Lesson 13 — Obstetrics and Gynecology Assisting

1. Assemble the materials needed and prepare the room. Prepare the equipment and supplies needed for the Pap test.
2. Sanitize your hands and follow Standard Precautions.

   Purpose

   To ensure infection control.

3. Introduce yourself, greet the patient and verify her identity by name and date of birth, then, briefly explain the procedure.

   Purpose

   Explanations gain the patient's cooperation and alleviate apprehension.

4. Instruct the patient to empty the bladder, and collect a urine specimen if needed.

   Purpose

   The provider's bimanual examination is performed on an empty bladder.

5. Instruct the patient to disrobe completely and to put on a gown with the opening in the front.
6. Assist the provider with the breast examination.
7. To start, have the patient sit at the end of the examination table. Drape the patient and reassure her as needed.
8. When the provider is ready to examine the breasts and the abdomen with the patient in the supine position, assist the patient into the supine position and drape as needed.

   Purpose

   To prevent unnecessary exposure of the patient.

9. When the provider is ready to begin the vaginal examination, assist the patient into the lithotomy position.
10. Have the patient slide down to the end of the table; then adjust the stirrups as needed so that the knees are relaxed and rotated outward.
11. Remember always to position the patient while she is underneath the drape.
12. Direct the light source onto the perineum.

    Purpose

    To facilitate better viewing of the cervix.

13. Put on gloves.
14. Warm the stainless steel vaginal speculum in warm water (the provider may prefer a disposable plastic speculum).
15. Pass the proper instruments to the provider in the proper sequence. The provider will need the Cytobrush for cervical cells and the spatula for the cervical sample.

    Purpose

    Teamwork enhances efficiency.

16. Assist the provider with ThinPrep preparation by swirling the cervical specimen in the preservative solution at least 10 times to ensure that the specimen has been mixed with the preservative solution.
17. Label the specimen container and place it in a biohazard bag.
18. Apply water-soluble lubricant to the provider's fingers.

    Purpose

    To facilitate the bimanual examination.

19. The provider may prepare a stool sample for occult blood testing after the rectal examination. Have the materials ready.
20. Instruct the patient to breathe deeply through the mouth with the hands crossed over the chest.

    Purpose

    To help relax the muscles.

21. Place the soiled instruments in a basin.

    Purpose

    To help create better aesthetic surroundings.

22. Assist the patient off the table and with dressing if needed.
23. While the patient is in the dressing room, sanitize and disinfect the examination room, removing used equipment.
24. Sanitize, disinfect, and sterilize stainless steel equipment. Remove your gloves, dispose of them in a biohazard waste container, and sanitize your hands.

    Purpose

    To ensure infection control.

25. Prepare the Pap test and other samples for transportation to the laboratory. Complete the requisitions, including the date of the patient's last menstrual period (LMP) and whether she is on hormone therapy.
26. Record all procedures in the patient's health record.

    Purpose

    A procedure is not done until it is entered into the patient's record.

1. Assemble the necessary equipment.
2. Sanitize your hands and follow Standard Precautions.

   Purpose

   To ensure infection control.

3. Greet the patient, introduce yourself, and verify the patient's identity by name and date of birth, then briefly explain the procedure.

   Purpose

   Explanations gain the patient's cooperation and alleviate apprehension.

4. Instruct the patient to examine her breasts while bathing or showering in warm water because the fingers glide more easily over wet tissue.
5. The best time to perform this examination is immediately after the end of the menstrual period, when breast engorgement is minimal. Non-menstruating women should examine their breasts the first of each month.
6. Instruct the patient to raise one arm, using the right hand to examine the left breast and the left hand for the right breast.
7. Using the finger pads of the three middle fingers, move in a small circular pattern up and down the breast.
8. Starting at the axillary region, work down the area and back up again from the axillary to the ribs below the breast, back up to the clavicle, and repeatedly across to the sternum bilaterally.
9. After finishing her bath or shower, the patient should continue the examination in front of a mirror with the arms at the sides.
10. Then, with her arms raised above her head, she should look carefully for changes in the size, shape, and contour of each breast. She should look for puckering, dimpling, or changes in skin texture.
11. Instruct the patient to squeeze both nipples gently and to look for discharge.
12. Before dressing, the patient should lie on a bed.
13. A towel or pillow is placed under the right shoulder, and the right hand is placed behind the head.
14. The right breast is examined with the left hand.
15. Instruct the patient to press gently in small circles, starting at the top outermost edge, including the axillary region, and spiraling in toward the nipple. This is repeated with the left breast.
16. The patient should provide a return demonstration using the teaching model to confirm her understanding.
17. Give the patient an instruction pamphlet and/or shower card to use at home.
18. Record the patient education intervention in the patient's health record.

    Purpose

    Patient education interventions should always be documented; a procedure is not done until it is entered into the patient's record.

1. Sanitize your hands and assemble the necessary equipment.
2. Greet the patient, introduce yourself, and verify the patient's identity by name and date of birth.
3. Weigh the patient and record the weight.
4. Apply gloves and collect a urine specimen and perform a urinalysis to detect protein, glucose, or ketones in the urine; remove gloves, dispose in a biohazard waste container, and sanitize hands. Record the urinalysis results.

   Purpose

   Protein, glucose, or ketones in the urine may indicate problems with the pregnancy.

5. Measure and record the patient's blood pressure. Instruct the patient to disrobe from the waist down and to put on a gown open to the front so that the uterine fundal height can be measured.
6. Assist the patient onto the examination table, if needed, and provide a drape for privacy.
7. Assist the provider as needed throughout the examination. If a Doppler fetoscope is to be used to listen to the fetal heart tones, apply a liberal amount of ultrasound gel to the patient's abdomen and hand the fetoscope to the provider.
8. After the procedure, clean the Doppler head with a paper towel and offer the patient tissues to wipe the gel off her abdomen.
9. After the examination is complete, assist the patient off the examination table; make sure to observe for signs of dizziness or problems with balance.
10. Answer the patient's questions and provide patient education materials as needed.
11. Apply gloves, collect and package all specimens for transport.
12. Complete labels as needed. Discard supplies and disinfect the equipment according to the manufacturer's guidelines.
13. Remove gloves and dispose in a biohazard waste container. Sanitize your hands.
14. Document the pertinent information in the patient's health record.

Knowledge-check items

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L13-01 · Gynecological Assisting

L13-02 · Instruct Self-Breast Examination

L13-03 · Prenatal Exam Assisting