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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.