MKSSS SN COLLEGE OF NURSING FOR

WOMEN, NAGPUR.
SUBJECT- NURSING EDUCATION

LESSON PLAN ON -
LIVER BIOPSY
SUMITTED TO: SUBMITTED BY:
MRS.RAMA DANAPURE MS. RUPALI S KHARABE
ASSOCIATE PROFESSOR M.Sc. 1 ST YEAR
MKSSS SN COLLEGE OF MKSSS SN COLLEGE OF
NURSING FOR WOMEN. NURSING FOR WOMEN.

SUBMITTED ON-
28/04/2024
NAME OF STUDENT TEACHER- Rupali S Kharabe
SUBJECT- Nursing Education
TOPIC: Liver Biopsy
GROUP- 1st semester
PLACE-MKSSS SN COLLEGE OF NURSING FOR WOMEN
DATE- 28/03/2024
TIME-11:00am
DURATION-45 mins
Method of teaching: Lecture Cum Demonstration.
A.V.AIDS- Chart, Black board.
Previous knowledge of student:
The student have some level of knowledge regarding Liver Biopsy.

OBJECTIVES:
GENERAL OBJECTIVES:
The student will be able to gain knowledge regarding intradermal injection ,appreciate its important and apply the same in clinical practice.
SPECIFIC OBJECTIVES:
At the end of the class the student will be able to demonstrate:
 Define Liver biopsy.
 Describe purpose of Liver Biopsy.
 Explain types of liver biopsy.
 Enlist articles needed for liver biopsy.
 Demonstrate the procedure for liver biopsy.
 Enumerate post procedure care.
 Discuss immediate and late complication of liver biopsy.
TIME SPECIFIC CONTENT TEACHING A.V. AIDS EVALUATION
OBJECTIVE LEARNING
ACTIVITY
4 min Introducing the LIVER BIOPSY Lecture - Student will be
topic able to
introduce the
INTRODUCTION topic liver
 A liver biopsy is a procedure to remove a small piece of liver biopsy.

tissue, so it can be examined under a microscope for signs of

damage or disease.
 Health care provider may recommend a liver biopsy if blood
tests or imaging studies suggest you might have a liver
problem.
 A liver biopsy also is used to find out the state of someone's
liver disease. This information helps guide treatment decisions.
 The most common type of liver biopsy is called percutaneous
liver biopsy. It involves inserting a thin needle through the
belly into the liver and removing a small piece of tissue.
 Another type of biopsy involves inserting instruments through
a small abdominal incision. This is known as the laparoscopic
method.

TIME SPECIFIC CONTENT TEACHING A.V. AIDS EVALUATION

OBJECTIVE LEARNING
ACTIVITY
2mins Define Liver DEFINITION Lecture - Students can
Biopsy? define liver
biopsy.
 Assisting in sampling of liver tissue by needle aspiration using
aseptic technique.

2mins What is the PURPOSE

purpose of doing Lecture - Students know
Liver Biopsy?  To diagnose liver through histological study. the purpose of
doing liver
biopsy.

1mins What are the TYPES OF BIOPSY Lecture - Students are

types of Liver 1. Open Biopsy able to tell the
biopsy.? type of liver
2. Closed Biopsy biopsy.

OPEN BIOPSY
What is open Lecture cum
-
2mins liver biopsy? discussion Student can
explain open
An open biopsy necessitates a general anaesthetic and a major
biopsy.
abdominal incision. it is not usually done unless abdominal is opened
for surgical reason.
ADVANTAGES-
1. Direct observation of entire liver.
2. Identifies grossly altered tissue.
3. Remove the biopsy specimen for study.

TIME SPECIFIC CONTENT TEACHING A.V. AIDS EVALUATION

OBJECTIVE LEARNING
ACTIVITY
2mins What is closed CLOSED BIOPSY Lecture cum - Students know
biopsy? It is usual in current practice. it is performed under fluoroscopy and is discussion the closed
a simpler procedure than open biopsy. biopsy.

CONTRAINDICATIONS FOR PERCUTANEOUS LIVER BIOPSY

1. Severe thrombocytopenia.
2. Local infection of the lung base.
3. Prolonged prothrombin time or any other known bleeding disorder.
4. Peritonitis.
5. Massive ascites.
6. Uncooperative client.
7. Extrahepatic obstructive jaundice, especially with an enlarged
gallbladder.

Enlisting the
ARTICLES Lecture cum -
4mins articles of the Students can
procedure A Sterile tray containing: discussion
enlist the
a) Sponge holding forceps. articles used in
procedure.
b) Syringe 5ml with needle to give local anaesthesia.
c) Liver biopsy needle with stiletts.
d) Specimen bottles with cork.
e) Bowl to take cleaning lotion.
f) Aspiration syringe, if aspiration biopsy is to be done.
g) Dissecting Forceps.
TIME SPECIFIC CONTENT TEACHING A.V. AIDS EVALUATION
OBJECTIVE LEARNING
ACTIVITY
 h) Dressing towels or slit towel.
i) Cotton balls, gauze pieces and cotton pads.
j) Gown, gloves and masks.

Clean tray containing:

a) Mackintosh and towel.
b) Kidney tray.
c) Sprit, iodine, tincture benzoin, etc.
d) Lignocaine 2%
e) Apron
f) Adhesive plaster and scissors.
g) Formalin 10% to preserve the biopsy specimen.
h) Shaving set.

TIME SPECIFIC CONTENT TEACHING A.V. AIDS EVALUATION

OBJECTIVE LEARNING
ACTIVITY
15mins Demonstrate the PROCEDURE Demonstration - Students are
procedure. able to do the
NURSING ACTION RATIONALE procedure.
1.Explain the procedure to Helps in obtaining cooperation
patient and family and inform of patient and reduces anxiety.
him how he has to cooperate.
2. Obtain informed consent from Prevents litigation of staff
patient. members.
3. Ensure that patient’s Prevents bleeding complication
coagulation profile are in normal during procedure.
limits.
4. Check baseline vital signs and Helps in obtaining baseline data.
record.
5. Instruct patient to be NPO for Prevents risk of aspiration
6-8 hours before procedure. during procedure
6. Administer premedication as
per physical’s instruction.
7. Instruct patient to refrain from Prevents bleeding tendencies.
ingesting aspirin, NSAID or
anticoagulants 2 weeks before
procedure.
8. Make the patient to lie down This position helps for easy
in supine position or in left insertion of needle.
lateral position with right arm
elevated.
9. Shave and clean the eighth
and nineth intercostal space at
the incision site.
10. Instruct patient to take Avoid puncturing of the
several deep breaths and to hold diaphragm
the breath while the needle is
introduced through the
intercostal or subcostal tissue
and then is withdraw.
TIME SPECIFIC CONTENT TEACHING A.V. AIDS EVALUATION
OBJECTIVE LEARNING
ACTIVITY
 11. The special needle assembly
is rotated to separate a fragment
of tissue and then is withdraw.
12. Assist physician to seal
puncture site with tincture
benzoin and apply pressure
dressing..
13. Collect the specimen in a
sterile container, label it and
send to laboratory.
14. Instruct patient to lie on his
right side.
15. Record the procedure with Acts as a communication
date, time method used and between staff members.
complications, if any.
Discussion - Students are
8mins Enumerate the POST PROCEDURE CARE able to
post procedure enumerate the
care post care
procedure.
 Monitor vital signs every 15 minutes for 2 Hours, and every 60
minutes for 4 hours.
 Assess for tachycardia and decreasing blood pressure which
may indicate haemorrhage.
 Check the puncture site by monitoring the dressing, palpating
the surrounding area for crepitus and observing for hematoma
formation/
 Observe for pain in the right upper quadrant of the abdomen
caused by a subscapular accumulation of blood or bile, or at the

 TIME SPECIFIC CONTENT TEACHING A.V. AIDS EVALUATION
OBJECTIVE LEARNING
ACTIVITY
right shoulder as a result of blood on the undersurface of the
diaphragm.
 Maintain the client on bedrest in right lateral position for 24
hours following procedure to reduce the risk of haemorrhage
and bile leakage.
 Administer post procedure medication on an individual basis,
depending on the client’s physical status.
 Give vitamin K if prescribed.
 Assess respiratory status for manifestations of dyspnea.
 Check abdominal girth every hour for first 12 hours.

Complication that may arises after liver biopsy are given below:

2mins What will be the Immediate complication Late complication Lecture cum Chart Students are
complications of Abdominal pain Haemorrhage discussion able to answer
liver biopsy? the
Pneumothorax Shock and collapse complications.
Injury to the stomach, pancreas, Bile peritonitis
small and large intestines,
kidney, inferior vena cava and
diaphragm.
 TIME SPECIFIC CONTENT TEACHING A.V. AIDS EVALUATION
OBJECTIVE LEARNING
ACTIVITY
3mins Reference Lecture - Student should
BIBLIOGRAPHY know reference
to use.
 Clinical Nursing Procedures: The Art of Nursing Practice 3rd
Edition , by Annamma Jacob JAYPEE Publication.
 A Text Book of Fundamentals of Nursing by LAKHWINDER
KAUR AND MANINDER KAUR PEE VEE Publication.
 Stephanie’s Principles & Practice Of Nursing Vol 1 Nursing
Arts Procedures 7th edition vol 1 author Sr. Nancy by N.R
Publication.
 https://www.mayoclinic.org/tests-procedures/liver-biopsy/
about/pac-20394576
 https://www.mountsinai.org/health-library/tests/liver-biopsy
TIME SPECIFIC CONTENT TEACHING A.V. AIDS EVALUATION
OBJECTIVE LEARNING
ACTIVITY
TIME SPECIFIC CONTENT TEACHING A.V. AIDS EVALUATION
OBJECTIVE LEARNING
ACTIVITY