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Diagnostics Unit 7-8


Bronchoscopy is used to diagnose or treat lung diseases by? using a hollow thin tube (bronchoscope) is placed either through the nose or mouth, can view the pt's trachea, vocal cords, and lung lobes
There are two types of bronchoscopy procedures? Therapeutic or diagnostic
What are rigid bronchoscopes? hollow, not flexible, used for the removal of a foreign body or inserting equipment(stents) into the lower airways
Rigid bronchoscopy is performed with the patient? under general anesthesia in a surgical suite or an operating room
A flexible bronchoscope is most commonly used for the bedside, for patients under? local anesthesia or conscious sedation
The flexible bronchoscope is used for? secretion removal, tissue sampling, 02 administration
The flexible scope has? long flexible end with 3 channels, a light transmission channel, visualizing channel, multipurpose open channel (function part, remove secretion, etc..)
You would use bronchoscopy to visualize the tracheo bronchial tree in order to see? sources of bleeding, locate and biopsy a tumor
Bronchoscopy is also used too? remove objects from airway, collect fluid samples, see lung damage, insert a stent to hold airway open
What is therapeutic bronchoscopy? treat or solve a medical issue....verifying et tube placement is also therapeutic, assist with untubation, laser reduction of obstruction from cancer, etc...
What is diagnostic bronchoscopy? used to establish the cause of a problem..bronchoalveolar lavage to collect sample, tissue samples, evaluate infections, etc..
What are some indications for bronchoscopy? Evaluate atelectasis, evaluate airway swelling, suspicious sputum cytology results, lung cancer staging, remove a mass or growth, investigate hemoptysis, unexplained cough, wheeze, or stridor
Contraindications for bronchoscopy? No consent unless an emergency, no experienced bronchoscopist, lack of adequate facilities, inability to oxygenate patient
Relative contraindications indicate that the procedure should only be done when the benefits outweigh the risks, these are? coagulopathy, refractory hypoxemia, unstable hemodynamic status including arrhythmia's
Complications of bronchoscopy? hypoxemia, irregular heart rhythms, bleeding, pneumothorax, fever, nausea, vomiting, pneumonia, medication complication, airway edema, respiratory arrest, vocal cord injury, death
Using washing for sample collection? sterile water or saline are instilled through teh scope into interest area, then suctioned back, repeated until adequate sample obtained
Brushing for sample collection? soft brush attachment to scope, once in area of interest cells are collected by brushing up and down the airway
Needle aspiration for sample collection? needle is inserted through scope into the airway and through the wall of the airway to obtain samples outside of the airway
Forceps biopsy for sample collection? Forceps biopsy a lesion is airway or lung
Acetylcystine? instilled through scope to wash airways and help break down thick secretions, often diluted to 50% (half strength) for lavage
Lidocaine is a topical anesthetic to numb pain, it is used in several ways. Lidocaine jelly? applied to scope before insertion to minimize discomfort
Atomized lidocaine? applied to nose, mouth, or back of throat to numb area prior to insertion, also can be nebulized
Lidocaine solution? 1-4% can be used as a lavage to numb lower airways that are irritated by scope
Sterile water is used to? lavage airways
Epinephrine should always be available for? bleeding, forces vessel to constrict and stop bleeding
Nasoephrine (nasal spray) ? applied to nostrils before insertion, often vasoconstrictors to minimize bleeding
Liquid cocaine? occasionally used to anesthetize airway
Scope must be working properly, check to make sure connections are tight. Certain equipment must be close by, such as? PPE (masks, gown, etc..), airway management( bite blocks, etc..) syringes and needles, sterile water and normal saline, specimen cups and lucken traps, gauze, bronchoscope accessories (brush, forceps, etc..), medications
The scope must be cleaned according to the facilities policy prior to use, you must also? perform a leak test, check integrity of scope, they are expensive and fragile
How to perform the leak test? place pressurized scope in sterile water, look for bubbles
If the scope bubbles during a leak test, this means? there is a leak, cannot be used, poses an infection risk to patient, must be sent out for repair
Checking bronchoscope integrity? checking for damage to the optics or scope channels, connect to light source and look through scope, if cloudy wipe the end with an alcohol pad
If you see black dots when looking through the scope? the fiber optic bundles have been damaged and it should not be used
Pt's must be prepared for the procedure to prevent bleeding, pain, coughing, and gagging. This is done by? topical anesthetics for pain and cough, bleeding in controlled by vasoconstriction nasal sprays and careful introduction of scope, nurse may give a sedative
Unless the patient is a chronic C02 retainer, the Fi02 is? often increased to compensate for the desaturation that can occur
Patient monitoring? vital signs, changes in cardiac rhythms, SP02 and Fi02, pain level, dyspnea, mechanical ventilation settings, types and amounts of lavage given
Vitals must be monitored? before, during, and after
Aside from monitoring the patient, the RT may also be asked too? Insert oral airway so pt does not bite scope, adjust pt's 02, prepare scope (sterile, leak test, no damage) prepare meds and lavage's, insert and direct forceps and brushes, collect and label samples, record vitals and lavage types and amounts
If the patient is getting a bronchoscopy while on a ventilator? increase Fi02 to 100%, attach PORTEX adapters to ET tube to introduce scope into ventilator circuit
It is difficult to bronch a patient through an ET tube that is? smaller than a 7.0
The patient should be monitored for several hours after the procedure? 02 therapy should be maintained for up to 4 hours, oximetry should be check before stopping 02 therapy, pt remains NPO until airway is no longer numb due to aspiration risk, pt assessed for stridor and weeze ( race epi!)
Sleep occurs in stages that make up what is refereed to as? the sleep cycle
The sleep cycle is broken down into 5 stages with two divisions? REM sleep- rapid eye movement sleep Non-REM sleep- non rapid eye movement
Every 90 minutes we start a new sleep cycle from? stage 1 of non-REM sleep into REM sleep
Different sleep disorders occur at? different sleep stages
Non REM sleep occupies 80% of the sleep cycle, it has four different stages, and? restorative functions of sleep occur during the 4 stages, hormones that help the body repair from damage done throughout the day are released
REM sleep is the remaining 20%, during this type of sleep you have an active mind but an inactive body? memories and thoughts from while awake are processed here, vivid dreams occur, normally lose use of limbs in REM sleep
REM sleep does not occur in one large block, we? go into cycles of REM sleep about every 90 minutes when we sleep.
Stage 1? transition to sleep, light sleep easily awoken, lasts about 5 minutes, experience eye body and muscle movement,
Stage 2? light sleep,eye movement stop and heart rate slows, brain waves/ activity becomes slow, last about 10-20 minutes
Stage 3? deep sleep, difficult to be woken up, would be cranky and disoriented if woken, slow brain waves appear during this stage
Stage 4? deepest stage of sleep, essential stage for proper sleep, lasts about 30 minutes, growth hormone released
Stage 5? REM stage, dreams occur, eye movement is fast, brain activity increases, heart rate and blood pressure increases, arms and leg muscles paralyzed
There are several sleep disorders that can be diagnosed with a sleep study, these are? sleep apnea, excessive daytime somnolence (sleepiness), periodic movements of sleep, major episodes of sleep, seizures, insomnia
The most common sleep disorder is sleep apnea, it is defined as? repeated episodes of complete cessation of airflow for 10 seconds or more
Obstructive sleep apnea is caused by? caused by airway closure
Central sleep apnea is caused by? a lack of ventilatory effort, pt has no airflow and no effort to breathe
About 2-4% of people has some degree of OSA, severity can range from? minor sleep disturbances to desaturation, pulm htn, rt heart failure, excessive daytime sleepiness
What is the primary cause of OSA? small/unstable pharyngeal airway due to soft tissue problems (obesity, tonsillar hypertrophy, skeletal factors like small chin)
What are some adverse consequences of OSA? nocturnal arrythmias, HTN, pulm HTN, ventrical failure, MI, CVA, sexual dysfunction, diabetes issues, personality changes, decreased quality of life, accidents (car accident)
CSA causes a patient to experience periodic breathing, it is a pattern where? the ventilatory drive waxes and wanes which causes an increase and decrease in RR and VT
Patients with CSA will stop breathing but they do not? snore, because they have lost their drive to breath
The cause for CSA is unknown, it is commonly seen in people with? brain stem lesions, cardiovascular disorders, cerebrovascular disease, spinal cord lesions, elderly, thyroid disease, narcolepsy, cheyne stokes respirations
What are the parts of a bronchoscope? light transmission channel, visualizing channel to see through the scope, multipurpose open channel to removes secretions, 02 administration, tissue sampling, etc..
If the patient is on a ventilator receiving a bronchoscopy, you should? increase the Fi02 to 100%
What is overlap syndrome? when a pt has COPD and OSA, pt's are usualy obese and have smoking hx with nocturnal oxyhemoglobin desaturation
The combination of overlap syndrome leads too? an increased incidence of complications especially cardiac arrhythmia and polycythemia ( too much hemoglobin in the blood)
What are the three components of a sleep study ( polysomnogram) ? Electroencephalogram ( EEG ) Electro-oculography ( EOG ) Electromyography ( EMG )
EEG? records the cortical cerebral potential using electrodes attached to the skull, like an EKG of the brain
EOG? electrodes attach to eyelids to record rapid eye movements, they record all eye movement during sleep
EMG? electrodes over the chin muscles that recognize the change in muscle tone during the different sleep stages
Strain gauges are used too? monitor chest and abdominal movements ( respiration's )
A slip tip syringe must be used during? bronchoscopy
What other parameters are also recorded during a sleep study? respiration, ECG, pulse oximetry, audio and video recording
Respiration's are monitored with thermocouplers that measure? the subtle temperature changes with inspiration and expiration, esophageal balloons can also be used to measure changes in pleural pressure, strain gauge can be used also
An ECG is used to? asses changes in heart rhythm that occurs with sleep apnea and REM sleep
Pulse oximetry is used to record oxyhemoglobin saturation changes, this is valuable in? studying sleep apnea, the pulse ox results will be compared to respiratory monitoring and ECG for the same time period
Audio and video recording is for the? observation of the sleeping patient, a small microphone is used to record respiratory sounds and vocalizations
What are cardio pulmonary indication for a sleep study? COPD pt's whose P02 is greater than 55 while awake, any pt with a PaC02 greater than 45, idiopathic hypersomnia, insomnia, snoring, nocturnal arrhythmia with bradycardia or tachycardia
A sleep study is indicated for any Pt with a restrictive ventilatory impairment due to chest wall or neuromuscular problems that also have? Rt heart failure, pulm HTN, polycythemia, daytime sleepiness (somnolence), morning headaches, fatigue
What are neurological indications for a sleep study? limb movement disorder (restless leg), seizure disorder, parasomnias (sleep walking, night terrors, teeth grinding), nocturnal movements, narcolepsy, REM behavior disorder
What are therapeutic indications for a sleep study? CPAP titration, assessment of sleep related interventions
Sleep related breathing disorders indications? suspected sleep apnea, cicardian rythm disorders or shift work sleep disorder, obesity hypoventilation syndrome, upper airway resistance syndrome
What pulmonary problems can cause a decreased DLCO? emphysema, cystic fibrosis, pulm resection, pulm/fat emboli, anemia, interstitial lung disease(asbestosis, sarcoidosis, fibrosis, pneumonitis) pulm hypertension/edema, lung cancer
What can cause an increased DLCO? supine position, increased pulm blood flow, exercise, pulm hemorrhage, polycythemia with increased Hb, left heart failure, left to right cardiac shunt, high altitudes that increase Hb
What are contraindications for a sleep study? psychotic, demented, febrile (fever), intoxicated, under heavy sedation
Proper patient preparation is important for a sleep study, The patient must be? at ease and mentally stable, the polysmonography tech must gather clinical information from that pt that could affect the test, and all medications taken within the past 10 days
Sleep apnea events are measured, classified, alongside? other parameters like snoring, body position, ekg changes, eeg abnormalities, saturation, etc...
All of the measurements and parameters taken during the sleep study are all? placed into a computer and displayed on histogram/hypnogram
Behavioral treatment of sleep apnea? weight loss for the obese pt, alcohol and sedative avoidance, avoiding sleep deprivation ( these should be used in the care of ALL sleep apnea pt's)
Medical treatment of sleep apnea? CPAP or BIPAP
Surgical treatment of sleep apnea? to correct OSA, surgery to bypass upper airway (tracheostomy), or surgery to reconstruc the upper airway; palatal surgery, maxillofacial surgery, uvulopalatopharyngoplasty (UPPP) this is the most common surgical treatment
Created by: juialynn92
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