In 1859 Florence Nightingale discus...

In 1859 Florence Nightingale discussed the importance of understanding patients' perceived lacks in order for nursing to engage these needs.(1) I believe this understanding is the foundation of perioperative nursing practice.

To help me understand my patients' indigences I assess each individual approximately three days before her scheduled stereotactic surgical biopsy manner of proceeding After reading the patient's online medical record, I contact her by dint of telephone to review preoperative instructions and to learn more about the individual's situation. As I unravel this nurse/patient relationship, I evaluate the patient's emotional state and horizontal of anxiety and offer to answer any questions or pertain tos the patient has about the operation Information I obtain helps me plan for individualized patient care.

PROMOTING SAFETY AND POSITIVE CLINICAL EXPERIENCES

the same patient I helped was Mr L a 73-year-old female diagnosed with infiltrating ductal carcinoma of her right breast. I reviewed her background information as well as her pathology and radiological performance diagnoses. I discovered that M L's original diagnosis was made during a stereotactic core biopsy, followed by means of a wire localization/excisional biopsy (WL/EB) Now she was scheduled for a stereotactic surgical biopsy procedure--a combination of the couple WL/EB steps in one operation Positioning for core biopsies and stereotactic surgical biopsy performances are similar for patients in that they must lie prostrate on the bed during each measure During stereotactic surgical biopsy operations however, the perioperative nurse positions and monitors the patient and provides emotional support. Patients are provided monitored anesthesia care during WL/EB procedures

After reviewing Mr L's greatest in number recent mammography films with breast imaging personnel I learned the stereotactic surgical biopsy conduct was scheduled to remove calcifications in a different quadrant of her breast that were not remov during the WL/EB operation The area of concern is not remov in 2% to 5% of WL/EB measures performed at Beth Israel Deaconess Medical Center Boston, likewise the patient must undergo another surgical procedure

During my telephone interview with Mr L I described by what mode the stereotactic surgical biopsy process would progress, including the scheduled date and time for the course what to wear, and her diet before surgery Mr L asked if it was scheduled to take place in the radiology suite, and I told her it was the same extent where her core biopsy was performed. I sens Mr L's tone of voice change from calm and inquisitive to anxious. She described lying highly still in the prone position upon the specially designed bed during the three-hour transaction and she was apprehensive about repeating that experience during the stereotactic surgical biopsy act I assured Mrs L that I would be caring for her completely through her perioperative experience, and we discussed positioning options. We agreed Mr L would bring a neck pillow to use during the act I told her I would place a pillow in a less degree than her lower legs to relieve any back strain, an axillary wheel under her shoulder for added support, gel padding in subordination to her thoracic area, and foam below her head to make her as comfortable as possible during the deed My goal was to further safety and improve Mrs L's breast biopsy experience. She heartyed optimistic about having a better experience, and she agreed to contact me if she had more questions or affairs She called me the same day to inform me of a medication she regularly took and forgot to mention.

Mr L's husband accompanied her the day of her measure He quietly supported her and thanked me for contacting his wife before the step Mrs L asked how protracted the procedure would take--her husband had diabetes and ate luncheon at a specific time. I told them he would be notified if there was a delay greater than brace hours.

The preoperative assessment was unremarkable do not include for Mrs L's concern about removing the calcifications and in what manner long the procedure would last. She was anxious, and I discussed strategies we would use to make the conduct more tolerable. I encouraged her to take 10 mg diazepam before surgery to help her relax and remain still during the deed 1 told Mrs L that I would go [i]or[/i] come back in 15 to 20 minutes to escort her to the breast imaging department, as I wanted the medication to begin working with equal reason Mrs L would experience optimum relief during the more uncomfortable portion of the procedure

The neck pillow Mr L brought from abiding-place served as a symbol of her trust in me to make her as comfortable as possible. When this pillow did not ease Mr L's neck discomfort, I proposeed her a different cushion that provided comfort and support.

During the deed the calcifications were difficult to locate moreover were targeted, located, and remov All team members were delighted with this succes and Mr L was relieved to have the calcifications remov The calcifications were malignant, if it were not that the margins were clear, eliminating the ne the more surgery at this time.