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Diagnostic studies of respiratory system

The document outlines various diagnostic studies for respiratory conditions, including pulmonary function tests (PFTs) that measure lung volumes and capacities, like tidal volume and vital capacity. It discusses the importance of blood gas measurements, imaging studies such as X-rays and CT scans, and endoscopic procedures like bronchoscopy and thoracoscopy for diagnosing respiratory issues. Additionally, it emphasizes the role of sputum and throat cultures in identifying pathogens related to respiratory illness.

Education◦
SWATILEKHA DAS RN, BSN, MSN
A wide range of diagnostic studies may be performed in patients with respiratory conditions.
Pulmonary function tests (PFTs) are routinely used in patients with chronic respiratory disorders. They are performed to assess respiratory function and to determine the extent of dysfunction. Such tests include measurements of lung volumes, ventilatory function, and the mechanics of breathing, diffusion, and gas exchange.
▪Lung Volumes • Tidal Volume(TV)-It is the amount of air that can be inhaled or exhaled during one respiratory cycle ▪ The normal adult value is 10% of vital capacity (VC), approximately 300-500ml (6‐8 ml/kg); but can increase up to 50% of VC on exercise • Inspiratory Reserve Volume(IRV) ▪ It is the amount of air that can be forcibly inhaled after a normal tidal volume. IRV is usually kept in reserve, but is used during deep breathing. The normal adult value is 1900-3300ml. • Expiratory Reserve Volume(ERV) ▪ It is the volume of air that can be exhaled forcibly after exhalation of normal tidal volume. The normal adult value is 700-1200ml. ERV is reduced with obesity, ascites or after upper abdominal surgery • Residual Volume(RV) ▪ It is the volume of air remaining in the lungs after maximal exhalation. Normal adult value is averaged at 1200ml(20‐25 ml/kg) .
▪Lung capacities Inspiratory capacity(IC) ▪ It is the maximum volume of air that can be inhaled following a resting state. It is calculated from the sum of inspiratory reserve volume and tidal volume. IC = IRV+TV Total Lung Capacity(TLC) ▪ It is the maximum volume of air the lungs can accommodate or sum of all volume compartments or volume of air in lungs after maximum inspiration. The normal value is about 6,000mL(4‐6 L). TLC is calculated by summation of the four primary lung volumes (TV, IRV, ERV, RV). ▪ TLC may be increased in patients with obstructive defects such as emphysema Vital Capacity(VC) ▪ It is the total amount of air exhaled after maximal inhalation. The value is about 4800mL and it varies according to age and body size. It is calculated by summing tidal volume, inspiratory reserve volume, and expiratory reserve volume. VC = TV+IRV+ERV. Function Residual Capacity(FRC) ▪ It is the amount of air remaining in the lungs at the end of a normal exhalation. It is calculated by adding together residual and expiratory reserve volumes. The normal value is about 1800 – 2200 mL. ▪ FRC = RV+ERV.
▪ Measurements of blood pH and of arterial oxygen and carbon dioxide tensions are obtained when managing patients with respiratory problems and adjusting oxygen therapy as needed. ▪ The arterial oxygen tension (partial pressure or PaO2) indicates the degree of oxygenation of the blood, and the arterial carbon dioxide tension (partial pressure or PaCO2) indicates the adequacy of alveolar ventilation.
▪ Pulse oximetry is a noninvasive method of continuously monitoring the oxygen saturation of hemoglobin (SaO2). When oxygen saturation is measured with pulse oximetry, it is referred to as SpO2
▪Normal SpO2 values are 95% to 100%. Values less than 85% indicate that the tissues are not receiving enough oxygen, and further evaluation is needed.
▪ Throat cultures may be performed to identify organisms responsible for pharyngitis. ▪ Nasal swabs may be performed for the same purpose.
▪ Sputum is obtained for analysis to identify pathogenic organisms and to determine whether malignant cells are present. ▪ Periodic sputum examinations may be necessary.
▪Expectoration is the usual method for collecting a sputum specimen.
▪Imaging studies, including x-rays, computed tomography (CT), magnetic resonance imaging (MRI), contrast studies, and radioisotope diagnostic scans
CHEST X-RAY ▪ A chest x-ray may reveal an extensive pathologic process in the lungs in the absence of symptoms. ▪ The routine chest x-ray consists of two views: the posteroanterior projection and the lateral projection.
▪ CT is an imaging method in which the lungs are scanned in successive layers by a narrow-beam x-ray. ▪ The images produced provide a cross-sectional view of the chest. ▪ CT may be used to define pulmonary nodules and small tumors adjacent to pleural surfaces that are not visible on routine chest x-rays.
MRI is similar to CT except that magnetic fields and radiofrequency signals are used instead of a narrow-beam x- ray. MRI yields a much more detailed diagnostic image than CT because it visualizes soft tissues. MRI is used to characterize pulmonary nodules, to help stage bronchogenic carcinoma.
Pulmonary angiography is most commonly used to investigate thromboembolic disease of the lungs, such as pulmonary emboli, and congenital abnormalities of the pulmonary vascular tree.
▪Fluoroscopy is used to assist with invasive procedures, such as a chest needle biopsy or transbronchial biopsy, that are performed to identify lesions. ▪It also may be used to study the movement of the chest wall, mediastinum, heart, and diaphragm; to detect diaphragm paralysis;and to locate lung masses.
▪lung scan is performed by injecting a radioactive agent into a peripheral vein and then obtaining a scan of the chest to detect radiation.
▪Endoscopic procedures include bronchoscopy- Bronchoscopy is the direct inspection and examination of the larynx, trachea, and bronchi through either a flexible fiberoptic bronchoscope or a rigid bronchoscope
▪Thoracoscopy- Thoracoscopy is a diagnostic procedure in which the pleural cavity is examined with an endoscope . Thoracoscopy is the visual examination of the lung surfaces and pleural space through a viewing tube (a thoracoscope). Thoracoscopy is used to view the lung and the space surrounding the lungs (pleural space).
▪Purposes of the procedure include removal of fluid and air from the pleural cavity, aspiration of pleural fluid for analysis, pleural biopsy, and instillation of medication into the pleural space.
Biopsy, the excision of a small amount of tissue, may be performed to permit examination of cells from the pharynx, larynx, and nasal passages. Local, topical, moderate sedation, or general anesthesia may be administered, depending on the site and the procedure. ▪ Pleural Biopsy ▪ Lung Biopsy Procedures ▪ Lymph Node Biopsy
Diagnostic studies of respiratory system