23 y/o G0P0, WF, here for LEEP and Implanon. Colpo results showed CinIII, so patient is having her 1st LEEP. In part this procedure has been chosen due to the nature of her colpo results, but also taking into consideration that she may wish to have children later, so preserving her cervix is important. She is premedicated with toradol and Xanax. Local anesthetic to the cervix is administered. A "tophat" sample is removed from her cervix and sent for evaluation. The cervix is then cauterized and then Monsell's solution applied. The patient tolerated the procedure well. It took about 30 minutes. What I took home from this was that I need to prepare my patients for what they are about to experience. I need them to understand their risks and benefits. I can now better describe what they can expect. I was surprised by the amount of tissue removed. The provider doing the surgery said that the cervix recovers quite well, showing some sign, but not to the extent it appeared as I watched the procedure performed.
The implant was actually done first, and it took about 10 minutes, from applying the local to removing the introducer and bandaging the site. It was simple quick and relatively painless. I could see some bruising beginning, and little bleeding.
I chose this case because it helped me in understanding the two procedures that I will eventually be describing to my patients. It also helped me to keep the different procedures for managing dysplasia straight in my own head.
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I wholeheartedly agree on the value of being able to describe a procedure/diagnostic test by having first hand experience of it. It's so important for the patient to understand what to expect. But also, just being able to describe the environment is priceless, and you never know when you will use it. I was at the front desk of billeting when the pregnant desk clerk noticed my purple OB booklet spill out of my bag. This struck up quite the conversation and she ended up confessing how she'd heard bad things about the local MTF, and that she was strongly considering transferring to a civilian OB site. I was able to tell her how the L&D floor was newly remodeled, how clean and nice it looked, and most importantly that the providers that I had worked with were great. I also let her know that if she was nervous about receiving care from a student, she had every right to decline care; and that we wouldn't take it personally. I don't know what her choice will ultimately be. But our exchange reinforced to me how important it is to actually know where/how the pt.'s are going to for the next phase of their care, and to be able to explain what to expect. It lends that much more credence and validity to your counseling when you explain something that you've "lived" instead of something that you read in a book or heard about from colleagues.
ReplyDeleteGreat initial post Sstephanie - and it is a bit reassuring for me, because sometimes I wonder if I'm wandering into the "weeds" by giving you all as much detail as I do (some people think that FNP's don't need to know some of the finer details because you won't ever be doing some of these things - like LEEP procedures). I happen to disagree. Patients really need as much information as they can get.
ReplyDeleteMa'am,
ReplyDeleteI agree that all providers should be able to explain these procedures to their patients. Most providers think of colpos and LEEPs as pretty benign, but to a patient they can be quite traumatic. I personally have had a colpo and I can say that it was far worse than what I expected. I didn't know up front that they would be doing a biopsy, so I didn't really prepare myself for it. I could have taken some Motrin before hand which I think would have helped after the fact. To be honest, since that experience I can understand why some women don't come back for subsequent procedures. I think the more information we can give the patients up front, the better prepared they will feel walking into these procedures. It is much more difficult to educate a patient while they are in the middle of a painful procedure or are concerned about the results.