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JM Diagnostic tests
Respiratory function/diagnotic tests pgs 7-13lag
| Question | Answer |
|---|---|
| Diagnostic Tests: Respiratory Function pgs 7-13 lag | |
| What is a peak flow meter used for? | to measure degree of airway constriction |
| What are pfts for? | to measure lung volumes & airflow. Results used to dx pulmonary disease, disease progression, evaluate disability, and evaluate response to bronchodilators. |
| How is spirometer used? | pt inserts mouthpiece, tks deep breath as possible, exhales hard, fast and long as possible. |
| What does spirometry measure? | before/after admin of bronchodilator to determine degree of response,to document reversibility of airway obstruction,monitor lung function w/asthma or cystic fibrosis, lung transplant |
| What is the benefit of using a peak flow meter to an asthmatic pt ? | helps pt recognize early signs of worsening asthma;alerts pt to tightening airways hrs/days prior to having symptoms |
| Discus instructions to pt pertaining to pft. | avoid eating a heavy meal/solid food for 4-6 hrs, smoking for 4 hrs,exercising for 4 hrs |
| What does PFT forced spirometry measure? | flow & volume capcities of lung;vol of air inhaled & exhaled plotted against time; restrictive and obstructive lung d/o shown on graph:flow vol loops called spirogram |
| Tidal volume (Vt). | total air volume inspied & expied during one breathing cycle. |
| Inspiratory reserve volume. | IRV: max air vol that can be inspired &with force following normal inspiration |
| Expiratory reserve volum. | ERV aire vol that can be expired w/force flowing normal expiration |
| Residual volume. | RV: air volume remaining in lungs following forced expiration. |
| Total lung capacity . | TLC: max capacity of air volume of lungs TLC= irv + Vt + ERV + RV |
| Inspiratory capacity | IC: max air vol that can be inhaled following anormal exhalation IC = Vt + IRC |
| Vital capacity | VC: max aire vol that can be exhaled after a max inhalation VC=IRC + Vt + ERV |
| Runctional residual capacity. | FRC: residual air vol in lungs after normal exhalation FRC – ERV + RV |
| OBSTURCTIVE AND RESTRICTIVE DISORDERS LAG PGS 8- | |
| Describe an OBSTRUCTIVE disorder. | THERE IS DIFFICULTY GETTING AIR OUT/EXHALING;affects the patency or elasticity(recoil) of airways, leads to an increase in airway resistance (small airwy/alveolar collapse) EXPIRATION IS PRIMARILY AFFECTED |
| Give examples of obstructive disorders. | Emphsema, chronic bronchitis; asthma(airways narrow and swell), bronchiectasis; airway inflammation |
| Discuss the basics of what happens in the lungs w/emphysema. | alveoli collapse on expiration-trapping air; emphysema slowly destroys elastic fibers that hold open small airways leading to airsacs. |
| Discuss way to remember obstructive. | think about the alveoli and small airways leading to them OBSTRUCTING the way of “anyone” leaving-they “close (collapse) the exit (the elastic holding the “exit” open is gone) |
| Discuss characteristics of RESTRICTIVE disorders. | difficulty getting the air in or inspiration |
| What is restrictive disorder caused by? | interference w/ chest wall or lung parenchyma (decreased compliance or expandability; harder to inflate) |
| How can we think of restrictive to remember it? | think “who comes in is restricted!” the “compliance is restricted! The expandability of who gets in is restricted! |
| Give examples of restrictive disorders. | kyphoscoliosis;pulmonary fibrosis;neuromuscular diseases/d/o (guillain-barre,myasthenia gravis, ALS); chest wall trauma(pneumothroax) congenital chest wall changes; obesity, pregnancy, tumors |
| What is diffusion? | movement of substance from higher concentration or pressure to lower (internal Y exteran resp) internal:tissue level; external resp: lungs |
| What is diffusion capacity? What does diffusion capacity measure? | a PFT that measure gas transfer of carbon monoxide (CO) across alveolar capillary membrane;indicates the ease CO do dufuses across alveolar cap membrane & binds with Hgb(Hgb has 250xgreater affinity for CO than O2) |
| What does a decreased diffusion capacity indicate with diffusion capacity? | A thickened alveolar membrane |
| What is SaO2? | % Hgb saturated w/ O2 |
| How is SaO2 measured? | pulse ox |
| What conditions may interfere with an accurate pulse ox reading? | hypotension, hypothermia/vasoconstriction;nail polish, |
| Discuss nursing care of puls ox. | avoid placing with same arm as BP;pressure dressing, A-lines, invasive catheters, dark polish, rotate Q4hrs;think about temp of fingers/toes: cold will affect ox |
| What is capnography? | used to measure exhaled co2 of pt on mech vent; |
| ABG analysis measures what? | arterial pH, PaCO2, PaO2,HCO3-,SaO2, & CO |
| What does PaCO2 reflect? | Ability of lungs to move air in & out: how well the lungs are eliminating CO2 |
| What does PaO2 measure? | how much O2 the lungs are delivering to the blood |
| What gives the most accurate reflection of tissue oxygenation & gas exchange? | PaO2: measures how much o2 the lungs are delivering to the blood |
| Discuss the procedure for ABG. | Arterial puncture(A-line or intermittent stick) sterile needle, heparinized syringe;radial is most common, brachial, femoral: allen test should be performed |
| How to educate pt for arterial puncture? | explain purpose and procedure: allen’s test for radial stick to assess for good collateral circ |
| Postprocedure care for ABG? | continuous pressure 5 min radial/brachial sites & 10 to femoral site;pressure bandage may be used after cessation of bleeding;SAMPLE PLACE ON ICE & SENT FOR ANALYIS. |
| What possible complications with arterial stick? | bleeding,hematoma@ site, artery/nerve injury. |
| How long should pressure be applied to site of arterial puncture? | 5 minutes! If you know lab is drawing it-be there in case they don’t hold it that long!l |
| V/Q or V/P measures what? | air and blood flow in lungs ventilation shows air flow and perfusion shows blood flow |
| Why would a v/q or v/p scan be used? | dx of pulmonary embolism, pulmonary infarction, emphysema, fibrosis, bronhiectasis;may help in pre-op of pt undergoing surgical lung resection |
| What is an infarct? | tissue death due to obstruction of blood supply |
| Describe a perfusion scan. | non-iodine contrast injected IV and carried into pulmonary vasculature, looking for areas of decreased blood flow |
| What is the preprocedure care for perfusion scan? | explain: painless, somelocal discomfort when radiologic material inected, will hear clicking noise, can sit up if becomes dyspniec, radiation exposure is minimal! Not metal, last 30-60 minutes |
| What is a bronchoscopy? | involves passage of lighted bronchoscope into bronchial tree: therapeutic or diagnostic |
| What diagnostic procedures may be performed with bronchoscopy? | examination & collection of tissue (biopsy);eval of tumor for surgical resection; eval of bleeding sites. |
| What therapeutic procedures may be performed with bronchoscopy? | remove foreign bodies; thick, viscous secretions, & mucous plugs; treat postop atelectasis;destroy & remove lesion |
| Discuss preprocedure care for bronchoscopy. | explain,consent;NPO @ LEAST 6 HRS PRIOR;sore throat after;initial difficulty swallowing;remove dentures,contact lenses before sedation,pt/gown |
| What interventions are done prior to bronchoscopy? | local anesthesia & IV sedation (suppress cough & relieve anxiety); topical anesthetic spray nasally or orally;CLIENT LIES SUPINE, HEAD HYPEREXTENDED; monitor vs, talk to & reassure during procedure, assist md |
| How long does bronchoscopy take? | 30-45 min |
| Discuss postprocedure care of bronchoscopy. | freqVS;s/s RESP DISTRESS: dyspnea,changes/absentlungsounds/ RR,useaccessory musc, NPO UNTIL GAG REFLEX RETURNS (start with ice chips/small sips h2o);LUNG SOUNDS MONITORED X24 HRS INCREASED RISK PNEUMOTHORAX! Inspect expectorated secretions for hemoptysis |
| What is alveolar lavage? | saline injected during bronch to wash tissues;saline aspirated & examined for atypical cells (cytology) |
| What is an endoscopic thoracotomy? | an alternative to open-lung biopsy & thoracotomy for pleural surgace d/o. |
| How is an endoscopic thoracotomy performed? | 3 small incisions made into mid chest walla scop w/camer & video proj insered, biopsies obtained; chest tube place |
| What are some advantages to endoscopic thoracotomy? | Reduced anesthesia time, less pain, shortened hosp stay. |
| Discuss preprocedure care for endoscopic thoracotomy. | teach need for test;consent;GENERAL ANESTHESIA, chest tube;CDB after |
| Discuss reasons for doing a Pulmonary angiography. | assess pulmonary vasculature: congential abnormalities, pulmonary venous & arterial circ; effects of emphysema ( loss of pulmonary cap bed) |
| Discuss the procedure of pulmonary angiography. | IV CONTRAST INJECTED: ASK PT ABOUT ALLERGY TO IODINE/SHELLFISH: photos tkn, need informed consent |
| How is sputum collection done? | instructto expectorateaftr coughingdeeply;obtainmucoidlike notsaliva.Obtainearly a.m.,AFTER mouthcare:secretionscollectduring night.Increasefluidintakunless restricted/unsuccessful;sterile container/suctioning or aspirating from trach. Send/lab promptly |
| What is a thoracentesis? | insertion of a large bore needle thru chest wall into pleural space to obtain specimens,remove pleural fluid or instill meds into pleural space |
| What position for pt during thoracentesis? | sitting upright with elbows on overbed table and feet supported. Skin cleansed&a local anesthetic (Xylocaine) is instilled subQ. Chest tube may be inserted to permit further drainage |
| What nursing interventions during preprocedure thoracentesis? | instruct, tks 5-15min; monitor VS, BBS(before,during,after)assess for dyspnea, c/o difficulty breathing, n/v or pain. |
| If pt can’t sit up for thoracentesis, what position can be used? | on side with side to be accessed up |
| How can we remember positioning/instructions for thoracentesis? | sit up, lean over and hold still!! VS BBS SOB n/v/pain |
| Discuss postprocedure care for thoracentesis. | USUALLY TURNED TO UNAFFECTED SIDEX1* to facilitate lung expansion: air rises. |
| What nursing interventions postprocedure thoracentesis? | RR,pattern, BBS, evidence of resp distress REPORT TO MD; record amount of fluid;sub q emphysema(crepitus)REPORT TO MD IF EXPANDING, CAUSING INCREASING DISCOMFORT, pain relief |
| How are tracheobronchial specimens taken? | via bronchoscopy ;scalene or mediastinal nodes (local anesthesia) |
| How is a pleural biopsy performed? | surgically through small throracotomy incision or during thoracentesis w/cope needle |
| What is a cope needle? | special biopsy needle, specimen of the parietal pleura is examined & cultured |
| What is preprocedure care for tracheobronch/pleural biopsy care? | consent;instruction, prep & position similar to throacentesis: sitting up, leaning over PAINFUL!!! MUST HOLD STILL! 15-30 min |
| Discuss post procedure care of tracheobronch/pleural biopsy pt. | RARE complications:intercostals nerve injury,pneumothroax,hemothorax; OBSERVE fo: dyspnea, palor,diaphoresis, excessive pain,chest tube equip abailable, follow up cxrs usually tkn |
| Think about why you would want chest tube equipment available after tracheobronchial or pleural biopsy? | risk for pneumothorax |
| What nursing interventions for tracheobronchial or pleural biopsy or TTNA (transthoracic needle aspiration). | ck site for bleeding, breath sounds q4 hrs for 24 hr and REPORT ANY RESPIRATORY DISTRESS!! |
| How is lung biopsy done? | may be done by surgical exposure (open-lung biopsy) w/wo endoscopy using needle designed to remove core lung tissue;transbronchially, percutaneously or via transthoracic needle aspiration, video-assisted thoracic surgery |
| Discuss possible complications from lung biopsy. | hemoptysis, hemothroax, pneumothorax. |
| What is the procedure for transthoracic needle aspiration ? | needle puncture (aspiration) biopsy done w/ fluoroscopy or ct guided |
| Discuss postprocedure care for lung biopsy. | examine sputum closely for blood, observe for resp distress; VS, breath sounds; skin color, temp |
| END HERE FOR STUDY STACKS |
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