2434408 respiratory diagnostic procedures

8/7/2019 2434408 Respiratory Diagnostic Procedures

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NURSINGBULLETS:

RESPIRATORY SYSTEM DIAGNOSTIC PROCEDURES


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RISK FACTORS FOR RESPIRATORY

DISORDERS

SmokingSmoking

Use of chewing tobaccoUse of chewing tobacco

AllergiesAllergies

Frequent respiratory illnessesFrequent respiratory illnesses Chest injuryChest injury

SurgerySurgery

Exposure to chemicals & environmentalExposure to chemicals & environmental

pollutantspollutants Family history of infectious diseaseFamily history of infectious disease

Geographic residence & travel to foreignGeographic residence & travel to foreigncountriescountries


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DIAGNOSTIC PROCEDURES

AND EXAMSChest x-ray film (radiograph)1. Description: provides information regarding the

anatomical location and appearance of thelungs.

2. Preprocedurea. Remove all jewelry and other metal objectsfrom the chest area.

b. Assess the clients ability to inhale and hold

breath.c. Question females regarding pregnancy or thepossibility of pregnancy.

3. Postprocedure:

Assist the client to dress.


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Nursingbullets: SPUTUM

SPECIMEN1. Description: a specimen obtained by

expectoration or tracheal suctioning to assist in

the identification of organisms or abnormal cells.

2. Preprocedurea. Determine specific purpose of collection and

check with institutional policy for appropriate

collection of specimen.

b. Obtain an early morning sterile specimen from

suctioning or expectoration after a respiratory

treatment, if a treatment is prescribed.


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c. Obtain 15 ml of sputum.

d. Instruct the client to rinse the mouthwith water before collection.

e. Instruct the client to take several deepbreaths and then cough deeply to obtain

sputum.f. Always collect the specimen beforeclient begins antibiotic therapy.

3. Postprocedurea. Transport specimen to laboratory STAT.

b. Assist the client with mouth care.


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Nursingbullets: SUCTIONINGNursingbullets: SUCTIONING

PROCEDUREPROCEDURE ---- SPUTUM SPECIMENSPUTUM SPECIMEN Aseptic technique

Hyperoxygenate

Lubricate the catheter with sterile water

Tracheal suctioningTracheal suctioning: 4 inches

Nasotracheal suctioningNasotracheal suctioning: insert to inducecough reflex

Dont apply suction while inserting

Suction intermittently for 10-15 seconds

Rotate and withdraw

Hyperoxygenate & deep breaths


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Nursingbullets: BRONCHOSCOPY

1. Description: direct visual examination of

the larynx, trachea, and bronchi with a

fiberoptic bronchoscope2. Preprocedure

a. Obtain informed consent.

b. Maintain NPO status for client frommidnight before the procedure.

c. Obtain vital signs.


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d. Assess the result of coagulation studies.

e. Remove dentures or eyeglasses.f. Prepare suction equipment.

g. Administer medication for sedation as

prescribed.h. Have emergency resuscitation

equipment readily available.

3. Postprocedurea. Monitor vital signs.

b. Maintain client in semi-Fowler position.


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c. Assess for the return of the gag reflex.

d. Maintain NPO status until gag reflex returns.

e. Have an emesis basin readily available forclient to expectorate sputum.

f. Monitor for bloody sputum.

g. Monitor respiratory status, particularly if

sedation was administeredh. Monitor for complications, such asbronchospasm, bronchial perforation indicatedby facial or neck crepitus, dysrhythmias, fever,bacteremia, hemorrhage, hypoxemia, and

pneumothorax.i. Notify the physician if fever, difficulty inbreathing, or other signs of complications occurfollowing the procedure.


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Nursingbullets: PULMONARY

ANGIOGRAPHY1. Description

a. Pulmonary angiography is an invasivefluoroscopic procedure in which a catheteris inserted through the antecubital orfemoral vein into the pulmonary artery orone of its branches.

b. Pulmonary angiography involves aninjection of iodine or radiopaque orcontrast material.


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2. Preprocedure

a. Obtain informed consent

b. Assess for allergies to iodine, seafood, orother radiopaque dyes.

c. Maintain NPO status of client for 8 hoursbefore procedure.

d. Monitor vital signs

e. Assess results of coagulation studies

f. Establish and intravenous access

g. Administer sedation as prescribedh. Instruct the client to lie still during theprocedure


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i. Instruct the client that he or she may feel anurge to cough, flushing, nausea, or salty taste

following injection of the dyej. Have emergency resuscitation equipmentavailable

3. Postprocedure

a. Monitor vital signs

b. Avoid taking blood pressures for 24 hours inthe extremity used for injection

c. Monitor peripheral neurovascular status of theaffected extremity

d. Assess insertion site for bleeding

e. Monitor for delayed reaction to the dye


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Nursingbullets: THORACENTESIS

1. Description: removal of fluid or air from the

pleural space via a transthoracic aspiration

2. Preprocedure


b. Obtain vital signs

c. Prepare the client for ultrasound or chest

radiograph, if prescribed, before procedured. Assess results of coagulation studies


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e. Note that the client is positioned sitting

upright, with the arms and head supportedby a table at the bedside during the

procedure.

f. If the client cannot sit up, the client is

placed lying in bed on the unaffected side

with the head of the bed elevated 45

degrees

g. Instruct the client not to cough, breathdeeply, or move during the procedure.


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3. Postprocedure

a. Monitor vital signsb. Monitor respiratory status

c. Apply a pressure dressing, and assess

the puncture site for bleeding and crepitus.d. Monitor for signs of pneumothorax, air

embolism, and pulmonary edema


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Nursingbullets: LUNG BIOPSY

1. Description

a. A percutaneous lung biopsy is

performed to obtain tissue for analysis byculture or cytological examination

b. A needle biopsy is done to identify

pulmonary lesions, changes in lung tissue,

and the cause


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2. Preprocedure


b. Maintain NPO status.c. Inform the client that a local anesthetic will be usedbut that sensation of pressure during needle insertionand aspiration may be felt.

d. Administer analgesics and sedatives as prescribed

3. Postprocedurea. Monitor vital signs

b. Apply dressing to the biopsy site and monitor fordrainage or bleeding

c. Monitor for signs of respiratory distress, and notify

physician if they occurd. Monitor for signs of pneumothorax and air emboli, andnotify physician if they occur

e. Prepare the client for chest radiography if prescribed


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Nursingbullets: VENTILATION

PERFUSION LUNG SCAN1. Descriptiona. The perfusion scan evaluates blood flow to the lungs.

b. The ventilation scan determines the patency of thepulmonary airways and detects abnormalities in

ventilation.c. A radionucleotide may be injected for the procedure

2. Preprocedure


b. Assess client for allergies to dye, iodine, or seafood

c. Remove jewelry around the chest aread. Review breathing methods that may be requiredduring testing.


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e. Establish an intravenous access

f. Administer sedation if prescribed

g. Have emergency resuscitation equipment

available.

3. Postprocedure

a. Monitor client for reaction to nucleotide

b. Instruct client to wash hands carefully

with soap and water for 24 hours following

the procedure.


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Nursingbullets: SKIN TEST

1. Description: A skintest is an intradermalinjection used to

assist in diagnosingvarious infectiousdiseases

2. Preprocedure:Determinehypersensitivity orprevious reactions toskin tests


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3. Procedure

a. Use test injection test that is free of

excessive body hair, dermatitis, and

blemishes.

b. Apply the injection at the upper one

third of inner surface of the left arm

c. Circle and mark the test site

d. Document the date, time, and test site


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4. Postprocedure

a. Advise the client not to scratch the test site so

as to prevent infection and abscess formation

b. Instruct the client to avoid washing the test

site.

c. Interpret the reaction at the injection site 48to72 hours after administration of the test

antigen

d. Assess the test site for the amount of

induration (hard swelling) in millimeters and forthe presence of erythema and vesiculation

(small blisterlike elevations)


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Nursingbullets: ARTERIAL BLOOD

GASES1. Description: measurement of the dissolved

oxygen and carbon dioxide in the arterial bloodto reveal the acid-base state and how well theoxygen is being carried to the body

2. Preprocedurea. Perform Allens test before drawing radialartery specimens.

b. Have the client rest for 30 minutes beforespecimen collection.

c. Avoid suctioning before drawing ABG sample.

d. Do not turn off oxygen unless the ABGsample is ordered to be drawn with clientbreathing room air.


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3. Postprocedure

a. Place the specimen on ice.b. Note the clients temperature on laboratory

form.

c. Note the oxygen and type of ventilation that

the client is receiving on the laboratory form.

d. Apply pressure to the puncture site for 5 to 10

minutes and longer if the client is taking

anticoagulant therapy or has a bleedingdisorder.

e. Transport the specimen to the laboratory

within 15 minutes.


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Nursingbullets: PULSE OXIMETRY

1. Description

a. Pulse oximetry is a noninvasive test that

registers the oxygen saturation of theclients hemoglobin.

b. This arterial oxygen saturation (SaO2) is

recorded as a percentage.

c. The normal value is 95% to 100%.


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d. After a hypoxic client

uses up the readily

available oxygen(measured as the arterial

oxygen pressure, PaO2, on

ABG testing), the reserve

oxygen, that oxygen

attached to the hemoglobin

(SaO2), is drawn on to

provide oxygen to the

tissues.

e. A pulse oximeter readingcan alert the nurse to

hypoxemia before clinical

signs occur.


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2. Procedure

a. A sensor is placed on the clients finger, toe,

nose, ear lobe, or forehead to measure oxygensaturation, which then is displayed on a monitor.

b. Maintain the transducer at heart level.

c. Do not select an extremity with animpediment to blood flow.

d. Results lower than 91% necessitateimmediate treatment.

e. If the SaO2 is less than 85%, the tissues ofthe body have a difficult time becomingoxygenated; an SaO2 of less than 70% is lifethreatening.


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Nursingbullets: CHEST

PHYSIOTHERAPY

Best time - morning upon arising, 1 hr beforemeals or 2-3 hrs after meals

Stop if pain occurs

Provide mouth care

CONTRAINDICATIONS OF CHESTCONTRAINDICATIONS OF CHESTPHYSIOTHERAPY (CPT)PHYSIOTHERAPY (CPT)

Increased respiratory distress

History of fractures

Chest incisions


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POSTURAL DRAINAGE:POSTURAL DRAINAGE: use of the

gravity

NURSING CARENURSING CARE

Position the client Best time A.M. upon arising, 1 hr before

meals, 2-3 hrs after meals

Stop if cyanosis or exhaustion occurs Maintain position 5-20 mins after

Provide mouth care after the procedure


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CONTRAINDICATIONS OF POSTURALCONTRAINDICATIONS OF POSTURALDRAINAGEDRAINAGE

Unstable V/S

Increased ICP

CLIENT INSTRUCTIONS FOR INCENTIVECLIENT INSTRUCTIONS FOR INCENTIVESPIROMETRYSPIROMETRY

Use the lips to form seal around the mouthpiece

Inspire deeply

Hold inspiration for a few seconds

Forcefully exhale Avoid the use of spirometry at mealtime - it may

cause nausea


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Nursingbullets: Chest Tube

Thoracotomy

Chest Tubes/Water seal drainage

A.Insertion of a catheter into the intrapleural space

to maintain constant negative pressure when

air/fluid have accumulated

B.Chest tube is inserted to underwater drainage to

allow for the space of air/fluid and prevent reflux

of air into the chest

C.For evacuation of air, chest tube is placed in the

second or third intercostal space, anterior or

midaxillary line (air rises to upper chest)


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D. For drainage of fluid, chest tube is place in the

eight or ninth intercostal space, midaxillary

line.E. Chest tube is connected to tubing for the

collection system; the distal end of the

collection tubing must be placed below the

water level in order to prevent atmospheric air

from entering the pleural space.

F. Drainage system: water-seal drainage system

can be set up using one, two, or three bottles;or a commercial, disposable device (e.g.,

Pleur-evac) may be used.


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One-Bottle System


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2. Two-bottle system

a. One bottle serves as a drainage collectionchamber, the other as a water seal.

b. The first bottle is the drainage collection andhas two short tubes in the rubber stopper. One of

these tubes is attached to the drainage tubingcoming from the client; the other is attached to theunderwater tube of the second bottle (the water-seal bottle). The air vent of the water-seal bottlemust be left open to the atmospheric air. If suction

is used, the first bottle serves as drainagecollection and water-seal chamber, and thesecond bottle serves as the suction chamber


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Two-way Bottle System


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Nursing care: without suction

1. Examine the entire system to ensure air

tightness and absence of obstruction from kinksor dependent loops of tubing

2. Note oscillation of the fluid level within the

water-seal tube. It will rise on inspiration and fall

on expiration due to changes in the intrapleural

pressure. If oscillation stops and system is

intact, notify physician.

3. Check the amount, color, and characteristicsof the drainage. If drainage ceases and system

is not blocked, assess for signs of respiratory

distress from fluid/ air accumulation


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Three-Bottle System

a. This system has a drainage collection, a waterseal, and a suction-control bottle.

b. The third bottle controls the amount ofpressure in the system. The suction controlbottle has three tubes inserted in the stopper,two short and one long. One short tube is joinedwith the tubing to former air vent of the water-seal; the second short tube is connected tosuction. The third (long) tube (or suction-controltube) is located between the short tubes and hasone end open to the atmosphere and otherbelow the water level.


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Nursing care: with suction

1. Attach suction tubing to suction apparatus,

and chest catheter to drainage system2. Open suction slowly until a stream of bubblesis seen in the suction chamber. There should becontinuous bubbling in this chamber and

intermittent bubbling in the waters seal. Checkfor an air leak in the system if bubbling in waterseal is constant; notify physician if air leak

3. Check drainage, keep drainage system below

level of clients chest, keep Vaseline gauze atbedside, encourage coughing and deepbreathing, and provide ROM


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4. Always keep drainage system lower than thelevel of the clients chest

5. Keep Vaseline gauze at bedside at all times incase chest tube falls out

6. Encourage coughing and deep breathing tofacilitate removal of air and drainage frompleural cavity

7. Never clamp chest tubes.

8. Removal of the chest tube: instruct the clientto perform Valsalva maneuver; apply Vaselinepressure dressing to the site

9. If the water-seal bottle should break,immediately obtain some type of fluid-filledcontainer to create an emergency water sealuntil a new unit can be obtained


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2434408 respiratory diagnostic procedures

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