2 Diagnostics.ppt 2003

“You never lose by loving. You always lose by holding back.” 1

Diagnostic Studies/Therapies

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Mantoux Test Also known as the PPD (Purified Protein Derivative) test Intradermal Read within 48 to 72 hours after injection Positive: Induration of 10 mm or more; signifies exposure to Mycobacterium tubercle bacilli

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Chest X-ray Radiographic visualization of the chest Instruct the client to hold his breath and remove metals from the chest

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Lung Scan Measures blood perfusion through the lungs. Helps confirm pulmonary embolism or other blood-flow abnormalities. After an injection with a radioisotope, scans are taken with a camera. Remain still during the procedure.

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Lymph Node Biopsy To assess lung cancer metastasis.

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Bronchography Radiopaque medium is instilled directly to the trachea or any part of the bronchial tree to be visualized through x ray. Nursing intervention before the procedure are:  Secure informed consent  Check for allergy to food, iodine, anesthesia  NPO for 6-8 hrs  Pre-op meds: Atropine SO4, Valium, topical anesthesia and anesthesia to be injected into the larynx  Secure O2, antispasmodic agents at bedside 7

Nursing intervention after the procedure are:  Side-lying position  NPO until cough, gag reflex return  Cough, deep breathing exercise  Low-grade fever is common

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Bronchoscopy Direct inspection and observation of the larynx, trachea and bronchi through flexible or rigid scope Diagnostic uses: to collect secretion, to determine location of pathologic process and collect specimen. Therapeutic uses: remove foreign object and excise lesions 9

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Nursing intervention before the procedure: 1. Informed consent 2. Atropine, valium as premeds, topical & local anesthesia 3. NPO for 6-8 hrs 4. Remove dentures, prosthesis, contact lens 12

Nursing intervention after the procedure:  Side lying position  Check for coughing, gag reflex prior to oral intake  Watch for signs of perforation of the bronchial tree: cyanosis, hypotension, tachycardia, hemoptysis, dyspnea

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Sputum Exam Sputum C & S AFB staining Early AM sputum Rinse mouth with plain water Use sterile container Important: specimen for C & S is collected before the first dose of antibiotic. 14

Pulmonary Function Test Volume

Symbol

Measurement

Tidal Volume (about 500 ml at rest)

TV

Amount of air that moves into and out of the lungs with each breath.

Inspiratory Reserve Volume (approximately 3000 ml)

IRV

Maximum amount of air that can be inhaled from the point of maximum inspiration.

Expiratory Reserve Volume (approximately 3000 ml)

ERV

Maximum volume of air that can be exhaled from the resting end-expiratory level.

Residual Volume (approximately 1200 ml)

RV

Volume of air remaining in the lungs after maximum expiration.

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Functional Residual Capacity (approximately 2300 ml)

FRC • Volume of air remaining in the lungs at end-expiration. • RV + ERV

Inspiratory Capacity

IC

IRV + TV

Vital Capacity

VC

Maximum amount of air that can be exhaled from the point of maximum inspiration.

Total Lung Capacity

TLC • Total amount of air that the lungs can hold. • The sum of all the volume components after maximal inspiration. • 20-25% less in females 16

Thoracentesis Aspiration of fluid or air from the pleural cavity May be used for diagnosis or therapy Nursing intervention before the procedure:  Secure consent  Take initial VS  Position: upright leaning on over bed table  Instruct to remain still during the procedure  Pressure sensation is felt upon needle insertion 17

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Nursing intervention after the procedure:  Turn on unaffected side to prevent leakage from the thoracic cavity  Bed rest  Check for expectoration of blood  Monitor VS

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Physiologic Responses to Respiratory Dysfunction

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Hypoxia Refers to inadequate cellular oxygenation May result from:  

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Insufficient oxygen intake Insufficient perfusion of oxygen in the pulmonary system or in the peripheral organs and tissues Inability of blood to transport oxygen Insufficient oxygen-carrying capacity of the blood. 22

Cyanosis Bluish discoloration of the skin indicating hypoxia; it results when oxygenation does not occur and carbon dioxide does not leave blood.

Dyspnea Difficult breathing 23

Increased work of breathing Occurs when energy expenditure for respirations is excessive and great effort is required for breathing

Tachypnea Rapid breathing with respiratory rates more than 20 cpm. 24

Cough If effective, it allows the body to expel excess mucus, keeping the airway clear. If ineffective, in compromises airway clearance by preventing mucus from being expelled. Along with mucociliary system, cough is a defense mechanism of the respiratory system. 25

Adventitious breath sounds These are abnormal breath sounds:  

Rales (crackles) - fluid is heard Rhonchi (gurgles) – mucus is heard

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Clubbing of Fingers Clubbing is an increase in the normal angle between the nail and its base (from 160 to 180 degrees or more) Accompanied by softening of nail base

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Fatigue Feelings of tiredness and exhaustion that usually result when energy requirements for breathing become excessive

Pain May or may not be present Due to rib-cage injury, infection or chest surgery 28

Hypoventilation Refers to a ventilation rate that is insufficient to meet the body’s metabolic needs May result in respiratory acidosis because Carbon Dioxide are not expelled off

Hyperventilation Refers to a ventilation rate that exceeds the body’s metabolic needs May result in respiratory alkalosis because excessive Carbon Dioxide is being expelled off.

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ALTERATIONS

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Epistaxis

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Causes: Trauma, HPN, cancer, foreign body

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Nursing interventions: Sit-up, lean forward, head tipped Pressure application for 5 min Cold compress or ice pack Liquid, then soft diet Avoid oral temp taking Do not blow nose for 2 days after removal of nasal pack Notify MD if epistaxis is persistent or recurrent 33

Sinusitis (Acute/Chronic)

URTI, cigarette smoking, allergic rhinitis

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Assessment Pain 1. 2. 3. 4.

Maxillary – cheek, upper teeth Frontal – above eyebrows Ethmoid – in & around eyes Sphenoid – behind eye, occiput, top of head

General body malaise Stuffy nose headache Post nasal drip Persistent cough Fever

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Nursing Intervention Rest Increase oral fluid intake Hot wet packs Codeine, avoid ASA – increase risk for bleeding Antibiotics (acute: 7 days, chronic: 21 days) Nasal decongestant – use for 72 hrs Irrigation of maxillary sinus with warm

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Tonsillitis

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Assessment: Sore throat Fever Snoring Dysphagia Mouth breathing Earache Frequent head colds 39

Bronchitis Halitosis Voice impairment Noisy respiration Draining ears

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Nursing Intervention: Promote rest Increase oral fluid intake Warm saline gargle Analgesics as ordered Antimicrobial as ordered

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Pre op Care: Assess for URTI, coughing & sneezing may cause bleeding Check prothrombin Time

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Post op Care: Prone, head turned to side or lateral position (awake: semi-fowlers) Oral airway until swallowing reflex returns Monitor for hemorrhage 1. 2. 3.

Frequent swallowing Bright red vomitus Increased PR

Promote comfort Ice collar acetaminophen Foods & fluids 44

Client Education: Avoid clearing of throat Avoid coughing, clearing of throat for 2 wks 2-3 L of fluids until mouth odor disappears Avoid hard scratchy food until throat is healed Reports signs of bleeding Throat discomfort on the 4-8 post op day is normal Stool may be black/dark for few days due to swallowed blood. 45

“It’s all right letting yourself go, as long as you can get yourself back.” 46