3 initial questions before Vaginal Exam? Why?

CCL RN, RN · Feb 6, 2011

Well, what are your thoughts on how to answer your question?

Miley22 · Feb 6, 2011

My thoughts for the 3 questions are:

a. What is your chief complaint or reason for coming to the hospital?: This question will ensure the nurse the primary reason the patient comes to the hospital and can guide the nurse to determine if it is emergency or not.

b. Do you have any bleeding or pain? If yes, please describe the color, consistency, amount, and the location and level of pain on a scale of 0-10.: This will give the nurse an idea if the patient is having placenta previa or abruption placentae.

In placenta previa, there is painless, bright red lady partsl bleeding, and the uterus is soft, relaxed, and nontender. The nurse in this case would monitor maternal vitals and FHR & fetal activity carefully. The nurse will avoid lady partsl examinations because this could stimulate uterine activity. The nurse will treat for signs of shock if necessary by administer IV fluids or blood products. If bleeding is heavy, C-Section may be performed.

In abruption placentae (premature separation of the placenta form the uterine wall after 20th week of gestation), there is dark red lady partsl bleeding, uterine pain or tenderness or both, and uterine rigidity. The nurse in this case would monitor maternal vitals and FHR & fetal activity carefully. The nurse would also assess for excessive lady partsl bleeding, abdominal pain, and prepare for delivery of the fetus as quickly as possible.

c. Please describe the following:

- Time and onset of contractions and progress in terms of frequency, duration, and intensity.

- Location and character of discomfort from contractions (ex: back pain suprapubic discomfort).

- Persistence of contractions despite changes in maternal position and activity (ex: walking or lying down)

- Presence and character of lady partsl discharge or show.

- Status of amniotic membranes, such as a gush or seepage of fluid.

These descriptions will help the nurse assess the degree of progress in the process of labor and to determine whether it is a true labor or a false labor. In true labor, the contractions occur regularly, becoming stronger, lasting longer, and occurring closer together. It will become more intense with walking and usually felt in the lower back, radiating to lower portion of the abdomen. The contractions will continue despite use of comfort measures. However, in false labor, the contractions occur irregularly or become regular only temporarily, often stop with walking or position change, can be felt in the back or abdomen above the navel, and can often be stopped through the use of comfort measures.

Please give me some comments on these. Especially the explanation for my 1st question. Thanks!

anonymousstudent · Feb 6, 2011

Is this a full-term mom or a pre-term with complications?

If it's a full-term mom, I'd want to know if she's having any leaking fluids for sure, and if so when she thinks the SROM happened.

I don't think with your full-term you need to ask specifically about pain and bleeding, as she's probably in labor. You would ask about timing of contractions, when they started...

Your first question is OK to me, it's open ended. You'll get a lot of information from just asking why she decided to come in, probably without having to ask much else.

If it's a pre-term mom you'll have some other issues...let us know if that's what you're looking at, right now I'll just leave it.

Miley22 · Feb 6, 2011

in the scenario, the it doesn't provide whether she is a full term or not. It just states that she comes to the hospital because she is having contractions and feeling somewhat uncomfortable.

CrunchyMama, ASN, RN · Feb 6, 2011

If it's a non complicated labor, the first question I would ask is if she even wants a lady partsl exam. It's her birth and labor, even though a lot of moms don't realize this. Anyway, your others questions are pretty good and definitely more important then what medically can go wrong, so your questions should obviously come first.....just keep in mind to respect the moms wishes. :)