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Similar to laryngoscopy thoracoscopy thoracocentesis pulmonary angiograpy.pptx
laryngoscopy thoracoscopy thoracocentesis pulmonary angiograpy.pptx
- 2. DIAGNOSTIC PROCEDURE OF RESPIRATORYSYSTEM Prepared by: Roshna Adhikari Roll No. : 1 BNS 2nd Year
- 3. Specific Objectives • Todefine bronchoscopy, it’s purposes, types, and complications • To list the nursing management of bronchoscopy • To introduce pulmonary angiography, it’s indication, contraindication and complications • To list about nursing intervention of pulmonary angiography
- 4. Cont.… • To introducelaryngoscopy and it’s indication • To explain about nursing consideration of laryngoscopy • To introduce thoracocentesis, it’s indication, purposes, complications and contraindication
- 5. Cont.... • To explainabout pre-procedure, intra procedure and post procedure nursing management of thoracocentesis. • To introduce thoracoscopy , it’s indication, procedure and complication • To state about nursing interventions of thoracoscopy.
- 6.
- 7. Introduction • Bronchoscopy isthe direct inspection and examination of larynx, trachea and bronchi through either a flexible fiberoptic bronchoscope or rigid bronchoscope. The fiberoptic bronchoscope is used more frequently in current practice.
- 8. Therapeutic Uses • Removeforeign bodies from the tracheobronchial tree. • Remove secretions obstructing the tracheobronchial tree when the patient cannot clear them. • Treat postoperative atelectasis.
- 9. Diagnostic Uses • Toexamine tissues or collect secretions • To determine the location and extent of the pathologic process and to obtain a tissue sample for diagnosis • To determine if a tumor can be resected surgically. • To diagnose bleeding sites diagnostic uses.
- 11. Types of bronchoscope Fiberoptic bronchoscope • It is a thin, flexible bronchoscope that can be directed into the segmental bronchi. • Small size, flexible and excellent optical system increases visualization which is ideal for pulmonary lesion
- 12. • Can beperformed through endotracheal or tracheostomy tubes on ventilators. • Cytologic examinations can be performed without surgical intervention. • Can be performed at the bedside.
- 13. Cont… Rigid bronchoscope • Itis a hollow metal tube with a light at its end. • Used for removing foreign substances • Used for investigating the source of massive hemoptysis, or performing endobronchial surgical procedure. • Performed at operating room not at bedside.
- 14. Complications • Reaction tothe local anesthetic. • Infection • Aspiration • Bronchospasm • Hypoxemia • Pneumothorax , bleeding, and perforation
- 15. Nursing Considerations • Beforethe procedure, a signed consent form is obtained from the patient. • Food and fluids are withheld for 6 hours before the test to reduce the risk of aspiration when the cough reflex is blocked by anesthesia. • The patient must remove dentures and other oral prostheses.
- 16. Cont… • The nurseexplains the procedure to the patient to reduce fear and decrease anxiety and administers preoperative medications (usually atropine and a sedative or opioid) as prescribed to inhibit vagal stimulation (thereby guarding against bradycardia, dysrhythmias, and hypotension), suppress the cough reflex, sedate the patient, and relieve anxiety.
- 17. cont.... • The examinationis usually performed under local anesthesia, but general anesthesia may be needed for rigid bronchoscopy • A topical anesthetic such as lidocaine (Xylocaine) may be sprayed on the pharynx or dropped on the epiglottis and vocal cords and into the trachea to suppress the cough reflex and minimize discomfort
- 18. Cont… • Sedatives oropioids are administered intravenously as prescribed to provide moderate sedation. • After the procedure, it is important that the patient takes nothing by mouth until the cough reflex returns, because the preoperative sedation and local anesthesia impair the protective laryngeal reflex and swallowing for several hours
- 19. Cont… • In theelderly patient assess for confusion and lethargy which may be due to the large doses of lidocaine administered during procedure . • Once the patient demonstrates a cough reflex, the nurse may offer ice chips and eventually fluids
- 20. Cont… • Monitor thepatient's respiratory status and observes for hypoxia, hypotension, tachycardia, dysrhythmias, hemoptysis, and dyspnea. Any abnormality is reported promptly. • The patient is not discharged from the recovery area until adequate cough reflex and respiratory status are present.
- 21. Cont… • The patientis not discharged from the recovery area until adequate cough reflex and respiratory status are present. • Instruct the patient and family caregivers to report any shortness of breath or bleeding immediately.
- 22.
- 23. Introduction • Pulmonary angiographyis most commonly used to investigate thromboembolic disease of the lungs, such as pulmonary emboli and congenital abnormalities of the pulmonary vascular tree. • It involves the rapid injection of a radiopaque agent into the vasculature of the lungs for radiographic study of the pulmonary.
- 24. catheter selection isdone (pigtail catheter)
- 25. Cont… • It canbe performed by injecting the radiopaque agent into a vein in one or both arms (simultaneously) or into the femoral vein, with a needle or catheter • The agent also can be injected into a catheter that has been inserted in the main pulmonary artery or its branches or into the great veins proximal to the pulmonary artery.
- 26.
- 27. Indications • Pulmonary embolism •Retrieval of foreign objects ( embolized catheter fragments ) • Right heart failure • Severe hypoxemia . • Free floating right ventricular thrombus
- 28. Contraindications • Allergy tothe radiopaque dye, • Pregnancy, and • Bleeding abnormalities
- 29. Potential complications • Acuterenal failure, • Acidosis, • Cardiac dysrhythmias, • Bleeding
- 30. Nursing Interventions • Thenurse should verify that informed consent • Assess for known allergies that may suggest allergies to radio opaque dye(e.g, iodine and shellfish) • ensure that the patient has not eaten or had anything to drink pre procedurally as prescribed(normally for 6 to 8 hours) and administer preprocedure medications that may include antianxiety medications, secretion-reducing agents, and antihistamines.
- 31. Cont… • Assess anticoagulation status and renal function • The nurse should instruct patients that they may experience a warm flushing sensation or chest pain during the injection of the dye
- 32. Cont… • Monitor vitalsigns, level of consciousness, oxygen saturation, and the vascular access site for bleeding or hematoma, and perform frequent assessment of neuro vascular status.
- 34.
- 35. Introduction • Laryngoscopy isvisual examination of larynx using a fiberoptic endoscope. • It can be performed during bronchoscopy or as a separate procedure used to diagnose laryngeal papilloma, nodule, polyps or cancer.
- 36. Indication • Any patientwith symptoms referable to the throat such as: • Dysphagia • Globus sensation • Hoarseness • It is good choice for initial examination of hypo pharynx in all patient presenting to the otolaryngologist
- 37. Direct laryngoscopy Indirectlaryngoscopy
- 38. Nursing Consideration • Makesure consent is taken. • For the direct laryngoscopy the client is prepared as a surgical procedure. • Food and fluids are withheld for 4-6 hours to prevent regurgitation and possible aspiration.
- 39. Cont… • The clientis given a pre-operative sedation. • If the laryngoscopy is to be done under general anesthesia a written consent is obtained. • If the laryngoscopy is done under local anesthesia throat is spread with topical anesthetic • Explain that the study takes about 30 minutes,it takes longer if minor surgery is performed as a part of procedure.
- 40. Cont… • If biopsyor excision of tissue is expected the necessary articles are kept ready. The procedure is done under strict aseptic technique. • Following laryngoscopy the client who had general anaesthesia is kept flat in bed without a pillow under the head. If it is done under local anaesthesia the swallowing reflexes are absent in the client; therefore the client is kept in a side-lying position to drain the saliva.
- 41. Post procedure • Placethe conscious patient in semi-Fowler’s position. Place the unconscious patient on his side with his head slightly elevated to prevent aspiration. • If the procedure done under local anesthesia the swallowing reflexes are absent ,therefore the client is kept in side-lying position to drain the saliva.
- 42. Cont… • Check thevital signs every 15 minute until patient is stable and then ever 30 minutes for 2 hours and then 4 hourly for 24 hours. • Listen the patient neck’s with stethoscope for the signs of stridor and airway obstruction. • The client is given nothing to oral intake until the gag reflex returns • Before oral feeds are started ,provides sips of water to check client’s ability to swallow
- 43. Cont… • Watch forsigns of complications. The following signs and symptoms may be looked for, especially if a biopsy was done: •Coughing and spitting of blood •Pain in the throat and neck •Swelling of the throat and neck •Restlessness and breathing difficulty •Impaired respiration
- 44. Cont… • Record theprocedure in the nurses record with date and time • Note allergies, history of hypersensitivity to anesthetic • Laryngoscope should be inserted through keeping patient in supine position with the head extended ,for better visualization . • After procedure keep client in semi-flowers position • Assess for respiratory difficulty, rate, pattern (dyspnea may result from laryngospasm. )
- 46. Contraindication of laryngoscopy •Disease or injuries of cervical spine. • Moderate or marked respiratory obstruction unless the air way has been provided by tracheostomy. • Recent coronary occlusion or cardiac decompensation.
- 47. complication of laryngoscopy •Injury to lips and tongue if they are nipped between the teeth and the laryngoscope. • Injury to teeth .They might be dislodged and fall into pharynx. • Bleeding • Laryngeal oedema.
- 48.
- 49. Introduction • Thoracocentesis isan invasive procedure that involves insertion of needle into the pleural space for removal of fluid or air. Pleural fluid is removed to therapeutically relieve pain or shortness of breath caused by excessive pleural pressure.
- 50.
- 51. Purposes. • To removethe air and fluid from pleural cavity • To decrease pressure on the lung tissue • To aspirate pleural fluid for diagnostic studies • To instill the medication in the pleural space • To perform pleural biopsy.
- 52. Indications • Traumatic pneumothorax •Hemopneumonthorax • Spontaneous pneumothorax • Broncho pleural fistula • Pleural effusion
- 53. Contraindication • Bleeding disorder •Taking blood thinners • With heart failure or enlargement of the trapped lung • Uncooperative patient
- 54. Complications • Pulmonary edema •Pneumothorax, • Tension pneumothorax, • Subcutaneous emphysema, • Pyrogenic infection • Cardiac distress can occur after a sudden shift in mediastinal contents when large amounts of fluid are aspirated.
- 55. Nursing management Before theprocedure • Verify a signed informed consent for the procedure. This invasive procedure requires informed consent. • Assess knowledge and understanding of the procedure and its purpose; provide additional information as needed. • A person who is fully informed will be less apprehensive and more able to cooperate during the thoracentesis.
- 56. Cont... • Pre-procedure fastingor sedation is not required. • Local anesthesia is used in this procedure and the gag and cough reflexes remain intact. • Administer a cough suppressant if indicated. Movement and coughing during the procedure may cause inadvertent damage to the lung or pleura.
- 57. Cont... • Obtain athoracentesis tray, sterile gloves, injectable lignocaine, povidone-iodine, dressing supplies and an extra over-bed table or Mayo stand. These supplies are used by the doctor performing the procedure. • Position the person upright, leaning forward with arms and head supported on an anchored over-bed table. This position spreads the ribs, enlarging the intercostal space for needle insertion.
- 58. Cont… • Inform theperson that, although local anesthesia prevents pain as the needle is inserted, a sensation of pressure may be felt. A pressure sensation occurs as the needle punctures the parietal .
- 59. Cont… During And AfterProcedure • Monitor pulse, colour, oxygen saturation and other signs during thoracentesis. These are indicators of physiological tolerance of the procedure. • Apply a dressing over the puncture site and position on the unaffected side for 1 hour. This allows the pleural puncture to heal.
- 60. Cont… • Label obtainedspecimen with name, date, time, source; send specimen to the laboratory for analysis. Fluid obtained during thoracentesis may be examined for abnormal cells, bacteria and other substances to determine the cause of the pleural effusion. • During the first several hours after thoracentesis, frequently assess and document vital signs; oxygen saturation; respiratory status, including respiratory excursion, lung sounds, cough or haemoptysis; and puncture site for bleeding or crepitus.
- 61. Cont… Frequent assessment isimportant to detect possible complications of thoracentesis, such as pneumothorax. • Obtain a chest x-ray. Chest x-ray is ordered to detect possible pneumothorax. • Normal activities generally can be resumed after 1 hour if no evidence of pneumothorax or other complication is present. The puncture wound of thoracentesis heals rapidly.
- 62.
- 63. Introduction • Thoracoscopy isa diagnostic procedure in which the pleural cavity is examined with an endoscope fluid and tissue can be obtained for analysis. • Small incisions are made into the pleural cavity in an intercostal space; the location of the incision depends on the clinical and diagnostic findings.
- 64. Cont… • After anyfluids present in pleural cavity is aspirated ,the fiberoptic mediastinoscope is insert into the pleural cavity, and its surface is inspected through the instrument. • After the procedure, a chest tube may being inserted, and the pleural cavity is drained by negative-pressure water-seal drainage
- 65.
- 66. Indication Diagnostic indication • Pleuraleffusions, pleural disease. • Staging of tumors • Biopsies of the lesions can be performed under visualization for diagnosis. Therapeutic indication: • Pleural effusion • Pneumothorax. • Empyema • Pulmonary and pleural masses
- 67. Procedure • Thoracoscopy isperformed in the operating room. • Patient is given general anesthesia. • Positioned in the lateral decubitus position with the involved side up.
- 68.
- 69. Cont… • Small incisionsare made into the pleural cavity in an intercoastal space, the location indicated by clinical and diagnostic findings. • The fiberoptic mediastinoscpeis inserted into the pleural cavity, any fluid present is aspirated, and the pleural cavity is inspected through the instrument. • After the procedure, chest tube may be inserted to facilitate re- expansion of the lung
- 70. Cont… • Chest tubeis removed after chest x-ray confirms re-expansion. • Thoracoscopic procedures have expanded with the availability of video monitoring, which permits improved visualization of the lung
- 72. Pre-procedure • Explain thepatient about procedure. • Ensuring that the informed consent is taken. • Make sure that pulmonary function, coagulation tests, electrocardiography and chest x-ray have been performed. • Patient remains NPO for 10-12 hours prior to procedure.
- 73. Post-procedure: • Monitor vitalsigns every 15 min for 1 hour, every hour for 2 hour and then every 4 hour. • Patient must remain NPO until gag reflex returns. • Assess pain level of patient. • Assess for respiratory status.
- 74. Cont… • Look forthe sign of bleeding and infection at the incisional site. • Assess for shortness of breathe as it may indicate a pneumothorax and should be reported immediately. • If the chest tube is inserted during the procedure, monitoring of chest drainage system and chest tube insertion site is essential
- 75. Complications: Major complications: • Empyema •Hemorrhage • Postoperative pneumothorax and pneumonia • Persistent air leak Minor complications • Subcutaneous emphysema • Minor hemorrhage • Operative site infection
- 77. Assignment: Write down thenursing intervention of thoracoscopy before during and after procedure.
- 78. References • Joyce.M .Black:Medical Surgical Nursing.7th edition. Elsevier. • Basavanthappa BT: Medical Surgical Nursing.1st edition. Jaypee Brothers Medical Publishers Pvt.Ltd. (2003) • Mandal.G.N: Text book of Medical Surgical Nursing. 5th edition,Makalu Publication House, Dillibazar, Kathmandu.(2016)
- 79. Cont… • Hinkle, J.Land Cheever K.H. Brunner and suddarth`s textbook of medical-surgical nursing (12th edition). Philadelphia: Lippincott Williams and Wilkins (2010) • Lewis, S.L., Dirksen, S.R., Heitkemper, M.M., Bucher, L., & Harding, M.M. (2017). Medical-Surgical Nursing: Assessment and Management of Clinical Problems (10th ed.). St. Louis: Elsevier. • Retrieved from: http://www.mayoclinic.com/health/respiratory diagnostic procedure on 2023/01/23 at 11am
Editor's Notes
- #12 Segmental bronchi are the smallest branches of the bronchial tree in the lung, and they supply air to a specific segment of the lung.
- #24 The contrast dye is injected into a blood vessel in the groin or arm and travels through the bloodstream to the lungs. Pulmonary embolism (PE) is a condition in which a blood clot, usually originating from a deep vein in the legs, travels to the lungs and blocks blood flow. Pulmonary artery agenesisPulmonary vein stenosis.
- #25 .radiopaque catheter is guided under fluoroscopy into femoral vein or radial vein. after gaining central venous access, catheter is advanced into right atrium – right ventricle –main pulmonary artery and finally to the left and right pulmonary artery which leads to the lungs.
- #26 superior vena cava:great veininferior vena cava:
- #28 Pulmonary embolism (PE) is a condition in which a blood clot, usually originating from a deep vein in the legs (deep vein thrombosis), travels to the lungs and blocks blood flow. foregin body removal. Severe hypoxemia is a condition in which there is a significant reduction in the amount of oxygen in the blood A free-floating right ventricular thrombus is a blood clot that has formed in the right ventricle of the heart and is not attached to the heart wall
- #30 .Acute renal failure (ARF) is a sudden loss of kidney function, resulting in an inability to filter waste and excess fluids from the blood Acidosis is a medical condition in which there is an excess accumulation of acid in the body fluids, resulting in a decrease in pH level below 7.35. Cardiac dysrhythmias refer to any abnormal heart rhythm or beat pattern.
- #31 Antihistamines are medications used to relieve symptoms of allergies, such as hay fever, hives, and itching.phenhydramine (Benadryl), loratadine (Claritin), fexofenadine (Allegra), and cetirizine (Zyrtec).
- #32 International Normalized Ratio (INR), A flushing sensation is a feeling of warmth or heat that spreads over a person's skin,
- #33 An arterial closure device is a medical device used to close an arterial puncture site after a diagnostic or therapeutic procedure. The purpose of an arterial closure device is to prevent bleeding and promote healing after an arterial puncture, which is a procedure that involves accessing the arterial system through a small puncture in the skin. A hematoma is a collection of blood that has escaped from the blood vessels into surrounding tissues. pulse, skin temperature, color, and sensation in the affected area, as well as the presence of any signs of nerve injury or ischemia (reduced blood flow).
- #36 An endoscope is a medical instrument used to visualize internal organs and tissues. Endoscopes consist of a long, flexible tube with a light source and a camera at the end. The endoscope can be inserted into the body through a natural opening, such as the mouth, or through a small incision in the skin. The images captured by the endoscope are displayed on a monitor, allowing the healthcare provider to examine the inside of the body in real-time.
- #37 initial examination of the hypopharynx (the part of the throat located behind the mouth and below the larynx) in patients presenting to an otolaryngologist (ear, nose, and throat doctor) is often a good choice, as it provides a non-invasive and detailed view of the area
- #38 Indirect laryngoscopy: This is performed using a mirror or a fiberoptic scope to visualize the larynx from outside the mouth. This method is commonly used in the office setting and does not require general anesthesia.. Direct laryngoscopy: This is performed using a laryngoscope, which is a specialized instrument with a light source and a blade that is inserted into the mouth to visualize the larynx directly. This method requires general anesthesia and is typically performed in the operating room.
- #41 after .
- #43 Stridor is a high-pitched, wheezing sound that is heard during breathing.
- #45 shortness of breath or difficulty breathing. laryngospasm is a sudden, involuntary contraction of the muscles in the larynx (voice box) that can partially or completely block the airway. This can cause difficulty breathing, stridor (high-pitched breathing sound), and a sensation of choking or suffocating. Laryngospasm can be triggered by a variety of factors, including irritation of the larynx, exposure to allergens or irritants, acid reflux, and anesthesia
- #50 The pleural space is a small fluid-filled area between the pleural membranes surrounding the lungs in the chest, allowing the lungs to move smoothly during breathing. Abnormalities in the pleural space can cause chest pain, shortness of breath, and other symptoms.
- #53 Traumatic pneumothorax is a condition that occurs when air enters the pleural space (the area between the pleural membranes surrounding the lungs in the chest) and causes the lung to collapse. This can happen due to a puncture or injury to the chest, such as a stab wound, a broken rib, or a puncture from a medical procedure. Hemopneumothorax is a condition in which air and blood accumulate in the pleural space (the area between the pleural membranes surrounding the lungs in the chest), causing the lung to collapse, Spontaneous pneumothorax is a condition in which air accumulates in the pleural space (the area between the pleural membranes surrounding the lungs in the chest), causing the lung to partially or completely collapse without any obvious cause
- #61 Crepitus is a medical term used to describe the grinding or crackling sound or sensation that occurs when bones rub against each other. I
- #65 Fiberoptic endoscopy (or simply endoscopy) is a medical procedure in which a thin, flexible tube with a light and camera at the end is used to examine the inside of a hollow organ, such as the digestive tract, lungs, or urinary tract. It is a type of minimally invasive procedure that allows for visualization of the internal structures without the need for open surgery
- #67 Empyema is a medical condition in which pus accumulates in the pleural cavity, the space surrounding the lungs in the chest.
- #76 ESubcutaneous emphysema is a condition in which air or gas is present in the tissue under the skin. empyema is a medical condition in which pus accumulates in the pleural cavity, the space surrounding the lungs in the chest.