Papanicolaou Test (Pap Smear)

Notes

Definition
  • The Papanicolaou test (Pap smear) is a widely known cystologic test for early detection of cervical cancer. The can also be used to detect cancerous cells of the breast, lung, stomach, and renal system. A physician or specifically trained nurse scrapes secretions from the patient’s cervic and spreads them on a slide, which is sent to the laboratory for cystologic analysis.
  • An alternative method is to use the ThinPrep preservative solution rather than a slide. The ThinPrep was introduced in 1996 and allows testing for malignancy cells from the cervix and shows the cell maturity, metabolic activity, and morphology variations.
  • The American Cancer Society recommends a Pap test every 3 years for women between ages 20 and 40 who aren’t in a high-risk category and who have had negative results from three previous Pap tests. Yearly tests (or tests at physician-recommended intervals) are advised for women older than age 40, for those in a high risk category, and for those who had a positive test previously. If a Pap test is positive or suggest malignancy, cervical biopsy can confirm the diagnosis.
Purpose
  • To detect malignant cells.
  • To detect inflammatory changes in tissue.
  • To assess response to chemotherapy and radiation therapy.
  • To detect viral, fungal, and occasionally, parasitic invasions.
Procedure
Patient Preparation
  1. Instruct the patient to avoid intercourse for 24 hours, douching for 48 hours, and vaginal creams or medication for 1 week.
  2. Just before the test, instruct the patient to empty her bladder.
  3. During the procedure, she might experience a slight discomfort but no pain from the speculum; however, she may feel some pain when the cervix is scraped.
  4. Explain the procedure takes only 5 to 10 minutes to perform.
  5. Instruct the patient to disrobe from the waist down and to drape herself.
  6. Ask her to lie on the examining table and to place her heels in the stirrups.
  7. Tell her to slide her buttocks to the edge of the table.papsmear
Implementation
  1. The patient is assisted into the lithotomy position with her feet in the stirrups.
  2. An unlubricated speculum is inserted into the vagina.
  3. The cervix is located.
  4. Secretions from the cervix and material from the endocervical canal are collected with an endocervical brush and wooden spatula.
  5. Specimens are spread on slides and immediately immersed in fixative or sprayed with a fixative.
  6. Specimens are appropriately labeled with date of last menses, collection site, and method.
  7. If vaginal or vulval lesions are present, scrapings taken directly from the lesion are preferred.
  8. The slides are preserved immediately.
Nursing Interventions
  1. Help the patient up and ask her to dress when the examination is completed.
  2. Supply the patient with a sanitary napkin if cervical bleeding occurs.
  3. Tell the patient when to return for her next Pap test.
Interpretation
Normal Results
  • No malignant cells or abnormalities are present.Pap-smear-1
Abnormal Results
  • Cells with relatively large nuclei, only small amounts of cytoplasm, abnormal nuclear chromatin patterns, and marked variation in size, shape, and staining properties, with prominent nucleoli, suggest malignancy.
  • Atypical but nonmalignant cells suggest a benign abnormality.
  • Atypical cells may suggest dysplasia.
Interfering Factors
  • Douching within 24 hours of testing.
  • Excessive use of lubricating jelly on the slide.
  • Collection of specimen during menstruation
  • Delay in fixing the specimens
  • Consistency of specimen too thin or too thick.
Precautions
  • Preserve the slides immediately after the specimen is collected.
  • Preserve the ThinPrep solution by immediately placing the lid back on the container, as exposure to air or light can cause distortion of cells.
Complications
  • Bleeding

Exam

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