Exam 2: Chap 8 Flashcards
Bronchoscopy
Expectoration of sputum sample/ tracheal suction
Analysis of sputum
amount, quality, color
The sputum sample may be examined for
- Culture and sensitivity 2. gram stain 3. acid fast smear and culture and 4. cytology
Culture and sensitivity study
single sputum sample is collected in a sterile container. Test is performed to diagnose bacterial infection, select an antibiotic, and evaluate the effectiveness of antibiotic therapy
Turn around time for Culture and sensitivity study
48 to 72 hours
Gram staining of sputum is performed to
to classify bacteria into gram negative organisms and gram positive organisms
Acid fast smear and culture is performed to
determine the presence of acid fast bacili (myobacterium, TB). a series of 3 early morning sputum samples is tested.
Cytology
examination entails the collection of a single sputum sample in a special container with fixative solution. Sample is evaluated under a microscope for the presence of abnormal cells that may indicate a malignant condition
Skin tests are commonly performed to evaluate
allergic reactions or exposure to tuberculous bacilli or fungi
Positive test/ negative test
patient has been exposed/ no exposure
anergy
Depression of cellmediated immunity which can show a negative test. such as which develops with (HIV)
Bronchoscope allows direct visualization of the
upper airways (nose, oral cavity, and pharynx), larynx, vocal cords, subglottic area, trachea, bronchi, lobar bronchi, segmental bronchi down to the third or fourth generation
Yellow sputum correlation
acute infection
Green sputum correlation
Associated with old, retained secretions, green and foul smelling secretions are freq found in pts with anaerobic or pseudomonas infection, such as bronchiectasis, CF, and lung abscess
Thick, stringy, and white or mucoid sputum correlation
Bronchial asthma
brown sputum correlation
Presence of old blood
Red sputum correlation
fresh blood
A diagnostic bronchoscopy is usually performed when an
infectious disease is suspected and not otherwise diagnosed or to obtain a lung biopsy sample when the abnormal lung tissue is located or near the bronchi
Bronchoscopy is indicated for a number of clinical conditions, including further inspection and assessment of
- abnormal radiographic findings 2. persistent atelectasis 3. excessive bronchial secretions 4. acute smoke inhalation injuries 5. intubation damage 6. bronchiectasis 7. foreign bodies 8. hemoptysis 9. lung abscess 10. major thoracic trauma 11. stridor or localized wheezing and 12. unexplained cough
Bronchoalveolar lavage (BAL)
A common diagnostic bronchoscopic technique. Involves injecting a small amount (30mL) of sterile saline through the bronchoscope and then withdrawing the fluid for examination of cells
Therapeutic Bronchoscopy includes
- suctioning of excessive secretions or mucous plugs, especially when lung atelectasis is present or forming 2. the removal of foreign bodies or cancer obstructing the airway 3. selective lavage and 4. management of life threatening hemoptysis
First line of defense in the treatment of atelectasis from retained secretions
Respiratory therapy modalities at the pts bedside (CPT, intermittent percussive vent, postural drainage, deep breathing and coughing tech, and PEP therapy)
Endobronchial unltrasound (EBUS) examination
may be performed during a bronchoscopy to help establish the stage of lung cancer and, importantly, establish if- and how- the cancer may have spread
EBUS can provide an accurate
staging of lung cancer and can help reduce the amount of tissue that needs to be removed during surgery without invasive procedures
During EBUS procedure
an ultrasound probe is used to send sound waves through the walls of the airways into the surrounding areas, lungs, and mediastinum. When abnormal areas are detected, a small sample of tissue is taken with asmall needle guided by the ultrasound. Sample then sent to lab
4 reasons EBUS is recommended
To detect the presence of tumors or enlarged lymph nodes, To diagnose tumors within the lung, To diagnose lymph node abnormalities in the mediastinum or hilum, To diagnose tumors in the mediastinum
Mediastinoscopy
Insertion of a scope through a small incision in the suprasternal notch; the scope is then advanced into the mediastinum.
Mediastinoscopy test is used to
inspect and biopsy lymph nodes in the mediastinal area
Transbronchial lung biopsy entails
passing a forceps or needle through a bronchoscope to obtain a specimen
Open lung biopsy involves
surgery to remove a sample of lung tissue. An incision is made over the area of the lung from which the tissue sample is to be collected. Then chest tube is inserted for drainage and suction for 7-14 days
An open lung biopsy is usually performed when
either a bronchoscopic biopsy or a needle biopsy has been unsuccessful or cannot be performed or when a larger piece of tissue is necessary to establish a diagnosis. More invasive and thus more likely to cause complications
a lung biopsy is especially useful in investigating
peripheral lung abnormalities, such as recurrent infiltrates and pleural or subpleural lesions
Video Assisted Thoracoscopy Surger (VATS)
a small incision is made in the chest wall, and a device called a thoracoscope is inserted. This device is equipped with a fiberscope that can examine the pleural cavity
Thoracentesis
is a procedure in which excess fluid accumulation (pleural effusion) between the chest cavity and lungs is aspirated through a needle inserted through the chest wall
Diagnostic Thoracentesis may be performed to identify the
cause of pleural effusion
Therapeutic thoracentesis may be performed to relieve
shortness of breath or pain caused by a large pleural effusion, to remove air trapped, or to administer medication directly into the lung cavity to treat the cause of the fluid accumulation or to treat cancer
Transudate or an exudate
fluid in the lung cavity
Transudates
develop when fluid from the pulmonary capillaries moves into the pleural space. Fluid produced is thin and watery and usually has a low WBC coung, a low lactate dehydrogenase (LDH) enzyme level, and a low protein level
A transudate may be caused by
left ventricular heart failure, cirrhosis, nephrotic syndrome, and peritoneal dialysis
Exudates
may be caused by a variety of conditions including pulmonary infections, cancer, chest trauma, pancreatitis, autoimmune disease, or a pulmonary embolism
When an infection is present…
WBC count is high, as well as the LDH enzyme level, a high protein level, a large amount of cellular debris, and the presence of bacteria or other infectious organism
When cancer is present…
High WBC count, high LDH enxyme level, high protein level, abnormal cells may also be found
When pulmonary embolism is present…
a large number of RBCs are usually present and the WBC and protein levels are low
Pleurodesis
is performed to prevent the recurrence of a pneumothorax or pleural effusion. Achieved by injecting any number of agents into the pleural space through a chest tue
Most frequent hematology test is the
complete blood count (CBC)
CBC
provides important info about the patients blood counts, clotting ability, and blood content. includes the RBC count, Hb, Hct, and total WBC count, and at least an estimate of the platelet count
Constitute the major portion of the blood cells
RBCs (erythrocytes)
Healthy man has about how much RBCs in each cubic mm of blood/ women
5 million/ 4 million
Clinically, the total number of RBCs and the RBC indices are useful in assessing the pats overal
oxygen carrying capacity
The RBC indices are helpful in identification of
specific RBC deficiencies
Major functions of the WBCs (leukocytes)
- fight against infection 2. defend the body by phagocytosis against foreign substances and 3. produce or at leasts transport and distribute antibodies in the immune response
WBCs per cubic mm of blood
5000 to 10,000
Two types of WBCs
granular leukocytes and nongranular leukocytes
Granular leukocytes (granulocytes)
classified because of the granules present in their cytoplasm. Neutrophils, eosinophils, and basophils. Polymorphanuclear leukocytes
Neutrophils comprise about/ function
60-70% of the total number of WBCs. first to arrive at the site of inflammation
They are phagocytes and Neutrophils also release an enzyme called lysozyme which
(Ingest and destroy bacterial organisms and particulate matter) destroys certain bacteria
An increased neutrophil count is associated with
- bacterial infection 2. physical and emotional stress 3. tumors 4. inflammatory or traumatic disorders 5. some leukemias 6. myocardial infarction and 7. burns
Eosinophils comprise total/ function
2% to 4% of the total number of WBCs. Unknown function, thought to play a role in the breakdown of protein material. Activated by allergies/ parasitic infection
Basophils comprise total/ function
only about 0.5% to 1% of the total WBC count. function not clearly understood.
Increased basophils are primarily associated with
certain myeloproliferative disorders. Are involved in allergic and stress response
Nongranular leukocytes
Monocytes and lymphocytes, have spheric nuclie
monocytes function
second order of cells to arrive at inflammation site, usually appearing about 5 hours or more after injury. after 48 hours the more predominant cell type in inflamed area
Monocytes comprise
3-8% of the total leukocyte count. they are short lived, phagocytic WBCs with a half life of about 1 day.mature into macrophages
Macrophages
large wandering cells that engulf larger and greater quantities of foreign material than the neutrophils. first line of inflammatory defense, involved in immune response, and malignancies
Therefore an elevated number of monocytes suggest
infection and inflammation
Lymphocytes
viral infection, and production of antibodies.
Lymphocytes divided into 2 categories
B cells and T cells
Rosettes (T cells)
have a smooth surface, comprise 70-90% of the total lymphocytes. formed in thymus
T cells form in thymus and further divide into four categories
- Cytoxic T cells (killer) 2. Helper T cells, recognize foreign antigens and help activate cytotoxic T cells and plasma cells (b cells) 3. inducer T Cells, stimulate the prod of different t cells 4. Suppressor T cells, suppress the responses of the other cells and prov feedback info to the system
T cells may also be classified according to their surface antigens
T4; 60%-70% of the circulating T cells, mainly of the helper and inducer cells, T8; consists mainly of the cytotoxic and suppressor cells
B cells
comprise 10-30% of the total lymphocytes, formed in bone marrow, further divide into either plasma cells or memory cells
Plasma cells
secrete antibodies in response to foreign antigens
Memory cells
retain the ability to recognize specific antigens long after the initial exposure and therefore contribute to long term immunity against future exposures to invading pathogens
Sequence of Lymphocyte Response to Infection
Initially, the macrophages attack and engulf the foreign antigens. Which stimulates the production of T cells, and ultimately, the B cells (plasma cells). The T4 cells play a pivotal role in the overall modulation of this immune response (next slide 5)
The T4 cells play a pivotal role in the overall modulation of this immune response
- Secreting a substance called lymphokine, which is potent stimulus to T cell growth and differentiation 2. recognizing fireign antigetns 3. causing clonal proliferation of T cells 5. enabling B cells to secrete specific antibodies
Platelets (thrombocytes)
are the smallest of the formed elements in the blood. Essential for blood clotting produced in bone marrow and possibly in lungs.
A low platelet count (thrombocytopenia) is associated with
- massive blood transfusion 2. pneumonia 3. cancer chemotherapy 4. infection 5. allergic reaction 6. toxic effects of certain drugs
A high platelet count is associated with
- cancer 2. trauma 3. asphyxiation 4. rheumatoid arthritis 5. iron deficiency 6. acute infections 7. heart disease 8. TB and 9. polycythemia vera
A platelet count of less than what is associated with spontaneous bleeding
20,000/mm
Therapeutic platelet count
50,000/mm
In the healthy women, what is the hct?
42% (45% in male)
Which of the following represent the primary defense against bacterial organisms through phagocytosis?
Neutrophils
What is the normal hemoglobin value for men
14 to 16 g% (women 12-15g%)
What percent of the normal WBC count are neutrophils
60%-70%
In the healthy man what is the RBC count?
5,000,000/mm3 (4,000,000 women)
What is the normal WBC count
5,000 to 10,000/mm3
Which of the following are activated by allergies?
Eosinophils
Various clinical procedures such as bronchoscopy or the insertion of an arterial catheter are generally safe when the platelet count is no lower than which of the following?
50,000/mm3
Which of the following are associated with hyperglycemia? 1. Diabetes mellitus 2. myocardial infarction 3. Thiazide and loop diuretics 4. Acute infection
all of the above
Which of the following are clinical manifestations associated with hyponatremia
- seizures
- confusion
- muscle twitching
- abdominal cramps
all of the above
