SKILL LABORATORY PRACTICE MODULE

BLOCK MODULE TOPIC : REPRODUCTIVE SYSTEM : 10 : PAP SMEAR

I. GENERAL OBJECTIVES: After completion of pap smear module, the student shall be competent in performing cervical smear, slide fixation and handling the sample slide. II. EXPECTED COMPETENCY: a. Student should be able to perform cervical smear. b. Student should be able to perform slide fixation. c. Student should be able to handle the slide for delivery III. TOPIC: Cervical Smear IV. METHOD: a. Lecture b. Discussion c. Demonstration and tutorial d. Mannequin/Anatomy model practice V. LABORATORY FACILITY: a. Class room b. Reading materials c. Audiovisual aids d. Anatomy model (pelvic model: normal) e. Student learning guide f. Tutor g. Tutor guide VI. Venue: Training room VII. Organizer: Department of Pathology Anatomy and Obstetrics and Gynecology Medical School Padjadjaran University / Dr. Hasan Sadikin Hospital. VIII. Evaluation: a. Written examination b. Competency assessment in model, based on check list

IX. LEARNING GUIDE

PAP SMEAR
No. I. 1. 2. 3. 4. STEP Anamnesis Greet the patient and introduce yourself, develop a warm and helpful enviroment. Politely ask: patient identity. Find out: is there anyone accompanying the patient, if so, ask one to accompany her in the examining room. Ask the reason why the patient needs to come to the clinic Ask the followings: Menstrual cycle, duration and first day of last menstrual periode (LMP) Parity and last delivery/abortion Other complaint such as contact bleeding or vaginal discharge, menopausal bleeding, previous radiation therapy Contraception usage Informed Consent Explain the procedure to the patient Explain the aim or the expected results of the examination Ex and sometime worry, plain that some women may experience certain discomfort during procedure, but that it shall not harm or put her in danger. Make sure that the patient understand about the procedure and the aim of the examination. Ask for verbal consent, if the patient agrees, soon as she understans the procedure. Preparation A. Patient PERFORMANCE SCALE 1 2 3 4 5

II. 5. 6. 7. 8. 9. III. 1.

Examining table Cotton and antiseptic solution Graves speculum and tray Cotton-tipped swab Spatula and Cervix brush Object glass with label Fixative Jar Fixative solution: Ethanol absolute (95%) Slide container Instrument table Lamp Pap Smear form

IV. 11. 12. 13. V. VI. 14. 15. 16.

17. 18. 19.

20.

B. Examining physician High-level disinfected handgloves Soap and tap-water Apron Clean and dry towel Getting Ready Ask the patient to void and to take off her underwear Ask patient to lay down on the examining table, and put her in lithotomy position. Turn on the lamp and direct it to the examining area. Putting on hand gloves Same as the previous skills competency Pap Smear Sitting on a chair, the physician faces the genital aspect of the patient Take some cotton with antiseptic solution and wipe it on the external genital area. Put the cotton into the disposal bin Take Graves speculum with your right hand, insert the left index finger into the introitus to make a slit, and then insert the tip of the specula blade into the introitus, parallel to the labia. Make sure that there is no tissue trapped between the blades, and slowly push them in. When the blades are far enough inside the vagina, turn it 90 0 clockwise so that the handle is directed downward. Arrange the blades by opening the blade lock, so each blade touches the anterior and posterior vaginal wall. Push the knob on the speculum to make it open wider and the vaginal lumen and portio is visible. Notice the shape and size of portio, any bleeding or discharge from the ostium. Take a cotton-tipped swab, swab the portio if there is a lot of discharge.

Pay attention to any abnormalities on portio like erosion, eritroplakia, lekoplakia, fragile mass on the portio or any mass coming out from the external uterine. Put the cotton-tipped swab into disposal bin. 21. Take the spatula, insert into the introitus avoid touching vaginal wall. Put the longer tip into the canalis cervicalis ostium and the short tip on the ectocervix. Turn the spatula 3600 clockwise once or more (until 3 times) to get enough sample. 22. Pull out the spatula, avoid touching the vaginal wall. Smear the sample onto one side of a clean and dry object glass. 23. Take the cervix brush, insert into the introitus avoid touching vaginal wall. Put the longer tip into the canalis cervicalis ostium and the short tip on the ectocervix. Turn the cervix brush 3600 clockwise once or more (until 3 times) to get enough sample. 24 Pull out the cervix brush, avoid touching the vaginal wall. Smear the sample onto the other side of the object glass. 25. Put the spatula and the cervix brush into disposal bin 26. Immediately put the slide into the fixative solution for 15 to 30 minute. 27. Release the knob and let the blades be in the original position, turn it 900 counter clockwise until the blades are parallel to the labia and take it out. 28. Put the speculum in a basin filled with decontamination solution. 29. Wipe clean the vulva and perineum from secret or liquids 30. Put the cotton swab into the disposal bin. 31. Tell the patient that the examination is completed 32. Let her get dressed and be seated for further consultation 33. Put the instrument soaked in the decontamination solutions. 34. Put your hands (still wearing the gloves) in the decontamination solution and then slowly take it off. Do not spill any liquids or secret to your surrounding. Note: The gloves and the instruments should be processed further (equipment treatment in infection prevention) VII. DATA RECORDING 35. Record your findings in the medical record 36. Fill the Pap smear Form completely VIII. Handling the slide 37. Take out the slide from the fixative solution and let it dry. 38. Write the identity of the patient on the label of the object glass 39. Put the slide into the container.

40. IX. 41. 42. 43. 44. 45.

Note: Pay attention when you place the slide, the surface should not get any scratch or touch. Make sure the container strong enough so the slide will not brake until received by the pathology laboratory Put the Pap smear form and the container into an envelope and addressed it to pathology laboratory Management Plan Explain that the result may take a few days Tell the patient the possibility of abnormalities in the result that may need an expert assistant in the higher rank medical facility . Tell the patient where the higher rank medical facility is located and the referral system. Make sure that the patient understands about all of the information and the management plan Give the medical record visiting card, show thenpatient way out and greet her.