Pap smear

1. PAP SMEAR

2. WHAT IS PAP SMEAR TEST?? Is obtaining sample of exfoliated cell (dead cells that are shed) @ simple test to look at cervical cells The specimen should be obtained 2 weeks after the first day of LMP taken by brushing or scraping.

3. PURPOSE To detect early cancer of the cervix To determine estrogen activity related to menopause or endocrine abnormalities.

4. WHEN TO DO PAP SMEAR? All women have initial pap smear test no later than 21 years old 3 years after onset of sexual intercourse After initial test, have annually or biannually After age 30, because screened for 2-3 years unless has high factor developing cervical cancer

5. EQUIPMENT FOR VE PAP SMEAR Vulva swabbing set •Container Vaginal speculum - Mask Receiver -Vaginal speculum Savlon -Torch light Perianal drapes -Cytobrush,Thin prep Sterile glove -Incopad KY jelly -Swab sticks for HVS Specimen Form

6. Vagina speculum

7. Cytobrush,Ayre’s spatula and thin prep

8. Thin prep Ayer’s spatula

9. KY jelly Swab stick for HVS

10. PREPARATION BEFORE : Nurse should advise patient to make an appointment other than during menstruation Before appoiment : 1.Avoid intercourse for 2 days 2.Refrain from douching for 1 day 3.Cease the use of vaginal medication for at least 48 hours.

11. PRE-PROCEDURE Inform and explain the procedure to patient Advice patient to void. Provide privacy. Assistant position Lithotomy to her on examining table Drape patient permit minimal exposure.

12. DURING PROCEDURE Explaining the procedure as needed. Encourage patient to take deep breaths- help the pelvic muscles relax. Give support to the patient. Assist Dr in doing pap smear. Help to open the set. Help to focus the torch light to perinea area of patient.

13. Insertion of speculum

14. POST-PROCEDURE Observed any discharge from the vagina. Perineal care as needed. Assist patient from the dorsal recumbent /Lithotomy position to supine position. Documentation. Sent the specimen to Laboratory with the form.

15. Normal: negative means there is no identifiable infection. ASCUS :presence of a high-risk infection with HPV. Low-Grade changes : frequently due to infection with HPV, which in some instances can be a risk for cervical cancer. High-Grade changes : very atypical cells that may result in cancer Squamous cell carcinoma or adenocarcinoma : cancer is evident and requires immediate attention.

16. HEALTH EDUCATION 1.Tell patient to inform any excessive bleeding after procedure(a little bid bleeding is normal.) 2.Instruct patient to follow up the procedure at least annually or biannually.(Depend on results)