respiratory diagnostic

1. Seminar
On
Diagnostic tests in Respiratory System
Presented By :
Mahendra Kumar
M.Sc . Nursing (1st year)

2. Introduction
• The respiratory system is vital part of human body
• Diagnostic tests in respiratory system are mainly divided into :
 Invasive test
 Non invasive test
• Diagnostic tests are performed to find problems as early as possible

3. Non invasive
Diagnostic procedures

4. Non invasive diagnostic procedures
 Physical examination
• Sputum culture
• Pulse oximetry
• Spirometry
• Pulmonary function test
• Bronchoscopy

5. Non invansive diagnostic procedures
Contd...
• Radiological imaging :
 X-ray
 CT scan
 MRI
 CT angiography

6. Physical examination
• Technique used during physical examination to objectively evaluate the
respiratory system :
 Inspection
 Palpation
 Percussion
 Auscultation

7. Inspection
• Inspection is primary source of information about patient
• Inspection consist of visual examination
• Depth of respiration, movement of abdominal wall with respiration
• Abnormalities detected on inspection provide clues about core problem

8. Palpation
• Palpation is tactile examination of the chest from which can be elected
tenderness, asymmetry
• After superficial palpitation , deeper examination of the lungs and air spaces
can be accomplished via testing for vocal fremitus
• Useful in examination in patients of c o p d and fluids outside lung space

9. Percussion
• How to do………….
• Percussion is performed by placing the pad of the non dominant long finger
on the chest wall and striking distal interaphalangeal joint of that finger with
the top of the dominant long finge
• Percussion produce sounds on the density of the underlying tissue .

10. Auscultation
• The ideal position for auscultation is to place the patient in a sitting position
• When auscultating ,the patient should inhale and exhale through the mouth,
deeper then usual breath auscultation should be performed with diaphragm
of the stethoscope applied directly to the skin
• Start near the apices and move down in a ladder like pattern until below the
level of the diaphragm is reached or breath sounds are no longer appreciated

11. Sputum examination
1. Description : A specimen obtained by expectoration or tracheal suctioning
to assist in the identification of organisms or abnormal cells.
2. Pre procedure
a. Determine specific purpose of collection and check with institutional
policy for appropriate collection of specimen.
b. Obtain an early morning sterile specimen from suctioning or
expectoration after a respiratory treatment, if a treatment is prescribed.

12. Sputum examination
Contd...
c. Obtain 15 ml of sputum.
d. Instruct the client to rinse the mouth with water before collection.
e. Instruct the client to take several deep breaths and then cough deeply to
obtain sputum.
f. Always collect the specimen before client begins antibiotic therapy.
3. Post procedure
a. Transport specimen to laboratory STAT.
b. Assist the client with mouth care.

13. Pulse oximetry
• Pulse oximetry is a non invasive method of continuously monitoring
• the oxygen saturation of hemoglobin (SpO2 or SaO2).
• it is an effective tool to monitor for subtle or sudden change in spo2
• This is easy to carry out through simple device

14. Pulse oximetry
Contd...
• after a hypoxic client uses up the readily available oxygen (measured as the
arterial oxygen pressure, PaO2, on ABG testing), the reserve oxygen, that
oxygen attached to the hemoglobin (SaO2), is drawn on to provide oxygen to
the tissues.
• a pulse oximetry reading can alert the nurse to hypoxemia before clinical
signs occur
• Normal spo2 value is above 94%

15. Pulmonary function test
• Pulmonary function test (PFT) is routinely used with patients in
respiratory ICU and in OPD basis
• With chronic respiratory disorders. They are performed to assess
respiratory efforts .
• PFT also assess respiratory function and to determine the extent of
dysfunction.

16. Pulmonary function test
Contd...
Pre procedure :
• Do not eat a heavy meal before the test .
• Do not smoke 6-8 hour before test
• Patients may have temporary shortness of breath or lightheaded…

17. Radiological Imagings
• X ray
• CT scan
• MRI
• PET scan

18. Chest x-ray
1. Description: provides information regarding the anatomical location and
appearance of the lungs.
2. Pre procedure
a. Remove all jewelry and other metal objects from the chest area.
b. Assess the client’s ability to inhale and hold breath.
c. Question females regarding pregnancy or the possibility of pregnancy.
3. Post procedure:
Assist the client to dress.

19. Chest x-ray
Contd…
• Chest x-ray help in diagnosis of acute and chronic respiratory disorder
• Provide pictures of the structure inside chest, such as lungs ,heart and blood
vessel
• Easy to carry out
• Can help to make spot diagnosis

20. CT scan
• CT scan is an imaging method in which the lungs are scanned in by a
narrow-beam x-ray. The produced images provide clear vision of lungs
• a cross-sectional view of the chest. Whereas a chest x-ray cannot show.
• shows major contrast between body densities, such as bones, soft organs
• CT of thorax may be performed when x-ray do not show some area well
such as mediastinum

21. MRI
• MRIs are similar to CT scans except that magnetic fields .
• radiofrequency signals are used instead of a narrow-beam x-ray.
• MRIs yield a much more detailed diagnostic image than CT
scans.
• MRI is used to characterize pulmonary nodules, stage

22. PET scan
• Non invasive test
• Used to examine the lungs
• Performed to identify lungs nodules
• The client is given a radioactive substance and cross sectional image display
on moniter
• Latest technology ..minimum radiation to patients

23. Nursing considerations in radiological diagnostic tests
• Right patients
• In case of pregnant women client ,Pregnancy information to radiology staff
• If patient is shifting for radiology dept. make sure about ornamenet and
metal instruments if any
• Radiology should well cover in envelop to protect from damage

24. Invasive diagnostic tests

25. Invasive diagnostic procedures of Respiratory System
• Intra dermal
• Thoracentesis
• Pulmonary angiography
• Lung biopsy
• Lung scan
• Arterial blood gases

26. Skin test
1. Description: A skin test is an intradermal injection used to assist in diagnosing
various infectious diseases
2. Pre procedure: Determine hypersensitivity or previous reactions to skin tests

27. Skin test
Contd...
3. Procedure
a. Use test injection test that is free of excessive body hair, dermatitis, and
blemishes.
b. Apply the injection at the upper one third of inner surface of the left arm
c. Circle and mark the test site
d. Document the date, time, and test site

28. Arterial blood gas Analysis
1. Description: measurement of the dissolved oxygen and carbon dioxide in
the arterial blood to reveal the acid-base state and how well the oxygen is
being carried to the body
2. Pre procedure
a. Perform Allen’s test before drawing radial artery specimens.
b. Have the client rest for 30 minutes before specimen collection.
c. Avoid suctioning before drawing ABG sample.
d. Do not turn off oxygen unless the ABG sample is ordered to be drawn
with client breathing

29. Arterial blood gas Analysis
Contd...
3. Post procedure
a. Place the specimen on ice.
b. Note the oxygen and type of ventilation that the client is receiving on the
laboratory form.
c. Apply pressure to the puncture site for 5 to 10 minutes and longer if the
client is taking anticoagulant therapy or has a bleeding disorder.

30. Lung biopsy
1. Description
a. A percutaneous lung biopsy is performed to obtain tissue for analysis by
culture or cytological examination
b. A needle biopsy is done to identify pulmonary lesions, changes in lung
tissue, and the cause

31. Lung biopsy
Contd...
2. Preprocedure
a. Obtain informed consent
b. Maintain NPO status.
c. Inform the client that a local anesthetic will be used but that sensation of
pressure during needle insertion and aspiration may be felt.
d. Administer analgesics and sedatives as prescribed

32. Lung biopsy
Contd…
3. Postprocedure
a. Monitor vital signs
b. Apply dressing to the biopsy site and monitor for drainage or bleeding
c. Monitor for signs of respiratory distress, and notify physician if they occur
d. Monitor for signs of pneumothorax and air emboli, and notify physician if
they occur
e. Prepare the client for chest radiography

33. Pulmonary angiography
1. Description
a. Pulmonary angiography is an invasive fluoroscopic procedure in which a
catheter is inserted through the antecubital or femoral vein into the
pulmonary artery or one of its branches.
b. Pulmonary angiography involves an injection of iodine or radiopaque or
contrast material.

34. Pulmonary angiography
Contd…
2. Preprocedure
a. Obtain informed consent
b. Assess for allergies to iodine, seafood, or other radiopaque dyes.
c. Maintain NPO status of client for 8 hours before procedure.
d. Monitor vital signs
e. Assess results of coagulation studies
f. Establish an intravenous access
g. Administer sedation as prescribed
h. Instruct the client to lie still during the procedure

35. Thoracentasis
1. Description: Removal of fluid or air from the pleural space
via a transthoracic aspiration
2. Preprocedure
a. Obtain informed consent
b. Obtain vital signs
c. Prepare the client for ultrasound or chest radiograph, if prescribed, before
procedure
d. Assess results of coagulation studies

36. Thoracentasis
Contd...
Note that the client is positioned sitting upright, with the arms and head
supported by a table at the bedside during the procedure.
f. If the client cannot sit up, the client is placed lying in bed on the unaffected
side with the head of the bed elevated 45 degrees
g. Instruct the client not to cough, breath deeply, or move during the procedure.

37. Lung scan
1. Description : a. The perfusion scan evaluates blood flow to the lungs.
b. The ventilation scan determines the patency of the pulmonary airways and
detects abnormalities in ventilation.
c. A radio nucleotide may be injected for the procedure
2. Pre procedure
a. Obtain informed consent
b. Assess client for allergies to dye, iodine, or seafood
c. Remove jewelry around the chest area
d. Review breathing methods that may be required during testing.

38. Conclusion
• The main clinical roles of respiratory function tests include diagnosis,
assessment of severity, monitoring treatment and evaluation of prognosis.

39. References
• Brunner,Suddarth.Textbook of Medical-Surgical Nursing.10th
edition.Lippincott williams and wilkins;2004.P.1014-1126
• Black.J.medical surgical nursing. 7thedition. missouri.elsevier; 2007. P1312-1323
• Nettina, Sandra M.Lippincott manual of nursing practice.8th edition. Lippincott
williams and wilkins;2006.P.1121-1134

40. Thanks……....