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- by jennymaths Jan 15, '10I'm a new grad and got hired into L&D recently. Nursing school did not present much of an opportunity with vag exams. Needless to say I feel pretty clueless about doing them. I know they're checking for dilatation, effacement, station and presentation. But I don't know HOW they do it. Sure, they stick their fingers into the vagina. But then what? What are the landmarks they are talking about? How do I know where the cervix is at? I don't even know what it feels like. I've been down there a couple times with my preceptor, but I don't know if I'm feeling the right thing. Yes, I feel pretty helpless. I've heard my preceptor talk about the cervix being posterior. What does that mean, and how does it impact doing a vag exam? If somebody could please, please, please help me out with all these questions, I would be so grateful. It would make me feel so much better if I was able to check my patients myself rather than wait for an experienced nurse to untie herself from her own mess. I feel guilty stealing others' time. So please do help me.... thank you....
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- Jan 15, '10 by pugmomrnYou know, it's just one of those things you need to dive in and get the feel of. Heck- I still remember my first successful SVE like it was yesterday! Effacement is the trickiest to get, but it will come. You just need to practice. There should be a preceptor checking right behind you for a while, and then you can step back and say "what did you feel"? Good luck! I'm heading back into OB after a 2 year detour-- can't wait! (And I can measure any circular object with my fingers alone!!)
- Jan 15, '10 by HM2VikingRNAbsolutely no desire to ever do this part of nursing.....Gives me the willies...
- Jan 15, '10 by rn/writerThis should be a big part of your orientation. The trend of recent years has been to reduce the number of internal exams, so it's a rare nursing student who is allowed to do any kind of vaginal exam in clinicals. New hires to OB should have a lengthy and detailed education in this skill and should be allowed a reasonable period to acquire the dexterity and "feel" for the procedure. It takes time.
You should discuss your questions with your preceptor. Don't be afraid of looking foolish. You're new to the job and new to OB as well. By not asking, you may be giving the impression that you know more than you do, and that's just asking for trouble.
Come clean and let your preceptor know that you're feeling a bit lost right now. Ask her to teach you what you need to know. Because women's anatomy varies so much, it can be confusing and challenging to find the landmarks and judge the parameters. I liken it to reading someone else's penmanship. Yeah, the basics are all there, but it can look sooo different from one sample to the next.
Are the other nurses expecting you to be up and running so quickly, or are you expecting this of yourself? You might be surprised at how supportive they can be if you are willing to let them know you need help.
- Jan 15, '10 by * RN *Do you know what the cervix feels like ordinarily? Sorry if it is TMI, I have an IUD and you need to check placement monthly, I didn't know what to look for, my doc told me a cervix in it's normal state feels like the tip of a nose, and that is exactly what it does feel like. I think if you find it once in a woman that is not fully effaced, it will make it easier. Good Luck!
- Jan 15, '10 by NurseNoraLet your preceptor check the patient first. Then when you follow her tell her what you are or are not feeling and she can sometimes guide you to the cervix.
Look at the illustrations in textbooks and try to keep them in mind as you compare with what you are feeling. Even the pictures of the pregnant woman done by the Maternity Center Association many many years ago can be helpful. They're often used in childbirth classes to show the uterus, baby, cervix and vagina during various phases of pregnancy and labor. They're done with the woman vertical. Turn them so she's on her back and look at the cervix. At term, before labor, you can see that the vagina points back toward the small of the woman's back and the cervix kinda points to the posterior vaginal wall. As labor progresses, you can see in those pictures how the cervix moves so that it points more toward the pelvic outlet.
When you do an exam, your fingers go in pointing toward the small of the patient's back (because that's the way the vagina points). The anterior wall of the vagina is usually soft and mushy. You can feel the pubic bone behind the vaginal tissue. In front of your fingers you'll run into the head, a firm roundness. If the membranes are intact, it feels a little like pushing against a water balloon. Move your fingers from side to side to see if you feel an opening. If not, can you slip your fingers between the head and the pubis? If so, she's complete, get ready for the delivery. If not, move your fingers posteriorly along the head until you feel an opening, or the protrusion of a thick cervix. It might feel like a mini donut--a protrusion with a dimple or hole in the middle. It's difficult to describe, and that's the best I can do.
What reference books does your department have? I have found the illustrations in Oxhorn and Foote's Human Labor and Birth helpful in visualizing the pelvis and the way the baby's head moves as it rotates from various positions. Varney's Midwifery is an excellent resource for explanations of how to do vaginal exams, spec exams, pretty much anything you might need to do to a pregnant woman.
But you can only learn so much from books. You have to do exam after exam to learn how to do them. See if other nurses would be willing to have you follow them in vaginal exams on their patients (they're more willing to do this if the patient has an epidural so it won't cause extra discomfort and if they are still intact or at least not ruptured for very long.
Good luck, you'll get it. Just keep practicing and looking at the pictures in the books and it will come together for you.
- Jan 15, '10 by canoeheadIt's like outer space in there at first. Go for the more fully dilated women first and work your way back. For me, after about 2 months it was like a light turned on and everything was great. Like riding a bike. all of a sudden you've got it, and you don't know what happened, but you've got it forever once it happens.
- Jan 15, '10 by jennymathsThank you so much for the explanations. My co-workers are very patient and helpful but I just feel like I'm burdening them. And I did a couple of exams with my preceptor. The first time, I thought I found the "donut" and was pretty happy. So, the next time I go in looking for the donut but couldn't find it. And I just couldn't find anything that resembled a complete ring. But I will definitely ask more nurses whether I could do checks with them. And hopefully, all the pieces will fall into place someday... soon. Thanks again...
- Jan 15, '10 by rn/writerYou aren't burdening them. You're precepting with them. There's a big difference. You aren't bothering them (and they shouldn't act like you are) when you are asking them to educate you so you can be a productive member of the team. Be eager to learn and appreciative of their efforts. And remember this down the road when you're the experienced nurse and it's your turn to help the newbie. Let's all break into a chorus of "Circle of Life."
- Jan 21, '10 by pugmomrnYou know what? Even the most experienced OB nurses need to occasionally ask a colleague for a recheck...