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;.