PULMONARY FUNCTION TEST

Pulmonary function test (PFTs) are routinely used in patients with chronic respiratory disorders. are a group of procedures that measure the function of the lungs, revealing problems in the way a patient breathes. The tests can determine the cause of shortness of breath and may help confirm lung diseases, such as asthma, bronchitis or emphysema. The tests also are performed before any major lung surgery to make sure the person won't be disabled by having a reduced lung capacity.

Purposes: Diagnose certain types of lung disease (such as asthma, bronchitis, and emphysema) Find the cause of shortness of breath Measure whether exposure to chemicals at work affects lung function Check lung function before someone has surgery

It also can be done to: Assess the effect of medication Measure progress in disease treatment

Preparation The patient should not eat a heavy meal before the test, nor smoke for four to six hours beforehand. The patient's doctor will issue specific instructions about whether or not to

use specific medications, including bronchodilators or inhalers, before the test. Sometimes, medication may be administered as part of the test. Precautions Pulmonary function tests shouldn't be given to patients who have had a recent heart attack, or who have certain other types of heart disease. It is crucial that the patient cooperate with the health care team if accurate results are to be obtained.

Risks The risk is minimal for most people, although the test carries a slight risk of a collapsed lung in some patients with lung disease.

Normal results Normal results are based on a person's age, height, and gender. Normal results are expressed as a percentage of the predicted lung capacity. The prediction takes into account the patient's age, height, and sex.

Abnormal results Abnormal results mean that the person's lung capacity is less than 80% of the predicted value. Such findings usually mean that there is some degree of chest or lung disease.
Symbol FVC Description Vital capacity performed with a maximally forced expiratory effort. Volume of air exhaled in the specified time during the performance is forced vital capacity; FEV1 is volume exhaled in 1 second. FEV1 expressed as a percentage of the forced vital capacity. Remarks Forced vital capacity is often reduced in COPD because of air trapping. A valuable clue to the severity of the expiratory airway obstruction. Another way of expressing the presence or absence of airway obstruction. An indicator of large airway obstruction. Slowed in small airway obstruction. Slowed in obstruction of smaller airway. An important factor in exercise tolerance.

Term used Forced vital capacity

Forced expiratory volume (qualified by subscript indicating the time intervals in seconds. Ratio of time forced expiratory volume to forced vital capacity Forced expiratory flow Forced midexpiratory flow Forced end expiratory flow Maximal voluntary ventilation

FEVt1, usually FEV1 FEVt /FVC %, usually FEV1 / FVC % FEF 200-1200 FEF 25%-75% FEF 75%-85% MVM

Mean forced expiratory flow between 200 and 1,200 mL of the FVC. Mean forced expiratory flow during the middle half of FVC. Mean forced expiratory flow during the terminal portion of the FVC. Volume of air expired in a specified period (12 seconds) during repetitive maximal effort.

ARTERIAL BLOOD GAS

Arterial Blood Gas (ABG) test measures the acidity (pH) and the levels of oxygen and carbon dioxide in the blood from an artery. This test is used to check how well your lungs are able to move oxygen into the blood and remove carbon dioxide from the blood.

Purposes:

Check for severe breathing problems and lung diseases, such as asthma, cystic fibrosis, or chronic obstructive pulmonary disease (COPD). See how well treatment for lung diseases is working. Find out if you need extra oxygen or help with breathing (mechanical ventilation). Find out if you are receiving the right amount of oxygen when you are using oxygen in the hospital. Measure the acid-base level in the blood of people who have heart failure, kidney failure, uncontrolled diabetes, sleep disorders, severe infections, or after a drug overdose.

Preparation: Tell your doctor if you:

Have had bleeding problems or take blood thinners, such as aspirin or warfarin (Coumadin). Are taking any medicines.

Are allergic to any medicines, such as those used to numb the skin (anesthetics). If you are on oxygen therapy, the oxygen may be turned off for 20 minutes before the blood test. This is called a "room air" test. If you cannot breathe without the oxygen, the oxygen will not be turned off. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results may mean. To help you understand the importance of this test, fill out the medical test information form.

Normal adult arterial values*

pH pCO2 pO2 CO2 Base Excess/Deficit SO2 7.35-7.45 35-45 torr >79 torr 23-30 mmol/L 3 mEq/L >94%

Normal Adult Venous Values*

pH pCO2 pO2 CO2 Base Excess/Deficit SO2 7.31-7.41 41-51 torr 30-40 torr 23-30 mmol/L 3 mEq/L 75%

Blood Gas Abbreviations

BE HCO3 H2CO3 PO2 PaO2 PvO2 PCO2 PaCO2 PvCO2 SO2 SaO2 SvO2 TCO2 Base Excess (positive number) or Base Deficit (negative number) Bicarbonate Carbonic Acid Partial Pressure of Oxygen Partial Pressure of Oxygen in Arterial Blood Partial Pressure of Oxygen in Venous Blood Partial Pressure of Carbon Dioxide Partial Pressure of Carbon Dioxide in Arterial Blood Partial Pressure of Carbon Dioxide in Venous Blood Oxygen Saturation Oxygen Saturation in Arterial Blood Oxygen Saturation in Venous Blood Total Carbon Dioxide Content

PULSE OXIMETRY

Pulse oximetry a non-invasive method of continuously monitoring the oxygen saturation of hemoglobin (SpO2 or SaO2). medical devices that monitor the level of oxygen in a patient's blood and alert the health-care worker if oxygen levels drop below safe levels, allowing rapid intervention.

Function: A pulse oximeter works by passing a beam of red and infrared light through a pulsating capillary bed. The ratio of red to infrared blood light transmitted gives a measure of the oxygen saturation of the blood. The oximeter works on the principle that the oxygenated blood is a brighter color of red than the deoxygenated blood, which is more blue-purple. First, the oximeter measures the sum of the intensity of both shades of red, representing the fractions of the blood with and without oxygen. The oximeter detects the pulse, and then subtracts the intensity of color detected when the pulse is absent. The remaining intensity of color represents only the oxygenated red blood. This is displayed on the electronic screen as a percentage of oxygen saturation in the blood.

False Low Readings

Hypoperfusion of the censored extremity, inappropriate application of the sensor, calloused skin and extraneous movement can all cause falsely low oximetry readings, which can make health personnel treat the patient for hypoxemia when there is no need.

False High Readings

If hemoglobin is bound to something else besides oxygen, or if the patient has carbon monoxide or cyanide poisoning, the oximeter can produce a falsely high reading. Such readings can mask signs of hypoxemia, a potentially dangerous condition.

CULTURE

Culture a test to find a bacterial or fungal infection in the throat. A sample swabbed from the throat is put in a special cup (culture) that allows infections to grow. If an infection grows, the culture is positive.

Purpose:

Find the cause of a sore throat. Most sore throat infections are caused by a virus. A throat culture shows the difference between a bacterial infection and a viral infection. Finding the organism that is causing the infection can guide treatment. Check a person who may not have any symptoms of infection but who carries bacteria that can spread to others. This person is called a carrier.

Normal Results: The presence of the usual mouth and throat bacteria is a normal finding.

Abnormal Results Mean: An abnormal result means bacteria or other organism is present. This is usually a sign of infection.

SPUTUM STUDIES

Sputum is the substance expelled from your respiratory tract when you cough or clear your throat. It may contain a variety of material, including mucus, cellular debris, blood, pus and bacteria. is obtained for analysis to identify pathogenic organisms and to determine whether malignant cells are present.

Purpose: To help identify microorganisms that is causing respiratory disease or infection. For obtaining sputum specimen is to test for infectious tuberculosis. Used to identify disease-producing organisms that may be causing pneumonia, bronchitis, lung abscess, or other respiratory disease. Used to identify conditions such as: aspiration pneumonia, histoplasmosis, cryptococcosis, blastomycosis, mycoplasma pneumonia, plague, mycobacterial infection, and pneumocystic pneumonia.

Preparation and Procedure Before collecting a sputum specimen for the culture or study, contact your nearest lab to obtain a sterile collection container. To collect the specimen:

In the morning when you wake up, blow your nose to discharge any nasal and sinus secretions that have accumulated during the night. Discard them. Clean and rinse your mouth, teeth and gums with water. Do not brush with toothpaste. Breathe deeply, inhaling to the full capacity of your lungs, then exhale with a cough. Expectorate sputum from your lungs into the sterile collection container. Do not expectorate saliva from your mouth. Saliva may cause contamination of the specimen, and you may be asked to collect another if it is found to be unsuitable for analysis. Deliver the specimen to the lab immediately. If this is not possible, you may refrigerate the specimen for up to 24 hours before delivering it.

Normal Results In a normal sputum sample there will be no disease-causing organisms present. Often, bacteria that normally live in the mouth will grow in a sputum culture. This does not mean that you have a lung or airway infection.

Abnormal Results Mean If the sputum sample is abnormal, the results are called "positive." Identifying the bacteria, fungus, or virus may help diagnose the cause of: Bronchitis Lung abscess Pneumonia Tuberculosis Flare up of chronic obstructive pulmonary disease or cystic fibrosis

IMAGING STUDIES

Imaging studies are tests performed with a variety of techniques that produce pictures of the inside of a patient's body.

Chest X-ray are a form of high-energy radiation and tissues of the body can absorb it to varying degrees.

Computed Tomography Scan (CT scan) an imaging method in which the lungs are scanned in successive layers by a narrow-beam x-ray.

Magnetic Resonance Imaging (MRI) similar to CT scans except that magnetic fields and radiofrequency signals are used to narrow-beam x-ray.

Fluoroscopic Studies used to assist with invasive procedures, such as a chest needle biopsy or transbronchial biopsy, performed to identify lesions.

Pulmonary angiography most commonly used to investigate thromboembolic disease of the lungs, such as pulmonary emboli and congenital abnormalities of the pulmonary vascular tree.

Radioisotope Diagnostic Procedures (Lung Scans) is a nuclear scanning test that is most commonly used to detect a blood clot that is preventing normal blood flow to part of a lung (pulmonary embolism). Several types of lung scan:

ventilation-perfusion scan gallium scan positron emission tomography

Ventilation-perfusion scan - is a nuclear scan so named because it studies both airflow (ventilation) and blood flow (perfusion) in the lungs.

Gallium scan - is a radioisotope lung scan used to detect inflammatory conditions, abscesses, adhesions, and the presence, location, and size of tumors.

Positron emission tomography (PET) - is a radioisotope study with advanced diagnostic capabilities.

ENDOSCOPIC PROCEDURE

Endoscopic procedure is a procedure where the inside of your body is examined internally using an endoscope .

Bronchoscopy - is the direct inspection and examination of the larynx, trachea, and bronchi through either flexible fiberoptic bronchoscope or a rigid bronchoscope. Purpose: Diagnostic bronchoscopy: to examine 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 Therapeutic bronchoscopy:

to remove foreign bodies from the tracheobronchial tree remove secretions obstructing the tracheobronchial tree when the patient cannot clear them treat postoperative atelectasis destroy and excise lesions

Common reasons to perform a bronchoscopy are: Lung growth, lymph node, atelectasis, or other changes seen on an x-ray or other imaging test Suspected interstitial lung disease Coughing up blood (hemoptysis) Possible foreign object in the airway Cough that has lasted more than 3 months without any other explanation Infections in the lungs and bronchi Inhaled toxic gas or chemical Bronchoscopy is also done to treat a lung or airway problem, such as: Remove fluid or mucus plugs from your airway Remove a foreign object from your airways Widen (dilate) an airway that is blocked or narrowed Drain an abscess Treat cancer using a number of different techniques Wash out an airway (therapeutic lavage)

Fibre-optic bronchoscope is the device usually used. This is a thin, flexible, telescope. It is about as thick as a pencil.

Rigid bronchoscope is used much less often. It is like a thin, straight telescope. It may be needed for some procedures, and in children. It requires a general anaesthetic. (A fibre-optic bronchoscopy only requires sedation.)

Nursing interventions BEFORE Bronchoscopy: Informed consent/ permit needed Explain procedure to the patient, tell him what to expect, to help him cope with the unknown Atropine(to diminish secretions) is administered one hour before the procedure about 30 minutes before bronchoscopy,

Valium is given to sedate patient and allay anxiety. Topical anesthesia is sprayed followed by local anesthesia injected into the larynx Instruct on NPO for 6-8 hours Remove dentures, prostheses and contact lenses The patient is placed supine with hyperextended neck during the procedure

Nursing interventions AFTER Bronchoscopy: Put the patient on Side lying position Tell patient that the throat may feel sore with some initial swallowing difficulty Maintain on NPO. Check for the return of cough and gag reflex before giving fluid per Orem. Assess sputum and respiratory status. Check vasovagal response. Watch for cyanosis, hypotension, tachycardia, arrythmias, hemoptysis, anddyspnea

NURSING ALERT! Sedation given to patients with respiratory insufficiency may precipitate respiratory arrest.

Thoracoscopy - is a diagnostic procedure in which the pleural cavity is examined with an endoscpe. Purpose: assess lung cancer take a biopsy for study determine the cause of fluid in the chest cavity introduce medications or other treatments directly into the lungs treat accumulated fluid, pus (empyema), or blood in the space around the lungs Nursing interventions: monitor the patient for shortness of breath (which might indicate pneumothorax), and minor activity restrictions, which vary depending on the intensity of the procedure monitor the chest drainage system and chest tube insertion site if essential

THORACENTESIS

Thoracentesis is a procedure to remove fluid from the space between the lining of the outside of the lungs (pleura) and the wall of the chest.

Purpose: To remove fluid or air from the chest. To determine why an abnormal amount of fluid has collected To help relieve the symptoms of shortness of breath when the fluid is causing compression of the normal lung.

Normal Results Normally the pleural cavity contains only a very small amount of fluid.

Abnormal Results Testing the fluid will help your health care provider determine the cause of pleural effusion. Possible causes include: Cancer Cirrhosis Heart failure Infection

Inflammation Malnutrition Kidney disease

If your health care provider suspects that you have an infection, a culture of the fluid may be done to test for bacteria. Risks

Bleeding Fluid buildup in the lungs Infection Pneumothorax Pulmonary edema Respiratory distress

Considerations A chest x-ray is often done after the procedure to detect possible complications.

BIOPSY

Biopsy The removal and examination of a sample of tissue from a living body for diagnostic purposes.

Purpose: Performed to determine the presence of cancer cells, establish tumor grading, and provide more information for treatment. To examine tissue for disease.

Normal Results The tissue removed is normal.

Abnormal Results An abnormal biopsy means that the tissue or cells have an unusual structure, shape, size, or condition.

This may mean you have a disease, such as cancer, but it depends on your biopsy. Risks

Bleeding Infection

Pleural biopsy - is a procedure to remove a sample of the tissue lining the lungs and the inside of the chest wall to check for disease or infection. Purpose: to determine the cause of a collection of fluid around the lung (persistent pleural effusion) or other abnormality of the pleural membrane Normal Results The pleural tissues appear normal, without signs of inflammation, infection, or cancer. Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

Abnormal Results Abnormal results may reveal cancer (including primary lung cancer, malignant mesothelioma, and metastatic pleural tumor), tuberculosis, a viral disease, a fungal disease, a parasitic disease, or collagen vascular disease.

Risks There is a slight chance of the needle puncturing the wall of the lung, which can partially collapse the lung. This usually gets better on its own. Sometimes, the patient needs a chest tube to drain the air and expand the lung. There is also a chance of excessive blood loss.

Considerations If a closed pleural biopsy is not enough to make a diagnosis, you may need a surgical biopsy of the pleura.

Lung biopsy - is a method to remove a piece of lung tissue for examination.

Purpose: Performed when there is an abnormal condition that is near the surface of the lung, in the lung itself, or on the chest wall. Performed to diagnose relatively large abnormalities seen on chest x-ray or CT scan. Normal Results Normal tissues and no microbial growth, if a culture is performed, are normal.

Abnormal Results

Bacterial, viral, or fungal lung infection Pneumonia Cancerous cells (lung cancer, mesothelioma) Immune disorder

Additional conditions under which the test may be performed:

Metastatic cancer to the lung Pneumonia with lung abscess

Risks The risks include a collapsed lung, bleeding, and infection.

A needle biopsy should NOT be performed if other tests show that you have:

Bullae (enlarged alveoli associated with emphysema) Cysts Blood coagulation disorder of any type Severe hypoxia Pulmonary hypertension Cor pulmonale

Considerations

Signs of a collapsed lung include: Shortness of breath Rapid heart rate (rapid pulse) Blueness of the skin

Lymph Node biopsy - is the removal and testing of a lymph node (or nodes) to determine if it contains cancer cells. Purpose: Improving the accuracy of cancer staging. Cancer staging is a system that classifies malignant tumors according to the extent of their spread in the body. It is used to guide decisions about treatment. Catching the spread of cancer to nearby lymph nodes as early as possible. Defining homogeneous patient populations for clinical trials of new cancer treatments.

Normal Results If a lymph node biopsy does not show any signs of cancer, it is more likely that other lymph nodes nearby are also cancer-free. This information can help the health care provider decide about further tests and treatments.

Abnormal Results Abnormal results may be due to many different conditions, from very mild infections to cancer.

For example, enlarged lymph nodes may be due to:

Cancers (breast, lung, oral) Hodgkin's lymphoma Infection (tuberculosis, cat scratch disease) Non-Hodgkin's lymphoma Sarcoidosis

Risks

Bleeding Infection (in rare cases, the wound may get infected and you may need to take antibiotics) Nerve injury if the biopsy is done on a lymph node close to nerves (the numbness usually goes away in a few months)

Assignment in NCM 103

Submitted by: Jehannah Dayanara B. Hayudini 3BSN-A Student

Submitted to: Maronie Tejon, RN Clinical Instructor

Manual On Nursing Procedures

Jehannah Dayanara B. Hayudini USM-CHS Department of Nursing Jehannah Dayanara B. Hayudini USM-CHS Department of Nursing Jehannah Dayanara B. Hayudini USM-CHS Department of Nursing