Cervical Smear Test Flashcards
(18 cards)
Equipment:
Equipment:
- Pair of gloves
- Speculum
- Lubricant
- Cervex-brush broom
- Vial
- Swab (to wipe any excess mucus around the cervix)
Introduction
Introduction - Basic information o pt name age occupation o Menstrual history (quick 2 question!) • When was last LMP – if on cant do test! • Any chance pregnant? • MUST RULE OUT POSSIBILITY OF PREGGERS!!! o Obstetric history • Any children? Vaginal delivery?
- Explanation + consent
- Explanation + consent
o I will be performing a smear today
o Have you had one of these before? Would you like me to remind you of what happens during this test?
o This involves taking a sample from the neck of the womb, which will be checked to make sure there an no abnormalities
o In order for me to take the cells, I will have to use a device know as a speculum to keep the walls of the vagina open – can show the patient what the speculum looks like
o I will then place a soft brush in the opening to collect the cells from the neck of the womb, which will be sent to the lab for investigation
o The examination may feel a little uncomfortable but should not be painful, however if you would like to stop at any point let me know
o Gain consent from the patient
- Chaperone + expose
- Chaperone + expose
o get a female chaperone
o If I may ask you to remove the clothing below your waist, lie back on the couch and cover yourself with the sheet I’ll provide you with
o Call me when you feel comfortable and ready to proceed - Remember BCD:
o B – ask patient whether they need to empty their bladder, as it will make the examination more comfortable
o C – inform the patient that there will be chaperone i.e. One of my medical colleagues will be present during the examination as a chaperone
o D- Ask the patient whether she would like you to lock the door, to ensure that nobody walks in during the examination
Abdominal exam
Abdominal exam
- Inspect the abdomen looking for any signs – scars, stomas etc
- Palpate the 9 areas superficial and deep
o There is no need to do a full abdo but mention to examiner
Smear test steps
Smear test
- Prepare
- Position
- Label
- Inspection
- Speculum
- Sample cells
- Remove
- Dispose speculum appropriately
- Dress allow pt to dress in privacy
- Form – complete investigation form
Smear test
- Prepare
o Wash hands
o sterile gloves,
o adjust light for max visibility
o choose medium-size speculum (or small/large)
• Ask patient how many children she has had and whether they were via vaginal birth, no children = small speculum, 3 children = medium speculum etc
Smear test
- Position
o ask pt to bring heels towards bottom + allow knees to flop apart
Smear test
- Label
o pt name, DOB, hospital no., date of cervical smear on vial
Smear test
- Inspection
o examine vulva for redness / irritation / discharge / cysts / warts /abnormal hair distribution/ piercings
Smear test
- Speculum
o Apply lubricant jelly just below tips of blades (to avoid covering the cervix with gel)
o Use non-dominant hand to part lips of labia
o Hold speculum so tip of blade is held vertically + insert into vagina gently (Warn)
o Rotate through 90 degrees as you progress so handle is anterior
o Warn patient before opening blades (it stretches vaginal wall to bring cervix into view)
o Lock blades into position by tightening screw once cervix is seen
Smear test
- Sample cells
o Introduce broom into canal approx 2 cm in length (similar to brush length)
o Central bristles – within endocervix, outer bristles – rest against ectocervix
o Rotate brush clockwise through 5 cycles + remove from canal
• Both direction
• (handbooks state once in one direction and once in other)
o Check expiry date of liquid based cytology vial
o Rinse the brush immediately into bottom of vial 10 x – forcing bristles apart
o Swirl brush vigorously to further release material
o Visually inspect brush to ensure no material remains attached + discard it
( Apply gentle pressure against back of brush head – to snap it off from main stem + enter into vial (preservative))
o Place further samples into same vial + document in request orm
o Apply cap to vial + tighten
o Document pts name, dob, date of sample on vial
Smear test
- Remove
o Unlock blades by loosening screw
o Let blades close under pressure from vaginal walls as you withdraw it from vagina
o Ensure blades rotate through 90 degrees as speculum is removed in reverse manner to how it is initially introduced
Smear test
- Dispose speculum appropriately
- Dispose – speculum appropriately
Smear test
- Dress allow pt to dress in privacy
- Dress – allow pt to dress in privacy
Smear test
- Form – complete investigation form
- Form – complete investigation form with pt details (name/dob/hospital no.) date of request, doctor’s name, clinical details
Results
- ‘The results will be sent through the post in 6-8 weeks with a copy sent to ur GP.
- If the results are negative then the cells are healthy and we will see you again for routine check in 3 years time.
- If the cervical smear is not negative it may need to be interpreted and explained by your GP.
- On occasion an inadequate sample may have been taken, which means that you may have to repeat the test.’
Complications
- inform pt she may experience some spotting for a day or two after the examination but it should not be heavy or painful
