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Ateneo de Zamboanga University

College of Nursing NURSING SKILLS OUTPUT (NSO)


Report No. 13

BIOPSIES
Description: A biopsy is a medical test involving the removal of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically. Materials/ Equipment Needed: Needle Microscope Sterile gloves Microscope slides Microscope, if read on unit Bright light source Sterile cotton tip swabs Sterile sponge forceps Syringe

Procedure: There are various kinds of biopsy procedure, including: Bone marrow biopsy - a small sample of bone marrow (usually from the hip) is removed via a slender needle. This type of biopsy helps to diagnose diseases such as leukaemia. Colposcopy-directed biopsy - a colposcope is a small microscope used to examine a womans cervix while a tissue sample is taken. This biopsy is usually performed to investigate the reasons for an abnormal Pap test result. Endoscopic biopsy - the endoscope is a flexible tube that can be inserted into an orifice (such as the mouth or anus) or through a small skin incision. Once the lump is reached, cutting tools are threaded through the endoscope so that a sample of tissue can be taken. Excisional biopsy - the lump is entirely removed. Depending on the location of the lump, the patient may need to undergo general anaesthesia. This type of biopsy may be used for breast lumps. Incisional biopsy - only a small slice of the lump is removed. Depending on the location of the lump, a general or local anaesthetic may be needed. This type of biopsy may be used for lumps located in connective tissue such as muscle. Needle biopsy - a small sample of the lump is removed via a slender hypodermic needle. This can be done either with or without local anaesthetic. This type of biopsy may be used to diagnose conditions of the liver or thyroid. Punch biopsy - a special tool is used to punch a hole through the uppermost layers of the skin. The anaesthetic used may be local or topical. This type of biopsy can help diagnose various skin conditions. Stereotactic biopsy - a series of x-rays help to guide the surgeons needle to the lump. This type of biopsy is usually performed whenever the lump is hard to see or feel.

Diagram/ Illustrations

NURSING RESPONSIBILITIES Before Procedure: 1. Explain the procedure to the patient, including the benefits, risks and potential complications. 2. Give the patient a time for the procedure and explain that they should refrain from eating food for six hours pre-procedure, and drinking fluids for two hours pre-procedure. 3. For females aged 12 to 55, pregnancy status should be obtained. 4. The patient should be advised that they should arrange for someone to drive them home, post-procedure.

During Procedure: 1. Patients who are taking anticoagulants may need and INR level taken within the last 48 hours. Refer to local guidance. 2. Consent from the patient will be obtained by the clinician performing the procedure, or a designated professional with sound knowledge of the procedure. 3. Ensure the patient is wearing an identification bracelet, with the correct information. 4. Insert an intravenous cannula, ensuring local guidance is followed. 5. Record the patients pulse, blood pressure, respirations and temperature. 6. Check the patient has undergone relevant procedures, for example ultrasound, blood tests. 7. Complete the pre-procedure checklist. 8. Escort the patient to the relevant department and hand over patient information to the radiology nurse.

After Procedure: Post pelvic/liver biopsy: 1. Observe wound site for signs of excess bleeding. Ask the patient to report any severe pain and monitor the patients temperature for signs of pyrexia. Post chest/lung biopsy: 1. Inform the medical stuff of any changes in the breathing, signs of distress, haemoptysis or changes in the patients skin colour. 2. Be aware of any signs of shock- hypotension, tachycardia, cool clammy skin 3. Have ready prescribed analgesia. 4. Monitor the patient, including oxygen saturation levels, pulse, blood pressure and respiration rate. Chart at 15 minute intervals and observe wound site. 5. Give full explanation of when results will be available and details of follow up visits to the patients referring doctor. 6. Once the patient is ready for discharge, give details of any potential complications, wound care and who to contact if they have any medical problems due to the procedure.

Reference: http://www.netdoctor.co.uk/health_advice/examinations/biopsy.htm

February 28, 2011 Mendez, RN Date Initials

Que, Honey Sharlotte L. BSN III G

Rowena

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