CHECKLIST PAP SMEAR

Alat : Asistant, Handscoon, kain penutup, lampu, speculum, cytobrush + ayre spatula, preparat
glass, spray fiksasi, pensil+ label.

STEP / TASK
GETTING READY
Greeted the woman respectfully and with kindness.
Explained why cervical smear is recommended and described the procedure.
Instructed her to empty the urinary bladder, undress and lie in the supine position
on the examination bed
Washed hands
Put on examination gloves
Procedure of cervical smear
Inspected external genitalia and checked urethral opening for discharge.
Inserted speculum and adjust it so that the entire cervix can be seen.
Scraped the whole transformation zone and the ectocervix by the Ayres spatula
Spread the specimen on a glass slide
Introduced a cytobruch inside the endocervical canal and rotated it 180 degree
Spread the specimen obtained from the endocervical canal on the same slide
Fixed the smear immediately with cytological fixative
After the procedure
Took off the gloves, disposed of them in the proper container
Washed hands
Told the client when to return for results
 CHECKLIST Wet SMEAR

Getting Ready
Greeted the woman respectfully and with kindness.
Explained why vaginal smear is recommended and described the procedure.
Instructed her to empty the urinary bladder, undress and lie in the supine position
on the examination bed
Washed hands
Put on examination gloves
Procedure
Inspected external genitalia and checked urethral opening for discharge.
Inserted speculum and adjust it so that the entire cervix can be seen.
Collected samples of vaginal fluid by wooden spatula or a swab.
Spread the sample on 2 slides for testing.
mixed the first sample with normal saline (positif = clue cell)
mixed the second sample with KOH and Did Whiff test. (positif = fishy odor)
Measured vaginal ph. (positif >4,5
Post Procedure
Took off the gloves, disposed of them in the proper container
Washed hands
Told the client when to return for results
 Checklist vaginal exam
Getting Ready
Greeted the woman respectfully and with kindness.
Explained why vaginal exam is recommended and described the procedure.
Instructed her to empty the urinary bladder, undress and lie in the supine position
on the examination bed
Asked for a third party (for example a nurse or midwife) to attend the
examination.
washed hands
Put on examination gloves
Lower abdominal and Groin examination
Inspected and palpated the lower abdominal quadrants for masses and
tenderness
Inspected and palpated the groins for Lymph node enlargement
Lower Genital Inspection and palpation
Separated the labia majora gently with the index finger and thumb of one gloved
hand
Inspected and commented on the mons pubis, clitoris, labia majora, labia minora,
vestibule, urethral orifice, perineum, anal and peri-anal area
Instructed the patient to strain and cough
Identified the Bartholin gland
Outward massage the anterior vaginal wall and urethra to detect urethral
discharge and discharge from Skene's glands
Speculum Exam
Selected a suitable sized speculum
Held the closed blades of the bivalve speculum between the index and middle
fingers of the right hand and placed the thumb on the upper posterior rim of the
speculum
Separated the labia majora with the index finger and thumb of the left-gloved
hand to expose the vaginal introitus
Placed the tip of the speculum at the vaginal introitus and gently advanced the
blades of the speculum into the vagina bearing in mind its upward and backwards
direction
Opened the blades of the speculum and fixed it open
Inspected and commented on the vaginal walls
Closed the blades of the speculum and gently withdraw it from the vagina
Bimanual Palpation
Separated the labia majora with the index finger and thumb of the left gloved
hand to expose the vaginal introitus
Inserted the index finger of the right gloved hand into the vagina first; only
inserted the middle finger as the patient relaxed the muscles around the vagina
palpated the vaginal walls and cervix
Placed the vaginal fingers in front of the cervix in the anterior fornix and moved
the cervix down to antevert the uterus
Placed the the left hand (abdominal hand) just below the umbilicus and gradually
move it lower until the fundus is caught and pressed against the fingers in the
anterior fornix and palpated the uterus
Palpated the right and left adnexa
Placed the fingers of the vaginal (right) hand in the posterior fornix and palpate
the pouch of Douglas,
Rectovaginal exam (when indicated)
Inserted the index or middle fingers of the right gloved hand into the anal canal
and the left hand on the lower abdomen and proceeded as in the bimanual
vaginal examination.
Inserted the index finger of the right hand in the vagina and the middle finger of
 Pap Smear

* Objectives:
(1) Inspect vagina & cervix.

(2) Obtain a specimen of cervical cells for cancer screening.

* Equipment:
(1) Light Source.

(2) Vaginal speculum.

(3) Gloves.

(4) Cotton balls.

(5) Slides.

(6) Specimen collection.

(7) Wooden or plastic spatula.

 Pap Smear

Procedure:
Nursing action Rational

1- Wash hands.

2- Prepare equipment beside exam

table.

3- Explain procedure to woman. - To relieve anxiety.

4- Instruct mother to empty bladder. - To relieve discomfort.

5- Assist woman into lithotomy

position.
6- With gloved hands inspect, - For any abnormality.

palpate the external genitalia.

7 - Insert sterile speculum into the

vagina:

a - Open the introitus.

b - Oblique insertion of speculum. - Prevent tissue injury

c - Final insertion of speculum.

d - Opening the blades of

speculum.

8- Excess mucus is removed from - The removal of excess mucus

the cervix with a dry cotton. allows for a more accurate

specimen sample.
 Nursing action Rational

9- A saline moistened Dacron - A specimen of cells is

applicator is introduced into the obtained distributes the cells

endocervical canal & rotated 360C on a slide.

& rolled on slide.

10- A Wooden or plastic spatula is - This action scrapes the tissue

used to obtain the ectocervical of the sqaomo columnar

sample. The longer end is junction. This is the area

introduced into the cervical os, where most malignancies

pressed & turned in a full circle. arise & can be seen as a

color change of cervical

epithelium.

11- The specimen is smeared on a - This prevents the specimen

glass slide & immersed in 95% from drying, which distorts

alcohol. the cells.

12- Clean the equipment.

13- wash hands.

 Pap Smear

Figure 11-12. A cervical scrape of

secretions for cytology is obtained by
using a wooden. Ayre spatula.
A. Shows the speculum in
place: the spatula is
inserted so that the
longer end is placed
snugly in the os.
B. A representative sample
of secretions is obtained
by rotating the spatula.
C. Cervical secretions are
gently smeared on a
glass slide in a single
circularmotion. The
slide is placed in the
appropriate laxative.
Using a cotton tipped
applicator, also obtain a
smear from the floor of
the vagina below the
cervix and preserve in
the same manner.
 Pap Smear

Procedure:
Nursing action Rational

1- Wash hands.

2- Prepare equipment beside exam

table.

3- Explain procedure to woman. - To relieve anxiety.

4- Instruct mother to empty bladder. - To relieve discomfort.

5- Assist woman into lithotomy

position.
6- With gloved hands inspect, - For any abnormality.

palpate the external genitalia.

7 - Insert sterile speculum into the

vagina:

a - Open the introitus.

b - Oblique insertion of speculum. - Prevent tissue injury

c - Final insertion of speculum.

d - Opening the blades of

speculum.

8- Excess mucus is removed from - The removal of excess mucus

the cervix with a dry cotton. allows for a more accurate

specimen sample.
 Nursing action Rational

9- A saline moistened Dacron - A specimen of cells is

applicator is introduced into the obtained distributes the cells

endocervical canal & rotated 360C on a slide.

& rolled on slide.

10- A Wooden or plastic spatula is - This action scrapes the tissue

used to obtain the ectocervical of the sqaomo columnar

sample. The longer end is junction. This is the area

introduced into the cervical os, where most malignancies

pressed & turned in a full circle. arise & can be seen as a

color change of cervical

epithelium.

11- The specimen is smeared on a - This prevents the specimen

glass slide & immersed in 95% from drying, which distorts

alcohol. the cells.

12- Clean the equipment.

13- wash hands.