Fillable Competency Checklist Procedure 401 Prepare the Patient for (Cengage)

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Competency Checklist Procedure 401 Prepare the Patient for (Cengage)

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© 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Name: __________________________________________ Date: _____________ Score: _____________
Competency Checklist
Procedure 40–1 Prepare the Patient for and Assist with a Gynecological Exam and
Pap Test
ABHES Curriculum
MA.A.1.4.a Follow documentation guidelines
MA.A.1.9.a Practice standard precautions and perform disinfection/sterilization techniques
MA.A.1.9.c Assist providers with general/physical examination
MA.A.1.9.d Assist provider with specialty examination including OB-GYN
CAAHEP Core Curriculum
I.P.9 Assist provider with a patient exam
I.A.1 Incorporate critical thinking skills when performing patient assessment
I.A.2 Incorporate critical thinking skills when performing patient care
I.A.3 Show awareness of a patient’s concerns related to the procedure being performed
V.A.1 Demonstrate (a) empathy, (b) active listening, and (c) nonverbal communication
V.A.2 Demonstrate the principles of self-boundaries
V.A.4 Explain to a patient the rationale for performance of a procedure
X.P.3 Document patient care accurately in the medical record
Task: To prepare the patient and assist the provider to complete a pelvic examination and obtain a Pap
test to determine a patient’s gynecological health.
Supplies and Conditions: Mayo tray, two cloth or paper towels, three pairs of disposable gloves, water-soluble lubricant,
vaginal speculum, tissues, endocervical broom, ThinPrep bottle, label, laboratory requisition,
patient’s chart/EHR, and pen.
Standards: A maximum of three attempts may be used to complete the task. The time limit for each attempt
is 25 minutes, with a minimum score of 70 percent. Scoring: Determine student’s score by
dividing points awarded by total points possible and multiplying results by 100.
EVALUATION
Evaluator Signature: Date:
Evaluator Comments:
553
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© 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Name: __________________________________________ Date: _____________ Score: _____________
Procedure 40–1 Steps
Start Time: End Time: Total Time:
Steps
Possible
Points
First
Attempt
Second
Attempt
Third
Attempt
1. Wash hands. 15
2. Prepare the room and equipment. Incorporate
critical thinking skills when performing
patient assessment and care.
15
3. Call the patient from the reception room;
introduce yourself and identify the patient.
5
4. Instruct the patient to go to the bathroom to
empty the bladder.
15
5.
Explain the rationale for performance of the
procedure. Show awareness of the patient’s
concerns related to the procedure being
performed. Demonstrate empathy, active
listening, and nonverbal communication.
15
6. Obtain the necessary information to complete
the cytology requisition form.
15
7. Attach a label to the ThinPrep bottle and place
it on the Mayo tray.
15
8. Instruct the patient to remove all clothing and
put on the examination gown with the opening
in front. Demonstrate the principles of self-
boundaries.
15
9. When the patient is gowned, enter the room and
pull out the step from the end of the table. Ask
the patient sit on the table. Cover the patient’s
legs with the drape. Push in the table step.
15
10. Notify the provider that the patient is ready. 5
11. Accompany the provider into the room and
apply critical thinking skills to provide
assistance as needed. Be sure to use proper
body mechanics when positioning the patient.
5
12. Position the patient in a sitting position for basic
assessment and initial breast examination. Be
sure to show awareness to any patient
concerns regarding the procedure.
5
13. Assist the patient to a supine position for a
continued breast exam.
15
14. When the breast exam is completed, assist the
patient to cover her chest with the gown and
drape and prepare for the pelvic exam.
5
15. Assist the patient into a lithotomy position,
helping her place her feet into the stirrups, and
adjust as needed.
15
16. Place the drape over the patient from the chest
to the feet. Push the drape down between her
legs until it touches the table. Instruct the
patient to slide her buttocks down to the end of
the table.
15
554
© 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Name: __________________________________________ Date: _____________ Score: _____________
17. The provider will take his or her position on the
exam stool at the end of the table. Remove the
cover from the Mayo tray if not previously
done. Hand gloves to the provider.
15
18. Adjust the lamp so that the light facilitates
inspection of the perineal and anal areas.
15
19. Put on gloves and run warm water over the
speculum.
15
20. Hand the speculum, handle first, to the provider. 15
21. Hand the endocervical broom, handle first, to
the provider.
15
22. Open the labeled specimen bottle and be ready
to accept the endocervical broom.
15
23. The provider will stand to perform the bimanual
pelvic and rectal exam. Apply lubricant to the
gloved index and middle fingers of the
examining hand.
15
24. When the provider has finished the exam, have
the patient push back up the table, help her get
her feet out of the stirrups, and push the stirrups
in.
15
25. Assist the patient to sit up. Pull out the table
step. When the patient’s sense of balance has
returned, assist her down from the table.
15
26. Hand tissues to the patient to remove any
residual lubricant.
5
27. Instruct the patient to dress. Provide assistance
as needed. Remove gloves and wash hands.
5
28. Advise the patient when results will be available
and schedule a follow-up appointment if
indicated.
5
29. Provide any patient teaching information
pamphlets that are appropriate, and dismiss the
patient. Record exam, Pap test, and any
teaching in the chart.
15
30. Apply gloves; properly clean and disinfect the
room and all instruments and restock supplies.
15
31. Place the labeled specimen bottle with the
attached requisition in the lab pickup area.
15
32. Pull down fresh table paper on the exam table. 15
33. Remove gloves and wash hands. 15
Points Awarded / Points Possible ____/
415
555
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Competency Checklist Procedure 401 Prepare the Patient for (Cengage)

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Completed 18 May 2021

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