diagnostic procedures
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DIAGNOSTIC EVALUATION
Assessment of Respiratory Function
Pulmonary function Test-performed by a technician using a spirometer(volume collecting device
attached to a recorder)-use to evaluate ventilatory function
Tidal volume – amt of air inhaled and exhaled during the normal respiration
Inspiratory reserve volume –amt of air inspired at the end of a normal inspiration
Expiratory reserve volume – amt of air expired following normal respiration
Residual volume- amt of air left in lungs after maximal expiration Vital capacity – total volume of air that can be expired after maximal
inspiration Total lung capacity – total volume of air in the lungs when maximally
inflated Inspiratory capacity – maximum amt of air that can be inspired after
normal expiration Forced vital capacity –capacity of air exhaled forcefully and rapidly
following maximal inpiration Minute volume – amt. of air breathed per minute
Nursing consideration: Rest after the procedure (can cause fatigue)
Arterial Blood Gas studies-aid in assessing the ability of the lungs to provide adequate oxygen and remove carbon dioxide
-assess the ability of the kidney to reabsorb or excrete bicarbonate ions to maintain normal body ph
-obtained through arterial puncture Radial Brachial Femoral artery Indwelling arterial catheter
Arterial oxygen tension (PaO2) – indicates degree of oxygenation of blood
Arterial Carbon dioxide tension (PaCO2) – indicates the adequacy of alveolar ventilation
pH 7.35-7.45PaO2 80-*100 mm
HgPaCO2 35-45 mmhgHCO3 bicarbonateion blood 22-26 mmghSaO2 95%-100%
Nursing consideration: Arterial puncture cause more
discomfort (painful) Place sample on ice to prevent
dissociation of oxygen from hemoglobin
Firm pressure at site for 5 mins. or until bleeding stops
Pulse Oximetry
o monitor oxygen saturation of hemoglobin (SpO2)
o effective in monitoring subtle or sudden changes in oxygen saturation
o non-invasive (a probe or a sensor)
- Sensor detects light signals generated by the oximeter and reflected by blood pulsing through the tissue at the probe
- Finger tip, forehead, earlobe and bridge of the nose
o NORMAL SpO2 = 95% - 100%
o 85% = indicates that tissues are not receiving enough oxygen
o UNREALIABLE –cardiac arrest, shock, low perfusions ( sepsis, peripheral vasculature, hypothermia), vasoconstriction meds, anemia, abnormal hemoglobin, high carbon monoxide level, use of dyes, patient with dark skin or nail polish, bright lights( sunlight, fluorescent, xenon lights), patient movement (shivering), hypoventilation
Cultures:
-identify organism responsible for infection
Throat culture Nasal swabs
Sputum studies o to identify pathogenic organisms o determine whether malignant cells are presento hypersentivity states (increase eosinophils)o should be within the lab in 2hrs
Deepest specimens – collect early morning after they have accumulated overnight
Expectoration – usual method for collecting sputum Clear nose and throat – rinse mouth – deep breath
– coughs
*When patient cannot induce cough – irritating aerosol of supersaturated saline, propylene glycol with ultrasonic nebulizer
IMAGING STUDIES
Chest x-ray
Computed Tomography (CT-Scan)
Magnetic Resonance Imaging (MRI)
Chest X-ray
o can detect fluid, tumors, foreign bodies, and other pathologic condition because normal pulmonary tissue is radiolucent.
Posteroanterior projection
Lateral projection
Computed Tomography (CT-Scan)-lungs are scanned in successive layers by a
narrow beam x-ray
-cross sectional view of the chest
-can distinguish fine tissue density, define pulmonary nodules and small tumors adjacent to pleural surfaces
-mediastinal abnormalities and hilar adenopathy*contrast agent – for mediastinum and its contents
Magnetic Resonance Imaging o use of magnetic field and
radiofrequency signals
o More detailed view- visualizes soft tissues
o stage brochogenic carcinoma, inflammatory activity in interstitial lung disease, acute pulmonary embolism, chronic thrombolytic pulmonary hypertension
Flouroscopic studies – invasive procedures
Pulmonary angiography rapid injection of radiopaque
agent into the vasculature of the lungs for radiographic study of pulmonary vessels
commonly to investigate thromboembolic disease of the lungs (pulmonic emboli)
Radioisotope diagnostic ProcedureLung scans:
o V/Q Scan measure the integrity of the pulmonary
vessels relative to blood flow and to evaluate blood flow abnormalities seen in pulmonary emboli
diagnosis of bronchitis, asthma, inflammatory fibrosis, pneumonia, emphysema and lung cancer
injecting a radioactive agent into peripheral vein and then obtaining a scan of the chest to detect radiation
imaging time is 20-40 mins.
Gallium Scan Detect inflammatory
conditions, abscess, adhesions and presence, location and size of tumors
Stage bronchogenic cancer Injected intravenously in
intervals
PET Scan Advance diagnostic capabilities that is
used to evaluate lung nodules for malignancies
Accurate for malignancies Detect display and metabolic changes in
tissues, distribution of regional blood flow and the distribution of fate of meds in the body
Endoscopic Procedures
Bronchoscopy
Thoracoscopy
Thoracentesis
Bronchoscopy-direct examination of larynx, trachea
and bronchi through either:
flexible fiberoptic bronchoscope thin and flexible that can be directed
into the segmental bronchi allows increase in visualization of the
peripheral airways and is ideal for diagnosing pulmonary lesions
biopsy of inaccessible tumors performed in endotracheal or
tracheostomy tubes in patient in ventilators
rigid bronchoscopes
hollow metal tube with light at its end
for removing of foreign substances
investigating the source of massive hemoptysis
performing endobrochial surgical procedures
Diagnostic brochoscopy examine tissues or collect secretions determine the location and extent of the
pathologic process and to obtain a tissue sample for diagnosis
to determine whether a tumor can be resected surgically
diagnose bleeding sites (hemoptysis)
Therapeutic brochoscopy remove foreign bodies from the trachea bronchial
tree remove secretions obstructing the trachea
bronchial tree when the patient cannot clear them treat postoperative atelectasis destroy and excise lesions
Nursing considerations: signed consent Restriction of food and fluid for 6hrs ( to
prevent aspiration) pre operative meds – to inhibit vagal
stimulation, suppress cough reflex, sedate patient and relieve anxiety (atropine and sedative or opoid)
remove dentures and oral prostheses After the procedure = NPO until cough
reflex return
Thoracoscopy pleural cavity is examined with an
endoscope indicated in diagnostic evaluation
of pleural effusions, pleural disease and tumor staging
small incisions are made into the pleural cavity in an intercostals space, fluid present is aspirated and fiber optic mediastinoscope is inserted in the pleural cavity
Nursing Considerations: assess patient for shortness of breath
(pneumothorax) minor activity restrictions monitor chest drainage system and chest
tube insertion site is essential
Thoracentesis aspiration of fluid or
air from the pleural space
Purposes: removal of fluid or air
from the pleural cavity aspiration of pleural
cavity for analysis pleural biopsy instillation of meds in
the pleural space
Biopsy-excision of a small amount of tissue
Plueral biopsy
Lung biopsy
Lymph node biopsy
Pleural Biopsy
Needle biopsy of the pleura Pleuroscopy
visual exploration through a fiberoptic bronchoscope inserted into the pleural space
need to stain the tissue to identify tuberculosis or fungi
Lung Biopsy Procedures Transcathter brochial brushing
fiberoptic bronchoscope is introduced into the bronchus under fluoroscopy and a small brush is attached to the end of the flexible wire inserted into the bronchoscope
brushed back and forth causing cells to slough off and adhere to the brush
identification of pathogenic organisms (Nocardia, aspergillus, pneumocystis jiroveci)
useful in immunologic patients
Transbronchial lung biopsy Biting or cutting forceps are introduced by
a fiberoptic bronchoscope Indicated when lung lesions are suspected
Percutaneous needle biopsy A cutting needle or a spinal type needle is
used for histologic study Analgesia maybe administered Complications are pneumothorax,
pulmonary hemorrhage and empyema
Nursing Considerations:
Monitor shortness of breath, bleeding and infection
Ask patient to report pain, redness of biopsy site, purulent drainage (pus)
Lymph node Biopsyo if scalene lymph node is palpable – biopsy can detect
pulmonary disease to the lymph nodes
o diagnosis of Hodgkin lymphoma, sarcoidosis, fungal disease, tuberculosis and carcinoma
Mediastinoscopy – endoscopic examination of the
mediastinum for exploration and biopsy of mediastinal lymph nodes that drain the lungs
Nursing considerations: Provide adequate oxygenation Monitor for bleeding provide pain relief Instruct patient for changes in respiratory status Discharged when chest drainage is removed
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