ATI: Chapter 17 - Respiratory Diagnostic Procedures Flashcards
Respiratory diagnostic procedures are used to evaluate a client’s respiratory status by checking indicators such as the oxygenation of the blood, lung functioning, and the integrity of the ______.
airway.
Pulmonary function tests (PFTs) determine lung function and __________.
breathing difficulties
PFTs measure lung volumes and capacities, diffusion capacity, gas exchange, flow rates, and airway resistance, along with _________.
distribution of ventilation
PFTs are helpful in identifying clients who have ______.
lung disease
PFTs are commonly performed for clients who have ______.
dyspnea
______ can be performed before surgical procedures to identify clients who have respiratory risks.
PFTs
Smokers should not smoke ___ to ____ hours before a PFT test.
6-8 hours
If a client uses inhalers, w/hold ___ to ____ hours prior to testing. (this can vary according to policy)
6 to 8 hours
An arterial blood gas (ABG) sample reports the status of oxygenation and _______ in the blood.
acid base
An ABG measures the following:
pH PaO2 PaCO2 HCO3 SaO2
______ is the amount of free hydrogen ions in the arterial blood (H+)
pH
_____ is the partial pressure of oxygen
PaO2
_____ is teh partial pressures of carbon dioxide.
PaCO2
_____ is the concentration of bicarbonate in arterial blood.
HCO3
_____ is the percentage of oxygen bound to Hgb as compared with the total amount that can be possibly carried.
SaO2
ABGs can be obtained by an arterial puncture or through an _________.
arterial line
Blood pH levels can be affected by a number of ______ (respiratory, renal, malnutrition, electrolyte imbalance, endocrine, or neurologic)
disease processes
PFTs and ABGs are helpful in monitoring the ________ of various treatments (such as acidosis interventions), in guiding oxygen therapy, in evaluating responses to weaning from mechanical ventilation.
effectiveness
An ______ is when you compress the ulnar and radial arteries simultaneously while instructing the client to form a fist. Then instruct the client to relax his hand while assessing the palm and fingers for blanching. Next, release pressure on the ulnar artery while observing the hand for flushing caused by capillary refilling. The client’s hand should turn pink within 15 seconds, indicating patency of the ulnar artery and an ability to use the radial artery to obtain arterial blood gases.
Allen’s test
Explain and reinforce the procedure with the client when doing an _______. Clients often experience pain with repeated ABG level checks and are often unaware of the purpose of the puncture.
arterial puncture
When performing an arterial puncture use surgical aseptic technique, and collect a specimen into a _______. Then the collected specimen is placed into a basin of ice and water to preserve pH levels and oxygen pressure. The specimen should be transported to the lab immediately.
heparinized syringe
Accessing the radial artery for sampling can be more difficult with ________ clients due to impaired peripheral vasculature.
older adult
Immediately after an arterial puncture, hold direct pressure over the site for at least ____ minutes. Pressure must be maintained for at least ___ minutes if the client is receiving anticoagulant therapy. Ensure that bleeding has stopped prior to removing direct pressure.
5 minutes
20 minutes
Monitor the ABG sampling site for bleeding, _____, swelling, and changes in temperature and color.
loss of pulse
Nurses should _____ all interventions and client responses after an arterial puncture.
document
Administer ______. Change ventilator settings as prescribed, or notify a respiratory therapist after an arterial puncture.
oxygen
Arterial puncture is frequently done by a _____ therapist in a hospital setting.
respiratory
Blood pH levels less than 7.35 reflect _____.
acidosis
Blood pH levels greater than 7.45 reflect _______.
alkalosis
Reference ranges for PaO2
80-100 mm Hg
Reference ranges for PaCO2
35 - 45 mm Hg
Reference ranges HCO3
21 to 28 mm Hg
Reference ranges SaO2
95 to 100%
A ______ is a complication that occurs when blood accumulates under the skin at the IV site.
hematoma
For a hematoma or arterial occlusion observe for changes in temperature, swelling, color, loss of pulse or ______. Notify the provider immediately if the manifestations persist. Apply pressure to the hematoma site.
pain
An ________ is a complication when air enters the arterial system during catheter insertion.
air embolism
If a pt has an air embolism place the client on his left side in the ________ position. Monitor for sudden onset of ______, decrease in SaO2, levels, chest pain, anxiety, and air hunger. Notify the provider immediately if symptoms occur, administer oxygen therapy and obtain ABGs. Continue to assess the client’s respiratory status for any deterioration.
Trendelenburg
Shortness of Breath
________ permits visualization of the larynx, trachea, and bronchi through either a flexible fiber-optic or rigid bronchoscope.
bronchoscopy
Bronchoscopy can be performed as an outpatient procedure, in a surgical suite under general anesthesia or at the bedside under local anesthesia and ________.
moderate (conscious) sedation
Bronchoscopy can also be performed on clients who are receiving mechanical ventilation by inserting eh scope through the client’s ___________.
endotracheal tube
Bronchoscopy is used to visualize abnormalities such as tumors, _______, and strictures.
inflammation
A bronchoscopy is indicated for a biopsy of ______ (lung cancer).
suspicious tissue
Clients undergoing a bronchoscopy with biopsy have additional risks for _______ and/or perforation.
bleeding
Bronchoscopy is indicated for the _______ or lung abscesses for culture and sensitivity or cytology (pneumonia)
aspiration of deep sputum
Bronchoscopy is also performed for ________, such as removal of foreign bodies and secretions from the tracheobronchial tree, treating postoperative atelectasis, and to destroy and excise lesions.
therapeutic reasons
Before a bronchoscopy assess for ______ to anesthetic agents or routine use of anticoagulants.
allergies
Before a bronchoscopy ensure that a ______ is signed by the client prior to the procedure.
consent form
Before a bronchoscopy remove the client’s ______, if applicable, prior to the procedure.
dentures
Before a bronchscopy maintain the client on NPO status usually ___ to ____ hours, to reduce the risk of aspiration when the cough reflex is blocked by anesthesia.
4 to 8 hours
Before a _______ administer preprocedure meds, such as an anxiolytic, atropine, viscous lidocaine, or local anesthetic throat spray.
bronchoscopy
During a bronchoscopy position the client in a ________ or _______ position. Assist in collecting and labeling specimens to ensure prompt delivery to the lab.
sitting or supine
During a bronchoscopy monitor vital signs, _______, and oxygenation status throughout the procedure.
respiratory pattern
During a bronchoscopy be aware that sedation given to older adult clients who have respiratory insufficiency can precipitate _________.
respiratory arrest
After a bronchoscopy continuously monitor respirations, BP, pulse oximetry, HR, and ______ during the recovery period.
LOC
During bronchoscopy postprocedure assess level of consciousness while recognizing that older adult clients can develop confusion or lethargy due to the effects of ______ given during the bronchoscopy.
medications
Prior to resuming oral intake after a bronchoscopy assess the LOC, presence of ______, and ability to swallow.
gag reflex
After a bronchoscopy allow adequate time for the cough and gag reflex to return prior to resuming oral intake. The gag reflex can be _____ to return in older adult clients receiving local anesthesia due to impaired laryngeal reflex.
slower
After a bronchoscopy, once the gag reflex returns, the nurse can offer _____ to the client and eventually fluid.
ice chips
After bronchoscopy, monitor for development of _________ (mild fever for less than 24 hr is not uncommon), productive cough, significant hemoptysis indicative of hemorrhage (a small amount of blood-tinged sputum is expected), and hypoxemia.
significant fever
Post bronchoscopy be prepared to intervene for unexpected responses, aspiration, and ______.
laryngospasm
Post bronchoscopy provide ______ hygiene.
oral
For older adult clients, encourage coughing and deep breathing ever _____ hours. There is an increased risk for respiratory infection and pneumonia in older adult clients due to decreased __________ and decreased secretion clearance. Respiratory infections can be more severe and last longer in older adult clients.
2
cough effectiveness
The client after bronchoscopy is not discharged from the recovery room until adequate cough reflex and _____ are present.
respiratory effort
After a bronchoscopy instruct clients that gargling with ______ or using throat lozenges can provide comfort for soreness of the throat.
salt water
______, is a complication after a bronchoscopy, which is an uncontrolled muscle contractions of the laryngeal cords (vocal cords) that impede the ability to inhale.
Laryngospasm
With a laryngospasm continuously monitor for signs of _____.
respiratory distress
A complication of bronchoscopy is __________, which can occur following a rigid bronchoscopy. Assess breath sounds and oxygen saturation, and obtain a follow-up chest x ray.
pneumothorax
This condition occurs when air leaks into the space between the lungs and chest wall. A blunt or penetrating chest injury, certain medical procedures, or lung disease can cause a ________.
Symptoms include shortness of breath.
When a ________ is large, a needle or tube is used to remove excess air.
pneumothorax
A complication of bronchoscopy, is _______, which can occur if the client chokes on oral or gastric secreations.
aspiration
To prevent aspiration with a bronchoscopy, withhold oral fluids or food until the _____ returns (usually 2 hours). Perform suctioning as needed.
gag reflex
A ____ is the surgical perforation of the chest wall and pleural space with a large-bore needle. It is performed to obtain specimen for diagnostic evaluation, instill meds into the pleural space, and remove fluid (effusion) or air form the pleural space for therapeutic relief of pleural pressure.
throracentesis
____ is performed under local anesthesia by a provider at the client’s bedside, in a procedure room, or in a provider’s office.
thoracentesis
Use of an _______ for guidance decreases the risk of complications with a thoracentesis
ultrasound
Aspirated fluid from a thoracentesis is analyzed for general appearance, cell counts, protein and glucose content, the presence of enzymes such as LDH and amylase, ________ and culture.
abnormal cells
Percussion, auscultation, radiography, or ______ is used to locate the effusion and needle insertion site for a thoracentesis.
sonography
It may be necessary for the nurse to assist the older adult client to maintain an appropriate _______ for the thoracentesis. Arthritis, tremors, or weakness can make it difficult for the client to remain still in the required position for this procedure.
position
Prior to a thoracentesis ensure that the client has ____ the informed consent form.
signed
Prior to a thoracentesis gather all needed supplies. Make sure to obtain preprocedure x-ray to locate ______ and to determine needle insertion site.
pleural effusion
During a thorancentesis position the client sitting _____with his arms and shoulders raised and supported on pillows and/or on an overbed table with his feet and legs well supported.
upright
Educate the patient getting a thorancentesis to remain ______ (risk of accidental needle damage) during the procedure ask to not cough or talk unless instructed by the provider
absolutely still
During a throacentesis assist the provider with the procedure maintaing strict ______.
surgical aseptic technique
With a throacentesis, prepare the client for a feeling of _____ with needle insertion and fluid removal.
pressure
With a ______ monitor vs, skin color, and oxygen saturation through the procedure.
throancentesis
Measure and record the amount of ______ form the chest with a thorancetesis.
fluid removed
The amount of fluid removed during a thorancentesis should be limited to ______ at a time to prevent re-expansion pulmonary edema.
1 Liter
After a thorencentesis apply a pressure dressing over the ______ site, and assess dressing for bleeding or drainage.
puncture
After a thorancentesis monitor vital signs and respiratory status (respiratory rate and rhythm, breath sounds, oxygenation status) _____ for the first several hours after the thoracentesis.
hourly
After a thoracentesisis auscultate lungs for reduced breathe sounds on the ________.
side of the thoracentesis
Encourage the client to deep breathe to assist with ________ after a throacentesis.
lung expansion
After a throacentesis obtain a postprocedure chest ______ to check resolution of effusions, rule out pneumothroax)
x ray
A complication of thorancentesis is __________, of thoracic structures to one side of the body.
mediastinal shift
If there is a medianstinal shift after a thoracentesis, monitor vs, asuculate lungs for a ______ in or absence of breath sounds.
decrease
_______ is a complication of thoracentesis, which is a collapsed lung. It can occur due to injury to the lung during the procedure.
Pneumothorax
Monitor for manifestations of pneumothorax, such as diminished breath sounds, distended neck veins, ________, respiratory distress, and cyanosis.
asymmetry of the chest wall
With a pneumothorax monitor postprocedure ____.
chest x rays
Educate the client on indications of a pneumothorax which can develop during the first 24 hours following a thoracentesis. Indications include deviated trachea, pain on the affected side that worsens at the end of inhalation and exhalation, __________, increased HR, rapid shallow respiration, nagging cough, or feeling of air hunger.
affected side not moving in and out upon inhalation and exhalation
______ can occur if the client is moved during the procedure or is at increased risk for bleeding after a thorancentesis.
bleeding
Monitor for coughing and hemoptysis (______) after a throracentesis.
bleeding
Monitor vital signs and lab results for evidence of ______ (hypotension, reduced Hgb levels) after a thoracentesis.
bleeding
____ can occur due to the introduction of bacteria with the needle puncture.
infection
To avoid infection after a thoracentesis make sure to use ____ technique and monitor the client’s temp following the procedure.
sterile
A nurse is caring for a client who is scheduled for a thoracentesis. Prior to the procedure, which of the following actions should the nurse take?
A. Position the client in an upright position, leaning over the bedside table.
B. Explain the procedure
C. Obtain ABGs
D. Administer benzocaine spray
A. Position the client in an upright position, leaning over the bedside table.
This position widens the intercostal space for the provider to access the pleural fluid.
A nurse is reviewing ABG lab results of a client who is in respiratory distress. The results are pH 7.4, PaCO2 32 mm Hg, HCO3 22 mm Hg. The nurse should recognize that the client is experiencing which of the following acid-base imbalances?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
B. Respiratory alkalosis
A client who is experiencing respiratory alkalosis will have an increased pH and a decreased PaCO2. Possible causes of respiratory alkalosis include hyperventilation, fever, and respiratory infections.
A client who is experience metabolic ________ will have an increased pH and an increased HCO3.
alkalosis
A client who is experiencing metabolic ______ will have a decreased pH and decreased HCO3.
acidosis
A client who is experiencing respiratory _______ will have a decreased pH and an increased PaCo2.
acidosis
A nurse is assessing a client following a bronchoscopy. Which of the following findings should the nurse report to the provider?
A. Blood-tinged sputum
B. Dry, nonproductive cough
C. Sore throat
D. Bronchospasms
D. Bronchospasms
A nurse is caring for a client who is scheduled for a thoracentesis. Which of the following supplies should the nurse ensure is in the client’s room?
A. Oxygen equipment B. Incentive spirometer C. Pulse oximeter D. Sterile dressing E. Suture removal kit
A. Oxygen equipment
Oxygen equipment is necessary to have in the client’s room if the client becomes short of breath following the procedures.
C. Pulse oximeter
Pulse oximetry is necessary to monitor oxygen saturation level during the procedure.
D. Sterile dressing
Is necessary to apply to the puncture site following the procedure.
A nurse is caring for a client following a thoracentesis. Which of the following clinical manifestations should the nurse recognize as risks for complications?
A. Dyspnea B. Localized bloody drainage on the dressing C. Fever D. Hypotension E. Report of pain at the puncture site
A. Dyspnea
Can indicate a pneumothorax or a reaccumlation of fluid. The nurse should notify the HCP immediately.
C. Fever
Can indicate infection
D. Hypotension
can indicate intrathoracic bleeding
