Nursing Procedure – Nurses in hospital and clinics use the following in gynaecology or female conditions.
VULVA SWABBING; A PROCEDURE IN NURSING
Vulva swabbing procedure used by professional nurses and student nursing during training in hospitals and clinics.
Requirements needed for vaginal swabbing
Items needed on top shelf of the trolley:
– Medium sized bowl containing:
(a) Cotton wool swabs
(b) Sanitary pad and gauze (if necessary)
– Kidney receiver with 2 pairs of gloves
– Small bowl with lotion e.g. hibitane 1:2000 e.t.c. (Temp. 37.7oc)
– Kidney receiver containing items for securing sanitary pad if the available pad has no adhesive. E.g. cotton bandage, safety pins and scissors.
– Additional requirement when wound dressing is necessary e.g. perineal wound or vulvectomy
– Instrument tray containing:
(a) 2 pairs of dressing forceps
(b) 1 pair of plain dissecting forceps
– Small bowl for resting forceps
– Galipot for dressing lotion
Rail of Trolley
– Small treatment mackintosh
– Destructor bowl for used swabs
– Kidney receiver if pad is required for inspection
– Angle poised lamp
– Explain procedure to client
– Provide adequate privacy
– Wheel trolley to the client’s bedside
– Remove lids from bowls on the lower shelf of the trolley
– Insert treatment mackintosh and then bedpan under the patient
– Place client on dorsal position with knees flexed and abducted
– Arrange bed liners so that client does not feel exposed
– Put on disposable gloves
– Remove and discard soiled pad into destructor bowl or kidney receiver if it is for inspection
– Wash and dry hands
– Remove lids of bowl on top of the shelf
– Put on gloves (surgical gloves)
– Put number of swabs required in small bowl containing lotion
– Pick swabs with your right hand, squeeze out excess lotion, then transfer to left hand swab vulva from above downward, using one swab once only
– Swab the left labium magus first, then the right labium majus
– Using the thumb and index finger of the left hand separate the labia majora gently
– Swab the labia minora and vestibule with right hand
– When urethral catheter is in position, swab from meatal opening outward for about 8-10cm
– Pour the remaining carefully over the vulva
– Using dry swabs pat vulva dry buttocks and thighs
– If pad is needed, insert appropriately e.g. for pad with string ask the client to hold in the string of pad
– Turn her to left lateral position
– Remove bedpan with left hand
– Keep on chair then swab perineum from front backward
– Pat it dry with dry gauze
– Fix pad in position with right hand
– Discard used glove
– Ensure patient is comfortable
– Remove screens and discard all used swabs immediately
– Take trolley to the treatment room, wash the instrument sterile and keep dry.
HOW TO CARRY OUT A VAGINAL EXAMINATION ON A CLIENT
Requirement on a Trolley:
– Medium sized bowl containing sterile cotton wool swabs sanitary pad
– Sterile instrument tray containing 2 sponge holding forceps, 1 cusco’s speculum, 1 Sim’s speculum
– Gallipot with hibitane or lubricant cream
– Kidney receiver with a pair of sterile gloves
– Bowl containing antiseptic lotion e.g. hibitane 1-250 (37.7oC)
– Medium size kidney receiver for used swabs
– Large kidney receiver for used instruments
TRAIL OF TROLLEY: Treatment Plastic
BED SIDE: Angle Poised Lamp
PREPARATION: Ensure client empties his bladder
– Explain procedure to the client
– Screen the bed
– Take tray to client’s bedside
– Put client in a recumbent with knees flexed and separated
– Arrange client bed linen to lessen feeling of exposure
– Ensure adequate light is provided with angle poised lamp
– Wash and dry hands, assist the doctor
– Ensure client is comfortable during and after the procedure. Record findings.
– Remove screens and discard trolley
HOW TO PERFORM VAGINAL DOUCHE OR IRRIGATION
Requirements on a Trolley:
Large bowl with lid or covered with a second bowl inverted, containing:
– Douche can
– Long piece of rubber tubing
– Douche nozzle of
– Size 14 Jacques catheter
(if a glass douche nozzle is used, it may be placed in an instrument tray.
Inspect nozzle after sterilization to make sure that it is not cracked).
Medium sized bowl containing:
– Cotton wool swabs Sanitary Pad
– Gauze swabs if necessary
Lotion bowl with hibitane 1:2000, temperature 100oP (37.7oC)
Kidney receiver with a pair of gloves
Tray and castor oil cream if required. Small receiver with, ‘T’ bandage,
Safety pins, Spatula, Scissors.
Note: Report the type of returned fluid, debris, Blood, or Pus observed.
PASSING OF A FLATUS TUBE
Requirement needed: this is a tray procedure. In the tray are contained:
CLEANING OF THE RECTAL TUBES
Wipe off the grease and adherent faecal matter with old linen square. Hold flatus tube eye upward under a running tap then
Wash thoroughly with a detergent and boil.
INSERTION OF SUPPOSITORIES
Requirements on Small Tray:
– A kidney receiver containing:
– Suppository, a rubber finger stall or right hand glove
– A gallipot containing Vaseline or warm water
– A gallipot containing old linen squares
– A small kidney receiver
– Wash and dry hands
– Take tray to patient’s bedside
– Explain to the patient what you are about to do Screen the bed
– Place patient in the left lateral position Put fingerstall or glove
– Lubricate the thumb, the first finger and the suppository
– Insert suppository into the anal canal then use the first finger to push the suppository gently into the rectum for 2”-3” inches.
– Advise the patient to pinch his buttock together for 5-10 minutes. Givea bedpan on patient’s request.
RECTAL LAVAGE OR WASH OUT
The objective is to cleanse the rectum in order to remove mucous, blood or debris before some rectal operations.
Articles the nurse requires for rectal lavage:
– A bowl containing a funnel, 12 to 14 rubber tubing straight connection and Jacques catheter No. 14 – 16 as rectal tube.
An evacuant enema may be necessary before the rectal wash out.
NOTE: The patient must be warned to describe any discomfort she may have. The nurse should also observe the general condition of the patient while carrying out the procedure.