respiratory assessment lecture 2b. assessment of breathing ability pulmonary function test pulse...
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Assessment of breathing ability
• Pulmonary function test• Pulse oximeter• Radiographic exams• Lab values
Pulmonary Function Tests
Purpose• Assess resp. function– Tidal volume– Vital capacity– Rate– Inspiratory force
• Progress of disease
Pulse oximeter
Not reliable in…• Cardiac arrest• Shock• Vasoconstrictive meds• Dyes• Anemia• High CO levels
The most appropriate nursing intervention for a client requiring a finger probe pulse oximeter is to:
A. Apply the sensor probe over a finger and cover lightly with gauze to prevent skin breakdown
B. Set alarms on the oximeter to at least 100%C. Identify if the client has had a recent diagnostic
test using intravenous dyeD.Remove the sensor between oxygen saturation
readings
Radiographic exams• Chesk x-ray• CT scan• PET• Fluroscopy• Barium Swallow• Angiography• Bronchoscopy• Thoracoscopy • Thoracentesis
CT Scan
Description• Computerize Tomography• With or without contrast
mediumPurpose• Tissue• Tumor• Foreign bodies• Fluid
CT scan
Nrs management• Without contrast
medium– No prep
• With contrast medium– NPO 6 hrs– Assess for allergies
Positron Emission TomographyPET
Purpose• Confirm adequate
blood supplyDescription• Radioactive tracers
injected IV
AngiographyNrs. Management• Pre-op
– NPO– Check Allergies
• Shellfish/iodine
• Post-op– Lie flat 8 hrs– Sandbag– Check pedal pulses– Assess hemorrhaging– Push fluids
• Normal pulmonary angiography
Bronchoscopy
Description• Direct inspection of
larynx, trachea & bronchi via flexible tube (fiberoptic)
Purpose• Examine• Tissue sample
Bronchoscopy
• Nrs Management• Pre-op– NPO 6-8 hrs– Sedation
• vegal response• cough/gag reflex• anxiety
Bronchoscopy
Nrs management• Post-op– Side-ling until gag back– NPO till gag back– Check gag– Check bleeding
Thoracoscopy
Description• Fiber-optic inspection of
thoracic cavity• IncisionPurpose• Inspect • tissue sample
Thoracentesis
Nrs Management• Position patient• Support• Post-op
– Vital signs q 15 – Chest x-ray– Breath sounds – bilateral– Cover site
• Check bleeding• Check drainage
White Blood Cell Count
• Normal– 5,000 – 10,000 cell/mm3
• Elevated– Bacterial infection
• Decreased– Leukemia– Viral infection
Hemoglobin
Normal• Female: 12-16 g/dl• Male:14-18 g/dlElevated• COPD• DehydrationDecreased• Anemia• Hemorrhaging• Over hydration
Hematocrit
Normal• Female: 37-47%• Male: 42-52%Elevated• Dehydration• Burns• COPDDecreased• Anemia• Leukemia
pH Quiz: Acidosis or alkalosis
• Arterial blood pH of 7.51?– Alkalosis
• Arterial blood pH of 7.30?– Acidosis
• Arterial blood pH of 7.34– Acidosis
• Arterial blood pH of 7.43– Normal / homeostasis
ABG’s
• PaO2
• Normal– 80-100 torr
• Elevated– Hypervenilation
• Decreased– resp. function– Hypoxemia
ABG’s
PaCO2• Normal– 35-45 mmHg
• Elevated– Hypercapnia– Impaired gas exchange
• Decreased– Hyperventilation
PTT/PT Partial Thromboplastin Time
• Prolonged– Liver disease – Vit K deficiency – Anticoagulant– Hemophilia
Quiz?
• The main function of platelets is to…A. Provide oxygen to tissueB. Fight viral infectionsC. Fight bacterial infectionsD. Form a blood clot
A fragile 87 year-old female has recently been admitted to the hospital with increased confusion and falls over last 2 weeks. She is also noted to have a mild left hemiparesis. Which of the following tests is most likely to be performed?
A.FBC (full blood count)B.ECG (electrocardiogram)C.Thyroid function testsD.CT scan
• A 84 year-old male has been loosing mobility and gaining weight over the last 2 months. The patient also has the heater running in his house 24 hours a day, even on warm days. Which of the following tests is most likely to be performed?
A.FBC (full blood count)B.ECG (electrocardiogram)C.Thyroid function testsD.CT scan
• A 20 year-old female attending college is found unconscious in her dorm room. She has a fever and a noticeable rash. She has just been admitted to the hospital. Which of the following tests is most likely to be performed first?
A.Blood sugar checkB.CT scanC.Blood culturesD.Arterial blood gases
• A 28 year old male has been found wandering around in a confused pattern. The male is sweaty and pale. Which of the following tests is most likely to be performed first?
A.Blood sugar checkB.CT scanC.Blood culturesD.Arterial blood gases