Seminar

On

Diagnostic tests in Respiratory System

Presented By :

Mahendra Kumar

M.Sc . Nursing (1st year)

Introduction

• The respiratory system is vital part of human body

• Diagnostic tests in respiratory system are mainly divided into :

Invasive test

Non invasive test

• Diagnostic tests are performed to find problems as early as possible

Non invasive

Diagnostic procedures

Non invasive diagnostic procedures

Physical examination

• Sputum culture

• Pulse oximetry

• Spirometry

• Pulmonary function test

• Bronchoscopy

Non invansive diagnostic procedures

Contd...

• Radiological imaging :

X-ray

CT scan

MRI

CT angiography

Physical examination

• Technique used during physical examination to objectively evaluate the

respiratory system :

Inspection

Palpation

Percussion

Auscultation

Inspection

• Inspection is primary source of information about patient

• Inspection consist of visual examination

• Depth of respiration, movement of abdominal wall with respiration

• Abnormalities detected on inspection provide clues about core problem

Palpation

• Palpation is tactile examination of the chest from which can be elected

tenderness, asymmetry

• After superficial palpitation , deeper examination of the lungs and air spaces

can be accomplished via testing for vocal fremitus

• Useful in examination in patients of c o p d and fluids outside lung space

Percussion

• How to do………….

• Percussion is performed by placing the pad of the non dominant long finger

on the chest wall and striking distal interaphalangeal joint of that finger with

the top of the dominant long finge

• Percussion produce sounds on the density of the underlying tissue .

Auscultation

• The ideal position for auscultation is to place the patient in a sitting position

• When auscultating ,the patient should inhale and exhale through the mouth,

deeper then usual breath auscultation should be performed with diaphragm

of the stethoscope applied directly to the skin

• Start near the apices and move down in a ladder like pattern until below the

level of the diaphragm is reached or breath sounds are no longer appreciated

Sputum examination

1. Description : A specimen obtained by expectoration or tracheal suctioning

to assist in the identification of organisms or abnormal cells.

2. Pre procedure

a. 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.

Sputum examination

Contd...

c. Obtain 15 ml of sputum.

d. Instruct the client to rinse the mouth with water before collection.

e. Instruct the client to take several deep breaths and then cough deeply to obtain sputum.

f. Always collect the specimen before client begins antibiotic therapy.

3. Post procedure

a. Transport specimen to laboratory STAT.

b. Assist the client with mouth care.

Pulse oximetry

• Pulse oximetry is a non invasive method of continuously monitoring

• the oxygen saturation of hemoglobin (SpO2 or SaO2).

• it is an effective tool to monitor for subtle or sudden change in spo2

• This is easy to carry out through simple device

Pulse oximetry

Contd...

• 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.

• a pulse oximetry reading can alert the nurse to hypoxemia before clinical

signs occur

• Normal spo2 value is above 94%

Pulmonary function test

• Pulmonary function test (PFT) is routinely used with patients in

respiratory ICU and in OPD basis

• With chronic respiratory disorders. They are performed to assess

respiratory efforts .

• PFT also assess respiratory function and to determine the extent of

dysfunction.

Pulmonary function test

Contd...

Pre procedure :

• Do not eat a heavy meal before the test .

• Do not smoke 6-8 hour before test

• Patients may have temporary shortness of breath or lightheaded…

Radiological Imagings

• X ray

• CT scan

• MRI

• PET scan

Chest x-ray

1. Description: provides information regarding the anatomical location and appearance of the lungs.

2. Pre procedure

a. Remove all jewelry and other metal objects from the chest area.

b. Assess the client’s ability to inhale and hold breath.

c. Question females regarding pregnancy or the possibility of pregnancy.

3. Post procedure:

Assist the client to dress.

Chest x-ray

Contd…

• Chest x-ray help in diagnosis of acute and chronic respiratory disorder

• Provide pictures of the structure inside chest, such as lungs ,heart and blood

vessel

• Easy to carry out

• Can help to make spot diagnosis

CT scan

• CT scan is an imaging method in which the lungs are scanned in by a

narrow-beam x-ray. The produced images provide clear vision of lungs

• a cross-sectional view of the chest. Whereas a chest x-ray cannot show.

• shows major contrast between body densities, such as bones, soft organs

• CT of thorax may be performed when x-ray do not show some area well

such as mediastinum

MRI

• MRIs are similar to CT scans except that magnetic fields .

• radiofrequency signals are used instead of a narrow-beam x-ray.

• MRIs yield a much more detailed diagnostic image than CT

scans.

• MRI is used to characterize pulmonary nodules, stage

PET scan

• Non invasive test

• Used to examine the lungs

• Performed to identify lungs nodules

• The client is given a radioactive substance and cross sectional image display

on moniter

• Latest technology ..minimum radiation to patients

Nursing considerations in radiological diagnostic tests

• Right patients

• In case of pregnant women client ,Pregnancy information to radiology staff

• If patient is shifting for radiology dept. make sure about ornamenet and

metal instruments if any

• Radiology should well cover in envelop to protect from damage

Invasive diagnostic tests

Invasive diagnostic procedures of Respiratory System

• Intra dermal

• Thoracentesis

• Pulmonary angiography

• Lung biopsy

• Lung scan

• Arterial blood gases

Skin test

1. Description: A skin test is an intradermal injection used to assist in diagnosing various infectious diseases

2. Pre procedure: Determine hypersensitivity or previous reactions to skin tests

Skin test

Contd...

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

Arterial blood gas Analysis

1. Description: measurement of the dissolved oxygen and carbon dioxide in the arterial blood to reveal the acid-base state and how well the oxygen is being carried to the body

2. Pre procedure

a. Perform Allen’s test before drawing radial artery specimens.

b. Have the client rest for 30 minutes before specimen collection.

c. Avoid suctioning before drawing ABG sample.

d. Do not turn off oxygen unless the ABG sample is ordered to be drawn with client breathing

Arterial blood gas Analysis

Contd...

3. Post procedure

a. Place the specimen on ice.

b. Note the oxygen and type of ventilation that the client is receiving on the

laboratory form.

c. Apply pressure to the puncture site for 5 to 10 minutes and longer if the

client is taking anticoagulant therapy or has a bleeding disorder.

Lung biopsy

1. Description

a. A percutaneous lung biopsy is performed to obtain tissue for analysis by

culture or cytological examination

b. A needle biopsy is done to identify pulmonary lesions, changes in lung

tissue, and the cause

Lung biopsy

Contd...

2. Preprocedure

a. Obtain informed consent

b. Maintain NPO status.

c. Inform the client that a local anesthetic will be used but that sensation of pressure during needle insertion and aspiration may be felt.

d. Administer analgesics and sedatives as prescribed

Lung biopsy

Contd…

3. Postprocedure

a. Monitor vital signs

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

c. Monitor for signs of respiratory distress, and notify physician if they occur

d. Monitor for signs of pneumothorax and air emboli, and notify physician if they occur

e. Prepare the client for chest radiography

Pulmonary angiography

1. Description

a. Pulmonary angiography is an invasive fluoroscopic procedure in which a catheter is inserted through the antecubital or femoral vein into the pulmonary artery or one of its branches.

b. Pulmonary angiography involves an injection of iodine or radiopaque or contrast material.

Pulmonary angiography

Contd…

2. Preprocedure

a. Obtain informed consent

b. Assess for allergies to iodine, seafood, or other radiopaque dyes.

c. Maintain NPO status of client for 8 hours before procedure.

d. Monitor vital signs

e. Assess results of coagulation studies

f. Establish an intravenous access

g. Administer sedation as prescribed

h. Instruct the client to lie still during the procedure

Thoracentasis

1. Description: Removal of fluid or air from the pleural space

via a transthoracic aspiration

2. Preprocedure

a. Obtain informed consent

b. Obtain vital signs

c. Prepare the client for ultrasound or chest radiograph, if prescribed, before

procedure

d. Assess results of coagulation studies

Thoracentasis

Contd...

Note that the client is positioned sitting upright, with the arms and head

supported by 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, breath deeply, or move during the procedure.

Lung scan

1. Description : a. The perfusion scan evaluates blood flow to the lungs.

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

c. A radio nucleotide may be injected for the procedure

2. Pre procedure

a. Obtain informed consent

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

c. Remove jewelry around the chest area

d. Review breathing methods that may be required during testing.

Conclusion

• The main clinical roles of respiratory function tests include diagnosis,

assessment of severity, monitoring treatment and evaluation of prognosis.

References

• Brunner,Suddarth.Textbook of Medical-Surgical Nursing.10th

edition.Lippincott williams and wilkins;2004.P.1014-1126

• Black.J.medical surgical nursing. 7thedition. missouri.elsevier; 2007. P1312-1323

• Nettina, Sandra M.Lippincott manual of nursing practice.8th edition. Lippincott

williams and wilkins;2006.P.1121-1134

Thanks……....