Vag Exams

  1. [font="comic sans ms"][font="comic sans ms"][font="comic sans ms"]so, i'm a new grad and started in l&d in march. i've been off orientation for a couple of weeks now, and things have been going relatively well. when i was learning vag exams at the beginning of my orientation one of my preceptors would check behind me, and i was right on target 99% of the time, maybe with the exception of determining effacement. my preceptors trusted my exams enough that after a little while they didn't feel the need to check behind me unless i had a weird exam that i was really unsure of. so fastforward to now, and i am a few weeks off of orientation, and i am suddenly feeling very unsure of my vag exam skills. i'm on target for the most part (or so i think), but last night i had a patient i was calling 6-7 and then we had shift change and i was talking at the nurse's station for a bit so the oncoming nurse went in to go check my patient because she was feeling pressure. she came out of the room and i asked her how she was doing, and she said she's a 4. :imbar i trust her exam because she definitely has a lot more experience than i do. she wasn't mad and said that it didn't matter. a lot of my co-workers tell me that closed and complete are all that really matters, but i want to be accurate. i don't know if this sudden uncertainty with my exams is just nerves due to being on my own now. i guess my question is how do i ensure that my exams are on target without constantly asking someone to check behind me? i want to improve my exams, but i don't want to become too dependent on my co-workers. any advice would be appreciated. thanks!
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    About LKB82

    Joined: Mar '05; Posts: 24
    L&D Nurse


  3. by   SmilingBluEyes
    Just keep on keeping on. Do not let this stymie you. I have still at times had to have coworkers back up a "weird" or different exam. And I have been wrong or "off" now and again, even though I have been doing L/D for 9 years. Don't get too freaked out; it comes with practice and time. And always remember to tell your patients, exams are subjective and not to take it all literally. What you call a 5 or 6 a doctor with bigger hands, may call a 4. No biggie. Chart your findings and let him or her chart theirs. And go on from there. Pay close attention to your patient and her coping with's far more important than a subjective reading of her dilation or effacement. And hang in gets better with time. You are still learning!
  4. by   LKB82
    [font="comic sans ms"]thanks deb. i know i just have to keep practicing. i guess my biggest concern is that if i continue to be off in my exams i may lose credibility with my patients, the other nurses, and the physicians. thanks for the advice!
  5. by   SmilingBluEyes
    Quickie vaginal dilation tool (if you are in the USA anyhow): Your monitor paper. Between each dark line (one minute) is 3 centimeters. SOOOOOOO when you check someone, take your fingers and place them (clean) on the paper, and compare. One minute, 3 centimeters, 2 minutes, 6cm, 3 minutes, 9cm. It's very handy when those little charts can't be found. Old OB nurse taught this to me, and it sure did help a LOT.
    Last edit by SmilingBluEyes on Aug 31, '06
  6. by   SmilingBluEyes
    Also remember, ALL physicians, nurses and midwives had to learn by practice. And EVERY ONE OF THEM WAS WRONG AT LEAST several times! Believe me, your coworkers and the doctors know you are new and know you may make mistakes. Don't spend a lot of time apologizing or being down; when you are wrong, just admit you made a mistake and move on. It WILL COME WITH TIME, believe me! Have patience with yourself.
  7. by   LKB82
    Quote from smilingblueyes
    quickie vaginal dilation tool (if you are in the usa anyhow): your monitor paper. between each dark line (one minute) is 3 centimeters. sooooooo when you check someone, take your fingers and place them (clean) on the paper, and compare. one minute, 3 centimeters, 2 minutes, 6cm, 3 minutes, 9cm. it's very handy when those little charts can't be found. old ob nurse taught this to me, and it sure did help a lot.
    [font="comic sans ms"]i didn't realize that. thanks for the tip!
  8. by   tryingtomakeit
    I have a story! lol

    I had been on my own for about six months in L&D (quite frequently we work alone in our unit with nsy and PP for backup), when I had a pt come in by ambulance, writhing in pain. I tried to check her, but she was moving around so - at one point she completely flipped on the bed with my fingers inside her! At any rate, I thought she was 7 cm. She was a previous section, so I called her MD who was out of town and afraid he wouldn't get to her in time to section her - so he called his backup (she was taking his emergency calls, but he had been asked to be called first). To make a long story short, the surgery crew was called in and I had opened the section room up - thinking all the while that this woman was going to vbac. When the covering MD came in and checked the pt, after the pt had been given IM stadol just so we could start an IV, she was 1cm and thick! I was sooo embarrassed! The one thing I did have on my side was that her membranes were ruptured, so she would have been sectioned anyway, lol.

    I had told her MD when I called him that I "think" she is 7 cm, but that she was moving so much it was hard to tell. Luckily I work with a very understanding group ...
  9. by   RNLaborNurse4U
    We all have our moments when we are wrong on exams. Don't beat yourself up over it! I've been in L&D for over 5 yrs, and there are some cervical exams that perplex me. First of all, finding the darn cervix. Not always an easy job in itself.

    I had a patient the other week, I was sure she was 8cm/100/+1. CNM rechecked a little while later - she was actually 5cm/80/+1. I swore she was what my exam showed!! The midwife had me actually follow her exam to double check (pt had an epidural, and was ok with me rechecking). Sure enough, that cervix was plain as day, 5 cm, feeling definitely thicker than what I had felt earlier. Oh well, live and learn.

    No matter...she delivered within 3 hrs anyway.

    Chalk it all up to learning.