Test bank For Advanced Practice Nursing Procedures By Margaret R. Colyar

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Punch Biopsy Margaret R. Colyar CPT Code 21550 Biopsy of soft tissue of neck or thorax 21920 Biopsy of soft tissue of back or flank, superficial 23066 Biopsy of soft tissue of shoulder, superficial 24... 065 Biopsy of upper arm and elbow area 23066 Biopsy of soft tissue of forearm or wrist, superficial 27040 Biopsy of soft tissue of pelvis and hip area 27323 Biopsy of soft tissue of pelvis and hip area 27613 Biopsy of soft tissue of leg and ankle area 11100 Skin lesion—Depends on the site, technique, and if benign or malignant lesions Biopsy is the removal of a small piece of tissue from the skin for microscopic examination. Partial or full thickness of skin over the lesion is removed for evaluation. OVERVIEW Punch biopsy is used for full and partial dermal lesions such as ● Basal cell carcinoma ● Squamous cell carcinoma ● Actinic keratoses ● Seborrheic keratoses ● Lentigo (freckles) ● Lipomas ● Melanomas ● Nevi ● Warts—verruca vulgaris RATIONALE ● To confirm etiology of lesion for treatment ● To establish or confirm a diagnosis for treatment and/or intervention 2 Section One | Dermatological Procedures INDICATIONS ● Partial- or full-dermal-thickness lesion not on the face, eye, lip, or penis CONTRAINDICATIONS ● Lesion on eyelid, lip, or penis, REFER to a physician. ● Infection at the site of the biopsy ● Bleeding disorder ● Lesions that are deep or on the face, REFER to a physician. ◗ Informed consent required PROCEDURE Punch Biopsy Equipment ● Antiseptic skin cleanser ● Drape—sterile ● Gloves—sterile ● Disposable biopsy punch (Fig. 1.1) ● Pickups—sterile ● Scissors—sharp for the fine tissue—sterile ● 3-mL syringe ● 27- to 30-gauge, ½-inch needle ● 1% lidocaine ● Container with 10% formalin ● 4 × 4 gauze Figure 1.1 Disposable biopsy punches. Chapter 1 | Punch Biopsy 3 ● Nonstick dressing (Adaptic or Telfa) ● Kling ● Tape ● Steri-Strips (if biopsy will be greater than 4 mm) or one suture Procedure ● Position the client so that the area to be biopsied is easily accessible. ● Cleanse the skin with antiseptic skin cleanser. ● Put on gloves. ● Drape the area to be biopsied. ● Anesthetize with 1% lidocaine. ● With the thumb and index finger, spread the skin to apply tension opposite natural skin tension lines. This allows a more elliptical-shaped wound for easy closure. ● Apply biopsy punch to skin, rotate per manufacturer’s directions, and remove the punch (Fig. 1.2). ● With pickups, pull up loosened skin. ● Cut with scissors, and place tissue in tissue container of 10% formalin (Fig. 1.3). ● If less than 2 to 3 mm, apply nonstick dressing and pressure dressing. ● If greater than 4 mm, apply Steri-Strips and cover with 4 × 4 gauze. ● Apply Kling and secure with tape. Client Instructions ● Keep dressing clean, dry, and in place for 48 hours to decrease the chance of bleeding and oozing. ● Avoid touching or contaminating the area biopsied. ● To prevent the chance of infection, take cephalexin (Keflex) 500 mg three times per day or amoxicillin (Amoxil) 500 mg twice a day for 5 days [Show More]

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