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Katia Gedeon

Clinical Experience

I had the opportunity of attending to pregnant women this week and faced some learning opportunities. Initially, I did not know how best to prepare a patient before conducting a pap smear. I felt I was not giving accurate information and explaining everything I needed to do and why. However, after consultation, collaboration, and experience, I was able to give the correct details in the right manner to these women.

One clinical case I undertook this week was of a 41-year-old male patient who had presented for her routine pap smear. The female had a history of infertility, yeast infections, and HPV. It had taken slightly more than two years since she last had her pap smear, and the result was negative.

I began by securing the patient's consent. I extensively discussed the procedure with her and ensured she understood everything before giving an informed, written consent. I then began to take some of her health histories. Her parity was gravida one para 0. The date of her last menstrual period was 26^th Sept 2022. Women should not go for pap smears when they are on their menstrual period. She did not have any surgical history (Cummings, 2020). She did not have any history of chemotherapy and radiation, and her previous pap smears were negative. Furthermore, she was using Depo-Provera and did not have any history of vaginal bleeding. The patient was not under any virginal antibiotic that would delay the procedure for another one month.

I then explained to the patient that the Pap smear is usually painless. Although the test requires some scrapping of the cervix, the patient would not feel any pain but might only experience minimal discomfort due to the speculum insertion. I then advised the patient on some of the interfering factors to avoid a few days or hours before the test. I advised her to avoid having any sexual intercourse for twenty-four hours, using a tampon, applying any vaginal lotions or creams, and douching within 48nhours before the test as those could wash away cellular deposits and end up changing the vagina's PH (Norkhafizah Saddki & Norehan Mokhtar, 2019). Finally, I advised the patient to empty her bladder before the test since a Pap smear entails speculum insertion into the vagina, which might press her lower abdomen.

I started the test by assisting the client in a supine, dorsal lithotomy position while her feet were in stirrups. I then put on gloves and inserted a moist speculum into the vagina. I started opening the speculum gently to spread the vagina apart so that I could access the cervix. Once I had positioned the speculum, I started taking the specimen from the cervix and the vagina. I inserted a cytobrush inside the cervix and rolled it firmly up to the endocervical canal. I rotated the brush once and removed it. I then scraped the outer opening of the vagina wall and cervix using a spatula. Then, I immediately immersed both the spatula and brush in a ThinPrep solution to release the material before closing and labeling it with the patient's name, age, initials, time, and collection date. I finally cleaned the area and provided a sanitary pad to the patient. I learned the procedures for conducting Pap smears, including the essential information before and after the test.

References

Cummings, D. A. (2020). Pap Smear and HPV Testing. In Primary Care Procedures in Women's Health (pp. 65-76). Springer, Cham. https://link.springer.com/chapter/10.1007/978-3-030-28884-6_8

Norkhafizah Saddki, M., & Norehan Mokhtar, M. (2019). Cervical cancer and pap smear screening: knowledge, attitude, and practice among working women in the northern state of Malaysia. Med J Malaysia, 74(1), 9. http://www.e-mjm.org/2019/v74n1/pap-smear-screening.pdf