Definition
Assisting to obtaining a PAP smear (Papanicolaou) is a vital nursing role in preventive women’s health. It involves supporting the clinician and patient during a cervical cytology test used to detect precancerous or cancerous changes in cervical cells.
Purposes
- To detect cervical and vaginal carcinomas.
- To perform routine screening and for diagnosing disorders of reproductive system.
Methods of Obtaining PAP Smear
- Slide method.
- Liquid method (thin preparation).
Articles Needed for Obtaining PAP Smear
- A glass slide.
- A sterile Ayre’s spatula.
- Cusco’s speculum.
- A pipette.
- Sterile cotton swabs.
- Sterile gloves.
- Ether/95% alcohol solution (1:1).
- Spray fixative.
- A graphite pencil.
- Light source.
- K-Y jelly.
Procedure for Obtaining PAP Smear
| NURSING ACTIONS | RATIONALE | |
| 1. | Before procedures Check the physician’s order and progress notes. | Obtains specific instructions/information. |
| 2. | Identify the patient and check identification against physician’s order. | Ensures that the right procedure is performed on the right patient. |
| 3. | Explain the pap cytology test to the patient. Allow the patient to ask questions. Consider the protocols to be followed in specific cases. | Obtains patient’s consent and cooperation. Promotes patient education. In rape cases, vaginal swabs may be used for forensic evidence. |
| 4. | For patients of child-bearing age, test should be done 10-20 days after the first day of LMP, and definitely not when the patient is menstruating or bleeding, unless bleeding is a continuous condition. | A smear taken any time other than mid-menstrual cycle can result in abnormal findings. Heavy menstrual flow and blood may make the interpretation of the results difficult and may obscure atypical cells. |
| 5. | Instruct the patient not to douche for 2-3 days before the test. | Douching may remove the exfoliated cells. |
| 6. | Instruct the patient not to use vaginal medications or vaginal contraceptives 48 hours before the examination. Intercourse should be avoided the night before the examination. | Use of contraceptives before examination may result in false test results. |
| 7. | Instruct the patient to empty her bladder and rectum before examination. | Ensures comfort during the procedure. |
| 8. | Ask the patient to give the following information: Age. Use of hormone therapy, birth control pills, oral contraceptive devices. Past vaginal surgical repair or hysterectomy. All medications taken, including prescribed, over the counter, and herbal. Any radiation therapy. Any other pertinent clinical history (e.g., previous abnormal pap smear, signs of inflammation, or bleeding.) | Identifies if patient is an adolescent, pregnant, or postmenopausal woman. Hormones and contraceptive devices can alter the findings. Some medications alter the test results. |
| 9. | Obtain the requirements of the procedure. | |
| 10. | Using the graphite pencil, label the ends of the slide with the patient’s name and the collection site. | |
| 11. | Ask the patient to undress from waist down. | |
| 12. | Position the patient in a lithotomy position on an examination table and drape. | Ensures good visibility and promotes comfort and provides privacy. |
| 13. | During procedure Don sterile gloves, lubricate, and insert a sterile Cusco’s speculum. | |
| 14. | A) For endocervical smear: Insert a sterile cotton swab into the cervical os and rotate it by 360°. Leave the swab in place for 10-20 seconds. Remove the swab and smear onto a glass slide. Fix it immediately. Note: Fixative must be applied to the slide before drying of the specimen occurs. B) Ectocervical scraping: Insert Ayre’s spatula into the cervical os, rotate or scrape the entire surface at the squamocolumnar junction. Remove the spatula and smear onto a glass slide. Fix it immediately. C) Cervical scraping: Insert the pointed edge of a wooden Ayre’s spatula into the cervical os and rotate the spatula by 360°. Spread the cervical scrapings on a glass slide, fix it with an ether/95% ethyl alcohol solution, and dry the slide. A cervix-brush sampling device may be used, and it is recommended to be rotated a full 180° to improve the sampling for abnormal cervical cells. D)Vaginal pool: Using the blunt side of a wooden Ayre’s spatula, scrape the vaginal floor behind the cervix. Spread the vaginal pool secretions on a glass slide, spray or soak them in fixative, and dry the slide. Vaginal fluid is obtained for suspected endometrial cancer or for a hormonal evaluation. E) Vulvar smear: Using the blunt side of a wooden Ayre’s spatula, directly scrape the vulvar lesion. Spread the scraping on a glass slide and fix immediately with spray fixative. | |
| 15. | Give the patient a perineal pad after the procedure to absorb any bleeding or drainage. | |
| 16. | Write the patient’s age, reason for the study. LMP (last menstrual period) etc. on the requisition form and send the slides to the cytology laboratory. |
Special Considerations
- Smears that dry before fixative is applied cannot be properly interpreted.
- Do not lubricate the speculum as it may distort cells.
- A smear taken any time other than in the mid-menstrual cycle can result in abnormal findings.
- Tetracycline or digitalis preparations can affect the appearance of squamous epithelium.
- Blood, mucus, or pus on the slide makes interpretation difficult.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884.
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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