Throughout the course of this semester, I have seen quite a few patients. Although there has been some variety in the kinds of conditions we have treated, I've talked diabetes and hypertension until I'm blue in the face. This isn't a bad thing by any means. There is huge opportunity to benefit the lives of patients with these conditions, and each case is unique. I'd be lying, however, if I said I didn't say I enjoyed having a procedure or two to mix things up.
The first procedure I learned was how to perform a punch biopsy. This was done to remove a piece of an irregularly shaped, rapidly growing mole to send off to the lab to verify whether or not the growth was malignant.
The first procedure I learned was how to perform a punch biopsy. This was done to remove a piece of an irregularly shaped, rapidly growing mole to send off to the lab to verify whether or not the growth was malignant.
-Prep.
- Create sterile field
-Includes: sterile drape, 4 mm punch, forceps, sterile scissors, betadine swab, and gauze
- Create a non-sterile field
- Includes: 1cc syringe with .5 in. 30 gauge needle, vile of lidocaine (local anesthetic), specimen cup with sterile water inside, packet of antibiotic ointment, and a band aid
- Begin.
- (With clean hands) Use alcohol swab to clean the area that will be biopsied
- Load syringe with lidocaine
- Inject lidocaine subcutaneously at 2-3 areas
- Don sterile gloves
- Swab (from inside to outside in circular motion) area with Betadine swab
- Use 4mm punch to apply downward pressure while twisting gently
- Use forceps to pull up on tissue cut by the punch, and trim at base using sterile scissors
- Place tissue sample in sterile water in specimen cup
- Label sample and send to lab
-Finish.
- Apply pressure with gauze if bleeding
- Apply antibiotic ointment to wound
- Cover with band aid
One other procedure I had the opportunity to perform was something that I had a lot of practice doing while working as a Nurse Technician at Spectrum Health's Burn Unit: wound dressings. This time, the patient presented with a large venous stasis ulcer on his lower leg.
-Prep.
- Create sterile field
-Includes: sterile drape, kerlix (rolled gauze), gauze (dressing) which is impregnated (using sterile technique) with Silver Sulfadiazine cream, and sterile scissors
- Prepare a basin of warm water and soap
- With gauze or a washcloth, debride wound
- Sanitize with antiseptic wash
- Dress wound
- (With clean hands) Don sterile gloves
- Impregnate dressing with Silver Sulfadiazine
- Cut dressing to approximately cover wound
- Place dressing on wound
- Place gauze on top of wet dressing
- Use Kerlix to secure dressing in place