Identify normal parameters for common diagnostic tests. Describe the purpose, significance of...

PN 132 – DAY 2

Respiratory Nursing -

LABORATORY AND DIAGNOSTIC PROCEDURES

Objectives

Identify normal parameters for common diagnostic tests.

Describe the purpose, significance of results, and nursing interventions related to diagnostic examinations of the respiratory system.

Identify how to interpret ABG lab findings

Respiratory Diagnostics

Chest Xray

roentgenogram, chest radiographs

done to diagnose a chest disorder.

-visualizes: lungs vertebrae ribs heart clavicles major thoracic vessels humeri scapulae

Nursing Interventions

Pre-exam preparation

Client needs to remove Articles of clothing Anything containing

metal

Wears a patient gown Tied (never pinned)

Computed Tomography [CT Scan]

Pictures of small layers of lung tissue

Scanner can rotate at different angles

Non-invasive

Minimal radiation exposure

Painless

CT Scan of the Lungs

Compare XRAY to CT Scan

Helical CT Scan Also called

Spiral CT Scan Volume-Averaging CT Scanning

Continuously obtains images

Produces faster and more accurate results

Images the chest and abdomen in just one breath-hold (about 30 seconds)

Contrast imaging can also be done


Patient teaching re: the procedure

Patient prep similar to CXR

Monitor post-contrast injection s/sx of allergic reaction to the contrast

medium

Allay the anxiety of claustrophobia

Answer questions

Pulmonary Angiography

Pulmonary Angiography

Radiographic contrast material injected into the pulmonary arteries

Visualization of the pulmonary vasculature

Detects: Pulmonary Embolism (clot) Variety of lesions (tissue damage) in the

pulmonary vessels

When would we use Pulmonary Angiography ?

Let’s say…Pulmonary Embolism is suspected A lung CT scan will be done first If lung CT scan is negative

pulmonary embolism is ruled out

However…. If the Lung CT Scan is uncertain If there are 2 or more other possibilities

Definitive diagnosis may involve a pulmonary

angiography

VENTILATION-PERFUSION SCAN (V/Q Scan)

Studies Air Flow (ventilation) Blood Flow (perfusion)

Purpose is to look for blood clots (pulmonary emboli) in the lungs

V/Q used in mathematical equations that calculate airflow and blood flow

V/Q Scan Procedure Performed in the radiology department

2-step procedure

Multiple pictures of the chest are taken from different angles Special camera that detects a radionuclide

For half of these pictures Patient breathes from a tube that has a mixture of air, oxygen, and a slightly

radioactive version of a gas called xenon Measures airflow in different parts of the lung

For the other half of the pictures Camera tracks an injected radionuclide Determines blood flow in different parts of the lung

Embolus is suspected in areas of the lung that have good airflow but poor blood flow.

Except for the minor discomfort of having the IV placed, the test is painless. It usually takes less than one hour.

V/Q Scan

Pulmonary Function Test [PFT]

Assesses the presence and severity of

disease in large and small airways

Composed of various procedures Lung Volume Tests Ventilation Tests (Volumes at rest

breathing) Pulmonary Spirometry (measures how

fast and how much air you breath out)

PFT

http://www.youtube.com/watch?v=1rjN2_hDXEY




Lung Volumes

Vital Capacity Volume of air Maximum inhalation slowly exhaled

Inspiratory Capacity Largest amount of air Inhaled in one breath from the resting expiratory level

(approx 3500ml)

Total Lung Capacity Volume of air in the lung after maximum inhalation

(approx 5800ml)

Video explanation with chart

http://humanphysiology.hubpages.com/hub/Lung-Volumes-and-Capacities


Ventilation Measures the amount of air inhaled and

exhaled in each respiratory cycle (at rest breathing = tidal volume).

Pulmonary Spirometry Evaluates the amount of air that can be

forcefully exhaled after maximum inhalation [big breath in and out (blow out for 6 seconds)] AKA Vital Capacity (which can include

peakflow FEV1).

Bronchoscopy

Bronchoscope Flexible tube with a camera

Bronchoscopy

Bronchoscope is passed through the nose, larynx, trachea, and bronchi

Local or general anesthetic may be given

Observation of the respiratory structures

Tissue samples may be obtained

Secretions can be suctioned for sampling

Bronchoscopy Procedure

http://www.youtube.com/watch?v=KqZc1JqArco




Pre-Procedure

Explain Procedure Answer Questions Allay Anxiety

Post-Procedure NPO until gag reflex

returns (about 2 hours) Semi-Fowler’s position Turn side to side

Eases removal of secretions Monitor for laryngeal

edema and laryngospasms

Monitor sputum S/Sx hemorrhage

Blood streaked sputum is expected to last for a few days after biopsy

LABORATORY TESTS

Sputum Culture

Sputum specimen collected - obtained for microscopic studies - culture and sensitivity

Cytology

Cell studies - tests for the presence of

abnormal or malignant cells

- Any body secretions - pleural fluid - abdominal fluid - pericardial fluid, etc.

Melanoma

Lung Biopsy

Open lung biopsy Transbronchial

Done through a bronchoscope

Cells and/or secretions obtained for testing

Done when pulmonary disease cannot be diagnosed by other means

Nursing Interventions Same as for

bronchoscopy

Thoracentesis

Surgical Perforation Into the pleural

space

Excess pleural fluid removed

Sample obtained for diagnostic testing

Instillation of medication into the pleural space

Thoracentesis

Diagnostic tests on pleural fluid - Specific gravity - RBCs - WBCs - protein - glucose - culture and sensitivity - abnormal or malignant cells - biopsy of the pleura.

Thoracentesis video

http://www.bing.com/videos/search?q=thoracentesis+video&FORM=VIRE1

http://www.bing.com/videos/search?q=thoracentesis+video&FORM=VIRE1


During procedure: Monitor vital signs Monitor respiratory status Monitor general appearance

After procedure: Position patient comfortably on the unaffected

side Continue to monitor patient respiratory status

and vital signs

Pulse Oximetry

Pulse Oximetry (SpO2)

Continuous peripheral monitoring of the pulse and saturation of oxygen in the blood

Assessment of gas exchange

Noninvasive method

Normal Range = 95-100%

Probe is applied to a finger, earlobe, toe, or the bridge of the nose.

Pulse Oximetry (SpO2)

Monitor displays the hemoglobin- oxygen saturation and pulse rates

Allows the nurse to see continuous

changes in the pt.’s oxygen

saturations

Interventions can happen immediately.

Pulse Oximetry - Precautions

For Best Results Do Not:

Place the probe on an extremity that has an injury, B/P cuff, IV, or arterial line in place

Do: Place the probe over a pulsating vascular blood

bed Protect the probe from strong light

Remove nail polish May affect the reading

Avoid excess patient movement

Note: Hypothermia, hypotension, and vasoconstriction can affect readings

Pulse Oximetry - Considerations

SpO2 < 85% (normal 95-100%) Weakened ability of hemoglobin to

release oxygen to the plasma

SpO2 < 70% Life threatening

If patient has circulatory problems: Probe may not be able to transmit

If Pulse Oximeter unable to accurately transmit: ABGs should be drawn

Understanding ABGsAcid/Base Balance

Arterial Blood Gases [ABG]

Done by Arterial Blood Draw

Measures lung’s ability to: Oxygenate arterial blood Remove Carbon Dioxide

Evaluates Acid-Base Balance

ABG Draw

Procedure:

5 mL (5cc) syringe with needle

Usually radial artery is used

Approximately 1mL (1cc) of blood is drawn

Apply direct pressure to the site for at least 5 minutes

If patient is taking aspirin, coumadin, or other blood thinner apply direct pressure for 20 minutes

ABG Results Measures:

pH Hydrogen (H+) ions present

PaO2 Partial pressure of oxygen dissolved in arterial blood

HCO3 Calculated value of amount of bicarbonate (HCO3-) in

the bloodstream PaCO2

Amount of carbon dioxide dissolved in arterial blood Base Excess (B.E.)

Amount of excess/insufficient level of bicarbonate in the system

SaO2 Arterial oxygen saturation

Arterial Blood Gases

Blood Gas Normal Range

pH 7.35 – 7.45

PaO2 80 – 100 mm Hg

HCO3 22 – 26 mEq/Liter

PaCO2 35 – 45 mm Hg

Base Ions -2 to +2 mEq/Liter

SaO2 95 – 100%

Acid/Base Balance

Body uses Acids and Bases to maintain homeostasis

Respiratory and Renal systems both contribute to the balance Respiratory System can effect change in 15-30

minutes Renal System takes hours to days to have an effect

Acids and Bases are counter balanced

ABG measures this acid/base status of the arterial blood

Understanding Acid/Base Balance

Respiratory System Intake of oxygen and release of CO2 CO2 is a volatile acid

Decreased respiratory rate = retain CO2 increased CO2 in blood

Acidosis

Increased respiratory rate = blow off CO2 decreased CO2 in blood

Alkalosis

Understanding Acid/Base Balance

Renal System Kidneys get rid of non-volatile acid

(Hydrogen – H+)

Maintain constant Bicarbonate (HC03-) level Bicarbonate is the body’s base

Understanding Acid/Base Balance “Acidosis”

Excess H+ (Hydrogen) elevated pH

Decreased HCO3- (Bicarbonate)

Kidneys try to compensate byExcreting H+ Retaining HCO3-

Respiratory System tries to compensate by Increasing ventilationBlow off CO2 to decrease the acidosis

Understanding Acid/Base Balance “Alkalosis”

Decrease of H+ and excess of HCO3-

Kidneys try to compensate by Excreting HCO3- Retaining H+

Respiratory System tries to compensate by Decreasing ventilations (hypoventilation) Retain CO2 and decrease the alkalosis

When we lose the balance…

Respiratory Acidosis

pH

( below 7.35)

PaCO2

(above 45 mmHg)


Respiratory Alkalosis

pH

( Above 7.45)

PaCO2

(below 35 mmHg)


Metabolic Acidosis

Increased H+ (Hydrogen)

Excess Loss (decrease) HCO3- (Bicarbonate)

pH( < 7.35 )

HCO3- (Bicarbonate) < 22 mEq/Liter


Metabolic Alkalosis

Decreased H+ (Hydrogen)

Increased HCO3- (Bicarbonate)

pH( > 7.45)

HCO3- (Bicarbonate) > 26 mEq/Liter

The Land of ABG Activity

Welcome to the Village

Once upon a time there was a village known as ABG

Everyone there was related Only a limited number of names

There were also very polite Etiquette for learning each other’s names

All villagers have a first, middle, and last name

To learn their whole name, we must look at one name at a time

Let’s Meet an ABG Villager

Learning Our Villager’s First Name

We need to look at her pH first The Hydrogen (H+) ions in her

blood stream

If pH is Between 7.35 – 7.45

(normal) Her first name is

COMPENSATED

< 7.35 OR > 7.45 Her first name is

UNCOMPENSATED


This Villager’s pH = 7.60

What is herFIRST NAME???


Hello! My first name is UNCOMPENSATED

My pH (7.60) is above Normal Range!

Normal is (7.35-7.45)

Learning Our Villager’s Middle Name

***Warning! Many villagers have the same first and

last name!

Knowing our villager’s Middle Name will give us more information about her!

It will tell us if it is Respiratory or

Metabolic


To find out our villager’s Middle Name we need to look at her:

PaCO2- (Amount of Carbon Dioxide in

her arterial blood)

Normal Range = 35 - 45andHCO3-

(Amount of Bicarbonate in her bloodstream)

Normal Range = 22 - 26


If her PaCO2- is < 35 or > 45Her Middle Name is

RESPIRATORY

If her HCO3- is < 22 or > 26Her Middle Nname is

METABOLIC


Our Villager’s

PaCO2- = 30(Carbon dioxide in arterial blood)

HCO3- = 22(Value of Bicarbonate in the bloodstream)

What is herMiddle Name??


My Middle Name is

RESPIRATORY !

My PaCO2- (30) is BELOW

Normal Range = 35 – 45

My HCO3- (22) is NORMAL Normal Range = 22 - 26

Learning Our Villager’s Last Name

To find out our villager’s Last Name we

need to look at her pH again: Normal pH is 7.35 - 7.45

If her pH is < 7.35 Her Last Name is ACIDOSIS

If her pH is > 7.45 Her Last Name is ALKALOSIS


To have a PERFECT Last Name our villager’s pH would have to be 7.40

This rarely happens!

If her pH is 7.35 - 7.39 She’s thinking of marrying into the ACIDOSIS

family

If her pH is 7.41 - 7.45 She’s thinking of marrying into the

ALKALOSIS family


Our villager’s pH is 7.60 > 7.45

Her Last Name is

ALKALOSIS

Our Villager’s Full Name is: First Name

UNCOMPENSATED

pH = 7.60 *above normal range 7.35 – 7.45

Middle Name RESPIRATORY

PaCO2- = 30 * below normal range 35 – 45

HCO3- = 22 *within normal range 22 – 26

Last Name ALKALOSIS

pH = 7.60 *above normal range 7.35 – 7.45

UNCOMPENSATED RESPIRATORY ALKALOSIS

Summary

Idenified normal parameters for common diagnostic tests.

Described the purpose, significance of results, and nursing interventions related to diagnostic examinations of the respiratory system.

Identified how to interpret ABG lab findings

Assignment

Read and review AHN (pp. 378 – 384) PowerPoint Lecture handouts (Day 1 and Day

2) Land of ABG handout

Study for Quiz 1 (to be taken on Day 3) Will cover Day 1 and Day 2 material

Select topic and begin research for Mid-Term Paper (due Day 5)

Next Class

Disorders of the Upper Airway Read and review

AHN - pp. 384 – 395

Quiz 1 Respiratory A&P Respiratory Assessment Respiratory Labs and Diagnostics ABG Lab Findings

QUESTIONS?

Identify normal parameters for common diagnostic tests. Describe the purpose, significance of...

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