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PN 132 – Day 2. Respiratory Nursing - Laboratory and Diagnostic Procedures. Objectives. Identify normal parameters for common diagnostic tests. Describe the purpose, significance of results, and nursing interventions related to diagnostic examinations of the respiratory system.

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pn 132 day 2

PN 132 – Day 2

Respiratory Nursing -Laboratory and Diagnostic Procedures

objectives
Objectives
  • Identify normal parameters for common diagnostic tests.
  • Describe the purpose, significance of results, and nursing interventions related to diagnostic examinations of the respiratory system.
  • Identify how to interpret ABG lab findings
chest xray
Chest Xray
  • roentgenogram, chest radiographs
  • done to diagnose a chest disorder.
  • -visualizes:
    • lungs
    • vertebrae
    • ribs
    • heart
    • clavicles
    • major thoracic vessels
    • humeri
    • scapulae
nursing interventions
Nursing Interventions
  • Pre-exam preparation
    • Client needs to remove
      • Articles of clothing
      • Anything containing metal
    • Wears a patient gown
      • Tied (never pinned)
computed tomography ct scan
Computed Tomography [CT Scan]
  • Pictures of small layers of lung tissue
  • Scanner can rotate at different angles
  • Non-invasive
  • Minimal radiation exposure
  • Painless
helical ct scan
Helical CT Scan
  • Also called
    • Spiral CT Scan
    • Volume-Averaging CT Scanning
    • Continuously obtains images
    • Produces faster and more accurate results
    • Images the chest and abdomen in just one breath-hold (about 30 seconds)
    • Contrast imaging can also be done
nursing interventions1
Nursing Interventions
  • Patient teaching re: the procedure
  • Patient prep similar to CXR
  • Monitor post-contrast injection
    • s/sx of allergic reaction to the contrast medium
  • Allay the anxiety of claustrophobia
  • Answer questions
pulmonary angiography1
Pulmonary Angiography
  • Radiographic contrast material injected into the pulmonary arteries
    • Visualization of the pulmonary vasculature
    • Detects:
      • Pulmonary Embolism (clot)
      • Variety of lesions (tissue damage) in the pulmonary vessels
when would we use pulmonary angiography
When would we use Pulmonary Angiography ?
  • Let’s say…Pulmonary Embolism is suspected
    • A lung CT scan will be done first
    • If lung CT scan is negative
      • pulmonary embolism is ruled out
  • However….
    • If the Lung CT Scan is uncertain
    • If there are 2 or more other possibilities

Definitive diagnosis may involve a pulmonary angiography

ventilation perfusion scan v q scan
VENTILATION-PERFUSION SCAN (V/Q Scan)
  • Studies
    • Air Flow (ventilation)
    • Blood Flow (perfusion)
  • Purpose is to look for blood clots (pulmonary emboli) in the lungs
  • V/Q used in mathematical equations that calculate airflow and blood flow
v q scan procedure
V/Q Scan Procedure
  • Performed in the radiology department
    • 2-step procedure
  • Multiple pictures of the chest are taken from different angles
    • Special camera that detects a radionuclide
  • For half of these pictures
      • Patient breathes from a tube that has a mixture of air, oxygen, and a slightly radioactive version of a gas called xenon
      • Measures airflow in different parts of the lung
  • For the other half of the pictures
    • Camera tracks an injected radionuclide
    • Determines blood flow in different parts of the lung
  • Embolus is suspected in areas of the lung that have good airflow but poor blood flow.
  • Except for the minor discomfort of having the IV placed, the test is painless. It usually takes less than one hour.
pulmonary function test pft
Pulmonary Function Test [PFT]
  • Assesses the presence and severity of

disease in large and small airways

  • Composed of various procedures
    • Lung Volume
    • Ventilation
    • Pulmonary Spirometry
slide18
PFT
  • http://www.youtube.com/watch?v=1rjN2_hDXEY
pulmonary function test pft1
Pulmonary Function Test [PFT]
  • Lung Volume
    • Vital Capacity
      • Volume of air
      • Maximum inhalation slowly exhaled
    • Inspiratory Capacity
      • Largest amount of air
      • Inhaled in one breath from the resting expiratory level
    • Total Lung Capacity
      • Volume of air in the lung after maximum inhalation
pulmonary function test pft2
Pulmonary Function Test [PFT]
  • Ventilation
    • Measures the amount of air inhaled and exhaled in each respiratory cycle
  • Pulmonary Spirometry
    • Evaluates the amount of air that can be forcefully exhaled after maximum inhalation
bronchoscopy
Bronchoscopy
  • Bronchoscope
    • Flexible tube with a camera
bronchoscopy1
Bronchoscopy
  • Bronchoscope is passed through the nose, larynx, trachea, and bronchi
  • Local or general anesthetic may be given
  • Observation of the respiratory structures
  • Tissue samples may be obtained
  • Secretions can be suctioned for sampling
bronchoscopy procedure
Bronchoscopy Procedure

http://www.youtube.com/watch?v=KqZc1JqArco

nursing interventions2
Nursing Interventions

Pre-Procedure

  • Explain Procedure
  • Answer Questions
  • Allay Anxiety

Post-Procedure

    • NPO until gag reflex returns (about 2 hours)
    • Semi-Fowler’s position
    • Turn side to side
      • Eases removal of secretions
    • Monitor for laryngeal edema and laryngospasms
    • Monitor sputum
      • S/Sx hemorrhage
  • Blood streaked sputum is expected to last for a few days after biopsy
sputum culture
Sputum Culture

Sputum specimen collected

- obtained for microscopic studies

- culture and sensitivity

cytology
Cytology

Cell studies

- tests for the presence of abnormal or

malignant cells

- Any body secretions

- pleural fluid

- abdominal fluid

- pericardial fluid, etc.

Melanoma

lung biopsy
Lung Biopsy

Open lung biopsy

Transbronchial

Done through a bronchoscope

Cells and/or secretions obtained for testing

Done when pulmonary disease cannot be diagnosed by other means

Nursing Interventions

Same as for bronchoscopy

thoracentesis
Thoracentesis

Surgical Perforation

Into the pleural space

Excess pleural fluid removed

Sample obtained for diagnostic testing

Instillation of medication into the pleural space

thoracentesis1
Thoracentesis
  • Diagnostic tests on pleural fluid

- Specific gravity

- RBCs

- WBCs

- protein

- glucose

- culture and sensitivity

- abnormal or malignant cells

- biopsy of the pleura.

nursing interventions3
Nursing Interventions

During procedure:

Monitor vital signs

Monitor respiratory status

Monitor general appearance

After procedure:

Position patient comfortably on the unaffected side

Continue to monitor patient respiratory status and vital signs

pulse oximetry spo2
Pulse Oximetry (SpO2)

Continuous peripheral monitoring of the pulse and saturation of oxygen in the blood

Assessment of gas exchange

Noninvasive method

Normal Range = 95-100%

Probe is applied to a finger, earlobe, toe, or the bridge of the nose.

pulse oximetry spo21
Pulse Oximetry (SpO2)

Monitor displays the hemoglobin- oxygen saturation and pulse rates

Allows the nurse to see continuous

changes in the pt.’s oxygen

saturations

Interventions can happen immediately.

pulse oximetry precautions
Pulse Oximetry - Precautions

For Best Results

Do Not:

Place the probe on an extremity that has an injury, B/P cuff, IV, or arterial line in place

Place the probe over a pulsating vascular blood bed

Protect the probe from strong light

May affect the reading

Remove nail polish

May affect the reading

Avoid excess patient movement

Note: Hypothermia, hypotension, and vasoconstriction can affect readings

pulse oximetry considerations
Pulse Oximetry - Considerations

SpO2 < 85%

Weakened ability of hemoglobin to release oxygen to the plasma

SpO2 < 70%

Life threatening

If patient has circulatory problems:

Probe may not be able to transmit

If Pulse Oximeter unable to accurately transmit:

ABGs should be drawn

understanding abgs acid base balance
Understanding ABGs

Acid/Base Balance

arterial blood gases abg
Arterial Blood Gases [ABG]

Done by Arterial Blood Draw

Measures lung’s ability to:

Oxygenate arterial blood

Remove Carbon Dioxide

Evaluates Acid-Base Balance

abg draw
ABG Draw
  • Procedure:
    • 5 mL (5cc) syringe with needle
    • Usually radial artery is used
    • Approximately 1mL (1cc) of blood is drawn
    • Apply direct pressure to the site for at least 5 minutes
    • If patient is taking aspirin, coumadin, or other blood thinner apply direct pressure for 20 minutes
abg results
ABG Results
  • Measures:
    • pH
      • Hydrogen (H+) ions present
    • PaO2
      • Partial pressure of oxygen dissolved in arterial blood
    • HCO3
      • Calculated value of amount of bicarbonate (HCO3-) in the bloodstream
    • PaCO2
      • Amount of carbon dioxide dissolved in arterial blood
    • Base Excess (B.E.)
      • Amount of excess/insufficient level of bicarbonate in the system
    • SaO2
      • Arterial oxygen saturation
acid base balance
Acid/Base Balance
  • Body uses Acids and Bases to maintain homeostasis
  • Respiratory and Renal systems both contribute to the balance
    • Respiratory System can effect change in 15-30 minutes
    • Renal System takes hours to days to have an effect
  • Acids and Bases are counter balanced
  • ABG measures this acid/base status of the arterial blood
understanding acid base balance
Understanding Acid/Base Balance
  • Respiratory System
    • Intake of oxygen and release of CO2
    • CO2 is a volatile acid
    • Decreased respiratory rate = retain CO2
      • increased CO2 in blood
      • Acidosis
    • Increased respiratory rate = blow off CO2
      • decreased CO2 in blood
      • Alkalosis
understanding acid base balance1
Understanding Acid/Base Balance
  • Renal System
    • Kidneys get rid of non-volatile acid
      • (Hydrogen – H+)
    • Maintain constant Bicarbonate (HC03-)level
      • Bicarbonate is the body’s base
understanding acid base balance acidosis
Understanding Acid/Base Balance “Acidosis”
  • Excess H+ (Hydrogen)
    • elevated pH
  • Decreased HCO3- (Bicarbonate)
      • Kidneys try to compensate by
        • Excreting H+
        • Retaining HCO3-
      • Respiratory Systemtries to compensate by
        • Increasing ventilation
        • Blow off CO2 to decrease the acidosis
understanding acid base balance alkalosis
Understanding Acid/Base Balance“Alkalosis”
  • Decrease of H+ and excess of HCO3-
    • Kidneys try to compensate by
      • Excreting HCO3-
      • Retaining H+
    • Respiratory System tries to compensate by
      • Decreasing ventilations (hypoventilation)
      • Retain CO2 and decrease the alkalosis
welcome to the village
Welcome to the Village
  • Once upon a time there was a village known as ABG
  • Everyone there was related
    • Only a limited number of names
  • There were also very polite
    • Etiquette for learning each other’s names
  • All villagers have a first, middle, and last name
  • To learn their whole name, we must look at one name at a time
learning our villager s first name
Learning Our Villager’s First Name
  • We need to look at her pH first
    • The Hydrogen (H+)ions in her blood stream
  • If pH is
    • Between 7.35 – 7.45 (normal)
      • Her first name is COMPENSATED
    • < 7.35 OR > 7.45
      • Her first name is UNCOMPENSATED
learning our villager s first name1
Learning Our Villager’s First Name
  • This Villager’s
    • pH = 7.60

What is her

FIRST NAME???

learning our villager s first name2
Learning Our Villager’s First Name

Hello!

My first name is

UNCOMPENSATED

  • My pH (7.60) is above Normal Range!
  • Normal is (7.35-7.45)
learning our villager s middle name
Learning Our Villager’s Middle Name

***Warning!

  • Many villagers have the same first and last name!
    • Knowing our villager’s Middle Name

will give us more information about her!

    • It will tell us if it is Respiratory or Metabolic
learning our villager s middle name1
Learning Our Villager’s Middle Name
  • To find out our villager’s Middle Name we need to look at her:
    • PaCO2-
    • (Amount of Carbon Dioxide in her arterial blood)

Normal Range = 35 - 45

    • and
    • HCO3-
    • (Amount of Bicarbonate in her bloodstream)

Normal Range = 22 - 26

learning our villager s middle name2
Learning Our Villager’s Middle Name

If her PaCO2- is < 35 or > 45

Her Middle Name is

RESPIRATORY

If her HCO3- is < 22 or > 26

Her Middle Nname is

METABOLIC

learning our villager s middle name3
Learning Our Villager’s Middle Name

Our Villager’s

PaCO2- = 30

(Carbon dioxide in arterial blood)

HCO3- = 22

(Value of Bicarbonate in the bloodstream)

What is her

Middle Name??

learning our villager s middle name4
Learning Our Villager’s Middle Name

My Middle Name is

RESPIRATORY !

My PaCO2- (30) is BELOW

Normal Range = 35 – 45

MyHCO3- (22) isNORMAL

Normal Range = 22 - 26

learning our villager s last name
Learning Our Villager’s Last Name
  • To find out our villager’s Last Namewe need to look at her pH again:
    • NormalpH is 7.35 - 7.45
  • If her pH is < 7.35
    • Her Last Name isACIDOSIS
  • If her pH is > 7.45
    • Her Last Name is ALKALOSIS
learning our villager s last name1
Learning Our Villager’s Last Name
  • To have a PERFECTLast Name
    • our villager’s pH would have to be 7.40
  • This rarely happens!
  • If her pH is 7.35 - 7.39
    • She’s thinking of marrying into the ACIDOSISfamily
  • If her pH is 7.41 - 7.45
    • She’s thinking of marrying into the ALKALOSIS family
learning our villager s last name2
Learning Our Villager’s Last Name
  • Our villager’s pH is 7.60
  • > 7.45
  • HerLast Nameis
    • ALKALOSIS
our villager s full name is
Our Villager’s Full Name is:
  • First Name
    • UNCOMPENSATED

pH = 7.60 *above normal range

      • 7.35 – 7.45
  • Middle Name
    • RESPIRATORY

PaCO2- = 30 * belownormal range

      • 35 – 45

HCO3- = 22*withinnormal range

      • 22 – 26
  • Last Name
    • ALKALOSIS

pH = 7.60 *abovenormal range

      • 7.35 – 7.45
summary
Summary
  • Identiednormal parameters for common diagnostic tests.
  • Described the purpose, significance of results, and nursing interventions related to diagnostic examinations of the respiratory system.
  • Identified how to interpret ABG lab findings
assignment
Assignment
  • Read and review
    • AHN (pp. 378 – 384)
    • PowerPoint Lecture handouts (Day 1 and Day 2)
    • Land of ABG handout
  • Study for Quiz 1 (to be taken on Day 3)
    • Will cover Day 1 and Day 2 material
  • Select topic and begin research for Mid-Term Paper (due Day 5)
next class
Next Class
  • Disorders of the Upper Airway
    • Read and review
      • AHN - pp. 384 – 395
  • Quiz 1
    • Respiratory A&P
    • Respiratory Assessment
    • Respiratory Labs and Diagnostics
    • ABG Lab Findings