DIAGNOSTIC EVALUATION

Assessment of Respiratory Function

Pulmonary function Test-performed by a technician using a spirometer(volume collecting device

attached to a recorder)-use to evaluate ventilatory function

Tidal volume – amt of air inhaled and exhaled during the normal respiration

Inspiratory reserve volume –amt of air inspired at the end of a normal inspiration

Expiratory reserve volume – amt of air expired following normal respiration

Residual volume- amt of air left in lungs after maximal expiration Vital capacity – total volume of air that can be expired after maximal

inspiration Total lung capacity – total volume of air in the lungs when maximally

inflated Inspiratory capacity – maximum amt of air that can be inspired after

normal expiration Forced vital capacity –capacity of air exhaled forcefully and rapidly

following maximal inpiration Minute volume – amt. of air breathed per minute

Nursing consideration: Rest after the procedure (can cause fatigue)

Arterial Blood Gas studies-aid in assessing the ability of the lungs to provide adequate oxygen and remove carbon dioxide

-assess the ability of the kidney to reabsorb or excrete bicarbonate ions to maintain normal body ph

-obtained through arterial puncture Radial Brachial Femoral artery Indwelling arterial catheter

Arterial oxygen tension (PaO2) – indicates degree of oxygenation of blood

Arterial Carbon dioxide tension (PaCO2) – indicates the adequacy of alveolar ventilation

pH 7.35-7.45PaO2 80-*100 mm

HgPaCO2 35-45 mmhgHCO3 bicarbonateion blood 22-26 mmghSaO2 95%-100%

Nursing consideration: Arterial puncture cause more

discomfort (painful) Place sample on ice to prevent

dissociation of oxygen from hemoglobin

Firm pressure at site for 5 mins. or until bleeding stops

Pulse Oximetry

o monitor oxygen saturation of hemoglobin (SpO2)

o effective in monitoring subtle or sudden changes in oxygen saturation

o non-invasive (a probe or a sensor)

- Sensor detects light signals generated by the oximeter and reflected by blood pulsing through the tissue at the probe

- Finger tip, forehead, earlobe and bridge of the nose

o NORMAL SpO2 = 95% - 100%

o 85% = indicates that tissues are not receiving enough oxygen

o UNREALIABLE –cardiac arrest, shock, low perfusions ( sepsis, peripheral vasculature, hypothermia), vasoconstriction meds, anemia, abnormal hemoglobin, high carbon monoxide level, use of dyes, patient with dark skin or nail polish, bright lights( sunlight, fluorescent, xenon lights), patient movement (shivering), hypoventilation

Cultures:

-identify organism responsible for infection

Throat culture Nasal swabs

Sputum studies o to identify pathogenic organisms o determine whether malignant cells are presento hypersentivity states (increase eosinophils)o should be within the lab in 2hrs

Deepest specimens – collect early morning after they have accumulated overnight

Expectoration – usual method for collecting sputum Clear nose and throat – rinse mouth – deep breath

– coughs

*When patient cannot induce cough – irritating aerosol of supersaturated saline, propylene glycol with ultrasonic nebulizer

IMAGING STUDIES

Chest x-ray

Computed Tomography (CT-Scan)

Magnetic Resonance Imaging (MRI)

Chest X-ray

o can detect fluid, tumors, foreign bodies, and other pathologic condition because normal pulmonary tissue is radiolucent.

Posteroanterior projection

Lateral projection

Computed Tomography (CT-Scan)-lungs are scanned in successive layers by a

narrow beam x-ray

-cross sectional view of the chest

-can distinguish fine tissue density, define pulmonary nodules and small tumors adjacent to pleural surfaces

-mediastinal abnormalities and hilar adenopathy*contrast agent – for mediastinum and its contents

Magnetic Resonance Imaging o use of magnetic field and

radiofrequency signals

o More detailed view- visualizes soft tissues

o stage brochogenic carcinoma, inflammatory activity in interstitial lung disease, acute pulmonary embolism, chronic thrombolytic pulmonary hypertension

Flouroscopic studies – invasive procedures

Pulmonary angiography rapid injection of radiopaque

agent into the vasculature of the lungs for radiographic study of pulmonary vessels

commonly to investigate thromboembolic disease of the lungs (pulmonic emboli)

Radioisotope diagnostic ProcedureLung scans:

o V/Q Scan measure the integrity of the pulmonary

vessels relative to blood flow and to evaluate blood flow abnormalities seen in pulmonary emboli

diagnosis of bronchitis, asthma, inflammatory fibrosis, pneumonia, emphysema and lung cancer

injecting a radioactive agent into peripheral vein and then obtaining a scan of the chest to detect radiation

imaging time is 20-40 mins.

Gallium Scan Detect inflammatory

conditions, abscess, adhesions and presence, location and size of tumors

Stage bronchogenic cancer Injected intravenously in

intervals

PET Scan Advance diagnostic capabilities that is

used to evaluate lung nodules for malignancies

Accurate for malignancies Detect display and metabolic changes in

tissues, distribution of regional blood flow and the distribution of fate of meds in the body

Endoscopic Procedures

Bronchoscopy

Thoracoscopy

Thoracentesis

Bronchoscopy-direct examination of larynx, trachea

and bronchi through either:

flexible fiberoptic bronchoscope thin and flexible that can be directed

into the segmental bronchi allows increase in visualization of the

peripheral airways and is ideal for diagnosing pulmonary lesions

biopsy of inaccessible tumors performed in endotracheal or

tracheostomy tubes in patient in ventilators

rigid bronchoscopes

hollow metal tube with light at its end

for removing of foreign substances

investigating the source of massive hemoptysis

performing endobrochial surgical procedures

Diagnostic brochoscopy examine tissues or collect secretions determine the location and extent of the

pathologic process and to obtain a tissue sample for diagnosis

to determine whether a tumor can be resected surgically

diagnose bleeding sites (hemoptysis)

Therapeutic brochoscopy remove foreign bodies from the trachea bronchial

tree remove secretions obstructing the trachea

bronchial tree when the patient cannot clear them treat postoperative atelectasis destroy and excise lesions

Nursing considerations: signed consent Restriction of food and fluid for 6hrs ( to

prevent aspiration) pre operative meds – to inhibit vagal

stimulation, suppress cough reflex, sedate patient and relieve anxiety (atropine and sedative or opoid)

remove dentures and oral prostheses After the procedure = NPO until cough

reflex return

Thoracoscopy pleural cavity is examined with an

endoscope indicated in diagnostic evaluation

of pleural effusions, pleural disease and tumor staging

small incisions are made into the pleural cavity in an intercostals space, fluid present is aspirated and fiber optic mediastinoscope is inserted in the pleural cavity

Nursing Considerations: assess patient for shortness of breath

(pneumothorax) minor activity restrictions monitor chest drainage system and chest

tube insertion site is essential

Thoracentesis aspiration of fluid or

air from the pleural space

Purposes: removal of fluid or air

from the pleural cavity aspiration of pleural

cavity for analysis pleural biopsy instillation of meds in

the pleural space

Biopsy-excision of a small amount of tissue

Plueral biopsy

Lung biopsy

Lymph node biopsy

Pleural Biopsy

Needle biopsy of the pleura Pleuroscopy

visual exploration through a fiberoptic bronchoscope inserted into the pleural space

need to stain the tissue to identify tuberculosis or fungi

Lung Biopsy Procedures Transcathter brochial brushing

fiberoptic bronchoscope is introduced into the bronchus under fluoroscopy and a small brush is attached to the end of the flexible wire inserted into the bronchoscope

brushed back and forth causing cells to slough off and adhere to the brush

identification of pathogenic organisms (Nocardia, aspergillus, pneumocystis jiroveci)

useful in immunologic patients

Transbronchial lung biopsy Biting or cutting forceps are introduced by

a fiberoptic bronchoscope Indicated when lung lesions are suspected

Percutaneous needle biopsy A cutting needle or a spinal type needle is

used for histologic study Analgesia maybe administered Complications are pneumothorax,

pulmonary hemorrhage and empyema

Nursing Considerations:

Monitor shortness of breath, bleeding and infection

Ask patient to report pain, redness of biopsy site, purulent drainage (pus)

Lymph node Biopsyo if scalene lymph node is palpable – biopsy can detect

pulmonary disease to the lymph nodes

o diagnosis of Hodgkin lymphoma, sarcoidosis, fungal disease, tuberculosis and carcinoma

  Mediastinoscopy – endoscopic examination of the

mediastinum for exploration and biopsy of mediastinal lymph nodes that drain the lungs

Nursing considerations: Provide adequate oxygenation Monitor for bleeding provide pain relief Instruct patient for changes in respiratory status Discharged when chest drainage is removed