identify normal parameters for common diagnostic tests. describe the purpose, significance of...
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PN 132 – DAY 2
Respiratory Nursing -
LABORATORY AND DIAGNOSTIC PROCEDURES
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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
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Respiratory Diagnostics
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Chest Xray
roentgenogram, chest radiographs
done to diagnose a chest disorder.
-visualizes: lungs vertebrae ribs heart clavicles major thoracic vessels humeri scapulae
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Nursing Interventions
Pre-exam preparation
Client needs to remove Articles of clothing Anything containing
metal
Wears a patient gown Tied (never pinned)
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Computed Tomography [CT Scan]
Pictures of small layers of lung tissue
Scanner can rotate at different angles
Non-invasive
Minimal radiation exposure
Painless
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CT Scan of the Lungs
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Compare XRAY to CT Scan
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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
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Nursing Interventions
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
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Pulmonary Angiography
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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
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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
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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
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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.
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V/Q Scan
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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)
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PFT
http://www.youtube.com/watch?v=1rjN2_hDXEY
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Pulmonary Function Test [PFT]
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
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Pulmonary Function Test [PFT]
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).
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Bronchoscopy
Bronchoscope Flexible tube with a camera
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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
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Bronchoscopy Procedure
http://www.youtube.com/watch?v=KqZc1JqArco
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Nursing Interventions
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
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LABORATORY TESTS
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Sputum Culture
Sputum specimen collected - obtained for microscopic studies - culture and sensitivity
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Cytology
Cell studies - tests for the presence of
abnormal or malignant cells
- Any body secretions - pleural fluid - abdominal fluid - pericardial fluid, etc.
Melanoma
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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
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Thoracentesis
Surgical Perforation Into the pleural
space
Excess pleural fluid removed
Sample obtained for diagnostic testing
Instillation of medication into the pleural space
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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
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Nursing Interventions
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
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Pulse Oximetry
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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.
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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.
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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
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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
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Understanding ABGsAcid/Base Balance
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Arterial Blood Gases [ABG]
Done by Arterial Blood Draw
Measures lung’s ability to: Oxygenate arterial blood Remove Carbon Dioxide
Evaluates Acid-Base Balance
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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
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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
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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%
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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
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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
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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
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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
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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
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When we lose the balance…
Respiratory Acidosis
pH
( below 7.35)
PaCO2
(above 45 mmHg)
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When we lose the balance…
Respiratory Alkalosis
pH
( Above 7.45)
PaCO2
(below 35 mmHg)
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When we lose the balance…
Metabolic Acidosis
Increased H+ (Hydrogen)
Excess Loss (decrease) HCO3- (Bicarbonate)
pH( < 7.35 )
HCO3- (Bicarbonate) < 22 mEq/Liter
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When we lose the balance…
Metabolic Alkalosis
Decreased H+ (Hydrogen)
Increased HCO3- (Bicarbonate)
pH( > 7.45)
HCO3- (Bicarbonate) > 26 mEq/Liter
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The Land of ABG Activity
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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
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Let’s Meet an ABG Villager
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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
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Learning Our Villager’s First Name
This Villager’s pH = 7.60
What is herFIRST NAME???
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Learning Our Villager’s First Name
Hello! My first name is UNCOMPENSATED
My pH (7.60) is above Normal Range!
Normal is (7.35-7.45)
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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
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Learning Our Villager’s Middle Name
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
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Learning Our Villager’s Middle Name
If her PaCO2- is < 35 or > 45Her Middle Name is
RESPIRATORY
If her HCO3- is < 22 or > 26Her Middle Nname is
METABOLIC
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Learning Our Villager’s Middle Name
Our Villager’s
PaCO2- = 30(Carbon dioxide in arterial blood)
HCO3- = 22(Value of Bicarbonate in the bloodstream)
What is herMiddle Name??
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Learning Our Villager’s Middle Name
My Middle Name is
RESPIRATORY !
My PaCO2- (30) is BELOW
Normal Range = 35 – 45
My HCO3- (22) is NORMAL Normal Range = 22 - 26
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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
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Learning Our Villager’s Last Name
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
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Learning Our Villager’s Last Name
Our villager’s pH is 7.60 > 7.45
Her Last Name is
ALKALOSIS
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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
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UNCOMPENSATED RESPIRATORY ALKALOSIS
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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
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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)
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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
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QUESTIONS?