o Slide abdominal hand slowly toward the pubis, press downward and forward with the flat surface of fingers while pushing inward and upward with the fingertips of the intravaginal hand while pushing downward on the cervix with the backs of your fingers * If uterus is anteverted or anteflexed, the fundus will be felt between fingers of two hands at the level of the pubis * If it is not felt as described above, place intravaginal fingers together in the posterior fornix, with the abdominal hand immediately above the symphysis pubis * Press firmly downward with the abdominal hand while pressing against the cervix inward with the other hand. A retroverted or retroflexed uterus will be felt utilizing this maneuver * If not felt as described above, move intravaginal fingers to each side of the cervix pressing inward and feeling as far as you can. * Slide fingers so that one is on top of the cervix and one is underneath. When uterus is in mid-position, the fundus will not be felt with the abdominal hand o Utilizing the palmar surface of fingers, palpate the uterine fundus while gently pushing the cervix anteriorly with the pelvic hand * To palpate the ovaries in order to note size, shape, mobility, and tenderness o Slide vaginal fingers gently into the lateral vaginal fornix, pushing inferiorly with the abdominal hand o Entrap the adnexa between the abdominal and vaginal hand o Complete both right and left sides * To palpate adnexa o Complete following palpitation of ovaries
o If unable to feel anything in adnexal areas with palpitation, no abnormality is presence (unless clinical symptoms exist) Proper technique for examining the male genitalia, including the prostate Proper technique for examining the male genitalia, including the prostate Check for hernia by having patient bare down and inspect the inguinal canal and fossa ovalis. Should be no bulges Insert finger into lower part of scrotum and up into vas deferens into inguinal canal where external oval ring can be felt. Have patient cough while finger is still inserted to assess for hernia which will bump against finger with coughing. Inspect penis for lesions, or sores. If uncircumcised retract foreskin for inspection and replace once done with inspection. (Smegma may be present over glands in uncircumcised male). Palpate testes using thumb and 1st 2 fingers to assess for lumps, nodules, or tenderness Should be smooth, and rubbery with no tenderness Palpate the epididymis on upper section of testes bilaterally (should be smooth and not lumpy or tender) Palpate vas deferens (Should be smooth, discrete, not lumpy or painful) PROSTATE-warn patient he may feel the urge to pee but he wont actually pee! Pg 491 To palpate prostate lube up index finger and touch the anus with tip of finger. Gently insert index finger in about 1 cm into the rectum to feel the posterior surface of the prostate through the anterior wall of the rectum. Prostate should be about the size of a pencil eraser, firm, smooth, and slightly moveable. Note size, contour, consistency, & mobility.
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- Summer '15
- pulse, Physical examination, intercostal space , 6512 Final