Diagnostic Test Chest x-ray film (radiograph)

Description provides info regarding anatomical locaxn & appearance of lungs bodys x-ray absorpxn: - bone: high; white - tissue: moderate; gray - air: low; black specimen obtained by expectoraxn/tracheal sucxning identificaxn of organisms/abno cells tracheal sucxning: - aseptic technique - hyperoxygenate/hyperventilate for 1 min, 100% O2 (so that px will have O2 reserve) - lubricate catheter w/ sterile H2O - tracheal sucxning 4 in - nasotracheal sucxning: insert to induce cough reflex - dont apply sucxn while inserting - sucxn: 10-15 secs - rotate (circular moxn) & withdraw

Pre Procedure remove all jewelry & metal objects fr chest area (bra for ladies) asses cxs ability to inhale & hold breath question female regarding pregnancy

Procedure

Post Procedure

Assist cx to dress

Sputum specimen

determine purpose of collecxn & check w/ instituxnal policy for proper collecxn of specimen obtain an early morning sterile specimen obtain 15ml sputum tell cx to rinse mouth w/ H2O bfore collecxn instruct cx to take several deep breaths then cough deeply to obtain sputum always collect specimen before cx begins antibiotic therapy informed consent cx NPO fr midnight bfore procedure (avoid aspiraxn, avoid vomiting [gag reflex might be stimulated], so that area is clean) obtain VS assess result of coagulaxn studies remove dentures/eyeglasses prepare sucxn equipment administer meds for sedaxn as prescribed have emergency resuscitaxn equipment available monitor VS assess results of coagulaxn studies administer sedaxn as prescribed instruct px to lie still during the procedure [then put pressure @ inguinal area] have emergency resuscitaxn equipment available informed consent obtain VS prepare px for ultrasound/chest radiograph if prescribed informed consent maintain cx NPO inform cx that local anesthetic will be used but sensaxn of pressure during needle inserxn & aspiraxn may be felt administer analgesics & sedatives as prescribed

transport specimen to lab STAT assist cx w/ mouth care

Bronchoscopy

direct visual exam of larynx, trachea, bronchi w/ fiberoptic bronchoscope

!!! semi fowlers position

assess for return of gag reflex maintain NPO until gag reflex returns 1-2 hrs in recovery rm (sedaxn med)

Pulmonary angiography [minor surgery]

invasive fluoroscopic procedure catheter inserted through antecubital/femoral vein into pulmonary artery/one of its branches involves injecxn of iodine/radiopaque/contrast material

monitor peripheral neurovascular status of unaffected extremity assess inserxn site for bleeding monitor delayed axn of dye

Thoracentesis [minor surgery]

removal of fluid/air fr pleural space via transthoracic aspiraxn [extract fluid fr lungs, btween intercostals spaces, getting pleural fluid fr px]

px posixn: sitted upright w/ arms & head supported by a table @ bedside if px cant sit: lying in bed on unaffected site w/ ...

monitor VS monitor respi status apply a pressure dressing & assess puncture site for bleeding/crepitus monitor for s of pneumothorax, air embolism [air; bubbles], pulmonary edema monitor VS apply dressing to the biopsy site & monitor for drainage or bleeding

Lung biopsy [minor surgery]

percutaneous lung biopsy obtain tissue for lung analysis by culture/cytological exam needle biopsy: identify pulmonary lesions, changes in lung tissue & the cause ultrasound guided [where to get specimen]

Ventilation perfusion

perfusion scan: evaluates blood flow to lungs ventilaxn scan: determines patency of the pulmonary

informed consent

lung scan

airways & detects abnormalities in ventilaxn radionucleotide may be injected for procedure ventilation: in-out air perfusion: in-out blood dye: radio opaque dye ID injecxn used to assist in dxsing various infectious dses determine hypersensitivity/previous rxns to skin tests e.g. mantoux test: TB * vesiculaxn: w/ H2O

establish IV access administer sedaxn as prescribed have emergency resuscitaxn equipment available site: must be free of excessive body hair, dermatitis & blemishes perform allens test * allens test: done to know whether ulnar artery can supply enough blood & O2 if the radial artery is damaged - hand elevated & px is asked to make a fist for 30 secs [10-20] - pressure applied ovr ulnar & radial arteries so as to occlude both of them - still elevated, hand is opened, should appear blanched (pallor observed on fingernails) - ulnar pressure is released & color should return in 7 secs cx rest 30 min bfore specimen collecxn avoid ... apply injecxn @ upper of inner surface of L arm circle & mark the test site document date, time ... assess test site for amt of induraxn (hard swelling, ... )

Skin test

Arterial blood gas

measurement of dissolved O2 & CO2 in the arterial blood to reveal acid-base state & how well the O2 is being carried to the body

place specimen on ice (bec blood fr artery=highly O2ated; coagulate right away) [then send to lab STAT] note on lab form pxs temp note on lab form O2 & type of ventilaxn that cx is receiving apply pressure on puncture site ...

Pulse oximetry

Chest physiotherapy

Postural drainage

Chest tube thoracotomy [minor surgery]

non-invasive registers O2 ... aka back clap best time: am upon rising, 1 hr bfore meals, 2-3 hrs aftr meals indicaxn: loosen secrexn contraindicaxns: - respi distress - hx of fractures - chest incisions use of gravity best time: am upon rising, 1 hr bfore meals, 2-3 hrs aftr meals indicaxn: to promote drainage contraindicaxns: - unstable VS - ICP chest tubes/H2O seal drainage inserxn of a catheter into intrapleural space to maintain constant negative pressure when air/fluid have accumulated * terms - pneumothorax = air - hemothorax = blood - pleural effusion = fluid!!! px w/ thora-bottle must have clamp (on bedside) ~ 300cc H2O ~ oscillation: up-down of H2O in tubing connected to lungs (must have; indicates there is change in pressure [in- / exhale] in lungs)

!!! dont do to px w/ lung tumors stop if pain occurs

mouth care

* cx instrucxn for spirometry [hinihipan] - use lips to form seal around mouth piece - inspire deeply, hold inspiraxn for a few secs, exhale forcefully - avoid use of spirometry aftr meals (may feel nauseated)

stop if cyanosis/exhaustion occurs

mouth care maintain posixn 5-20 mins aftr

informed consent

chest tube is inserted to under H2O drainage to allow for the space of air/fluid & prevent reflux of air into chest for accumulaxn of air, chest tube is placed in 2nd or 3rd intercostals space, anterior on mid axillary line (air rises to upper chest) for drainage of fluid, chest tube is placed in 8th9th intercostals space, maxilliary line