Ateneo de Zamboanga University
College of Nursing
Nursing Skills Output (NSO)

Biopsy
Report no.___
I. Description: A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist involving sampling 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. When an entire lump or suspicious area is removed, the procedure is called an excisional biopsy. When only a sample of tissue is removed with preservation of the histological architecture of the tissue’s cells, the procedure is called an incisional biopsy or core biopsy. When a sample of tissue or fluid is removed with a needle in such a way that cells are removed without preserving the histological architecture of the tissue cells, the procedure is called a needle aspiration biopsy. Biopsies are most commonly performed for insight into possible cancerous and inflammatory conditions.
II. Materials/ Equipment Needed:
Clean Gloves
Anesthesia (surgical biopsy)
Mdication (antianxiety)
Sterile eye dressing (pad), as needed, and paper eye tape to secure it
Clean Gloves
Anesthesia (surgical biopsy)
Mdication (antianxiety)
Sterile eye dressing (pad), as needed, and paper eye tape to secure it

Procedures:

III. Procedure
Prepare the site where the biopsy is to be done and the patient.
Depending on the site, instruct the patient to be in a position comfortable for themedical practitioner to do the biopsy.
Administer anesthesia.
Patient may also be given an anti anxiety to relax.For surgical biopsies, the anesthesiologist may administer general anesthesia.
Assist with the procedure.
There are various kinds of biopsy procedure, including:
Bone marrow biopsy- a small sample of bone marrow (usually from the hip) is removedvia 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 awoman’s cervix while a tissue sample is taken. This biopsy is usually performed toinvestigate 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 locationof the lump, a general or local anaesthetic may be needed. This type of biopsy may beused 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 beused to diagnose conditions of the liver or thyroid.
Punch biopsy- a special tool is used to punch a hole through the uppermost layers of theskin. The anaesthetic used may be local or topical. This type of biopsy can help diagnosevarious skin conditions.
Stereotactic biopsy- a series of x-rays help to guide the surgeon’s needle to the lump.This type of biopsy is usually performed whenever the lump is hard to see or feel.A large needle is inserted into the area of interest and used to remove a samplefrom a conscious patient. If the area being biopsied is on the skin, ascalpelwill beused to scrape off a sample.The biopsy may be taken with the assistance of medical imaging such asultrasound. The medical imaging is used to correctly identify the area of interestso that the sample is taken from the right place.In a wire-guided biopsy, the imaging is used while fine wires are placed to mark the area which needs to be biopsied, and a surgeon uses the wires as a guide for asurgical biopsy.
• Assess client’s response. IV. Diagram/ Illustration
September 12-14,2011Date Que, Honey Sharlotte Clinical Instructor’s InitialsIllustration/diagram

NURSING RESPONSIBILITIES Before Procedure:
Before the procedure, you need to discuss a range of issues with your doctor or surgeonincluding:
•Medical history, including any prescription drugs, over-the-counter drugs, herbs, vitaminor mineral supplements you may be taking. Some preparations can interact with surgicalmedications and need to be avoided.
•Other tests, such as blood tests or ultrasound scans, may need to be done prior to the biopsy (depending on the nature of the condition under investigation).
•Clean the area where the biopsy is supposed to be done. If hair is present, shave it off.
•Inform the patient that he/she will experience discomfort during the procedure.
•Instruct the patient to stay completely still during the procedure, if conscious. During Procedure:
•Assist with the procedure.
•Monitor the patient, if unconscious. After Procedure:
•Inform the patient that it will be normal for him/her to feel some pain around the biopsysite. This should resolve, or at least ease over the next two or three days.
•Monitor the patient and check for bleeding on site of biopsy.
•Document all relevant assessments and interventions

References:
Brunner & Suddarth’s Textbook of Medical Surgical Nursing 11th Edition by Suzanne C. Smeltzer and Brenda Bare, Volume 1, pp 985-992
Abdominal Paracentesis. (June 2, 2011). Health Information, Aurora Healthcare. Retrieved on July 9, 2012, from http://www.aurorahealthcare.org/yourhealth/healthgate/getcontent.asp?URLhealthgate=%2214758.html%22 http://www.aurorahealthcare.org/yourhealth/healthgate/getcontent.asp?URLhealthgate=%2214758.html%2