Laboratory and diagnostic procedures part1
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  • echocardiogram and basic blood analysis. No special dietary restrictions are required for pericardiocentesis. The patient will receive an IV line for sedation Read more:
  • echocardiogram and basic blood analysis. No special dietary restrictions are required for pericardiocentesis. The patient will receive an IV line for sedation Read more:
  • echocardiogram and basic blood analysis. No special dietary restrictions are required for pericardiocentesis. The patient will receive an IV line for sedation Read more:
  • http://www.rcjournal.com/cpgs/ispircpg.html
  • http://www.rcjournal.com/cpgs/ispircpg.html
  • http://www.rcjournal.com/cpgs/ispircpg.html

Laboratory and diagnostic procedures part1 Laboratory and diagnostic procedures part1 Presentation Transcript

  • REDUCTION OF RISK POTENTIAL: LABORATORY AND DIAGNOSTIC PROCEDURES Mr. Jaime R. Soriano. RN. RM.
  • OBJECTIVES OF THE SEMINAR
    • To identify different laboratory and diagnostic procedures according to body system.
    • To describe the appropriate preparation, teaching, and post test management for patients who are undergoing diagnostic and laboratory testing
  • DIAGNOSTIC AND LABORATORY PROCEDURES
    • Indications and Purposes
    • Pre-test Preparation
    • What will the patient feel?
    • Post-test Management
    • Nursing Considerations
  • NERVOUS SYSTEM Skull and Spinal X-ray Lumbar Puncture CT Scan MRI Electroencephalography
  • SKULL X-RAY
    • Radiographs of the skull:
    • ize
    • hape
    • uture separation
    • ome calcification
    • hows erosion and fracture
    S S S S S
  • SKULL X-RAY
  • SPINAL X-RAY
    • Spinal radiographs:
    • bnormal spine and dislocation
    • one degeneration
    • ompression
    • eformed curvature
    • rosion
    • racture
    A B C D E F
  • SPINAL X-RAY
  • SKULL AND SPINAL X-RAY
    • -clude metal items from body parts
    • -eassure nursing support
    • -ccurate documentation if with thick and heavy hair
    • -ou immobilize
    X R A Y
  • LUMBAR PUNCTURE
  • LUMBAR PUNCTURE
    • Insertion of a spinal needle through the L3-L4 interspace into the lumbar subarachnoid space to obtain cerebrospinal fluid, measure CSF fluid or pressure, or instill air, dye, or medications.
  • LUMBAR PUNCTURE
    • DIAGNOSTIC
    • Suspected meningitis
    • Subarachnoid hemorrhage
    • Hydrocephalus
    • Benign Intracranial hypertension
    • THERAPEUTIC
    • Spinal anesthesia
    • Chemotherapy
  • LUMBAR PUNCTURE
    • CONTRAINDICATIONS
    • -coliosis
    • -CP unidentified
    • -oagulopathy
    • -yphosis
    S I C K
  • LUMBAR PUNCTURE
    • PRETEST
    • orm of informed
    • consent
    • ree of urine bladder
    • etal position
    F F F
  • LUMBAR PUNCTURE
    • INTRATEST
    • hrimp or Fetal position
    • pecimens to be collected
    • terile vials- 4
    • trict asepsis
    S S S S
  • LUMBAR PUNCTURE
    • POSTTEST
    • lat 12-24 hrs
    • or vital signs and LOC monitoring
    • orce fluid unless contraindicated
    • uncture site for bleeding, CSF leakage
    • erform CMS assessment
    F F F F F
  • LUMBAR PUNCTURE
    • COMPLICATION
    • Spinal Headache
    • -lat
    • -luids
    • -ain Management
    F F F
  • CT SCAN
    • Scans the following in successive layers by a narrow beam of x-rays:
    • ngiogram
    • elly and Pelvic
    • hest
    • ’ heart
    • xtremities
    A B C D E
  • CT SCAN
  • CT SCAN
    • PRETEST:
    • ssess allergies to iodine and seafoods
    • e sure to obtain informed consent
    • onscious sedation for claustrophobia
    • o remove jewelries and hair pins
    • xplain hot flushed sensation and metallic taste in the mouth when dye is injected
    • luids and hydration
    • ive instruction to lie supine with small pillow under the head
    • old if pregnant
    • t takes 20 minutes
    A B C D E F G H I
  • CT SCAN
    • POSTTEST:
    • llergic reaction check
    • e sure to replace fluid
    • MS
    • istal pulse check
    • xtremity color check
    • ind bleeding and hematoma
    A B C D E F
  • MRI
    • -RI is nonivasive
    • -eveals types of tissue, tumors and vscular abnormalities
    • -s similar to CT scan
    M R I
  • MRI
  • MRI
    • PRETEST
    • -etal objects must be removed
    • -ssess for ineligibility and contraindications
    • -ive instruction to lie supine with small pillow under the head
    • -ormal audible humming, thumbing, grating, or knocking sounds
    • -ncourage conscious sedation for claustrophobia
    • -akes 45 to 60 minutes
    • -nformed consent
    • -ompletely enclosed in scanner
    M A G N E T I C
  • MRI
    • POSTTEST
    • Resume normal activities
    • Fluids and hydration
  • MRI
    • Ineligible to undergo MRI:
    • Automatic Internal Defibrillator
    • Cerebral Aneurysm Clip
    • Cochlear Implant
    • Hip Replacement
    • Knee Replacement
    • Non-removable dental prosthesis
    • Pacemaker
    • Prosthetic Valve Replacement
    • Soldiers
  • EEG
  • EEG
    • graphic recording of electrical activity of the brain by several small electrodes placed on the scalp
    • To diagnose:
    • bnormal firing of electrical activity
    • rain tumors
    • ertain psychiatric disorders
    • egenerative disorders
    • nflammation of brain and spinal cord
    A B C D E
  • EEG
    • PRETEST
    • ash the client’s hair
    • ssure that electrodes will not cause electric shock
    • timulants and depressants avoided for 24 to 48 hours
    • ypoglycemia prevention, do not omit breastfeeding
    W A S H
  • EEG
    • POSTTEST
    • Wash the client’s hair
    • Maintain side rails and safety precaution, if the client was sedated
  • EEG
    • Sleep Deprivation EEG
  • CARDIOVASCULAR SYSTEM Electrolytes Coagulation Studies Erythrocyte Studies White Blood Cell Count Serum Enzymes and Cardiac Markers Serum Lipids ECG CVP Pericardiocentesis
  • ELECTROLYTES
    • SODIUM
    • -bsorbed from the small intestine and excreted in the urine in amounts dependents dependent on dietary intake
    • -ustains osmotic pressure and acid base balance
    • -s major extracellular cation
    • -ormal daily requirement is 15 mEq
    A S I N
  • ELECTROLYTES
    • SODIUM
    • Nursing Consideration:
    • Drawing blood samples soon after an intravenous infusion of sodium chloride will increase the level, producing an inaccurate result.
  • ELECTROLYTES
    • POTASSIUM
    • -romote cellular water balance, electrical conduction in muscle cells, and acid base balance
    • -btains K through dietary ingestion and the kidneys preserve or excrete K
    • -o evaluate cardiac, renal, and gastrointestinal function
    • - major intracellular cation
    O P T A
  • ELECTROLYTES
    • POTASSIUM
    • Nursing Consideration:
    • -ccurate note if the patient is receiving K supplement
    • -lood should not be drawn from site where an IV infusion exists
    • -lenching and unclenching of hand can increase the level
    • -o identify elevated WBC and platelet counts
    A B C D
  • ELECTROLYTES
    • CHLORIDE
    • -ighly abundant body anion in the extracellular fluid
    • -ounterbalance cations and buffer
    • -ets digestion and maintenance of osmotic pressure and water balance
    H C L
  • ELECTROLYTES
    • CHLORIDE
    • Nursing Consideration:
    • -raw blood from an extremity that does not have normal saline infusing into it
    • -o not allow the client to clench and unclench his or her hand before drawing blood
    • -iarrhea and prolong vomiting will alter cholride results
    D D D
  • ELECTROLYTES
    • MAGNESIUM
    • lotting mechanism
    • ontrols neuromuscular activity
    • ofactor that modifies activity of many enzymes
    • alcium metabolism
    C C C C
  • ELECTROLYTES
    • MAGNESIUM
    • Nursing Consideration:
    • -rolong use of magnesium products will cause increased serum levels
    • -arenteral nutrition therapy or excessive loss of body fluids may decrease serum levels
    P P
  • ELECTROLYTES
    • CALCIUM
    • - one formation
    • - n conversion of prothrombin to thrombin
    • - ransmission of nerve impulse
    • - n contraction ok skeletal and myocardial muscles
    B U T O
  • ELECTROLYTES
    • CALCIUM
    • Nursing Consideration:
    • Instruct the client to eat a diet with a normal calcium level (800 mg/day) for 3 days before the test.
    • Instruct the client that fasting may be required for 8 hours before the test
  • COAGULATION STUDIES
    • ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT)
    • - mount of time it takes in seconds for recalcified plasma to clot after partial thromboplastin is added
    • -erformed for patient receiving heparin
    • -est for deficiencies and inhibitors of clotting factors
    • -ime: 20 to 36 seconds
    A P T T
  • COAGULATION STUDIES
    • ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT)
    • Nursing Consideration:
    • -spirate blood sample 1 hour before next scheduled heparin dose
    • -erform blood exraction from arm into which heparin is not infusing
    • -ransport specimen to the laboratory immediately
    • -ime: 1.5 to 2.5 times normal if on heparin therapy
    A P T T
  • COAGULATION STUDIES
    • PROTHROMBIN TIME (PT) and INTERNATIONAL NORMALIZED RATIO (INR)
    • -rothrombin is a vitamin K dependent glycoprotein produced by the liver for fibrin clot formation
    • -o monitor response to warfarin sodium (Coumadin)
    P T
  • COAGULATION STUDIES
    • PROTHROMBIN TIME (PT) and INTERNATIONAL NORMALIZED RATIO (INR)
    • Normal Values:
    • PT:
      • 9.6 to 11.8 secs (male)
      • 9.5 to 11.3 secs (female)
    • INR:
      • 2.0 to 3.0 (standard warfarin tx)
      • 3.0 to 4.5 (high dose warfarin tx)
  • COAGULATION STUDIES
    • PROTHROMBIN TIME (PT) and INTERNATIONAL NORMALIZED RATIO (INR)
    • Nursing Considerations:
    • - baseline PT should be drawn before anticoagulation therapy
    • -e sure to apply direct pressure to the venipuncture site
    • -oncurrent warfarin therapy with heparin therapy can lengthen the PT
    • -iets high in green leafy vegetables can shorten PT
    • -xpect 1.5 to 2 times longer PT if on anticoagulation therapy
    • -or PT greater than 30 secs, initiate bleeding precautions
    A C B D E F
  • COAGULATION STUDIES
    • CLOTTING TIME
    • -lient should not receive heparin 3 hours before specimen collection
    • -ong on any anticoagulation therapy
    • -n thrombocytopenia
    • -ime: 8 to 15 minutes
    C L O T
  • COAGULATION STUDIES
    • PLATELET COUNT
    • Plug formation
    • Clot retraction
    • Coagulation factor activation
  • COAGULATION STUDIES
    • PLATELET COUNT 150T – 400T cells/mm3
    • <PLT – thrombocytopenia (risk for bleeding)
    • >PLT – thrombocytosis (risk for clot) – prophylaxis of Anicoagulant - Lovenox
  • COAGULATION STUDIES
    • PLATELET COUNT
    • Nursing Considerations:
    • B -leeding precautions should be instituted in clients with low platelet
    • M -onitor venipuncture site
    • C -hronic cold weather, high altitudes, and exercise increase platelet count
  • ERYTHROCYTE STUDIES
    • ERYTHROCYTE SEDIMENTATION RATE (ESR)- 0 to 30 mm/hr
    • ndirectly measures how much inflammation is in the body.
    • pecial preparations not needed, but fatty meal may cause plasma alterations
    • ate at which erythrocytes settle out of anticoagulated blood in 1 hour
    E S R
  • ERYTHROCYTE STUDIES
    • RED BLOOD CELLS
    • -esults in the delivery of oxygen to the body tissues
    • -lood diseases diagnosis
    • -irculate for 120 days and are removed from the blood via the liver, spleen, and bone marrow
    • -pecial preparation not needed
    R B C S
  • ERYTHROCYTE STUDIES
    • RED BLOOD CELLS 4.5-5.5 million/mm3
    • <RBC – Anemia (Faitgue, SOB)
    • >RBC – Polycythemia (erythrocytosis) – management phlebotomy
  • ERYTHROCYTE STUDIES
    • HEMOGLOBIN and HEMATOCRIT
    • Hemoglobin is the main component of erythrocytes and serves as the vehicle for transporting O2 and CO2
    • Normal Values:
      • 14 to 16.5 g/dl (male)
      • 12 to 15 g/dl (female)
  • ERYTHROCYTE STUDIES
    • HEMOGLOBIN and HEMATOCRIT
    • Hematocrit represents red blood cell mass and is an important measurement in the identification of anemia or polycythemia
    • Normal Values:
      • 42% to 52% (male)
      • 35% to 47% (female)
  • WHITE BLOOD CELL COUNT
    • WHITE BLOOD CELL
    • Immune defense system of the body
    • WBC 5,000-10,000 cells/mm3
      • <WBC – leukopenia (risk for infection)
      • >WBC – leukocytosis (infection/inflammation)
      • >100,000 – incapable of phagocytosis (leukemia)
  • WHITE BLOOD CELL COUNT
    • WHITE BLOOD CELL
    • Nursing Consideration:
    • SHIFT TO THE LEFT: increased number of immature neutrophils is present on the blood
    • SHIFT TO THE RIGHT: cells have more than usual number of nuclear segments, found in liver disease, Down syndrome, pernicious anemia, and megaloblastic anemia
  • CARDIAC MARKERS
    • CREATINE KINASE (CK)
    • Found in:
    • CK-MB (Cardiac)--- 0% to 5%
    • CK-BB (Brain)--- 0%
    • CK-MM (Muscles)--- 95% to 100%
  • CARDIAC MARKERS
    • CREATINE KINASE (CK)
    • R: 6 hours
    • P: 18 hours
    • N: 2 to 3 days
  • CARDIAC MARKERS
    • CREATINE KINASE (CK)
    • Nursing Considerations:
    • CK-MM: Avoid strenuous physical activity for 24 hours before the test
    • Avoid ingestion of alcohol for 24 hours before the test
    • Invasive procedures and intramuscular injections may falsely elevate CK levels
  • CARDIAC MARKERS
    • LACTASE DEHYDROGENASE (LDH)
    • R: 24 hours
    • P: 48 to 72 hours
    • N: 7 to 14 days
  • CARDIAC MARKERS
    • LACTASE DEHYDROGENASE (LDH)
    • Nursing Considerations:
    • LDH isoenzyme levels should be interpreted in view of the clinical findings
    • Testing should be repeated on 3 consecutive days
  • CARDIAC MARKERS
    • TROPONIN
    • - and I
    • -egulatory protein found in striated muscle
    • -n bloodstream when an infarction causes damage to the myocardium
    T R O
  • CARDIAC MARKERS
    • TROPONIN I
    • >1.5 ng/ml… MI
    • R: 3 hours
    • N: 7 to 10 days
  • CARDIAC MARKERS
    • TROPONIN T
    • >0.1 to 0.2 ng/ml… MI
    • R: 3 hours
    • N: 7 to 14 days
  • CARDIAC MARKERS
    • TROPONIN
    • Nursing Considerations:
    • Testing is repeated in 12 hours, followed by daily testing for 3 to 5 days.
    • Rotate venipuncture sites.
  • CARDIAC MARKERS
    • MYOGLOBIN
    • Oxygen-binding protein found in striated muscle that releases oxygen at very low tensions
    • Injury to skeletal muscle will cause a release of myoglobin into the blood
  • CARDIAC MARKERS
    • MYOGLOBIN
    • >90 mcg/L… MI
    • R: 1 to 2 hours
    • P: 4 to 6 hours
    • N: 24 to 36 hours
  • SERUM LIPIDS
    • Total Cholesterol---
    • 140 to 199 mg/dl
    • Low Density Lipoprotein (LDL)--- <130 mg/dl
    • High Density Lipoprotein (HDL)--- 30 to 70 mg/dl
    • Triglycerides---
    • < 200 mg/dl
  • SERUM LIPIDS
    • Nursing Considerations:
    • o oral contraceptives
    • PO except water for 12 to 14 hours
    • o alcohol for 24 hours
    • o high cholesterol foods the evening meal before the test
    N N N N
  • ECG
    • -valuates heart rate and the regularity of heartbeats.
    • -ardiac dysrhythmias, MI, and cardiac hypertrophy
    • - raph of the electrical impulses moving through the heart.
    E C G
  • ECG
    • Nursing Consideration:
    • -lectrical shock will not occur
    • -ardiac medications of the patient should be documented
    • -ive instructions to lie still, breathe normally, and refrain from talking during the test
    E C G
  • BASIC ECG INTERPRETATION Normal Sinus Rhythym Sinus Tachycardia Sinus Bradycardia Atrial Tachycardia Atrial Fibrillation Atrial Flutter Ventricular Tachycardia Ventricular Fibrillation Asystole
  • STANDARD LEAD PLACEMENT
    • PRECORDIAL LEADS
    White: Right Arm Black: Left Arm Green: Right Leg Red: Left Leg
  • STANDARD LEAD PLACEMENT
    • LIMBS LEADS
  • BASIC ECG INTERPRETATION
  • BASIC ECG INTERPRETATION
    • P WAVE: Atrial depolarization
    • PR INTERVAL: AV conduction time
    • QRS COMPLEX: Ventricular depolarization
    • ST SEGMENT: Time interval between complete depolarization of ventricles and repolarization of ventricles
    • T WAVE: Ventricular repolarization
  • NORMAL CARDIAC RHYTHM PARAMETERS
    • NORMAL SINUS RHYTHM: 60 TO 100 bpm
    • SINUS BRADYCARDIA: <60 bpm
    • SINUS TACHYCARDIA: >100 bpm
    • QRS WIDTH: 0.08 to 0.12 sec
    • PR INTERVAL: 0.12 to 0.20 sec
    • QT INTERVAL: 0.30 to 0.40 sec
  • FIGURING HEART RATE
    • 1500 method
    • RR method
    • 6-second method
  • FIGURING HEART RATE
    • 1500 method
  • FIGURING HEART RATE
    • 2. RR method
  • FIGURING HEART RATE
    • 3. 6-second method
  • NORMAL SINUS RHYTHM Rate Rhythm P Waves P-R QRS 60 to 100 Regular Present 0.12 to 0.20 secs 0.08 tp 0.12 secs
  • SINUS TACHYCARDIA Rate Rhythm P Waves P-R QRS >100 BPM Regular Present 0.12 to 0.20 secs 0.08 to 0.12 secs
  • SINUS BRADYCARDIA Rate Rhythm P Waves P-R QRS <60 BPM Regular Present 0.12 to 0.20 secs 0.08 to 0.12 secs
  • ATRIAL TACHYCARDIA Rate Rhythm P Waves P-R QRS 150 to 250 bpm Regular Present Short <0.12 0.08 to 0.12 secs
  • ATRIAL FIBRILLATION Rate Rhythm P Waves P-R QRS Variable Irregularly- Irregular Absent Non- discernible Narrow
  • ATRIAL FLUTTER Rate Rhythm P Waves P-R QRS 250 to 350 bpm Usually regular Sawtooth pattern Non- discernible Usually narrow
  • VENTRICULAR TACHYCARDIA Rate Rhythm P Waves P-R QRS 100 TO 220 BPM Usually regular Absent NA Wide >0.12 sec
  • VENTRICULAR FIBRILLATION Rate Rhythm P Waves P-R QRS 350 TO 450BPM Completely chaotic and disorganized Absent NA Absent
  • ASYSTOLE Rate Rhythm P Waves P-R QRS No Rate No Rhythm Absent NA Absent
  • CVP
    • -atheter is attached to an IV infusion and H2O manometer by a three way stopcock
    • -eins external jugular, antecubital, or femoral
    • - ressure within the superior vena cava
    C V P
  • CVP
    • Normal Value: 3 to 8 mmHg
    • Position:
    • Cardiac Disease: Semi Fowler’s
    • Dressing or Tubing Change: Flat or Trendelenburg
    • CVP Reading and Monitoring: Flat, Supine, or Dorsal Recumbent
    • Air Embolism: Left Side Lying
  • CVP
  • 1. Maintain zero point of manometer always at level of right atrium (intersection between midaxillary line and 4 th ICS, also referred to as the phlebostatic axis) 2. Determine patency of catheter by opening IV infusion line
  • 3. Turn stopcock to allow IV solution to run into manometer to a level of 10-20cm above expected pressure reading 4. Turn stopcock to allow IV solution to flow from manometer into catheter; fluid level in manometer fluctuates with respiration
  • 5. Stop ventilatory assistance during measurement of CVP 6. After CVP reading, return stopcock to IV infusion position 7. Record CVP reading and position of client (angle of recline)
  • PERICARDIOCENTESIS
    • ericardial effusion
    • uncture
    • ericardial sac
    • ericardial fluid
    P P P P
  • PERICARDIOCENTESIS
    • PREPROCEDURE
    • erform blood analysis
    • CG
    • estriction of food and water is recommended for six hours before the test.
    • V line for sedation
    P E R I
  • PERICARDIOCENTESIS
    • INTRAPROCEDURE
    • vail emergency resuscitative equipment at bedside
    • ed is elevated to 45 to 60 degrees
    • ardiac activity monitoring
    • one in emergency room, ICU, or at the bedside
    A B C D
  • PERICARDIOCENTESIS
    • POSTPROCEDURE
    • pical pulse monitoring
    • lood pressure
    • VP
    • etect complications: Ventricular or coronary artery puncture, dysrhythmias, pleural laceration, gastric puncture, myocardial trauma
    A B C D
  • RESPIRATORY SYSTEM Chest X-ray Sputum Specimen Bronchoscopy Thoracentesis Lung Biopsy ABG Analysis Incentive Spirometer Peak Flow Meter
  • CHEST X-RAY
    • A-natomy
    • A-ppearance
  • CHEST X-RAY
    • PREPROCEDURE:
    • emove all jewelry and other metal objects from the chest area
    • ssess the client’s ability to inhale and hold his or her breath
    • ou question women regarding pregnancy or possibility of pregnancy
    R A Y
  • CHEST X-RAY
    • POSTPROCEDURE:
    • Help the client get dressed
  • SPUTUM SPECIMEN
    • pecimen thru expectoration
    • uctioning of the trachea
    • putum amount: 15 ml
    S S S
  • SPUTUM SPECIMEN
    • PREPROCEDURE:
    • -lways collect the specimen before antibiotic therapy
    • -e sure that the client rinse mouth with water
    • -lient to take several deep breaths and then cough deeply
    A B C
  • SPUTUM SPECIMEN
    • POSTPROCEDURE:
    • If a culture of sputum is prescribed, transport the specimen to the laboratory immediately
    • Assist the client with mouth care
  • BRONCHOSCOPY
    • To visualize:
    L B T arynx rachea ronchi
  • BRONCHOSCOPY
  • BRONCHOSCOPY
    • Purposes:
    • -pply medications
    • -rush biopsy
    • -arefully remove foreign objects
    • -irect visualization
    A B C D
  • BRONCHOSCOPY
    • PREPROCEDURE:
    • tain informed consent
    • emove dentures or eyeglasses
    • btain vital signs
    • PO postmidnight
    • oagulation studies result must be checked
    • ave emergency resuscitation equipment readily vailable
    • give IVF and medication for sedation
    • uction equipment at bedside
    B O N C H U S R
  • BRONCHOSCOPY
    • POSTPROCEDURE:
    • ag reflex return
    • ssess for bloody sputum
    • ive instruction that sore throat is common
    • espiratory status must be monitored
    • mesis basin at bedside
    • owler’s semi position
    • ook out for complications like bronchospasm or bronchial perforation
    • levated temperature and DOB- Notify!
    • amine vital signs
    G A G R E F L E X
  • THORACENTESIS
    • Insertion of a needle through the chest wall:
    • Obtain specimen
    • Remove pleural fluid accumulation
    • Instill medication
  • THORACENTESIS
  • THORACENTESIS
    • PREPROCEDURE:
    • o obtain informed consent
    • ealth teaching: not cough, breathe deeply, or move during the test
    • n doctor's office, in the X-ray department, ER, OR or at bedside
    • idden on bed: Sidelying towards the unaffected side with HOB elevated
    • mbulatory: Sit upright with arms and shoulders supported by a table
    • -ray or ultrasound before the procedure
    T H O R A X
  • THORACENTESIS
    • POSTPROCEDURE:
    • Monitor vital signs
    • Monitor respiratory status
    • Apply a pressure dressing
    • Assess the puncture site for bleeding and crepitus
    • Monitor for signs of pneumothorax, air embolism, and pulmonary edema
  • LUNG BIOPSY
    • C -ulture
    • C -ytological exam
    • P -ulmonary lesion
    • P -leural effusion
  • LUNG BIOPSY
    • PREPROCEDURE:
    • -et the patient signs informed consent
    • -se of local anesthesia, pressure during insertion of needle
    • -PO
    • -ive analgesics and sedatives as prescribed
    L U N G
  • LUNG BIOPSY
    • POSTPROCEDURE:
    • -ital signs must be monitored
    • -nspect biopsy site for drainage or bleeding
    • -n biopsy site dressing must be applied
    • -neumothorax and air embolism
    • -igns of respiratory distress must be monitored
    • -ou prepare the patient for chest x-ray
    B I O P S Y
  • ABG ANALYSIS
    • Measurement
    • Oxygen
    • Carbon dioxide
    • Arterial blood
    • Acid base state
  • ABG ANALYSIS
    • PREPROCEDURE:
    • - llen’s test before drawing radial artery specimens
    • -efore specimen collection, client to rest for 30 minutes
    • -iving suction before drawing ABG sample is avoided
    A B G
  • ABG ANALYSIS
    • POSTPROCEDURE:
    • Place the specimen on ice
    • Note the client’s temperature on the laboratory form
    • Note the oxygen and type of ventilation that the client is receiving on the laboratory form
  • ABG ANALYSIS
    • POSTPROCEDURE:
    • Apply pressure to the puncture site for 5 to 10 minutes or longer if the client is taking anticoagulant therapy or has a bleeding disorder
    • Transport the specimen to the laboratory within 15 minutes
  • ABG ANALYSIS
    • Normal Arterial Blood Gas Values:
    pH 7.35 to 7.45 PCO2 35 to 45 mmHg HCO3 22 to 26 mmHg PO2 80 to 100 mmHg O2 sat 96% to 100 %
  • ABG ANALYSIS
    • R - espiratory
    • O - pposite
    • M - etabolic
    • E - qual
  • INCENTIVE SPIROMETER
    • Sustained
    • Maximal
    • Inspiration
  • INCENTIVE SPIROMETER
  • INCENTIVE SPIROMETER
    • INDICATIONS:
    • Upper-abdominal surgery
    • Thoracic surgery
    • Surgery in patients with chronic obstructive pulmonary disease
    • Pulmonary atelectasis
    • Presence of a restrictive lung defect associated with quadraplegia and/or dysfunctional diaphragm.
  • INCENTIVE SPIROMETER
    • Nursing Considerations
    • PREPROCEDURE
    • -void smoking or eating heavy meal for 4 to 6 hours before the test
    • -e sure to remove dentures
    • -onsult with the physician regarding holding bronchodilators before testing
    • -etermine whether analgesic that may depress the respiratory function is being administered
    • -ncourage to void and wear loose clothing
    A B C D E
  • INCENTIVE SPIROMETER
    • Nursing Considerations
    • POSTPROCEDURE
    • Resume:
    • Diet
    • Bronchodilators
    • Respiratory treatments
  • PEAK FLOW METER
    • determines the effectivity of bronchodilator for asthmatic patients
  • PEAK FLOW METER
    • Management:
    • Diary
    • Weeks period that the child is well
    • Blows
    • Results:
    • GREEN: 80 to 100%... Very Good
    • YELLOW: 50 to 80%... Beginning Attack
    • RED: <50%... Bring to ER