Nursing Care of the Patient
Undergoing a Breast Biopsy
Breast
biopsies are one of the most common ambulatory surgical procedures performed,
with 80% of the results negative for malignancy (Norris, 2001). Prior to the
procedure, the nurse’srole is to provide instruction; however, it is important
for the nurse to first assess how the woman is coping with her need for the
procedure and her ability to process information about the procedure and the
possible implications of the biopsy results. Anxiety and fear are normal
responses to the need for a breast biopsy, but these responses may interfere
with the woman’s abil-ity to recall and understand the information that is
provided prior to the procedure. Therefore, written information and book-lets
are used to reinforce teaching. The nurse also must give the patient an
opportunity to address issues and concerns related to the biopsy.
The
nurse instructs the patient to avoid use of agents that can interfere with
blood clotting and increase the risk for bleed-ing. Among these agents are
nonsteroidal anti-inflammatory drugs, vitamin E supplements, herbal substances
(such as gingko biloba and garlic supplements), warfarin, and products
con-taining aspirin. The patient may be instructed not to eat or drink after
midnight, depending on the type of biopsy planned. Most breast biopsy
procedures today are performed with the use of moderate sedation and local
anesthesia; thus, the recovery pe-riod is relatively brief.
Postoperative
assessment includes monitoring the effects of the anesthesia and inspection of
the dressing covering the inci-sion. Prior to discharge from the ambulatory
surgery center or of-fice, the patient must be able to tolerate fluids or food,
ambulate, and void. The patient should be accompanied home by a family member
or friend. At discharge, the nurse reviews with the pa-tient the care of the
biopsy site, pain management, and activity restrictions. The dressing covering
the incision is usually removed on the second day, but use of a supportive bra
is encouraged im-mediately after the procedure for 3 to 7 days to limit
movement of the breast and reduce discomfort. Steri-strips applied over the incision
are left in place until they start to come off, usually a cou-ple of weeks
after the procedure. A follow-up telephone call to the patient by the nurse 24
to 48 hours after the procedure is stan-dard care and provides an opportunity
for the nurse to answer any questions the patient might have.
Most
women return to their usual activities the day after the procedure but are
encouraged to avoid jarring or high-impact activities for 1 week to promote
healing of the biopsy site. Dis-comfort is usually minimal from the procedure
and most women find acetaminophen sufficient for pain relief; however, a mild
opioid may be prescribed, if needed.
Follow-up
after the biopsy includes a return visit to the sur-geon for discussion of the
final pathology report and assessment of the healing of the biopsy site.
Depending on the results of the biopsy, the nurse’s role varies. If the
pathology report is negative for cancer, the nurse reviews incision care and
explains what to expect as the biopsy site heals (ie, changes in sensation may
occur weeks or months after the biopsy due to injury to the nerves within the
breast tissue). If a diagnosis of cancer is made, the nurse’s role changes
dramatically;.
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