- Email: [email protected]
Examination: Sentinel Lymph Node Biopsy Using Lymphoscintigraphy
OCTOBER 1998, VOL 68, NO 4
Lxamination SENTINEL LYMPH NODE BIOPSY USING LYMPHOSCINTIGRAPHY
1.The pathology of cancer is difficult to generalize, but tumor growth invariably leads to invasion of what system? a. the vascular system b. the muscular system c. the lymphatic system d. the nervous system 2.Where are cancer cells first trapped after they have first begun to spread? a. surrounding lymphatic channels b. the nearest organ c. cells in blood vessel walls d. a lymph node %Lymph nodes are generally found in groups known as basins or chains. a. true b. false 4.What is the normal progression of body tissue drainage via the lymphatic system? a. nodes (found in basins or chains), to channels, to central ducts in the thoracic cavity b. channels, to nodes (found in basins or chains), to central ducts in the thoracic cavity @.Although the lymphatic system cleanses body tissues, this is not its primary function. a. true b. false
6.Why do lymph nodes become enlarged when the body is fighting off antigens? a. The reason for this is not known. b. Antigens cause an allergic reaction (ie, histamine release). c. It is a progression of the inflammatory process. d. Antigens cause damage (ie, swelling, edema) to the nodes. 7.When foreign particles are filtered out of lymph fluid by the lymph nodes, leukocytes respond to
engulf and destroy the invaders. This inflammatory process also prevails when the node is “seeded” with cancer cells. a. true b. false
8. Where do cancers cells spread after they have spilled out of the first lymph node? a. afferent vascular channels b. afferent lymphatic channels 9.Tumor spread to regional lymph nodes initially progresses from the primary tumor site to a single lymph node. What is this node known as? a. the secondary site b. the sentinel lymph node c. the primary metastatic site d. none of the above 10.Why is this node important in the treatment of cutaneous melanoma? a. It is predictive of the disease process in cutaneous melanoma. * b. If this node is removed quickly, the cancer will not spread. c. It is predictive of the disease process in all cancers. d. none of the above 11.If the sentinel lymph node is tumor free, although the outcome is good, no assumptions about cancer spread to other lymph nodes can be made. a. true b. false 1 2 T h e r e may be more than one sentinel lymph node. a. true b. false 1 8 W h a t does lymphoscintigraphy use radioactive material to identify? a. cancer cells
589 AORN JOURNAL
OCTOBER 1998, VOL 68, NO 4
a. b. c. d.
b. metastatic sites c. primary sites d. lymph nodes and channels 1 A B y localizing the lymphatics, what is ultimately identified? a. the need for adjuvant therapy b. sites of metastasis c. the sentinel lymph node d. none of the above
2O.Lymphoscintigraphy is helpful in locating the sentinel lymph node, but isosulfan blue (an injectable dye) is injected into the primary tumor site to help visually identify this node in the OR. a. true b. false
15.Lymphoscintigraphy uses Technetium-99m sulfur colloid (ggmTc), a special tracer compound. This material is an isotope that emits a. radioactivity b. gamma rays c. heat d. sound picked up by a Geiger counter 1 L G a m m a rays are emitted as an isotope spontaneously decays. Gamma radiation is inversely related to time. What is an important characteristic of an isotope? a. the time it is exposed to the patient b. its half-life c. its radioactivity d. none of the above
21.Sentinel lymph node biopsy commonly is used for patients diagnosed with early cutaneous melanoma. Physicians are facing an increase in these cases, and it is estimated that new cases will be diagnosed in 1997. a. 20,000 b. 30,000 c. 40,000 d. 50.000 =Melanoma patients are classified into three clinical stages. Which stage patients are the best candidates for sentinel lymph node biopsy? a. stage I b. stage I1 c. stage I11
17.Working with radioactive substances can be disconcerting for health care workers: however, the environment is full of naturally occurring isotopes. What is the radioactivity they give off called? a. radioactive half-life b. ambient radioactivity c. nuclear potential d. none of the above 18.During lymphoscintigraphy, the flow of lymph from the primary tumor site to the regional lymph nodes is approximated by injecting the ‘I‘ImTc isotope around the tumor site, where it is taken up by the lymphatics and carried to the sentinel lymph node. A special high-resolution gamma camera with a large field view is used to track the movement of the isotope. a. true b. false
19.h the OR, what does the surgeon use to localize the sentinel lymph node?
a Geiger counter a gamma ray-detecting instrument fluoroscopy sequential x-ray shots of the area
=What other criteria need to be met for a patient to be considered for sentinel lymph node biopsy? 1. no other criteria 2. a lesion at least 0.75 mm thick 3. no clinical adenopathy 4. no family history of cancer a. 1 only b. 2 and 3 c. 3 a n d 4 d. 4 only =Sentinel lymph node biopsy helps identify patients who would benefit from lymph node dissection but has little effect on adjuvant therapy. a. true b. false =.What other cancer has lymphoscintigraphy been used for? 1. colon 2. vulvar 3. breast
590 AORN JOURNAL
OCTOBER 1998, VOL 68, NO 3
4. penile a. 1 and 3 b. 2 and 4 c. 2 , 3, and 4 d. 1,2, and4
two things does the surgeon do to facilitate this? 1. injects isosulfan blue around the primary tumor site 2. verifies the skin markings by the use of the g am m a ray - d e t e c tin g ins t r u m e n t , w h i c h should demonstrate high radioactivity c. verifies the location with the radiologist by telephone d. verifies the primary site with the patient a. 1 and 2 b.3and4 c. 2 and 3 d. 1 and4
=After being taken to the nuclear medicine department, the radiologist injects the patient’s melanoma intrademially. The most difficult part of this procedure for the patient is having to remain perfectly still. How long must the patient remain still? a. one hour b. 30 minutes c. 15 minutes d. two hours
31.The surgeon must consider the angle of the gamma ray probe in relation to the injection site, which is a strong source of gamma rays. Why? a. The isosulfan blue interferes with gamma ray detection, b. If the probe is pointing in the direction of the injection sites, the activity of the tissues between sites will measure higher than it actually is. c. The gamma ray probe is difficuIt to use and may provide false positives. d. none of the above
=.The patient must remain still to facilitate the dynamic lymph flow study. After that is completed, a single frame image is produced and the patient is allowed to stretch briefly. a. true b. false =In
the OR, the perioperative nurse must check the gamma-detecting probe by measuring the room’s background gamma ray count. When this is done, he or she must apply a cap to the probe to test the ability of the probe to accurately measure gamma activity in what range? a. 100 to 200 counts per second (CPS) b. 200 to 300 CPS c. 300 to 500 CPS d. 400 to 600 CPS
=.Positioning the patient is important. Why? a. The type of anesthesia and the location of the sentinel node, as marked by the radiologist, determine the position the patient must be placed in to facilitate the biopsy. b. The patient has been required to remain still for a prolonged time and, therefore, positioning in the OR is important to reduce patient discomfort. c. The patient may need to be repositioned during the biopsy to replicate skin tension at the time of skin marking in the nuclear medicine department. d. all of the above =.Finding
the sentinel node can be difficult. What
=The surgeon locates the sentinel node by virtue of its low radioactivity relative to surrounding tissue. a. true b. false =.After logging its arrival, fixing the specimen, and preparing it according to the surgeon’s request, the pathologist takes the specimen to the nuclear medicine department, where it remains until its radiation levels have dropped to background levels. a. true b. false 34.Specific patient teaching for lymphoscintigraphy includes which of the following? 1. straining the urine 2. hand washing after toilet use to remove traces of radioactivity 3. to expect a blue tinge to the patient’s urine for 48 hours. 4. emphasis on the low levels of radiation and
591 AORN JOURNAL
OCTOBER 1998, VOL 68, NO 4
that this is not dangerous to the patient or those close to him or her. a. 1 and2 b. 1,2, and 3 c. 2, 3, and 4 d. 3 and 4
=.It
is important to remind the patient that the radiation in the sentinel node must be allowed to decay to background levels and, therefore, the final pathology report will be delayed. a. true b. false
Interactive Wound Dressing for Skin Ulcers Approved The US Food and Drug Administration (FDA) has approved an interactive wound dressing that can improve healing in skin ulcers caused by venous insufficiency (ie, lack of proper blood flow to the skin). The material, called Apligraf, is a cellular dressing that can be used with standard therapy to enhance the healing process, even in older, difficult to treat venous insufficiency ulcers. According to the FDA, venous insufficiency ulcers affect thousands of Americans each year, and treatment of the ulcers often requires multiple surgeries. Although Apligraf will not eliminate the
need for standard treatment, its use may enhance and shorten the healing process. Apligraf is a cellular, bilayered skin construct produced from bovine collagen and cells derived from human infant foreskins. Its composition allows it to provide wound protection and to foster the growth of healthy new skin.
FDA Approves New Treatment for Serious Skin Ulcers (news release, Rockville, Md: Food and Drug Administration, US Department of Health and Human Sewices, May 26, 1998).
Exhibitors’ Committee Commits $SO,OOO to AORN Foundation The AORN Foundation will administer the Congress Incentive Program (CIP), a program designed to help chapters send members to Congress, through a grant from the Exhibitors’ Advisory Committee (EAC). This program distributes awards of $800 to 60 chapters and $350 to two members at large. To be eligible for the drawing, individuals must register for the AORN Congress in San Francisco by Dec 14, 1998, and be current members of AORN. One entry is allowed per chapter for the drawing. The previous year’s winners (ie, winners for the 1998 Congress) are ineligible for the 1999 drawing, The drawing will be held Dec 18, 1998, and chapter presidents of the winning chapters will receive a letter notifying them, along with a check for $800. If you have any questions concerning the CIP, please contact the AORN Foundation at (800) 755-2676 x 8229 or send
-
an e-mail to [email protected]. Another program is the Exhibitor Sponsorship Program (ESP), which t h Q O R N Foundation will administer through a grant from the EAC. This program will distribute funds to two student nurses, two international nurses, four AORN members, and two nonmember RNs. Applicants will be required to write an essay addressing statement of financial need, where they think AORN should be in the twenty-first century, how surgery will be different in the future, how they will share what they have learned at Congress with colleagues, and what they wish to gain from attending Congress. For an ESP grant application, contact Twilla Barlow, AORN Foundation, at (800) 755-2676 x 8229, or send an e-mail to [email protected]. 9
592
AORN JOURNAL
OCTOBER 1998, VOL 68, NO 1
Answer Sheet SENTINEL LYMPH NODE BIOPSY USING LVMPHOSCINTIGRAPHV
P
lease fill out the application and answer form below and the evaluation on the back of this page. Tear out the page from the Journal or make photocopies and mail to: AORN Customer Service c/o Home Study Program 2170 S Parker Rd, Suite 300 Denver, CO 80231-571 1
Event # 9905 1
IDES Number
1
0000000000 0 0 0 0 0 0 0 0 0 0 CJ 0000000000 % 0@@@@@@ s; @ @ @ 0000000000 0000000000 0000000000 0000000000 0000000000 0 0000000000
Session # 1143
Program offered October 1998. The deadline for this program is Nov 30, 1999.
Session Number
1. Record your AORN identification number in the appropriate section below. 2. Using a pen or pencil, completely darken the space that indicates your answer to each question. Do not circle or check the answer spaces. 3. A score of 70% correct is required for credit. 4. Record the time required to complete the program.
!
0000000000 0000000000 0000000000 0000000000
Mark only one answer per question. 100000 200000 300000 400000
2100000 22@@@@@ . I 2300000 2400000 s o o o o o 2500000 600000 2600000 7000@0 2700000 800000 2800000 900000 2900000 1000000 3000000 1100000 3100000 1200000 3200000 1300000 3300000 1400000 3400000 I500000 3500000 1600000 3600000 1700000 3700000 1800000 3800000 1900000 3900000 2000000 4000000
5. Enclose fee: Members $10; Nonmembers $20.
AORN (ID) # Name Address City State Zip RN license # State Phone number ( If nonmember, please provide social security number. Fee enclosed or bill the credit card indicated 0Mastercard 0Visa American Express Card # Expiration date Signature (for credit card authorization)
593 AORN JOURNAL
OCTOBER 1998, VOL 68, NO 4
Learner Evaluation SENTINEL LYMPH NODE BIOPSY USING LYMPHOSCINTIGRAPHY
The following evaluation is used to determine the extent to which this Home Study Program met your leaming needs. Rate the following items on a scale of 1 to 5.
Session Number
'
(Low) (High) (Low) (High)
OBJECTIVES
To what extent were the following objectives of this Home Studv . Program - achieved? (1) Discuss the spread of cancer as it relates to the sentinel lymph node. (2) Describe lymphoscintigraphy. (3) Discuss the care of the patient undergoing a sentinel lymph node biopsy with lymphoscintigraphy . CONTENT
(4) Did this article increase your knowledge of the subject matter? (5) Was the content clear and organized? (6) Did this article facilitate learning? (7) Were your individual objectives met? (8) Was the content of the article relevant to the objectives? T U T QUESTIONS/ANSWERS
(9) Were they reflective of the content? (10) Were they easy to understand? (1 1) Did they address important points?
What other topics would you like to see addressed in a future Home Study Program? Would you be interested or do you know someone who would be interested in writing an article on this topic? Topic(s):
Author names and addresses:
594 AORN JOURNAL
Lxamination SENTINEL LYMPH NODE BIOPSY USING LYMPHOSCINTIGRAPHY
1.The pathology of cancer is difficult to generalize, but tumor growth invariably leads to invasion of what system? a. the vascular system b. the muscular system c. the lymphatic system d. the nervous system 2.Where are cancer cells first trapped after they have first begun to spread? a. surrounding lymphatic channels b. the nearest organ c. cells in blood vessel walls d. a lymph node %Lymph nodes are generally found in groups known as basins or chains. a. true b. false 4.What is the normal progression of body tissue drainage via the lymphatic system? a. nodes (found in basins or chains), to channels, to central ducts in the thoracic cavity b. channels, to nodes (found in basins or chains), to central ducts in the thoracic cavity @.Although the lymphatic system cleanses body tissues, this is not its primary function. a. true b. false
6.Why do lymph nodes become enlarged when the body is fighting off antigens? a. The reason for this is not known. b. Antigens cause an allergic reaction (ie, histamine release). c. It is a progression of the inflammatory process. d. Antigens cause damage (ie, swelling, edema) to the nodes. 7.When foreign particles are filtered out of lymph fluid by the lymph nodes, leukocytes respond to
engulf and destroy the invaders. This inflammatory process also prevails when the node is “seeded” with cancer cells. a. true b. false
8. Where do cancers cells spread after they have spilled out of the first lymph node? a. afferent vascular channels b. afferent lymphatic channels 9.Tumor spread to regional lymph nodes initially progresses from the primary tumor site to a single lymph node. What is this node known as? a. the secondary site b. the sentinel lymph node c. the primary metastatic site d. none of the above 10.Why is this node important in the treatment of cutaneous melanoma? a. It is predictive of the disease process in cutaneous melanoma. * b. If this node is removed quickly, the cancer will not spread. c. It is predictive of the disease process in all cancers. d. none of the above 11.If the sentinel lymph node is tumor free, although the outcome is good, no assumptions about cancer spread to other lymph nodes can be made. a. true b. false 1 2 T h e r e may be more than one sentinel lymph node. a. true b. false 1 8 W h a t does lymphoscintigraphy use radioactive material to identify? a. cancer cells
589 AORN JOURNAL
OCTOBER 1998, VOL 68, NO 4
a. b. c. d.
b. metastatic sites c. primary sites d. lymph nodes and channels 1 A B y localizing the lymphatics, what is ultimately identified? a. the need for adjuvant therapy b. sites of metastasis c. the sentinel lymph node d. none of the above
2O.Lymphoscintigraphy is helpful in locating the sentinel lymph node, but isosulfan blue (an injectable dye) is injected into the primary tumor site to help visually identify this node in the OR. a. true b. false
15.Lymphoscintigraphy uses Technetium-99m sulfur colloid (ggmTc), a special tracer compound. This material is an isotope that emits a. radioactivity b. gamma rays c. heat d. sound picked up by a Geiger counter 1 L G a m m a rays are emitted as an isotope spontaneously decays. Gamma radiation is inversely related to time. What is an important characteristic of an isotope? a. the time it is exposed to the patient b. its half-life c. its radioactivity d. none of the above
21.Sentinel lymph node biopsy commonly is used for patients diagnosed with early cutaneous melanoma. Physicians are facing an increase in these cases, and it is estimated that new cases will be diagnosed in 1997. a. 20,000 b. 30,000 c. 40,000 d. 50.000 =Melanoma patients are classified into three clinical stages. Which stage patients are the best candidates for sentinel lymph node biopsy? a. stage I b. stage I1 c. stage I11
17.Working with radioactive substances can be disconcerting for health care workers: however, the environment is full of naturally occurring isotopes. What is the radioactivity they give off called? a. radioactive half-life b. ambient radioactivity c. nuclear potential d. none of the above 18.During lymphoscintigraphy, the flow of lymph from the primary tumor site to the regional lymph nodes is approximated by injecting the ‘I‘ImTc isotope around the tumor site, where it is taken up by the lymphatics and carried to the sentinel lymph node. A special high-resolution gamma camera with a large field view is used to track the movement of the isotope. a. true b. false
19.h the OR, what does the surgeon use to localize the sentinel lymph node?
a Geiger counter a gamma ray-detecting instrument fluoroscopy sequential x-ray shots of the area
=What other criteria need to be met for a patient to be considered for sentinel lymph node biopsy? 1. no other criteria 2. a lesion at least 0.75 mm thick 3. no clinical adenopathy 4. no family history of cancer a. 1 only b. 2 and 3 c. 3 a n d 4 d. 4 only =Sentinel lymph node biopsy helps identify patients who would benefit from lymph node dissection but has little effect on adjuvant therapy. a. true b. false =.What other cancer has lymphoscintigraphy been used for? 1. colon 2. vulvar 3. breast
590 AORN JOURNAL
OCTOBER 1998, VOL 68, NO 3
4. penile a. 1 and 3 b. 2 and 4 c. 2 , 3, and 4 d. 1,2, and4
two things does the surgeon do to facilitate this? 1. injects isosulfan blue around the primary tumor site 2. verifies the skin markings by the use of the g am m a ray - d e t e c tin g ins t r u m e n t , w h i c h should demonstrate high radioactivity c. verifies the location with the radiologist by telephone d. verifies the primary site with the patient a. 1 and 2 b.3and4 c. 2 and 3 d. 1 and4
=After being taken to the nuclear medicine department, the radiologist injects the patient’s melanoma intrademially. The most difficult part of this procedure for the patient is having to remain perfectly still. How long must the patient remain still? a. one hour b. 30 minutes c. 15 minutes d. two hours
31.The surgeon must consider the angle of the gamma ray probe in relation to the injection site, which is a strong source of gamma rays. Why? a. The isosulfan blue interferes with gamma ray detection, b. If the probe is pointing in the direction of the injection sites, the activity of the tissues between sites will measure higher than it actually is. c. The gamma ray probe is difficuIt to use and may provide false positives. d. none of the above
=.The patient must remain still to facilitate the dynamic lymph flow study. After that is completed, a single frame image is produced and the patient is allowed to stretch briefly. a. true b. false =In
the OR, the perioperative nurse must check the gamma-detecting probe by measuring the room’s background gamma ray count. When this is done, he or she must apply a cap to the probe to test the ability of the probe to accurately measure gamma activity in what range? a. 100 to 200 counts per second (CPS) b. 200 to 300 CPS c. 300 to 500 CPS d. 400 to 600 CPS
=.Positioning the patient is important. Why? a. The type of anesthesia and the location of the sentinel node, as marked by the radiologist, determine the position the patient must be placed in to facilitate the biopsy. b. The patient has been required to remain still for a prolonged time and, therefore, positioning in the OR is important to reduce patient discomfort. c. The patient may need to be repositioned during the biopsy to replicate skin tension at the time of skin marking in the nuclear medicine department. d. all of the above =.Finding
the sentinel node can be difficult. What
=The surgeon locates the sentinel node by virtue of its low radioactivity relative to surrounding tissue. a. true b. false =.After logging its arrival, fixing the specimen, and preparing it according to the surgeon’s request, the pathologist takes the specimen to the nuclear medicine department, where it remains until its radiation levels have dropped to background levels. a. true b. false 34.Specific patient teaching for lymphoscintigraphy includes which of the following? 1. straining the urine 2. hand washing after toilet use to remove traces of radioactivity 3. to expect a blue tinge to the patient’s urine for 48 hours. 4. emphasis on the low levels of radiation and
591 AORN JOURNAL
OCTOBER 1998, VOL 68, NO 4
that this is not dangerous to the patient or those close to him or her. a. 1 and2 b. 1,2, and 3 c. 2, 3, and 4 d. 3 and 4
=.It
is important to remind the patient that the radiation in the sentinel node must be allowed to decay to background levels and, therefore, the final pathology report will be delayed. a. true b. false
Interactive Wound Dressing for Skin Ulcers Approved The US Food and Drug Administration (FDA) has approved an interactive wound dressing that can improve healing in skin ulcers caused by venous insufficiency (ie, lack of proper blood flow to the skin). The material, called Apligraf, is a cellular dressing that can be used with standard therapy to enhance the healing process, even in older, difficult to treat venous insufficiency ulcers. According to the FDA, venous insufficiency ulcers affect thousands of Americans each year, and treatment of the ulcers often requires multiple surgeries. Although Apligraf will not eliminate the
need for standard treatment, its use may enhance and shorten the healing process. Apligraf is a cellular, bilayered skin construct produced from bovine collagen and cells derived from human infant foreskins. Its composition allows it to provide wound protection and to foster the growth of healthy new skin.
FDA Approves New Treatment for Serious Skin Ulcers (news release, Rockville, Md: Food and Drug Administration, US Department of Health and Human Sewices, May 26, 1998).
Exhibitors’ Committee Commits $SO,OOO to AORN Foundation The AORN Foundation will administer the Congress Incentive Program (CIP), a program designed to help chapters send members to Congress, through a grant from the Exhibitors’ Advisory Committee (EAC). This program distributes awards of $800 to 60 chapters and $350 to two members at large. To be eligible for the drawing, individuals must register for the AORN Congress in San Francisco by Dec 14, 1998, and be current members of AORN. One entry is allowed per chapter for the drawing. The previous year’s winners (ie, winners for the 1998 Congress) are ineligible for the 1999 drawing, The drawing will be held Dec 18, 1998, and chapter presidents of the winning chapters will receive a letter notifying them, along with a check for $800. If you have any questions concerning the CIP, please contact the AORN Foundation at (800) 755-2676 x 8229 or send
-
an e-mail to [email protected]. Another program is the Exhibitor Sponsorship Program (ESP), which t h Q O R N Foundation will administer through a grant from the EAC. This program will distribute funds to two student nurses, two international nurses, four AORN members, and two nonmember RNs. Applicants will be required to write an essay addressing statement of financial need, where they think AORN should be in the twenty-first century, how surgery will be different in the future, how they will share what they have learned at Congress with colleagues, and what they wish to gain from attending Congress. For an ESP grant application, contact Twilla Barlow, AORN Foundation, at (800) 755-2676 x 8229, or send an e-mail to [email protected]. 9
592
AORN JOURNAL
OCTOBER 1998, VOL 68, NO 1
Answer Sheet SENTINEL LYMPH NODE BIOPSY USING LVMPHOSCINTIGRAPHV
P
lease fill out the application and answer form below and the evaluation on the back of this page. Tear out the page from the Journal or make photocopies and mail to: AORN Customer Service c/o Home Study Program 2170 S Parker Rd, Suite 300 Denver, CO 80231-571 1
Event # 9905 1
IDES Number
1
0000000000 0 0 0 0 0 0 0 0 0 0 CJ 0000000000 % 0@@@@@@ s; @ @ @ 0000000000 0000000000 0000000000 0000000000 0000000000 0 0000000000
Session # 1143
Program offered October 1998. The deadline for this program is Nov 30, 1999.
Session Number
1. Record your AORN identification number in the appropriate section below. 2. Using a pen or pencil, completely darken the space that indicates your answer to each question. Do not circle or check the answer spaces. 3. A score of 70% correct is required for credit. 4. Record the time required to complete the program.
!
0000000000 0000000000 0000000000 0000000000
Mark only one answer per question. 100000 200000 300000 400000
2100000 22@@@@@ . I 2300000 2400000 s o o o o o 2500000 600000 2600000 7000@0 2700000 800000 2800000 900000 2900000 1000000 3000000 1100000 3100000 1200000 3200000 1300000 3300000 1400000 3400000 I500000 3500000 1600000 3600000 1700000 3700000 1800000 3800000 1900000 3900000 2000000 4000000
5. Enclose fee: Members $10; Nonmembers $20.
AORN (ID) # Name Address City State Zip RN license # State Phone number ( If nonmember, please provide social security number. Fee enclosed or bill the credit card indicated 0Mastercard 0Visa American Express Card # Expiration date Signature (for credit card authorization)
593 AORN JOURNAL
OCTOBER 1998, VOL 68, NO 4
Learner Evaluation SENTINEL LYMPH NODE BIOPSY USING LYMPHOSCINTIGRAPHY
The following evaluation is used to determine the extent to which this Home Study Program met your leaming needs. Rate the following items on a scale of 1 to 5.
Session Number
'
(Low) (High) (Low) (High)
OBJECTIVES
To what extent were the following objectives of this Home Studv . Program - achieved? (1) Discuss the spread of cancer as it relates to the sentinel lymph node. (2) Describe lymphoscintigraphy. (3) Discuss the care of the patient undergoing a sentinel lymph node biopsy with lymphoscintigraphy . CONTENT
(4) Did this article increase your knowledge of the subject matter? (5) Was the content clear and organized? (6) Did this article facilitate learning? (7) Were your individual objectives met? (8) Was the content of the article relevant to the objectives? T U T QUESTIONS/ANSWERS
(9) Were they reflective of the content? (10) Were they easy to understand? (1 1) Did they address important points?
What other topics would you like to see addressed in a future Home Study Program? Would you be interested or do you know someone who would be interested in writing an article on this topic? Topic(s):
Author names and addresses:
594 AORN JOURNAL