual, and social), obtaining labs (e.g., urine sample or vaginal cultures, if indicated), conducting a general exam (i.e., vital signs, thyroid gland, lymph nodes, heart, lungs, breast, etc.), conducting a pelvic exam (i.e., external and internal), conducting a and Pap smear (if indicated) (Hawkins, Roberto-Nichols, & Stanley-Haney, 2016, pp. 6-21). I would explain that a comprehensive health history provides an overall picture of her health. I would explain that urine samples are obtained to test for pregnancy, infections, and the status of her kidneys. I would explain that vaginal cultures are used to test for infections or sexually transmitted infections (STI). I would explain that the thyroid gland, lymph nodes, heart, lungs, abdomen, and breast would be assessed for abnormalities. I would explain that an external pelvic exam is performed to check the vulva and labia of the vagina to check for visual indications of irritation, swelling, redness, cysts, or any STIs (WebMD, 2018). I would explain that the internal pelvic exam is performed to check the cervix (i.e., whether there are irritating symptoms, abnormal secretions, or signs of STIs) and the health of the ovaries (WebMD, 2018). I would explain that a Pap smear is used to check for precancerous and cancerous cells and that it would be done with the pelvic exam (Weatherspoon, 2019).
After explaining the required exams, I would describe the steps of the physical exam. I would tell the patient we would begin with obtaining her vital signs and body mass index (BMI). That in private, she would undress and cover herself with the supplied patient gown and drape for privacy during the exam; ensuring that the gown is open to the front. I would explain the steps of the general exam. I would tell the patient that part of the general exam would be conducted on the exam table in the sitting position. First, in the sitting position, I will assess your thyroid gland and lymph nodes for enlargement. Next, I will listen to your heart and lungs, listening for abnormal heartbeats or breath sounds. Then you would lie down and I will check your breasts for lumps, thickening, or discharge. After that, I will assess your stomach for abnormalities and listen to your bowel sounds. Lastly, I will assess whether your inguinal lymph nodes are enlarged.
After explaining the steps of the general exam, I would explain the steps of the pelvic exam and the Pap smear. I would tell the patient for this part of the exam she would stay lying on her back and slide to the edge of the exam table and put her heels in the stirrups. If she is uncomfortable, she could lay on her side. First, an external examination of the pelvis will be performed. Lastly, the internal pelvic exam and Pap smear would be performed. I would tell the patient at the end of the visit when she is fully dressed, we would discuss any findings, applicable additional testing or treatments if indicated, and annual visits.
The Journal of Nursing Research published a research article on “Evaluating the Effectiveness of Interventions on Increasing Participation in Cervical Cancer Screening.” The researchers studied the effectiveness of three interventions that were commonly used to increase cervical cancer screening (i.e., one-on-one training with an educational brochure, educational brochure only, and verbal invitation-only without additional materials), the participation rate of cervical cancer screening, health promotion perceptions, and women knowledge of cervical cancer and screening. The interventional study included 365 women between the ages of 30 and 65 years old, that were randomized into one of the three interventional groups with 520 home visits. The results showed that participants that received one-on-one training with an educational brochure had a higher cervical cancer screening rate than the participants who received an educational brochure only or a verbal invitation only. Therefore, proving that effective teaching is an important part of a gynecological well-visit.