Republic of the Philippines
PALAWAN STATE UNIVERSITY
Puerto Princesa City
COLLEGE OF NURSING AND HEALTH SCIENCE
MIDWIFERY DEPARTMENT
M101-B RLE
CHECKLIST IN INTERNAL EXAMINATION
NAME: ________________________________________ SCORE:____________
Instructions: Rate the performance of each step or task using the following scale:
2 – has the skills and was able to perform the task correctly.
1 – has the skills seldom performs the task, lacks confidence (e.g. display of
nervousness, unsure of what should be done)
0 – task not performed and needs verification.
PARAPHERNALIAS:
STERILE GLOVES
LUBRICATING JELLY
Water for flushing
PROCEDURE 2 1 0
GETTING READY
1. Prepare materials needed.
2. Identify your client.
3. Introduce yourself to the client.
4. Explain the procedure and made her feel comfortable.
PROCEDURE
5. Assist the patient in a Dorsal Lithotomy position.
6. Wash or flush the perineum
7. Wash hands and dry.
8. Put on sterile gloves.
9. Inspect the vulva for masses, amniotic fluid, blood and pus.
10. Lubricate the two fingers of the with dominant hands with
antiseptic or lubricating jelly.
11. Separate the labia with the thumb and little finger of the
dominant hand.
12. Insert the 2nd and 3rd fingers sidewise deep into the vagina in
downward direction.
13. Palms facing upwards sway the fingers on the wall of the
vagina till they come in contact with the cervix.
ASSESS THE FOLLOWING:
A. VAGINA: firm, distensible
a. Condition of the CERVIX:
Hard
Soft
Close
Open
Effacement/Percent
Dilation/cm
b. Position of the fetus:
LOA
LOP
ROA
ROP
Others
B. MEMBRANES:
Intact,
Ruptured (characteristics of amniotic fluid)
C. PRESENTATION of the fetus:
Breech
Cephalic
Shoulder
others
D. Station of the presenting part:
Station:
-3
-2
-1
0
+1
+2
+3
E. Pelvic architecture
1. Ischial spines: prominent and non-prominent
2. Diagonal conjugate >11.5cm / < 11.5cm
POST-PROCEDURE TASK
14. Flush the perineum and vulva after IE, use tissue paper to dry
the area.
15. Remove gloves and discarded them in a leakproof container or
plastic bag and dispose properly.
16. Inform the client about the findings or labor progress.
17. Assist a woman into a more comfortable appropriate position.
18. Washed hands thoroughly or used antiseptic solution.
19. Make necessary notations, recording and reporting of findings,
Report the following base on your FINDINGS:
20. CONDITION OF THE CERVIX (texture, dilatation, effacement)
21. PRESENTATION
22. FETAL POSITION
23. STATION
24. MEMBRANES
25. PELVIC ARCHITECTURE
26. VAGINAL DISTENSIBILITY
27. ABNORMAL FINDINGS (if any)
Recommendations:_____________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
_______________________________________
Student Signature over Printed Name
_______________________________________
Clinical Instructor Signature over Printed Name
