Diagnostic Procedures


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Diagnostic Procedures

  1. 1. Assessment of Respiratory Function<br />diagnostic Evaluation<br />
  2. 2. Pulmonary function Test<br />-performed by a technician using a spirometer(volume collecting device attached to a recorder)<br />-use to evaluate ventilatory function<br />Tidal volume – amt of air inhaled and exhaled during the normal respiration<br />Inspiratory reserve volume –amt of air inspired at the end of a normal inspiration<br />Expiratory reserve volume – amt of air expired following normal respiration<br />Residual volume- amt of air left in lungs after maximal expiration<br />Vital capacity – total volume of air that can be expired after maximal inspiration<br />Total lung capacity – total volume of air in the lungs when maximally inflated<br />Inspiratory capacity – maximum amt of air that can be inspired after normal expiration<br />Forced vital capacity –capacity of air exhaled forcefully and rapidly following maximal inpiration<br />Minute volume – amt. of air breathed per minute<br />
  3. 3. Nursing consideration: Rest after the procedure (can cause fatigue)<br />
  4. 4. Arterial Blood Gas studies<br />-aid in assessing the ability of the lungs to provide adequate oxygen and remove carbon dioxide <br />-assess the ability of the kidney to reabsorb or excrete bicarbonate ions to maintain normal body ph<br />-obtained through arterial puncture<br />Radial<br />Brachial<br />Femoral artery<br />Indwelling arterial catheter<br />
  5. 5. Arterial oxygen tension (PaO2)<br /> – indicates degree of oxygenation of blood <br />Arterial Carbon dioxide tension (PaCO2)<br /> – indicates the adequacy of alveolar ventilation<br />pH 7.35-7.45<br />PaO2 80-*100 mm Hg<br />PaCO2 35-45 mmhg<br />HCO3 bicarbonateion blood 22-26 mmgh<br />SaO2 95%-100%<br />
  6. 6. Nursing consideration: <br />Arterial puncture cause more discomfort (painful)<br />Place sample on ice to prevent dissociation of oxygen from hemoglobin<br />Firm pressure at site for 5 mins. or until bleeding stops<br />
  7. 7. Pulse Oximetry<br /><ul><li>monitor oxygen saturation of hemoglobin (SpO2)
  8. 8. effective in monitoring subtle or sudden changes in oxygen saturation
  9. 9. non-invasive (a probe or a sensor)</li></ul> - Sensor detects light signals generated by the oximeter and reflected by blood pulsing through the tissue at the probe<br /> - Finger tip, forehead, earlobe and bridge of the nose<br />
  10. 10. <ul><li>NORMAL SpO2 = 95% - 100%
  11. 11. 85% = indicates that tissues are not receiving enough oxygen
  12. 12. UNREALIABLE –cardiac arrest, shock, low perfusions ( sepsis, peripheral vasculature, hypothermia), vasoconstriction meds, anemia, abnormal hemoglobin, high carbon monoxide level, use of dyes, patient with dark skin or nail polish, bright lights( sunlight, fluorescent, xenon lights), patient movement (shivering), hypoventilation</li></li></ul><li>Cultures:<br />-identify organism responsible for infection<br />Throat culture<br />Nasal swabs<br />
  13. 13. Sputum studies <br /><ul><li>to identify pathogenic organisms
  14. 14. determine whether malignant cells are present
  15. 15. hypersentivity states (increase eosinophils)
  16. 16. should be within the lab in 2hrs</li></ul>Deepest specimens – collect early morning after they have accumulated overnight<br />Expectoration – usual method for collecting sputum<br /> Clear nose and throat – rinse mouth – deep breath – coughs<br />*When patient cannot induce cough – irritating aerosol of supersaturated saline, propylene glycol with ultrasonic nebulizer<br />
  17. 17. IMAGING STUDIES<br />Chest x-ray<br />Computed Tomography (CT-Scan)<br />Magnetic Resonance Imaging (MRI)<br />
  18. 18. Chest X-ray<br /><ul><li>can detect fluid, tumors, foreign bodies, and other pathologic condition because normal pulmonary tissue is radiolucent.</li></ul>Posteroanterior projection<br />Lateral projection<br />
  19. 19. Computed Tomography (CT-Scan)<br />-lungs are scanned in successive layers by a narrow beam x-ray<br />-cross sectional view of the chest <br />-can distinguish fine tissue density, define pulmonary nodules and small tumors adjacent to pleural surfaces<br />-mediastinal abnormalities and hilaradenopathy<br />*contrast agent – for mediastinum and its contents<br />
  20. 20.
  21. 21. Magnetic Resonance Imaging <br /><ul><li>use of magnetic field and radiofrequency signals
  22. 22. More detailed view- visualizes soft tissues
  23. 23. stage brochogenic carcinoma, inflammatory activity in interstitial lung disease, acute pulmonary embolism, chronic thrombolytic pulmonary hypertension</li></li></ul><li>Flouroscopic studies – invasive procedures<br />Pulmonary angiography<br />rapid injection of radiopaque agent into the vasculature of the lungs for radiographic study of pulmonary vessels<br />commonly to investigate thromboembolic disease of the lungs (pulmonic emboli)<br />
  24. 24. Radioisotope diagnostic Procedure<br />Lung scans:<br /><ul><li>V/Q Scan </li></ul>measure the integrity of the pulmonary vessels relative to blood flow and to evaluate blood flow abnormalities seen in pulmonary emboli<br />diagnosis of bronchitis, asthma, inflammatory fibrosis, pneumonia, emphysema and lung cancer<br />
  25. 25. injecting a radioactive agent into peripheral vein and then obtaining a scan of the chest to detect radiation<br />imaging time is 20-40 mins.<br />
  26. 26. Gallium Scan<br />Detect inflammatory conditions, abscess, adhesions and presence, location and size of tumors<br />Stage bronchogenic cancer <br />Injected intravenously in intervals<br />
  27. 27. PET Scan<br />Advance diagnostic capabilities that is used to evaluate lung nodules for malignancies<br />Accurate for malignancies<br />Detect display and metabolic changes in tissues, distribution of regional blood flow and the distribution of fate of meds in the body<br />
  28. 28. Endoscopic Procedures<br />Bronchoscopy<br />Thoracoscopy<br />Thoracentesis<br />
  29. 29. Bronchoscopy<br />-direct examination of larynx, trachea and bronchi through either:<br />flexible fiberoptic bronchoscope<br />thin and flexible that can be directed into the segmental bronchi<br />allows increase in visualization of the peripheral airways and is ideal for diagnosing pulmonary lesions<br />biopsy of inaccessible tumors<br />performed in endotracheal or tracheostomy tubes in patient in ventilators<br />
  30. 30. rigid bronchoscopes<br />hollow metal tube with light at its end<br />for removing of foreign substances<br />investigating the source of massive hemoptysis<br />performing endobrochial surgical procedures<br />
  31. 31. Diagnostic brochoscopy<br />examine tissues or collect secretions<br />determine the location and extent of the pathologic process and to obtain a tissue sample for diagnosis<br />to determine whether a tumor can be resected surgically<br />diagnose bleeding sites (hemoptysis)<br />Therapeutic brochoscopy<br />remove foreign bodies from the trachea bronchial tree<br />remove secretions obstructing the trachea bronchial tree when the patient cannot clear them<br />treat postoperative atelectasis<br />destroy and excise lesions<br />
  32. 32. Nursing considerations:<br />signed consent<br />Restriction of food and fluid for 6hrs ( to prevent aspiration)<br />pre operative meds – to inhibit vagal stimulation, suppress cough reflex, sedate patient and relieve anxiety (atropine and sedative or opoid)<br />remove dentures and oral prostheses<br />After the procedure = NPO until cough reflex return<br />
  33. 33. Thoracoscopy<br />pleural cavity is examined with an endoscope<br />indicated in diagnostic evaluation of pleural effusions, pleural disease and tumor staging<br />small incisions are made into the pleural cavity in an intercostals space, fluid present is aspirated and fiber optic mediastinoscope is inserted in the pleural cavity<br />
  34. 34. Nursing Considerations:<br />assess patient for shortness of breath (pneumothorax)<br />minor activity restrictions<br />monitor chest drainage system and chest tube insertion site is essential<br />
  35. 35. Thoracentesis<br />aspiration of fluid or air from the pleural space <br />Purposes:<br />removal of fluid or air from the pleural cavity<br />aspiration of pleural cavity for analysis<br />pleural biopsy<br />instillation of meds in the pleural space<br />
  36. 36. Biopsy<br />-excision of a small amount of tissue<br />Plueral biopsy<br />Lung biopsy<br />Lymph node biopsy<br />
  37. 37. Pleural Biopsy<br />Needle biopsy of the pleura<br />Pleuroscopy<br />visual exploration through a fiberoptic bronchoscope inserted into the pleural space<br />need to stain the tissue to identify tuberculosis or fungi<br />
  38. 38. Lung Biopsy Procedures<br />Transcathterbrochial brushing<br />fiberoptic bronchoscope is introduced into the bronchus under fluoroscopy and a small brush is attached to the end of the flexible wire inserted into the bronchoscope<br />brushed back and forth causing cells to slough off and adhere to the brush<br />identification of pathogenic organisms (Nocardia, aspergillus, pneumocystisjiroveci) <br />useful in immunologic patients<br />
  39. 39. Transbronchial lung biopsy<br />Biting or cutting forceps are introduced by a fiberoptic bronchoscope<br />Indicated when lung lesions are suspected<br />Percutaneous needle biopsy<br />A cutting needle or a spinal type needle is used for histologic study<br />Analgesia maybe administered<br />Complications are pneumothorax, pulmonary hemorrhage and empyema<br />
  40. 40. Nursing Considerations:<br />Monitor shortness of breath, bleeding and infection<br />Ask patient to report pain, redness of biopsy site, purulent drainage (pus)<br />
  41. 41. Lymph node Biopsy<br /><ul><li>if scalene lymph node is palpable – biopsy can detect pulmonary disease to the lymph nodes
  42. 42. diagnosis of Hodgkin lymphoma, sarcoidosis, fungal disease, tuberculosis and carcinoma</li></ul> <br />Mediastinoscopy – endoscopic examination of the mediastinum for exploration and biopsy of mediastinal lymph nodes that drain the lungs<br />Nursing considerations:<br />Provide adequate oxygenation<br />Monitor for bleeding provide pain relief <br />Instruct patient for changes in respiratory status<br />Discharged when chest drainage is removed<br />