Papanicolaou Test (Pap Smear)

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 patients 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 arent 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 of Pap Smear

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.
Pap Smear 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.
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.

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