lab skill bronchoscopy
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Prepare Bronchoscopy
page 64-66By
Arif Muttaqin
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Bronchoscopy
Bronchoscopy examination conducted by passinga bronchoscope into the trachea and bronchus.
Bronchoscopy performed to diagnose also manage thecircumstances in tracheo-bronchial branching.
Diagnostic purposes include the visualization of thesource of hemoptysis; detect the causeof wheezing atelectasis local sources, causedby an obstruction, and to take an examination andinspection of material damage in patients whoare intubated trachea.
Indications include the treatment of patients whoexperienced flushing excess secretions, foreignbody retrieval, drainage of lung abscess, and retrievalof food particles on aspiration pneumonia.
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The purpose of
diagnostic bronchoscopy
1. To check the network or collect secretions.
2. To determine the location and extent of the
pathology and to obtain a sample / tissue
samples in order to establish the diagnosis (byforceps biopsy, curettage, the brush biopsy).
3. To determine whether a tumor is resect able or
not surgically.
4. To diagnose the bleeding (haemoptysiss
ource).
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Rigid bronchoscope
(Figure 2-19) is a hollow
metal tube with a light at the
tip; bronchoscope is
used primarily to remove aforeign body, sucking a
very thick secretions, resear
ching the source of
massive hemoptysis, endobronchial or peform surgical
procedures.
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Fiberoptic bronchoscope
Fiberoptic bronchoscope (Figure 2-20) is
better tolerated by patients compared
to the rigid
bronchoscope, allowing tumor biopsies that were previously not achievable, safe to
use for severely ill patients, and can be
done in bed or through theendotracheal tube.
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Nursing Interventions.
Letter of permission (informed consent)
Deferred gift of food and fluids for 6 hours before theexamination to reduce the risk of aspiration
If the patient has additional tools, such
as dentures will need to be released first. Sedative drug administration collaborated
Patient education
After the procedure, patient sfasted until
the cough reflex recovered becauseof sedation and local anesthesia praoperatif thatdamage the protective laryngeal reflex andswallowing for a few hours.
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PREPARE
Thoracentesis
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Description
Thoracentesis (alsoknownas thoracocentesisor pleural tap) is aninvasive procedure to
remove fluidor airfrom the pleuralspacefor diagnosticor therapeuticpurposes. A cannula,
or hollow needle, iscarefully introducedinto the thorax,generally afteradministration of localanesthesia.
http://en.wikipedia.org/wiki/Pleural_effusionhttp://en.wikipedia.org/wiki/Pneumothoraxhttp://en.wikipedia.org/wiki/Pleural_cavityhttp://en.wikipedia.org/wiki/Pleural_cavityhttp://en.wikipedia.org/wiki/Cannulahttp://en.wikipedia.org/wiki/Local_anesthesiahttp://en.wikipedia.org/wiki/Local_anesthesiahttp://en.wikipedia.org/wiki/Local_anesthesiahttp://en.wikipedia.org/wiki/Local_anesthesiahttp://en.wikipedia.org/wiki/Cannulahttp://en.wikipedia.org/wiki/Pleural_cavityhttp://en.wikipedia.org/wiki/Pleural_cavityhttp://en.wikipedia.org/wiki/Pneumothoraxhttp://en.wikipedia.org/wiki/Pleural_effusion -
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Indications
This procedure is indicated when unexplained fluidaccumulates in the chest cavity outside the lung. In morethan 90% of cases analysis of pleural fluid yieldsclinically useful information. If a large amount of fluid is
present, then this procedure can also be usedtherapeutically to remove that fluid and improve patientcomfort and lung function.
The most common causes of pleural effusionsarecancer, congestive heart failure, pneumonia, and
recent surgery. In countries where tuberculosisiscommon, this is also a common cause of pleuraleffusions.
http://en.wikipedia.org/wiki/Cancerhttp://en.wikipedia.org/wiki/Congestive_heart_failurehttp://en.wikipedia.org/wiki/Pneumoniahttp://en.wikipedia.org/wiki/Surgeryhttp://en.wikipedia.org/wiki/Tuberculosishttp://en.wikipedia.org/wiki/Tuberculosishttp://en.wikipedia.org/wiki/Surgeryhttp://en.wikipedia.org/wiki/Pneumoniahttp://en.wikipedia.org/wiki/Congestive_heart_failurehttp://en.wikipedia.org/wiki/Cancer -
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Prepare
Informed consent
Education
VS Privacy
Get the standard thoracentesis kit
The patient is positioned as shownin Fig 2-22.
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Prepare Sputum Taking
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Sputum examination
Sputum wascollected for examination to identify pathogenicorganisms and to determine whether thereare malignant cells or not. Also likely beused to assess the sensitivity of the situation(where
there is an increase in eosinophils). Sputum examinationmay be required periodically to patientsreceiving antibiotics,corticosteroids, and immunosuppressive medication for along
time, because these preparations can cause opportunistic infections. Generally used in diagnosing sputumculture, drug sensitivity examination, and as treatmentguidelines.
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Sputum Taking
If sputum can not be expelled spontaneously, clientsare often stimulatedto cough in a highly attractive aerosol saturated saline,propylene glycol is an irritant or other agents provided by
ultrasonic nebulizer. Other methods of collecting specimens including
endotracheal aspiration, disposal with bronchoscopy, bronchial brushing, transtrakeal aspiration, and aspirationof the stomach,usually for tuberculosis organisms.
Generally, the deeper specimens obtained in themorning.
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Sputum 24 hours
For quantitative examination, the patient is given aspecial container for the issue. These containers areweighed at the end of 24 hours, and the numberand character of the contents recorded and described.
Specimens like these are treated as a dangerousbiological materials and disposed of in an appropriatemanner.
To prevent odors, all sputum containers covered.
Napkins are very smelly mouth discarded and notice theroom is well ventilated. Oral hygiene is oftena nursing priority for clients.
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Lung biopsy
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Definition
Lung biopsy is a procedure for obtaining a
small sample of lung tissue for
examination. The tissue is usually
examined under a microscope, and maybe sent to a microbiological laboratory for
culture. Microscopic examination is
performed by a pathologist.
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Purpose
A lung biopsy is usually performed to determine thecause of abnormalities, such as nodules that appear onchest x rays. It can confirm a diagnosis of cancer,especially if malignant cells are detected in the patient'ssputum or bronchial washing. In addition to evaluatinglung tumors and their associated symptoms, lung
biopsies may be used to diagnose lung infections,especially tuberculosis and Pneumocystis pneumonia,drug reactions, and chronic diseases of the lungs suchas sarcoidosis and pulmonary fibrosis.
A lung biopsy can be used for treatment as well as
diagnosis. Bronchoscopy , a type of lung biopsyperformed with a long, flexible slender instrument calleda bronchoscope, can be used to clear a patient's airpassages of secretions and to remove airway blockages.
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Types o f lung biopsies BRONCHOSCOPIC BIOPSY. During the bronchoscopy, a thin,
lighted tube (bronchoscope) is passed from the nose or mouth,down the windpipe (trachea) to the air passages (bronchi) leading tothe lungs. Through the bronchoscope, the physician views theairways, and is able to clear mucus from blocked airways, andcollect cells or tissue samples for laboratory analysis.
NEEDLE BIOPSY. The patient is mildly sedated, but awake during
the needle biopsy procedure. He or she sits in a chair with armsfolded in front on a table. An x ray technician uses a computerizedaxial tomography (CAT) scanner or a fluoroscope to identify theprecise location of the suspicious areas. Markers are placed on theoverlying skin to identify the biopsy site. The skin is thoroughlycleansed with an antiseptic solution, and a local anesthetic is
injected to numb the area. The patient will feel a brief stingingsensation when the anesthetic is injected.
PEN BIOPSY. Open biopsies are performed in a hospital operatingroom under general anesthesia. Once the anesthesia has takeneffect, the surgeon makes an incision over the lung area, aprocedure called a thoracotomy .
http://www.surgeryencyclopedia.com/La-Pa/Operating-Room.htmlhttp://www.surgeryencyclopedia.com/La-Pa/Operating-Room.htmlhttp://www.surgeryencyclopedia.com/St-Wr/Thoracotomy.htmlhttp://www.surgeryencyclopedia.com/St-Wr/Thoracotomy.htmlhttp://www.surgeryencyclopedia.com/St-Wr/Thoracotomy.htmlhttp://www.surgeryencyclopedia.com/La-Pa/Operating-Room.htmlhttp://www.surgeryencyclopedia.com/La-Pa/Operating-Room.htmlhttp://www.surgeryencyclopedia.com/La-Pa/Operating-Room.html -
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Preparation
During a preoperative appointment, usually scheduled within one totwo weeks before the procedure, the patient receives informationabout what to expect during the procedure and the recovery period.
A chest x ray or CAT scan of the chest is used to identify the area tobe biopsied.
About an hour before the biopsy procedure, the patient receives a
sedative. Medication may also be given to dry up airway secretions. For at least 12 hours before the open biopsy the patient should not
eat or drink anythingPatients who will undergo surgical diagnostic and treatmentprocedures should be encouraged to stop smoking and stop usingtobacco products. The patient needs to make the commitment to be
a nonsmoker after the procedure. Informed consent
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Aftercare
Needle biops y Following a needle biopsy, the patient is allowed to
rest comfortably. He or she may be required to lie flatfor two hours following the procedure to prevent therisk of bleeding.
The nurse checks the patient's status at two-hourintervals. If there are no complications after fourhours, the patient can go home once he or she hasreceived instructions about resuming normalactivities.
The patient should rest at home for a day or twobefore returning to regular activities, and should avoidstrenuous activities for one week after the biopsy.
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Aftercare
Bronchoscop ic b iopsy Bronchoscopy is generally safe, and complications
are rare. If they do occur, complications may includespasms of the bronchial tubes that can impairbreathing, irregular heart rhythms, or infections suchas pneumonia
Needle biopsy Needle biopsy is associated with fewer risks than
open biopsy because it does not involve general
anesthesia. Some hemoptysis (coughing up blood)occurs in 5% of needle biopsies. Prolonged bleedingor infection may also occur, although these are veryrare complications.