Colposcopy

General

Synonym/Acronym:
cervical biopsy, endometrial biopsy.

Rationale
To visualize and assess the cervix and vagina related to suspected cancer or other disease.

Patient Preparation
There are no food, fluid, activity, or medication restrictions unless by medical direction.

Normal Findings

  • Normal appearance of the vagina and cervix.
  • No abnormal cells or tissues.

Critical Findings and Potential Interventions
N/A

Overview

(Study type: Endoscopy; related body system: Reproductive system.)

In this procedure, the vagina and cervix are viewed using a colposcope, a special binocular microscope and light system that magnifies the mucosal surfaces. Colposcopy is usually performed after suspicious Papanicolaou (Pap) test results or when suspected lesions cannot be visualized fully by the naked eye. The procedure is useful for identifying areas of cellular dysplasia and diagnosing cervical cancer because it provides the best view of the suspicious lesion, ensuring that the most representative area of the lesion is obtained for cytological analysis to confirm malignant changes. Colposcopy is also valuable for assessing females of reproductive potential with a history of exposure to diethylstilbestrol (DES) in utero. The goal is to identify precursor changes in cervical tissue before the changes advance from benign or atypical cells to cervical cancer. Photographs (cervicography) can also be taken of the cervix.

Indications

  • Evaluate the cervix after abnormal Pap smear.
  • Evaluate vaginal lesions.
  • Localize the area from which cervical biopsy samples should be obtained because such areas may not be visible to the naked eye.
  • Monitor conservatively treated cervical intraepithelial neoplasia.
  • Monitor patients whose birth parent took DES during pregnancy.

Interfering Factors

  • Inadequate cleansing of the cervix of secretions and medications.
  • Scarring of the cervix.
  • Severe bleeding or the presence of feces, blood, or blood clots, which can interfere with visualization.

Potential Medical Diagnosis: Clinical Significance of Results

Abnormal Findings In:

  • Atrophic changes
  • Cervical erosion
  • Cervical intraepithelial neoplasia
  • Infection
  • Inflammation
  • Invasive cancers
  • Leukoplakia
  • Papilloma, including condyloma

Nursing Implications, Nursing Process, Clinical Judgement

Before the Study: Planning and Implementation


Teaching the Patient What to Expect

  • Review the procedure with the patient.
  • Discuss how this procedure can assist in assessing the cervix for disease. The colposcopy takes about 10 to 20 min.
  • Explain that if a biopsy is performed, menstrual-like cramping during the procedure and a minimal amount of bleeding may be experienced.
  • Explain that medications to reduce discomfort and to promote relaxation and sedation may be administered.

Procedural Information

  • The procedure will be performed based on facility guidelines.
  • Baseline vital signs are recorded and monitored throughout the procedure.
  • Positioning for the study is on an examination table in the lithotomy position.
  • The patient is modestly draped and the external genitalia are cleansed with an antiseptic solution.
  • When a Pap smear is performed, the cervix is swabbed and a speculum is inserted into the vagina using water as a lubricant. A lighted magnification scope is used to carefully examine the cervix. Photographs may be taken for future reference.
  • Biopsy samples are placed in appropriately labeled containers with special preservative solution and promptly transported to the laboratory.
  • Afterward, the vagina is rinsed with sterile saline or water to remove the acetic acid and prevent burning after the procedure. If bleeding persists, a tampon may be inserted after removal of the speculum.

Potential Nursing Actions
Make sure a written and informed consent has been signed prior to the procedure and before administering any medications.

After the Study: Implementation & Evaluation Potential Nursing Actions


Avoiding Complications

  • Monitor the patient for complications related to the procedure, which may include bleeding, infection, and cardiac dysrhythmias.
  • Monitor for any bleeding as it may occur after undergoing biopsy and may be controlled by cautery, suturing, or application of silver nitrate or ferric subsulfate (Monsel solution) to the site.

Treatment Considerations

  • Follow postprocedure vital sign and assessment protocol.

Clinical Judgement

  • Consider how to overcome cultural hesitancy to have this procedure performed.

Followup Evaluation and Desired Outcomes

  • Understands to remove the vaginal tampon, if inserted, within 8 to 24 hr and afterward to wear pads if there is bleeding or drainage.
  • Acknowledges that there may be slight bleeding and/or a discharge for a few days after removal of biopsy specimens but that persistent vaginal bleeding or abnormal vaginal discharge, an increasing amount of bleeding, abdominal pain, and fever must be reported to the HCP immediately.
  • Agrees to avoid strenuous exercise 8 to 24 hr after the procedure and to avoid douching and intercourse for about 2 wk or as directed by the HCP.

Colposcopyis the Nursing Central Word of the day!