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Papanicolaou Test

Test Description:
The Papanicolaou test, also known as Pap smear/test or ThinPrep Pap test
(new variation), is a cytologic study for premalignant and malignant cervical
changes, rather than a diagnostic test. Sample cervical cells are obtained from the
ectocervix, transformation zone (squamo-columnar junction), and endocervical
areas. Any cellular findings that may suggest a cancerous or precancerous state are
followed by biopsy. False positives and false negatives can occur, so client
symptoms are also important indicators for further testing.
Cytologic examinations can also detect viral, fungal, and parasitic disorders.
Examination of cells from the vaginal walls can evaluate the function of steroid
hormones.

Purpose or Indication of Test:


 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 invasion

Contraindication: Menstruation

Recommended Frequency of Routine Test:

Age or Condition Recommended Test Frequency


Within 3 years of becoming sexually Annual screening
active or by 21 years of age

At 30 years of age

- If liquid-based test is used: Conventional screening or every 2 years

After three or more consecutive Screening may be performed less


negative test results frequently until 65 to 70 years of age
Client may choose to discontinue the
*No abnormal tests for 10 years
screening
May need less frequent screening or may
**Client with hysterectomy
not need screening at all
According to American Cancer Society (ACS)
*ACS, 2005; U.S. Preventive Service Task Force, 2003
**DiSaia & Creasman, 2002; Saraiya et al., 2001

Equipment Needed for the Test:


 vaginal speculum
 wooden spatula/swab/cytobrush/cytobroom
 glass slides
 fixative
Test Procedure:
1. The client is assisted into the lithotomy position with her feet in stirrups.
2. A speculum is inserted into the vagina. Usually, the cervix is visualized and
then scraped with one of the various sampling tools available, such as a
cytology brush, cotton-tipped applicator, endocervical aspirator, or wooden or
plastic spatula.
3. One sample is taken from the endocervical canal and a second from the
ectocervical and transformation zone (squamo-columnar junction).
4. Both specimens are immediately transferred to glass slides and are either
sprayed with or immersed in a fixative solution. If the smear dries on the slide
before the fixative is applied, the diagnosis will be inaccurate.
5. The slides are sent to a laboratory for interpretation.
For liquid-based test (e.g., ThinPrep Pap Test):
4. After the sample is obtained, the cells are rinsed into a vial filled with a
preserving solution.
5. The vial is sent to the laboratory, where an automated instrument separates
the cells from blood and mucus. The thinner layer of cells can then be better
visualized under a microscope, which improves the accuracy of the test.

Nursing Management:
Before Test:
o Make sure the patient has signed an appropriate consent form.
o Note and report all allergies.
o Explain the test procedure and the purpose of the test.
o Assess the client’s knowledge of the test.
o Confirm with the client that she has not douched or had a tub bath in the 24
hours prior to the test.
o Confirm that the client is not menstruating and has not had sexual
intercourse in the last 24 hours.
o Ask the client to void prior to the examination.
o Reassure the client that while the insertion and presence of the speculum
into her vagina may feel uncomfortable, there should be no sensation of pain
during the procedure.
o Reassure the pregnant client that the Pap test is a procedure that is safe
when done during pregnancy.
o Assemble the necessary equipments needed for the test. These include
drapes, gloves, vaginal speculum, warm water or lubricant, and supplies for
cytology and culture studies.
During Test:
o Adhere to standard precautions.
o Encourage the client to take deep breaths that will help the pelvic muscles
relax.
After Test:
o Assist the client from the lithotomy position and with perineal care as
needed.
o Document the procedure including the date and time it was performed, the
name of the examiner, and any nursing assessments and interventions.
o Instruct client that they may have a small amount of pink to bloody discharge
after the Pap test.
o Provide the client with a perineal pad, if needed, to protect her clothes from
any bleeding from the cervix.
o The test results may be shared with the client in person, by telephone, or by
letter.
o If a woman’s smear has atypical cells, she is urged to have follow-up testing.
o Schedule a return appointment for the patient’s next Pap test.

Complication: Bleeding

Test Results Time Frame: Within 3 to 5 days after the screening.

Interpretation:
Normal Results:
o No malignant cells or abnormalities are present.
Abnormal Results:
o 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.
o Atypical but non-malignant cells suggest a benign abnormality.
o Atypical cells may suggest dysplasia.
Interfering Factors:
o Douching within 24 hours of testing
o Excessive use of lubricating jelly on the slide
o Collection of specimen during menstruation
o Delay in fixing the specimen
o Consistency of specimen, too thin or too thick
References:
Daniels, Rick. (2006). Delmar’s Manual of Laboratory and Diagnostic Tests
(Thomson Asian ed.). Singapore: Delmar Cengage Learning.
Ignatavicius, D. D. & Workman, M. L. (2006). Medical-Surgical Nursing:
Critical Thinking for Collaborative Care (5th ed.). Singapore: Elsevier
Inc.
Kozier, Barbara, et. al. (2008). Fundamentals of Nursing: Concepts, Process,
and Practice (8th ed.). Singapore: Pearson Education, Inc.
Nurse’s Quick Check: Diagnostic Tests by Lippincott Williams & Wilkins

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