RESPIRATORY DIAGNOSTIC EXAMS

Differentiate Invasive from Non-invasive Exams.

Radiography

Chest X-ray Flouroscopy

Sputum Examinations

Culture & sensitivity Cytology AFB

Nursing care first morning specimens before initiating antibiotics sterile specimen approximately 15 ml sputum not saliva to laboratory in 2 hours

Pulmonary Function Tests Direct or indirect measurement of various lung volumes to assess lung function.

PFT measures
Tidal volume (TV) Inspiratory reserve volume (IRV) Expiratory reserve volume (ERV) Residual volume (RV) Minute volume (MV) Vital capacity (VC)

Pulse Oximetry Continuously assess oxygenation Principle: Passes beam of light through tissue Measures amount of light absorbed by oxygen-saturated hemoglobin.

Disadvantages: Motion at sensor site changes light absorption hypotension, hypothermia, vasoconstriction reduce arterial blood flow to sensor

Arterial Blood Gas Studies Arterial puncture - brachial, radial or femoral artery or indwelling arterial catheter. Send sample (on ice) immediately to laboratory Measures amount of supplemental oxygen

Bronchoscopy Direct inspection/ examination of larynx, trachea and bronchi using a bronchoscope.

Broncoscopy

Purposes
examine tissue or collect specimen determine location/extent of pathology obtain tissue sample for diagnosis determine if tumor can be resected surgically diagnose bleeding sites (source of hemoptysis)

Nursing Responsibilities Pre-procedure Post-procedure

Consent Vital signs NPO 6-12 hours Oral hygiene Remove dentures Pre medicate (atropine or sedative)
Vital signs NPO until gag reflex returns Observe respirations Observe hoarseness, dysphagia Bloody sputum normal after biopsy

Biopsy
Specimens are taken from various respiratory tissue: broncoscopy Thoracotomy incision needle

Nursing Responsibilities
observe for rare Consent complications: Position similar to - temporary pain. due intercostals nerve injury thoracentesis Painful -client must - pneumothorax - hemothorax hold still - others: dyspnea, pallor, Assist & reassure diaphoresis, excessive pain Explain - Test takes Vital signs 15-30 minutes Check sputum for bleeding

Pre-procedure

Post-procedure

Thoracentesis Aspiration of pleural fluid and/or air from the pleural space no more than 1,200 ml should be removed at one time.

Pre-procedure Preparation

Consent Chest X-ray film Sterile equipment sit on bed leaning over bedside table

Post-procedure
Apply pressure to puncture site Position: Semifowlers or puncture site up Assess breath sounds Vital Signs Chest X-ray

Monitor for: shock Pneumothorax Respiratory arrest Subcutaneous emphysema