Question

what information should the nurse include about pap smear

Answer 1

Definition

The Papanicolaou test (Pap smear) is a non invasive 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. Here scrapes secretions from the patient’s cervix and spreads them on a slide, which is sent to the laboratory for cystologic analysis. Tests are advised yearly 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

1. To detect viral, fungal, and occasionally, parasitic invasions.
2. To assess response to chemotherapy and radiation therapy.
3. Evaluate abnormal cervical changes (cervical dysplasia).
4. Detect condyloma and endometriosis.
5. To asess the patient’s response to chemotherapy and radiation therapy.

Interfering factors

There are some factors which can alter the outcome of the study

• Delay in fixing a specimen, destroy the effectiveness of the stain and makes cytologic interpretation difficult.
• Improper collection site
• Use of lubricating jelly on the speculum that may affect the viability of some organisms
• Specimen collection during normal menstruation can contaminate the sample.
• Douching, using tampons, or having sexual intercourse within 24 hours before the procedure can wash away cellular deposits.
• Existing perineal infections that may interfere with hormonal cytology.

Procedure

Patient Preparation

• Explain the procedure and obtain a concent.
• Obtain the patient’s health history include parity, date of last menstrual period, surgical status, contraceptive use, history of bleeding, history of previous Pap smears, and history of radiation or chemotherapy.
• Instruct the patient to avoid intercourse for 24 hours, douching for 48 hours, and medication or creams for 1 week.
• Instruct the patient to empty her bladder just before the test.
• During the procedure, she might experience a slight discomfort however may feel some pain when the cervix is scraped.
• Tell the patient to lie on the examining table and to place her heels in the stirrups and slide her buttocks to the edge of the table.

Implementation

• The patient is assisted into the lithotomy position with her feet in the stirrups.
• Unlubricated speculum is inserted into the cervix.
• The cervix is located.
• Secretions from the cervix and material from the endocervical canal are collected with the help of endocervical brush and wooden spatula.
• Specimens are spread on slides and immediately immersed in fixative or sprayed with a fixative.
• Specimens are appropriately labeled with date and time. date of last menses, collection site, and method.
• If lesions present, scrapings taken directly from the lesion.
• The slides are preserved immediately for evaluation.

Nursing Interventions

1. Clean the perineal area
2. Help the patient to sit and ask her to dress once the examination is completed.
3. Provide sanitary napkin if cervical bleeding occurs.
4. Inform the patient about her next Pap test.

Interpretation

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.
• Benign tumour
• Dysplasia.

Normal Result

• If only normal cervical cells present.

Complications

• Bleeding