Respiratory Assessment

1. Respiratory Assessment Lecture 2b

2. Assessment of breathing ability • Pulmonary function test • Pulse oximeter • Radiographic exams • Lab values

3. Pulmonary Function Tests Purpose • Assess resp. function • Tidal volume • Vital capacity • Rate • Inspiratory force • Progress of disease

4. Pulse Oximeter Purpose • Noninvasive O2 Sat Normal • 95-100% • <85%  • Tissue is not receiving enough O2

5. Pulse oximeter Not reliable in… • Cardiac arrest • Shock • Vasoconstrictive meds • Dyes • Anemia • High CO levels

6. The most appropriate nursing intervention for a client requiring a finger probe pulse oximeter is to: • Apply the sensor probe over a finger and cover lightly with gauze to prevent skin breakdown • Set alarms on the oximeter to at least 100% • Identify if the client has had a recent diagnostic test using intravenous dye • Remove the sensor between oxygen saturation readings

7. Radiographic exams • Chesk x-ray • CT scan • PET • Fluroscopy • Barium Swallow • Angiography • Bronchoscopy • Thoracoscopy • Thoracentesis

8. Chest x-ray Description • 2-d image Purpose • Fluid • Tumor • Foreign bodies

9. Chest – X-ray Nrs management • Call pink ladies • Normal heart size & clear lung field

10. CT Scan Description • Computerize Tomography • With or without contrast medium Purpose • Tissue • Tumor • Foreign bodies • Fluid

11. CT scan Nrs management • Without contrast medium • No prep • With contrast medium • NPO 6 hrs • Assess for allergies

12. Positron Emission TomographyPET Purpose • Confirm adequate blood supply Description • Radioactive tracers injected IV

13. Fluoroscopy Purpose • Detect movement • Diaphragm paralysis Description • X-ray

14. Barium Swallow Purpose • View esophagus and cardiac sphincters Description • Drink barium • X-ray

15. Barium swallow Nrs Management • NPO • Post-procedure • Laxatives • BM  white

16. Angiography Purpose • Pulm. Circulation Description • Dye • Femoral vein  • Heart  • Pulm Arteries

17. Angiography Nrs. 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

18. Bronchoscopy Description • Direct inspection of larynx, trachea & bronchi via flexible tube (fiberoptic) Purpose • Examine • Tissue sample

19. Bronchoscopy • Nrs Management • Pre-op • NPO 6-8 hrs • Sedation • i vegal response • i cough/gag reflex • i anxiety

20. Bronchoscopy Nrs management • Post-op • Side-ling until gag back • NPO till gag back • Check gag • Check bleeding

21. Thoracoscopy Description • Fiber-optic inspection of thoracic cavity • Incision Purpose • Inspect • tissue sample

22. Thoracentesis Purpose • Remove fluid for dx • Remove fluid for tx • Obtain biopsy • Instill meds

23. Thoracentesis Nrs Management • Position patient • Support • Post-op • Vital signs q 15 • Chest x-ray • Breath sounds – bilateral • Cover site • Check bleeding • Check drainage

24. Lab Values • Sputum • WBC • Hemoglobin • Hematocrit • ABG’s • PTT/PT

25. Sputum studies • Check for • Pathogens • C&S • Acid-fast bacillus • What? • TB • Duration • 4-6 wks

26. White Blood Cell Count • Normal • 5,000 – 10,000 cell/mm3 • Elevated • Bacterial infection • Decreased • Leukemia • Viral infection

27. Hemoglobin Normal • Female: 12-16 g/dl • Male:14-18 g/dl Elevated • COPD • Dehydration Decreased • Anemia • Hemorrhaging • Over hydration

28. Hematocrit Normal • Female: 37-47% • Male: 42-52% Elevated • Dehydration • Burns • COPD Decreased • Anemia • Leukemia

29. Arterial Blood Gases Purpose • Adjust O2 levels • Hypoxemia Description • Must by arterial blood

30. Arterial Blood Gases Values • pH • PaO2 • PaCO2 • HCO3- • SaO2

31. ABG’s pH • Normal • 7.35-7.45 • Elevate • > 7.45 • Alkalosis • Decreased • <7.35 • Acidosis

32. 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

33. ABG’s • PaO2 • Normal • 80-100 torr • Elevated • Hypervenilation • Decreased • i resp. function • Hypoxemia

34. ABG’s PaCO2 • Normal • 35-45 mmHg • Elevated • Hypercapnia • Impaired gas exchange • Decreased • Hyperventilation

35. ABG’s HCO3- • Normal • 22-26 SaO2 • Normal • 95-100% • Decreased • Hypoxemia

36. PTT/PT Partial Thromboplastin Time • Prolonged • Liver disease • Vit K deficiency • Anticoagulant • Hemophilia

37. Quiz? • The main function of platelets is to… • Provide oxygen to tissue • Fight viral infections • Fight bacterial infections • Form a blood clot

38. 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? • FBC (full blood count) • ECG (electrocardiogram) • Thyroid function tests • CT scan

39. 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? • FBC (full blood count) • ECG (electrocardiogram) • Thyroid function tests • CT scan

40. 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? • Blood sugar check • CT scan • Blood cultures • Arterial blood gases

41. 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? • Blood sugar check • CT scan • Blood cultures • Arterial blood gases

42. A nurse is administering blood to a patient who has a low hemoglobin count. The patient asks how long to RBC’s last in my body? The correct response is. • The life span of RBC is 45 days. • The life span of RBC is 60 days. • The life span of RBC is 90 days. • The life span of RBC is 120 days.