PAPANICOLAU (PAP) SMEAR It is a cytologic study that is effective in detecting precancerous and cancerous cells from the cervix.

It is used to detect cervical cancer. Cervical secretions are gently removed from the cervical canal and may be transferred to a glass slide and fixed immediately by spraying with a fixative or immersed in solution. The American Cancer Society (ACS) advises all women to begin having an annual Pap test within 3 years of becoming sexually active or by 21 years of age. Terminology used to describe findings includes the following categories: Normal atypical squamous cells of undetermined significance (ASCUS), either human papilllomavirus (HPV) + or Low - grade squamous intraepithelial lesion (LSIL), which is equivalent to cervical intraepithelial neoplasia (CIN; grade 1) and to mild changes related to exposure to HPV High - grade squamous intraepithelial lesion (HGSIL), which equates to moderate and severe dysplasia, carcinoma in situ (CIS), as well as CIN grade 2 and CIN grade 3 Client Preparation 1. Explain the Pap test purpose and procedure. 2. It should be scheduled between the client's menstrual periods so that the menstrual flow does not interfere with the test interpretation. 3. Instruct the patient not to douche for to 3 days before the test because douching may remove exfoliated cells. 4. Instruct the patient not to use vaginal medications or vaginal contraceptives during the 48 hours before the examination. Intercourse is not recommended the night before the examination. 5. have the patient empty bladder and rectum before examination. Procedure 1. Ask the client to remove clothing from the waist. 2. Assist the client into the lithotomy position. Realaxation techniques, including concentrating on breathing patterns or a visual focal point, may help apprehensive client. 3. Gently insert an appropriately sized bivalve speculum, lubricated and warmed only with water, into the vagina to expose the cervix. 4. If a conventional Pap smear, as opposed to liquid base, is being taken, scrape the posterior fornix and the external canal of the cervix with a spatula or a cytobrush. Smear material obtained on a glass slides and place immediately in 95% alcohol or spray fixative before air drying occurs. 5. The cytobrush is inserted 2cm into the cervical canal and rotate 180 degrees. Roll the brush onto the Pap smear slide. (With ThinPrep Pap smears (liquid-based test), the brushings are not spread onto a slide. the spatula and brush are placed in a bottle of fixative and swirled. 6. Label the specimen properly with pateint's name and identifying number and the area from which the specimen was obtained, and send it to the laboratory with a properly completed sheet, including date of collection, patient's date of birth, date of last menstrual period, and pertinent clinical history. Follow-Up Care

1. Give the patient a perineal pad after the procedure to absorb any bleeding or drainage. 2. The test results may be shared with the client in person, by telephone, or by letter. 3. If a woman's smear has atypical cells, the client is urged to have follo-up testing. Interpretation of Pap smear test are as follows: Class I - Normal Class II - Inflammation Class III - Mild to Moderate Dysplasia Class IV - Probably Malignant Class V - Possibly Malignant Class I result requires follow up checkup examination every 1 to 3 years as recommended by physician. Class II and III results may require repeat Pap exam in 3 to 6 months as prescribed. Class IV and V require biopsy. Clinical Implications Patient may incorrectly assume that an abnormal pap smear signifies cancer. If the Pap smear (liquid immersion method) shows atypical cells and ho high-risk HPV types, the next Pap smear is performed in 1 year. If a specific infection is causing inflammation, it is treated appropriately, and the pap smear is repeated. If the repeat pap smear reveals atypical squamous cells with high-risk HPV types, colposcopy may be indicated. Pap smear that indicate LSIL should be repeated in 4 to 6 months and colposcopy perfoormed if the LSIL has not resolved. Patients with Pap smears that indicate HGSIL and CIS require prompt colposcopy. If the Pap smear results are abnormalm prompt notification, evaluation and treatment are crucial.

Written Report PAP SMEAR

Submitted By: CAMELA JOY D. CENTENO BSN 4-2 Group 4 Submitted to: Ms. Elvira Casanas