Vag Exams on Preterm Patients?? - page 2

Ok, so just started a new job and on my Second day of work was asked to go do a vag exam and FFN on a preterm patient to determine if she would be admitted SROMed or go home. When I said that it... Read More

  1. 0
    I would go straight to your regulating body but if they don't have a problem with it, and you're rural and the hospital and MD want you doing it then it'd be a good idea to ask for guidance in learning!

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  2. 0
    What do I do...just email my board of nursing??
  3. 0
    Really you need to check your policy. Vaginal exams are not prohibited by nurses (only if it is written into the bylaws of the hospital). As a nurse you are considered a qualified medical professional who acts on behalf of the physician. The physician has the ultimate decision as to how to proceed based the assessment given to him. As I said before, your hospital SHOULD have a policy on what the cutoff is for gestational age and exams. If at all possible you shouldn't check preterm patients unless imminent delivery is possible. I have examined patients of all gestations on request of a physician based on specific circumstances (mostly because the patient appeared to be imminently delivering.

    Some things are fuzzy for me still. FFN and recent sex and vag exam excludes is pointless. This should definitely be reflected in your policy and is a directly identified by the manufacturer. Your nurse buddy is wrong. mentioned SROM and FFN. Why? I could see amnisure, but not FFN.

    While I understand that you came from a facility that utilized residents, vaginal exams are a part of life in community hospitals. You are just going to have to get used to doing that. Its really not a scope of practice issue. Having never worked with residents myself, I don't know if I would be comfortable in the reverse and never have to do them :-)
  4. 0
    Are you sure it was FFN, or was it ferning she was checking?
  5. 0
    Nooo I am Very competent in doing vaginal checks. But on 37 weeks and above. It was the hospital policy in both hospitals I've done L&D was Not to do vag checks on pretermers. Of course if they appear to be quickly dilating you do what you have to do. But yeah never worked in a facility without any MD or residents on site. Apparently this doc they have here is extremely difficult too...doesn't like to come in..ugh. They have no policy..yet.
  6. 0
    Sorry but this is a new situation for me. The fear being that putting your fingers in a preterm patient and accidentally rupture her.
  7. 0
    Klone the nurse that was in the situation said that's what it was.
  8. 0
    I had sex at 31 weeks and started having contractions. They weren't too intense but lasted a few hours. I called my OB, they suggested changing positions and hydrating and go to the hospital if still going on another 2 hours. Well, I called on my way to the hospital. I was in L&D triage hooked to the monitors--intense contractions q 7 minutes, as close as q 2 minutes. The L&D triage nurse did a vag exam to see if I was dilated at all. Fortunately I wasn't so they gave me a shot of terbutaline to stop the contractions and was no sex until after the birth. (I'd also had contractions at 29 weeks due to dehydration; those took 2 shots of terbutaline to stop). I can understand why a vag exam would be ordered in a case like mine. I'd ask what the earliest gestational age is for RNs to perform vag exams. If you're just checking and not being forcible then there shouldn't be any harm.
  9. 0
    Yeah well ill want them to formulate a policy about this first : )
  10. 0
    At my hospital in rural GA we check almost everybody regardless of gestation. ..unless they have absolutely zero risk of PTL or labor. We do sterile speculum exams and FFN when appropriate. We have policies for FFN and speculum exams etc. I usually make an order for SVE to cover me. There are no doctors on site unless its office hours. If any new nurse or old nurse for that matter is uncomfortable with her findings we get a second opinion from a coworker or just tell the MD exactly what our concerns are. Theres alot of trust involved but it does seem kind of scary now that I think about it.

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