Nursing Procedure – Steps Used by Nurses in Gynecology Conditions

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

Bottom Shelf

–     Bedpan

–     Destructor bowl for used swabs

–     Kidney receiver if pad is required for inspection

Bedside:

–     Angle poised lamp

METHOD:

–     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:

Top Shelf

–     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)

Bottom Shelf:

–     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

METHOD:

–     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:

Top Shelf:

Large bowl with lid or covered with a second bowl inverted, containing:

–     Douche can

–     Long piece of rubber tubing

–     Clip

–     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.

Lower Shelf:

Destructor bowl

Salvage bowl

Kidney receiver

Sterile bedpan

METHOD:

  • Explain procedure to the patient
  • Screen the bed
  • Wheel trolley to patient’s bedside
  • Open bowls on bottom shelf
  • Place patient in dorsal or recumbent position, arranging the bed sheet to lessen a feeling of exposure
  • Place bedpan under the patient
  • Wash and dry hands
  • Remove lids of bowls on top shelf
  • Wear gloves
  • Swabs the vulva in the usual manner
  • Connect tubing and pour in the lotion from the litre jug of temperature 100of (37.7oC)
  • Open the clip and let some fluid flow into the bedpan to expel air and warm the tubing
  • Run some lotion unto the thigh before gently inserting the nozzle into the vagina. Let the liquid flow and when finished, discard soiled nozzle.
  • Discard used nozzle into kidney receiver
  • Instruct patient to sit up on the bedpan and give a little cough to make sure no fluid is left in vagina.
  • Dry the vulva
  • Apply pad folded
  • Swab the perineum from backwards Clean and dry buttocks and thigh, fix pad in position with right hand
  • Discard used glove into bowl with disinfectant. Make patient comfortable.
  • Remove screens
  • Discard trolley in the usual manner

Note: Report the type of returned fluid, debris, Blood, or Pus observed.

 

PASSING OF A FLATUS TUBE

PURPOSE:

  • To rid the bowl of flatus
  • To relieve abdomen distension

 

Requirement needed:   this is a tray procedure. In the tray are contained:

  1. Bowl containing funnel, rubber tubing, plastic or glass connection and rectal tube
  2. Galipot with lubricant
  3. Galipot with gauze swabs and squares old linen
  4. Mackintosh and dressing towel
  5. Receiver for soiled swabs
  6. Bowl of water

PROCEDURE:

  1. Wash and dry hands
  2. Explain procedure to the patient
  3. Screen the bed
  4. Take equipment to patient’s bedside
  5. Assemble them and place the funnel under the water in the bowl
  6. Place patient in a left lateral position with the mackintosh and towel under buttocks
  7. Lubricate the tip of the tube and insert into the rectum from about 4-6 inch (10cm – 15cm)
  8. Observe water in the bowl. If flatus is expelled bubbling will be seen in the water
  9. Note quantity of bubbles +
  10. Leave tube in position for about 10 minutes if relief is experienced
  11. Remove the rectal tube using gauze swabs
  12. Make patient comfortable
  13. Cleanse equipment and keep in place
  14. Record treatment given to the patient

 

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

METHOD:

–     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.

  1. Lubricant
  2. Swab or disposable paper in a bowl for cleaning the rectum
  3. Large jug containing litres of warmed tap water or other fluid (Temp. 37oC or 100oF)
  4. Lotion thermometer

Bottom Trolley:

  1. Receiver of disposable waterproof bag for soiled swab or disposable paper.
  2. A pail with lid for the returned fluid.
  3. Mackintosh and towel to protect the bedclothes.

PROCEDURE:

An evacuant enema may be necessary before the rectal wash out.

  1. The nurse should explain to the patient what she is going to do. She should briefly explain the procedure of the patient.
  2. Screen the client
  3. Offer the patient a bedpan or urinal to empty the bladder
  4. Remove the backrest, leaving the patient with one pillow.
  5. Fold down the top bedclothes
  6. Put the patient in the left lateral position with the buttock to the edge of the bed.
  7. Roll the treatment mackintosh and towel under the buttock to protect the bottom sheet.
  8. Connect the tubing to the flannel the spring clip, straight connection and Jacques catheter.
  9. Connect the tubing to the flannel the spring clip, straight connection and Jacques catheter.
  10. Run a little of the lotion through to expel air and clip off
  11. Lubricate the end of the catheter
  12. Clean the rectum
  13. Raise the funnel with the lotion
  14. Gently insert the catheter into the rectum
  15. Release the clip and allow the fluid to run in
  16. As a rule it is possible to refill the funnel three or four times and then by inverting the funnel over to the pail at the bedside return it by siphon age.
  17. This is repeated until the rectum fluid is clear for reasonable amount is used.
  18. The apparatus is then removed and the patient made comfortable

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.

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