Ateneo de Zamboanga University

College of Nursing

NURSING SKILLS OUTPUT (NSO)

Papanicolaou Test

Description: Also known as Pap test or Pap smear, the Papanicolaou test developed
in the 1920’s by George N. Papanicolaou allows early detection of cervical cancer.
The cytologic test involves scraping secretions from the cervix, spreading them on
slide with fixative spray or solution to preserve specimen cells for nuclear staining.
Cytologic evaluation then outlines cell maturity, morphology, and metanbolic
activity.

Materials/ Equipments Needed:

• Bivalve vaginal speculum

• Gloves

• Pap stick (wooden spatula)

• Long cotton-tipped applicator

• Three glass microscope slides

• Fixative (a commercial spray of 95% ethyl alcohol solution)

• Adjustable lamp

• Drape

• Laboratory request forms

Procedure:

1. Get ready: Select a speculum of the appropriate size, and gather the
equipment in the examining room. Label each glass slide with the patient’s
name, and an “E”, “C”, or “V” to differentiate endocervical, cervical, and
vaginal specimens.

2. Explain the procedure to the patient and wash hands

3. Instruct the patient to void to relax the perineal muscles and facilitate
bimanual examination of the uterus

4. Provide privacy and instruct the patient to undress below the waist. Then
instruct her to sit on the examination table and to drape her genital region

5. Place the patient in the lithotomy position, with her feet in the stirrups and
her buttocks extended slightly beyond the edge of the table. Adjust the drape

6. Adjust the lamp so that it fully illuminates the genital area

Date
Clinical Instructor’s Initials
LAKIBUL, JASEM I.
BSN III-D
Page 1 of 2
 7. Put on gloves then take the speculum in your dominant hand and moisten it
with warm water to ease insertion.

8. Warn the patient that you’re about to touch her to avoid startling her. Then
gently separate the labia with the thumb and forefinger of your nondominant
hand

9. Instruct the patient to take several deep breaths, and insert the speculum
into the vagina. After it’s in place, slowly open the blades to expose the
cervix. Then lock the blades in place.

10.Insert a cotton-tipped applicator through the speculum 1/5” (5mm) into the
cervical os. Rotate the applicator 3600 to obtain endoendocervical specimen.
Then remove the applicator and gently roll it in a circle across the slide
marked “E”. Refrain from rubbing the applicator on the slide to prevent cell
destruction. Immediately place the slide in a fixative solution spray to
prevent drying of the cells, which interferes with nuclear staining and
cytologic interpretation

11.Insert a small curved end of the Pap stick through the speculum, and place it
directly over the cervical os. Rotate the stick gently but firmly to scrape cells
loose. Remove the stick, spread the specimen across the slide marked “C”

12.Insert the opposite end of the Pap stick or a cotton-tipped applicator through
the speculum, and scrape the posterior fornix or vaginal pool, an area that
collects cells from the endometrium, vagina, and cervix. Remove the stick or
applicator, spread the specimens across the slide marked “V”

13.Unlock the speculum to ease removal and avoid accidentally pinching the
vaginal wall. Then withdraw the speculum

14.Remove the glove of your nondominant hand to perform the bimanual

examination, which usually follows the Pap test. Then remove your other
glove, and discard both gloves

15.Gently remove the patient’s feet from the stirrups, and assist her to a sitting
position. Provide privacy for her to dress

16.Fill out the appropriate laboratory request forms, including the date of the
patient’s last menses.

Nursing Responsibilities:

• Many preventable factors can interfere with the Pap test’s accuracy, so
provide appropriate patient teaching beforehand. For example, use of a
vaginal douche in 48-hour period before specimen collection washes away
cellular deposits and prevents adequate sampling.

Date
Clinical Instructor’s Initials
LAKIBUL, JASEM I.
BSN III-D
Page 2 of 2