Diagnostic Evaluation Flashcards
Performed to assess respiratory function and to determine the extent of dysfunction, response to therapy, and as screening test in potentially hazardous industries.
Pulmonary Function Test
Indications of Pulmonary Function Test
*Chronic respiratory disorders
*Patients for thoracic and upper abdominal surgery
*Obese
*Symptomatic patient with a history suggesting high risk
How well the performance of the patient is compared with an average based on age, gender, race and height.
Percentage Predicted Value
Patient Preparation when undergoing pulmonary function Test
Instruct patient to avoid:
*Smoking for 24 hours
* Drinking alcohol for at least 4 hours
* Vigorous exercise for at least 30 minutes
* Wearing any tight clothing
* Eating a large meal for at least 2 hours
* Taking short-acting bronchodilators for four hours
*Taking long-acting beta-2-agonist inhalers for 12 hours
* Taking slow-release medicines that affect respiratory function, and theophylline-based drugs for 24 hours
Assess oxygenation and acid-base balance
Arterial blood gas (ABG)
In the specimen the result of the arterial blood is
Bright red in color
The most common site for the withdrawal of specimen
Radial Artery
The purpose of using heparinized syringe to draw blood specimen
To prevent clotting
Why it is important to place the specimen in a container with ice
To prevent hemolysis
What happens if hemolysis occurs?
Oxygen and carbon dioxide are released and cannot be measured accurately
A non-invasive method of continuously monitoring the oxygen saturation of hemoglobin.
Pulse Oximetry (sp02)
If the result of Pulse Oximetry is <90% or less than 90% the interpretation would be?
Hypoxia- Tissue are not receiving enough oxygen
Factors affecting pulse oximetry readings:
*Anemia
*Abnormal hemoglobin
*Carbon monoxide poisoning
* Use of dyes (methylene blue)
*Dark skin
*Nail Polish
*Bright lights
*Patient movement, including shivering
Identifies pathogens
Culture
Test which drugs is/are most effective against identified pathogen
Sensitivity
Useful in detecting streptococcal infections
Throat Swab
Thick type of mucus produced in the lungs
Sputum
Rapid method of detecting bacterial infection; indicates whether it is gram-positive or gram-negative
Gram staining
To test for PTB
Acid-fast bacilli
Specimen collection:
*Obtain early in AM before intake or food or fluid
* Instruct patient to rinse mouth with WATER prior to collection
*Instruct to take a few deep breaths then cough deeply
*Let patient expectorate sputum into sterile container
*Offer oral care
Help detect densities produced by fluid, tumors, foreign bodies, and other pathologic conditions
Chest X-ray
Nursing Interventions of Chest X-ray
Inform patients that x-rays do not require fasting and is not painful
A CT is an imaging method in which the lungs are scanned in successive layers by a narrow-beam x-ray. The images produced provide a cross-sectional view of the chest.
Computed Tomography (CT) Scan
Nursing Interventions for CT Scan
*Informed patient that they will be required to remain in supine for about 30 minutes
If contrast medium will be used:
*Asses for allergy to iodine
*Monitor kidney function
*Maintain NPO for 4 hours before procedure or as ordered
Uses magnetic fields and radiofrequency instead of radiation and can produce a much more detailed diagnostic image than x-rays and CT Scan
Magnetic Resonance Imaging (MRI)
Contraindications of Chest MRI
*With metallic implants- absolute
*Pacemakers-absolute
*Morbid obesity
* Confused/agitated patients
*Claustrophobia
MRI nursing interventions
- Remove all metal items
*Instruct to remain still for approximately 30 to 90 minutes
*Inform that a loud humming or thumping noise will be heard - Administer anxiolytics, as ordered in case of claustrophobia
is the direct inspection and examination of the larynx, trachea, and bronchi using a flexible fiberoptic bronchoscope or a rigid bronchoscope
Bronchoscopy
A hollow metal tube with light at its end and mainly used for removing foreign substances, investigating source of hemoptysis, or performing endobronchial surgical procedures
Rigid Bronchoscope
A thin, flexible bronchoscope that can be directed into the segmental bronchi. Allows increased visualization of the peripheral airways. Can be performed at the bedside.
Flexible Bronchoscope
Remove foreign bodies or secretions from the tracheobronchial tree
Therapeutic Bronchoscopy
Used to visualize tissues and determine the nature, location, and extent of the pathologic process
Diagnostic Bronchoscopy
Collects secretions for analysis and to obtain tissue sample for diagnosis
Diagnostic Bronchoscopy
Determines whether a tumor can be resected surgically
Diagnostic Bronchoscopy
Diagnose sources of hemoptysis
Diagnosis Bronchoscopy
Remove foreign bodies or secretions from the tracheobronchial tree
Therapeutic Bronchoscopy
Bronchoscopy that controls bleeding
Therapeutic Bronchoscopy
Treat postoperative atelectasis
Therapeutic Bronchoscopy
Destroy and excise lesions
Therapeutic Bronchoscopy
Provide brachytherapy
Therapeutic Bronchoscopy
Ensure that informed consent has been obtained
Before the procedure of Bronchoscopy
The purpose to facilitate NPO 4 to 8 hour before the procedure of Bronchoscopy
To reduce risk of aspiration
The purpose to explain procedure to patient before bronchoscopy
to reduce fear and anxiety
The purpose to administer atropine and sedatives as ordered before the bronchoscopy
to inhibit vagal stimulation
During the procedure of flexible bronchoscopy
- Local Anesthetic (Lidocaine (xylocaine)
*Sprayed on the pharynx or dropped on the epiglottis and vocal cords and into the trachea
The purpose of spraying on the pharynx or dropped on the epiglottis and vocal cords and into the trachea
to suppress cough reflex and minimize discomfort
Anesthesia used during rigid bronchoscopy
General Anesthesia
After the procedure of Bronchoscopy
*Maintain NPO until cough reflex returns
* Once cough reflex has returned, offer ice chips first then fluids
* Monitor for hypoxia, hypotension, tachycardia, dysrhythmias, hemoptysis, and dyspnea.
*Small amount of blood
Aspiration of fluid and/or air from the pleural space
Thoracentesis
Purpose of thoracentesis
*Removal of fluid and/air
*Aspiration of pleural fluid for analysis
*Pleural biopsy
*Instillation of medication into the pleural space
Before the procedure of thoracentesis
*Secure written consent
*Obtain baseline vital signs
*Position the pt upright, leaning over table
*Instruct patient to remain still and avoid coughing during insertion of needle
* Inform patient about pressure sensation felt on needle insertion
The purpose of obtaining baseline vital signs before the procedure of Thoracentesis
Aspiration may cause hypovolemic shock
The appropriate position before the procedure of Thoracentesis
Position upright and leaning over the table
After the procedure (Thoracentesis)
*Turn the patient to UNAFFECTED SIDE- to prevent leakage of fluid in the thoracic cavity
* Promote bed rest- to promote postural hypotension
*Check for expectoration of blood- this indicates trauma to lung
*Monitor VS
Purpose of chest drainage
*Re-expand the involved lung
*Remove excess air, fluid, or blood
*Treat pneumothorax
Act as a reservoir for fluid draining from the chest tube
Drainage Chamber
Regulates the amount of negative pressure applied to the chest
Suction Control Chamber
Has a one-way valve or water seal that prevents air from moving back into the chest when the patient inhales
Water Seal Chamber
Normal result of Drainage Systems
*Tidaling- increase in the water level with inspiration and a return to the baseline level during exhalation
*Intermittent bubbling
abnormal result of Drainage Systems
Continuous bubbling- presence of air leak
