Diagnostic Exams
breathing difficult.
(DEAN Gasco)
1. NON-INVASIVE
PULMONARY FUNCTION TEST
• Measures: (Highlight ni
Dean)
1. Lung Volume
2. Lung Mechanics
3. Lung Diffusion
Capacities
• Measure respiratory
Volume
• Measures abnormalities
in respiratory function
measured by
spirometry
• Lung Volume
determination is
measured by
PLETHYSMOGRAPHY
• Spirometry - Measures
how well the lung
exhale
• Forced Spirometry -
measures flow and
volume capacities of
the lungs
• Lung Volume
Measurement detects
restrictive lung disease
such as COPD
• Testing the diffusion
capacity permits an
estimate of how
efficiently the lungs
transfer oxygen from
the air into the
bloodstream.
Vital Capacity [4,800 mL]
It is the volume of air that is
measured during slow
maximal expiration, after a
maximal inspiration
Inspiratory Capacity[3,000 mL]
Largest volume of air that can
be inhaled from resting
expiratory volume
Functional Residual Capacity
[2,400 mL]
Largest volume of air exhaled
from end-expiratory level
Inspiratory Reserve Volume
[3,100 mL]
Volume of air that can be
inhaled from a tidal volume
level
Residual Volume [1,200 mL]
It is the volume of air
remaining in the lungs at the
end of maximal expiration
Total Lung Capacity [6,000 mL]
Volume of air contained in the
lungs after maximal
inspiration
Tidal Volume [400mL-700mL]
Volume of air inhaled or
exhaled during respiratory
cycle
Reverse Vital Capacity
Maximal volume of air that can
forced fully expired
Forced Expiratory Volume
Volume of air expired during a
given time interval
Forced Expiratory Flow
Peak Expiratory Flow Rate
Maximal Voluntary Ventilation
Largest volume that can be
breathe during 10-15 seconds
interval with voluntary effort
Maximal Inspiratory Pressure
Greatest negative or sub
atmospheric pressure
Minimal Expiratory Pressure
PURPOSE:
✓ To show reduction of
volume in patients with
COPD
COPD (Chronic
Obstructive Pulmonary
disease)
✓ To test lung function
before surgery
✓ To help diagnose lung
condition (if ever
restrictive, obstructive,
cancer)
Ex:
• Tuberculosis
• Asthma
• Bronchiectasis
• Bronchitis
• COPD
✓ To check the extent of
lung disease or to help
explain new breathing
symptoms
✓ To check if you are
having side effects
from some medicines
that can make
INDICATIONS:
• Chronic Shortness of
Breath
• Asthma
• Chronic Obstructive
Pulmonary Disease
• Restrictive Lung
Disease
• Pre-Operative Testing
for Surgery Impairment
or early morning
Wheezing can be an
asthma
CONTRAINDICATIONS:
• Hemoptysis
• Pneumothorax (Air in
the lungs)
• Unstable Angina
Pectoris (Chest Pain)
• Recent Myocardial
Infection
• Thoracic Aneurysms
Aneurysms (Out
pouching of your
blood)
• Abdominal Aneurysms
• Cerebral Aneurysms
Note: Aneurysms may
cause ruptured because
of pressure.
• Recent Eye Surgery
Ex: Cataract Surgery
• Recent Abdominal or
Thoracic Surgical
Procedures
• Patients with a history
of syncope associated
with forced exhalation
Sometimes there is less
oxygen that goes to the
brain or the more mag
sysyncopy ka.
• Patients with active
tuberculosis should not
be tested
COMPLICATIONS:
✓ Trigger an asthmatic
episode
✓ Temporarily Irritate
breathing symptoms
✓ Cross Infection due to
use of mouth piece
✓ Collapse of the Lung
✓ Pneumothorax
✓ Nosocomial Infections
(Such as infections in
the hospital from)
✓ Increase ICP
✓ Oxygen Desaturation
 ✓ Fainting
✓ Bronchospasm
✓ Paroxysmal Coughing
✓ Chest Pain
RISKS: Collapse Lung PROCEDURES:
PROCEDURES: PLETHYSMOGRAPHY
1. Client to take a deep
breathe, then blow as
hard as he/she can and
expire through a mouth
piece, until he/she feel
that there is no more
air left in the lungs.
2. His/her lips should be
sealed tightly
3. Put a clip into the nose
and close it
4. All of the air of the Helium Dilution Method
client breathe in and
out must be measured
for.
5. The test should be
accurate
6. Repeat the test 3 times
to ensure an accurate
reading.
MAXIMAL VOLUNTARY
VENTILATION (MMV)
• Like the FYL Test, put a Gas Dilution Method
clip into the patient’s
nose and ask him to
tightly seal his lips
around the mouthpiece.
• Ask the client to
breathe deep and fast
for 12-15 seconds,
without stopping
• This test will be done 3
times for accuracy.
(Actually pareho gadla, ini na
part is ha ppt, an kanina is iya FACTORS:
gindictate hehe)
POST BRONCHODILATOR
TESTING
• To ask the client to
breathe in the medicine,
that would relax the
muscles around the
airway.
Ex: Benadryl, Ventolin
• Repeat the flow volume
loop test
• These 3 test measures
Lung volume:
✓ To measure the lung
capacity
✓ The normal amount of
air that you breathe in
and out. The maximal
amount of air that you RESPONSIBILITIES:
breathe in and out
✓ Amount of air DO NOT FAIL TO INSTRUCT
remaining in the lungs THE PATIENT!
✓ No Bronchodilator
✓ No Ventolin
✓ No Coffee
✓ No Smoking
1. The client will sit in the
booth?? Bangin, PULSE OXIMETER/PULSE
“airtight room.” OXIMETRY – Provides
2. Ask the client to clip estimates of arterial
his lips and nose sealed oxyhemoglobin saturation
3. Ask the client to (Sa02) by utilizing wavelengths
breathe of light to non-invasively
4. Take a deep big determine the saturation of
breathe and blow out oxyhemoglobin (Sp02)
slowly
Could be placed on index or
middle finger, toes, earlobe,
nose or forehead
1. Ask the client to keep
his lips sealed and nose If neonates, ha hand or foot
2. The client will breathe
in a mixture of helium • It is non-invasive device
and oxygen that estimates a client’s
3. This test will last 3-7 arterial blood oxygen
minutes saturation (Sa02) by
4. The client will take a means of a sensor
deep breathe and blow attached to the client.
• Has an alarm system
out.
that signals high and
low oxygen saturation
• Normal: 95%-100%
1. Will open circuit Lower 91%: Emergency
method and lung
Lower 70-80%: Life-
determination threatening
2. The lung determination
• Pulse Rate:
is measured by gas 50 bpm for adults
dilution method
technique or body RESPONSIBILITIES:
PLETHYSMOGRAPHY
3. This test is done to • No nail polish
measure functional • Check for pigmentation
residual capacity. • Check for low
perfusion
PREPARE:
• Failure to follow
instructions ✓ Attach sensor to the
• Anxiety or Fatigue connection outlet in the
• Recent or current oximeter and turn on
the machine
Respiratory Diseases
such as COPD, TB, ✓ Check the present
alarm limits
Asthma
✓ Ensure client’s safety
• Taking
Bronchodilators, INDICATIONS:
sedatives and other
drugs that affect • To monitor oxygen
breathing or all body arterial saturation
systems • To detect hypoxemia
• Time of the day: Lower 91%: Emergency
Pulmonary Function Lower 70-80%: Life-
Tests tends to arise threatening
and then fall from • Oxygen Need Therapy
morning to evening such as:
✓ Dyspnea
✓ Cardiac
Problems
 ✓ Cyanotic
CONTRAINDICATIONS:
• Abnormal Hemoglobin
• Taking Vasopressor
Drugs
• Highly callus skin
• Shivering
• Hyperbilirubinemia
• Carbon Monoxide
Poisoning
COMPLICATIONS:
• May have negative
results for:
✓ Hypoxemia
✓ Normoxemia
✓ Hyperoxemia
Note: Pulse Oximeter cannot
be discriminate within
hemoglobin saturation and
carbon monoxide
VENTILATION PERFUSION
SCAN – It has a radionuclide
dye introduced into the
bloodstream through a needle.
When injected, technician
remove IV and will remove
special scanner
Special Scanner will detect if
the dye has already traveled
and look at how it flows into
lungs when in the bloodstream
If not, there will be an
obstruction.
PURPOSE: To see how well air
moves and how well blood will
go to the lungs. To detect
pulmonary embolus
Explanation! Sometimes if
nanay daw nanganganak, there
is an area in the placenta such
as Lanugo and Vernix Caseosa,
ma-enter ha open sinuses
where the placenta detach and
will go into the blood
circulation and it will lodge in
greater pulmonary artery and
pulmonary vein, it will lead to
pulmonary embolism and the
patient will die in 20 minutes
from delivery.
INDICATIONS:
• Detects abnormal
circulation (shunts) in
the blood vessels of the
lungs (pulmonary
vessels)
• Test regional (different
lung areas) lung
function in people with
advanced pulmonary
disease such as COPD
• Pneumothorax
(Abnormal Air into the
Lungs)
SYMPTOMS OF PULMONARY
EMBOLISM:
✓ Dyspnea
✓ Rapid Heart Rate
✓ Decreased Oxygen
Saturation Level
(Through the use of
Pulse Oximeter)
✓ Chest Pain
✓ Ashen Gray in the Face
CONTRAINDICATIONS:
• Allergy to Radioisotope
• Allergy to Seafoods
• Allergy to Radiation
(there should be gown
and you should not be
present in the
procedure)
• Allergy to Iodine
• Pregnant
• Breast Cancer
RADIOLOGIC STUDIES: CHEST
X-RAYS
To produce pictures of the
organs, tissues or bones.
• If you have fluid in the
lungs, water in the
lungs, blood in the
lungs, pus in the lungs,
it can be seen here.
• Any calcification
• Fluid or Blood: White
Color
• Fluid in the lungs: Seen
in Perfusion
• Blood in the lungs:
Hemothorax
• Air in the lungs:
Pneumothorax
PLEURAL EFFUSION
Chest X-Rays: Pneumonia
CT SCAN, MRI, PET,
PULMONARY ANGIOGRAPHY
PROCEDURES:
1. While you wait, you’ll
want to limit any
movement, relax, and
try to stay warm. If
you’re undergoing a
brain scan, you’ll want
to avoid television,
music, and reading.
2. Next, you’ll undergo
the scan, which can last
anywhere from 30-45
minutes.
3. This involves lying on a
narrow table attached
to a PET machine,
which looks like a giant
letter “O”
4. The table glides slowly
into the machine so
that the scan can be
conducted.
5. You’ll need to lie still
during the scan.
6. The technician will let
you know when it is
that you need to
remain still/
7. You may ask to hold
your breath for several
seconds.
8. You’ll hear buzzing
and clicking noises
during the test.
Dye in MRI called “gadolinium”
COMPUTED TOMOGRAPHY
SCAN OR CT SCAN
Computed Tomography of the
chest uses special x-ray
equipment to examine
abnormalities found in other
imaging tests.
To help diagnoses the cause of
unexplained cough, shortness
of breath, chest pain or fever.
PURPOSE: To detect very small
nodules in the lung, chest CT
is especially effective for
diagnosing lung cancer as its
earliest, most curable stage. To
detect bone and joint
problems like complex bone
fractures and tumors.
Condition like cancer, heart
disease, empyshema, or
masses.
They show internal injuries
and bleeding such as those
caused by a car accident.
They can locate a tumor, blood
clot, excess fluid, or infection.
Doctors use them to guide
treatment plans and
procedures such as biopsies,
surgeries, and radiation
therapy.
Doctors can compare CT scans
to find out if certain
treatments are working.
INDICATIONS:
• Head Trauma
• Stroke
• Headaches
• Initial Evaluation for
space-occupying lesins
• Unexplained change in
mental status
• Seizures
• Suspected
Hydrocephalus
• Suspected Intracranial
Hematoma (especially
schizophrenia) because
there is atrophy from
the frontal portion of
the brain.
• Psychiatric Disorders
Note: In CT scan has a
radiation. The patient cannot
undergo frequent CT scan
because it has a radiation and
may cause cancer.
CT SCAN WITH CONTRAST
• In a CT scan, dense
substances like bones
are easy to see. But soft
tissues don’t show up
as well.
• They may look faint in
the image.
• To help them appear
clearly, you may need a
special dye called a
contrast material.
• They block the x-rays
and appear white on
the scan, highlighting
blood vessels, organs or
other structures.
CONTRAINDICATIONS FOR
THE USE OF IODINATED
CONTRAST MEDIA:
• Allergy to Iodine
• Toxic Goitre of the
thyroid
• Planned radioiodine
treatment of thyroid
cancer
CONTRAINDICATIONS
AGAINST THE USE OF IODINE-
BASED CONTRAST MEDIA IN
PATIENTS:
• Children below 2 years
of age
• Pregnant Woman
✓ Persons with
complications after the
previous
✓ Persons with acute and 1. The patient will have to
chronic circulatory and remove jewelries and
respiratory failure clothing and a gown
✓ Persons with hepatic should be worn
and Renal Failure (also 2. If the patient is to have
dialyzed patients) a procedure with a
✓ Persons with asthma contrast an IV line will
and pulmonary edema be started in the hand
✓ Persons with allergies or arm for the injection
✓ Persons with insulin- of dye.
dependent diabetes 3. The patient will lie in
✓ Persons with her back with arms
hypertension above the head on the
✓ Persons with scan table
convulsions of cerebral 4. The technologist will
aetiology be in another room to
✓ Persons with glaucoma where the contrast are
but will be in constant
Note: If you are taking sight for there are
Metformin, stop anay because speakers to.
it will affect the result. That’s
insulin dependent diabetes. 2. INVASIVE
Also with hypertension.
ENDOSCOPY EXAMS
COMPLICATIONS:
ENDOSCOPY - It is an
• CT scans save lives. But instrument that can be
they can also cause introduced into the body to
cancer give a view of its internal
• Every effort should be parts.
made to identify and
PURPOSE: Used to investigate
counsel patient who
symptoms, such as symptoms
are or maybe pregnant
in the digestive system
• Toxicity to the kidneys
including nausea, abdominal
which can results in
pain, difficulty swallowing and
kidney failure is an
gastrointestinal pain
extremely rare
complication of the Confirmation of diagnosis
intravenous contrast most commonly by performing
material used in CT a biopsy to check for
scans. conditions such as anemia,
bleeding, inflammation and
NURSING RESPONSIBILITIES:
cancers of digestive system.
PREPARATION
Giving treatment, such as
✓ Take off some or all of
cauterization of a bleeding
the clothing and wear a
vessel, widening a narrow
hospital gown
esophagus, clipping off a
✓ Remove any metal
polyp or removing a foreign
objects such as belt or
object.
jewelry which might
interfere with image INDICATIONS:
results.
✓ Stop eating for a few • Dyspepsia
hours before the scan • Dysphagia
✓ If the patient has a • Odynophagia
• Persistent
history of allergy to
gastroesophageal
contrast material (such
reflux symptoms
as iodine), the
requesting physician • Occult GI bleeding
and radiology staff • Surveillance for
should be notified malignancy
✓ The patient will be
asked to drink slightly CONTRAINIDCATIONS:
less than a quart • Poor Patient
spread out over 1.5-2 Cooperation
hours. • Coma (unless the
PROCEDURES: patient is intubated)
 • Cardiac arrhythmias or
recent myocardial
ischemia
• Patients taking
anticoagulants or
chronic NSAID therapy
RISK OR POSSIBLE
COMPLICATION:
• Bleeding
PROCEDURES:
1. The patient will be
given sedatives to
sedate the patient
2. After being sedated,
while side lying the
flexible video
endoscope is passed
through the mouth into
the esophagus,
stomach and
duodenum
LARYNGOSCOPY - A visual
examination below the back of
the throat, where the voice box
containing the vocal cords is
located.
Visualization of the larynx
through a laryngoscope
INDICATIONS:
Causes of voice and breathing
problems:
✓ Pain in the throat or ear
Difficulty in swallowing
✓ PURPOSE: For examination of
Narrowing of the throat
✓ the patient’s airways for
Blockages in the airway
✓ abnormalities such as foreign
Note: Prepare the patient
psychologically and physically.
PURPOSE:
✓ To have clear view of
larynx and into the
throat
✓ Used to figure out why
the patient has cough
or sore throat
✓ Find something in
there
✓ Remove objects that
are stuck in the throat
or larynx
✓ Take samples of tissue
(Biopsy)
RISKS:
• Bleeding
• Infection
• Injury to teeth
• Failure of a vocal cord
to heal after the biopsy
• Complications due to MATERIALS AND
anesthesia PROCEDURES:
MATERIAL USED: 1. Listen for breath
LARYNGOSCOPE sounds over
epigastrium (one
LAPAROSCOPY KINDS: breath), then to each
1. Indirect Laryngoscopy - hemothorax in the mid
Uses a small mirror axillary line (one
held at the back of breathe on each side).
2. Attach C02 detector to
your throat. The health
care provider shines a tube or use endotidal
light on the mirror to C02 monitor to verify
view the throat area. return of carbon
2. Fiberoptic dioxide with each
Laryngoscopy - Allows breath.
a doctor to see deeper 3. Use esophageal syringe
into the throat by using or bulb syringe to
either a flexible or rigid verify tube is in non-
telescope collapsing trachea
3. Direct Laryngoscopy - 4. Secure the tube in
Done in the OR. Patient position and request
in general anesthesia chest x-ray to confirm
and will not feel the position.
scope in his/her throat 5. Ensure proper
attachment to
INDICATIONS: mechanical ventilator
and review ventilator
• Throat Examination
settings
• Throat Surgery
6. Consider ongoing
• Endotracheal
sedation, particularly if
Intubation
induction agent may
• Endotracheal
wear off before
Suctioning
paralytic agent
CONTRAINDICATIONS:
BRONCHOSCOPY – A test to
a. Severe Systemic view the airways and diagnose
Disease and patients lung disease.
with very weak
constitution, may
consider postponing
the surgery
bodies, bleeding tumors, or
b. Cases of Laryngeal
inflammation.
obstruction, whether
due to inflammation, COMPLICATIONS/SIDE
edema, foreign object, EFFECTS:
tumor tracheostomy
should be well • Tracheal or Bronchial
prepared Perforation
c. Severe Cervical Lesions • Pneumothorax
• Laryngeal Edema
COMPLICATIONS: • Hypoxia
• Cardiac Arrhythmias
1. Dental Injury
• Bleeding
2. Cervical Spine Cord
• Laryngosspasm
Injury
Due to Neck extension INDICATIONS:
during Intubation may
badly affects the ✓ Lung Growth
cervical instability and ✓ Lung Cancer
this is maybe imply ✓ Lymph Node
✓ Atelectasis or other
upon risk of spinal
cord injury. changes seen on an x-
3. Swallowing or ray or other imaging
Aspirating a Foreign test
Body ✓ Suspected Interstitial
Lung Disease
✓ Coughing up blood
 ✓ Possible Foreign Object
in the airway
✓ Cough that has lasted
more than 3 months
without any other
explanation
✓ Infections in the lungs
and bronchi that
cannot be diagnosed
any other way or need
a certain type of
diagnosis
✓ Inhaled toxic gas or
chemical
✓ To diagnose a lung
rejection after a lung
transplant
CONTRAINDICATIONS:
• Acute Myocardial
Infarction
• Coagulation effect
• Tracheal Stenosis
• Foreign Body
• Asthma
COMPLICATIONS:
• A drop in your o2 Level
during the procedure.
Your doctor will use
Pulse oximeter if this
happens
• Minor Bleeding
• Infection
• Fever
• Pneumothorax
PROCEDURES: FOR DOCTORS
1. A bronchoscopy is
performed in one of
three areas:
✓ Special room
designated for
bronchoscopies
and similar
procedures
✓ OR
✓ ICU
2. During the procedure,
doctors will provide an
agent to sedate the
patient, although the
patient remains
conscious. Recently
propofol has become
more commonly used
as an anesthesia agent
for bronchoscopies
3. The patient will be
monitored during the
procedure with
periodic BP checks, RR,
continuous
electrocardiogram
monitoring of heart
and O2 measurement.
4. The doctor will insert a INDICATIONS:
flexible bronchoscope
through either the nose
or mouth. The patient
can either be sitting or
lying down
5. Once the bronchoscope
is inserted into the
patient’s upper airway,
the doctor will examine
the vocal cords. The
doctor continues to
advance the instrument
to the trachea and on
down, examining each
area.
6. If doctors discover an
abnormality, they may CONTRAINDICATIONS:
sample it using a
brush, a needle or
forceps.
ROLE FOR NURSES
1. Prepare the materials
used
2. Prepare the IV
3. Prepare the medicine
FOR BIOPSY SAMPLE: (ROLE
FOR NURSES):
1. Transport the sample
into the laboratory
2. Properly Documented
NURSING RESPONSIBILITIES:
1. Explain Bronchoscopy
2. Describe the procedure
3. Fast for 6-12 hours
before the test
4. A chest x-ray and blood
studies will be
performed before
bronchoscopy and
afterwards
5. Advise the patient that
he may receive an IV
sedative to help him
relax
6. Make sure that the
patient or a family
members signed the
informed consent
MEDIASTINOSCOPY
A surgical procedure to
examine the inside of the
upper chest between and in
front of the lungs.
COMPLICATIONS:
PURPOSE: Used in staging
lymph nodes in lung cancer or
for diagnosing other
conditions.
• Detect problems of the
lungs and
mediastinum, such as
sarcoidosis
• Diagnose lung cancer
or lymphoma
• To check lymph nodes
in the mediastinum
before considering lung
removal surgery to
treat lung cancer
• Diagnose certain types
of infection especially
those that can affect
the lungs
• Previous
Mediastinoscopy
• Heart surgery
• Other Chest Surgery
• Pregnancy
• Superior Vena Cava
Obstruction
• Previous Neck or
Cervical Spine Surgery
or other conditions
which would prevent
proper positioning of
the neck during the
procedure
• Vats uses a
thoracoscope passed
through a small
incision in the chest to
remove a sample of
lung tissue
• Diagnose certain lung
conditions such as
sarcoidosis or
pulmonary fibrosis
• Diagnose suspected
lung cancer
• Evaluate any
abnormalities seen on
other tests such as
chest s-rays or CT scan
• Abnormalities of lung
function
• Respiratory Failure
• Arterial and Venous
Pulmonary
Hypertension
• Coagulation
abnormalities
• Uncooperative Patients
✓ Pneumothorax
✓ Pneumothorax
requiring a chest pain
✓ Hemoptysis
✓ Death
PROCEDURES:
1. During the Biopsy, you
will sit on an exam
table. Your arms
should rest by your
sides.
2. Your skin will be
cleaned then you will
be injected with an
anesthetic to numb the
area.
3. A small incison or cut
will be made in the
skin. The biopsy needle Indications:
will be inserted. Your
doctor will use it to
take samples of the
abnormal tissue.
NURSING RESPONSIBILITIES:
✓ Explain that
mediastinoscopy is
used to evaluate lymph
nodes and other
structures in the client
✓ Review his history for
previous
mediastinoscopy
✓ Describe the procedure
to the patient
✓ Tell the patient who
will perform the
procedure where it will
be done that he will be
given general
anesthesia and the
procedure may take 1
hr. Nursing and Patient Care
✓ Tell the patient that he Considerations:
may have temporary
chest pains
✓ Reassure the patient
that complications are
rare
✓ Make sure that the
patient or a family
member
LUNG BIOPSY
What is the lung biopsy?
Procedure used for obtaining
histological material from the
lung to aid in diagnosis
Removes a small piece of the
lung tissue which can looked
at under a microscope
This includes:
• Transbronchoscopic
biopsy - biopsy forceps
inserted through
bronchoscope and
specimen of lung tissue
obtained
• Transthoracic need providing post-biopsy
aspiration biopsy – care and teaching
specimen obtained
through needle Contraindications:
aspiration under • Abnormalities of lung
fluoroscopic guidance function
• Open lung biopsy – • Respiratory failure
specimen obtained • Arterial and venous
through small anterior pulmonary hypertension
thoracotomy; used in • Coagulation
making a diagnosis when abnormalities
other biopsy methods Failure to obtain
•
have not been effective informed consent form
or are not possible the patient
Side Effects:
• Diagnose certain lung • Pain
conditions, such as • Infection at the site
sarcoidosis or pulmonary
• Bleeding under the skin
fibrosis where the need was
• In rare cases, a lung placed, at the incision
biopsy may be done for site or in the tissue or
severe pneumonia, organ
especially if the • Complications
diagnosis is not clear • Blood clots
• Diagnose suspected lung Drainage and/or swelling
•
cancer at the biopsy site
• Evaluate any • Fever
abnormalities seen on
• Infection
other tests such as chest • Pain at the biopsy site
x-ray or a CT scan • Pneumonia
• It is done when other
tests can’t identify the Materials used are needle
cause of lung problems biopsy and CT Scan
• Remove a lump or mass
of cells
• Find out if cancer has
spread and if it is
present I nearby lymph
nodes or organs
✓ Obtain permission for
consent, if required
✓ Observe for possible
complications
including
pneumothorax,
hemorrhage, and
bacterial contamination Procedures:
of pleural space
✓ Monitoring the patient 1. Radiologist indicates
for shortness of breath, the exact spot where
bleeding and infection the needle should be
✓ Instructs the patient placed by drawing
and family to report into the skin using a
pain, shortness of marker
breath, visible bleeding, 2. IV line will be
or redness of the inserted into a vein,
biopsy site or pus, used to deliver
report to the health sedation medication
care provider 3. The area of biopsy
immediately site will be cleaned
✓ Patient who have with an antiseptic
undergone biopsy are solution
often anxious because 4. Then the patient will
of the need for the be injected with
biopsy and potential anesthesia to numb
findings; the nurse the area
must consider this in
 5. A tiny incision is Contraindications: • Syringes: • Local
made in your skin 5-, 20, anest
allowing an easy • An uncooperative patient 50-ml hesia
insertion of the or a coagulation disorder • Needles: • Sterile
biopsy needle that cannot be corrected 22G, gauze
6. The biopsy needle are absolute 25G, or pad
will be inserted; how contraindications 16G • Sterile
much it is inserted • Relative • Three- towel
depends on the contraindications are site way or
location of the of insertion has known stopcock drape
abnormal lung tissue bullous disease (e.g. and • Sterile
7. The radiologist takes emphysema) tubing speci
samples of the • Use of positive end- • Hemosta men
abnormal tissue. expiratory pressure t contai
(PEEP) ners
• Biopsy
Nursing Responsibilities: • Only one functioning needle • Overh
lung (due to diminishing ead
✓ Pain infection at the
reserve) table
site
✓ Bleeding under the Purposes: and
skin where the needle chair
was placed, at the • To obtain the pleural
incision site or in the fluid from the pleural
tissue or organ cavity Procedures:
complications • To obtain diagnostic • Preparatory Phase
✓ Blood clots aspiration of pleural 1. Determine in advance
✓ Drainage and/or fluid x-ray or other tests
swelling at the biopsy • To obtain pleural biopsy have been prescribed
site • To instill medication into and completed. These
✓ Fever the pleural space should be available at
✓ Infections the bedside.
✓ Pain at the biopsy Complications:
2. Check if informed
site MAJOR MINOR consent has been
THORACENTESIS AND COMPLICATI COMPLICAT explained or signed
PLEURAL FLUID ANALYSIS ONS IONS 3. Determine if patient
• Pneumot • Pain is allergic to local
• Thoracentesis – is the horax • Dry tap anesthetic
withdrawal of pleural • Hemoth • Cough 4. Inform the patient
fluid from the pleural orax • Subcuta about the procedure
cavity or pleural space • Lacerati neous and indicate how the
• Therapeutic on of the hemato patient can be helpful
Thoracentesis – removes liver or ma 5. Assist patient to
an accumulation of the spleen • Subcuta obtain during
pleural fluid or air that • Diaphra neous procedure
has caused lung gmatic seroma Three types of
compression and injury • Vasovag positioning the client for
respiratory distress • Empyem al Thoracentesis:
• Diagnostic Thoracentesis a syncope
– is performed when the • Air 1. Patient sitting the
goal is to determine the Embolis edge of the bed
cause of infection m with head and
• Pulmona hands on over the
Indications:
ry table
• This procedure is edema 2. Straddling a chair
indicated when • Hypoten with arms and
unexplained fluid sion (low head resting on
accumulates in the chest blood the back of the
cavity outside the lung pressure chair
• If a large amount of fluid due to a 3. Lying unaffected
is present, then this vasovaga side with the bed
procedure can also be l fhfdh) elevated at 45°
therapeutically to remove 6. Support and reassure
that fluid and improve the patient during the
Equipment: procedure
patient comfort and
function • Performance Phase
• The most common 1. Expose the site to be
causes of pleural • Thorace • Germi aspirated.
effusions are cancer, ntesis cide 2. Prepare hand hygiene
congestive heart failure, tray (if Soluti and put on personal
pneumonia, and recent available on protective equipment.
surgery, tuberculosis ) (Betad 3. Procedure is done
ine) during aseptic
 conditions. After skin • Injury or inflammatory fluid and to guide
is cleaned the health or the pleurae may cause antimicrobial therapy.
care provider slowly abnormal collection of
injects local fluid FUNGAL TEST
anesthetics with a • Exudate are associated May include fungal culture and
small gauge needle with a variety of susceptibility therapy
into the intercostal conditions and diseases
space. ▪ Infectious diseases – ADENOSINE DEAMINASE
4. Ultrasound or direct caused by viruses,
physical examination bacteria or fungi May help detect tuberculosis
is used to guide ▪ Bleeding – bleeding (TB)
needle placement. disorders, pulmonary SKIN TEST FOR PPD (PURIFIED
5. The thoracentesis embolism, or trauma PROTEIN DERIVATIVES)
needle is advanced can lead to blood in
with the syringe the pleural fluid • The Mantoux Test is the
attached. When the ▪ Inflammatory standard method of
pleural space is conditions determining whether a
reached, suction may ▪ Malignancies person is infected with
be applied with the Mycobacterium
syringe. tuberculosis.
6. After needle is • The local skin reaction to
withdrawn, pressure is Tuberculin Purified
applied over the Protein Derivative (PPD)
puncture site and a injected into the skin is
small sterile dressing used to assess the
is fixed in place. individual’s sensitive
• Follow-up Phase tuberculin protein.
1. Place patient at bed • The mantoux test is
rest. A chest x-ray • Additional Testing on given to:
usually obtained after exudate fluid may ▪ Children aged 3
thoracentesis. include: months to 6 years
2. Record vital signs ▪ Pleural fluid glucose living at high risk
every 15 minutes for ▪ Lactate environments
1 hour. ▪ Amylase ▪ Infants and children
3. Administer oxygen as ▪ Triglyceride and/or under six years of age
directed if patient ▪ Tumor markers with a history of
has cardiorespiratory residence or
disease. MICROSCOPIC EXAMINATION prolonged stay (more
4. Record amount of than three months) in
fluid withdrawn and A laboratory professional may
a country of high
the nature of the place a sample of the fluid on
endemic.
fluid, its color and a slide and examine it under a
▪ There is a history of
viscosity. microscope.
TB in a household
5. Encourage deep Normal pleural fluid has a contact in the last
breaths to expand the small numbers of white blood five years.
lungs cells but no red ▪ Those who have had
cells/microorganisms close contact with a
PLEURAL ANALYSIS – is used
person with known
to help diagnose the cause of CYTOLOGY TB.
accumulation of fluid in the
• Administering the
chest cavity A laboratory professional may
Mantoux Test
use a special centrifuge
TRANSUDATE ▪ Tuberculin PPD RT 23
(cytocentrifuge) to concentrate
SSI, 2 T.U./0.1ml
• An imbalance between the fluid’s cell on a slide
solution for injection:
the pressure within The slide is treated with a ❖ 1 dose = 0.1ml
blood vessels and the special stain and evaluated for contains 0.04
amount of protein in abnormal cells; such as microgram
blood (which keeps from malignant cells Tuberculin PPD
the blood vessel) can ❖ Store at 2°C – 8°C,
result in accumulation of GRAM STAIN protected from
fluid light
• Frequently caused by For direct observation of a ▪ 1ml graduated
congestive heart failure bacteria or fungi under a syringe fitted with
or cirrhosis microscope. There should be bevel 26G
• If the fluid is determined no organisms present in the (0.45x10mm) needle
to be a transudate, then fluid ▪ Injection Site
usually no more tests on BACTERIAL CULTURE & ❖ The test is usually
the fluid are necessary. SUSCEPTICIBILITY TESTING applied on the
middle third of
EXUDATE Ordered to detect any bacteria the flexor surface
that may present in the pleural of the forearm, as
a reaction may be
 weaker near the 5 or 10 or 15 or • Two most common
wrist or the elbow more more more reasons for false positive
joint millime millime millime PPD reactions are:
❖ It is usually ters ters ters ▪ Infection with
applied on the An An An nontuberculous
left forearm indurati indurati indurati mycobacteria
❖ Ensure adequate on of 5 on of on of (mycobacteria other
lighting or more 10 or 15 or than M. Tuberculosis)
❖ Select an area of millimet more more • However, the reaction is
healthy skin ers is millime millime more likely to be truly
which is free of consider ters is ters is caused by TB infection if
muscle margins, ed for conside conside any of the following are
heavy hair, veins, red for red for true:
sores, or scars. People Foreign- People ▪ The reaction is large
❖ Only visibly dirty with born with no ▪ The person was BCG-
skin needs to be HIV persons risk vaccinated a long
washed with soap infectio factors time ago
and water n for TB ▪ The person comes
Close HIV- from an area of the
Procedures: world where TB is
contacts negativ
1. Use a 1mL syringe to e common
aspirate out 0.1mL of persons ▪ The person has been
PPD RT 23. who exposed to someone
2. Inject the PPD inject with infectious TB
intradermally on the illicit disease
volar surface of the drugs
FALSE-NEGATIVE REACTION
forearm. Position the
syringe at a 10-15° to the People People • Some people have a
forearm and insert just who with negative reaction to the
below the epidermis have certain tuberculin skin test even
(about 2mm). had TB medical though they have TB
3. Remove the needle disease conditi infection. These are
quickly. Do not massage before ons called false-negative
or use dressing. A well- People Childre reactions.
defined bleb of 6-10mm who n • False-negative reactions
in a diameter should be inject younger may be caused by:
formed if injected illicit than 4 ▪ Anergy
correctly. If the bleb is drugs years’ ▪ Recent TB infection
<6mm, repeat the and old (within the past 10
process 2.5cm from the whose weeks)
first site. HIV ▪ Very young age
4. Mark down the site, date status is (younger than 6
and time of injection, known months old)
both on the forearm and
in patient’s record. • A healthy person whose
5. After 48 to 72 hours, immune system is
Adverse Effect
read the test result by normal, induration
marking down the greater than or equal to • Anaphylactic reaction
transverse diameter od 15mm is considered a and foreign body
induration, not erythema, positive skin test. reaction
by Sokal’s ballpoint • In most cases, people • Slight risk of having a
method. who have a very small severe reaction to the
6. Measure the largest reaction or no reaction test including swelling
transverse diameter of probably do not have TB and redness of the arm,
induration and note infection. particularly in people
down in millimeters • Induration of less than who have had TB or been
(mm) 2mm, without blistering, infected previously and
is considered a negative in those who have
Reading the Mantoux Test skin test. previously had the BCG
The reaction should be vaccine.
FALSE-POSITIVE PPD
evaluated 48-72 hours after REACTION Contraindication:
the injection
• Sometimes people who • Severe reaction (e.g.
Only the induration, which is a are not infected with M.
hard, dense, raised formation, necrosis, blistering,
Tuberculosis will have a anaphylactic shock, or
is measured. positive reaction to the ulcerations) to a previous
The area of erythema is not PPD tuberculin skin test. TST.
included in the measurement. This is called a false-
positive reaction. SPUTUM COLLECTION
POSITIVE PPD REACTION
Sputum – secretion formed by
the lungs and the lower
airways; thick in consistency,
opaque, and varies in color
from white to yellow to green;
is a mucus material spit out of
the mouth that may rise from
nose, throat, or lungs.
Saliva – clear and colorless,
and examining it will not
reveal the cause of chest
infection.
3 TYPES OF SPUTUM
COLLECTION
1. DIRECT METHOD –
Patient is the one who
voluntarily expectorates
sputum to the container.
2. INDIRECT METHOD –
Consists of a sterile
suction catheter with an
attached sputum trap.
3. GASTRIC LAVAGE –
Based on the assumption
that sputum is swallowed
during sleep and
sometimes after
coughing.
Purpose:
✓ Sputum is obtained for
evaluation of gross
appearance,
microscopic
examination, gram
stain, culture, acid fast
bacillus and cytology
✓ To obtain sputum for
diagnostic purposes
✓ To prevent infection
that may result from
accumulated sputum.
Indications:
Used as laboratory specimen
for the isolation of organisms
that might be causing
abnormalities of the
respiratory tract:
• Tuberculosis
• Pneumonia
• Bronchitis
• Causes of lung abscess
DIRECT METHOD
• For culture and
sensitivity
• For cytology
• For identification and
staining of acid-fast
bacillus
• To assess the
effectiveness of therapy
INDIRECT METHOD
• Diagnostic chronic
respiratory tract
disorders
• Obtain materials from
the tracheal and
bronchial lumens for
cytologic and microbial
evaluation
• Avoids contamination of
sample with oral normal
flora and tissue
Contraindications:
• Hemoptysis
• Pneumothorax
• Unstable cardiovascular
status
• Recent eye surgery
• Recent surgery of thorax
or abdomen
• Unstable angina SPUTUM GRAM STAIN
• Coughed up blood
recently and cause is
unknown
Materials:
DIRECT METHOD
• Oral care stuff
• Sputum specimen
container
• Sterile gloves
INDIRECT METHOD
• Sterile disposable
container for fluids
• Sterile normal saline
solution
Procedures:
1. The direct smear shows
presence of white
blood cells and
intracellular
(pathogenic) bacteria
and extracellular
(mostly nonpathogenic)
bacteria
2. Gram stain is a quick,
commonly used
method to identify
general strains of
bacteria by their color
Purposes:
3. A culture is a
placement of
microorganism on
culture plates to
facilitate their growth
4. Cytology is used to
identify tumor cells
5. Obtain a sterile jar to
serve as a container for
the specimen Indications:
6. The best time to collect
sputum is upon
awakening up in the
morning
7. Do not refrigerate the
sample unless it is for
tuberculosis testing
DIRECT METHOD
• Offer mouth care
• Ask client to breathe
deeply and then cough
up 1-2tbsp or 15-30ml of
sputum
• Wear gloves and mask
• Ask client to expectorate
the sputum, into the
specimen container
• Offer mouthwash to
remove any unpleasant
taste
• Label and transport
specimen to the
laboratory
• Document the collection
of the specimen in the
client’s chart.
• A sputum Gram stain is a
laboratory test that
allows your doctor to
diagnose a bacterial
infection in your
respiratory tract. They
may order it if you have
symptoms of a
respiratory infection that
might be caused by
bacteria. It is the most
common preliminary test
beyond a chest x-ray for
pneumonia and other
respiratory infections,
and can help your doctor
promptly prescribe a
treatment plan.
• The test is sometimes
called a Gram stain of
sputum. It’s named after
its inventor. Hans
Christian Gram.
• A test to detect and
identify bacteria and
fungi that infect the or
breathing passages
• Sputum is a thick fluid
produced in the lungs
and in the adjacent
airways
✓ Fungal Determination
✓ Determination of
pathogenic bacteria
✓ Gram’s stain
✓ Culture and
sensitivity
✓ Cytologic Exam
• Bronchitis
• Lung abscess
• Tuberculosis
• Pneumothorax
• Assist in the diagnosis of
respiratory infections, as
 indicated by the presence studied by a
differentiation microbiologist.
• (Gram Stain: assist in the 12. Obtaining a specimen
of Gram-positive from for the culture allows
gram-negative bacteria in further identification
respiratory infection of the infecting
organism.
Complications: 13. When the organism is
identified, its
• Pneumothorax
sensitivity to antibiotic
• Syncope
treatment is tested and
• Light headedness
an appropriate
• Increased Intracranial
antibiotic is prescribed.
Pressure
14. Identification of
• Chest pain
organisms that cause
• Coughing tuberculosis and
• Oxygenation similar diseases (acid-
Desaturation fast bacilli) requires
Procedures: tests other than gram’s
stain, culture, and
1. Explain the need for sensitivity study.
and the purpose of this 15. Regardless of the
test to the client techniques used to
2. DIRECT METHOD: the obtain the specimen,
client brushes the teeth note the color,
to reduce consistency, odor, and
contamination and amount of sputum
then coughs into a obtained.
sputum container.
3. Encourage the client to Nursing Responsibilities:
cough, not spit, to ✓ Explain procedure to
obtain sputum. the patient
4. Inhaling nebulized ✓ Obtain medical
saline or water can be
history
used to thin the ✓ Obtain history of
sputum to facilitate respiratory disorder
expectoration ✓ No fluid or food
5. Indirect techniques for restrictions
obtaining sputum ✓ Advice client to
consists of a sterile increase fluid intake
suction catheter with the night before
an attached sputum sputum exam
trap. ✓ Instruct patient to sit
6. Sputum can also be up straight, take 2-3
obtained by breaths then cough
transtracheal
aspiration SPUTUM CYTOLOGIC EXAM
7. Gastric juice is
aspirated with a Cytology is the study of the
origin, structure, function, and
syringe and sent to the
laboratory pathology of cells.
8. The tube is then In clinical practice, cytological
removed. exams detect cell changes
9. The collected sputum resulting from neoplastic or
is analyzed for Gram’s
inflammatory conditions
stain, culture, and
sensitive study Procedures:
10. Gram’s stain is used to
classify bacteria as 1. Explain the procedure
to the patient
gram-positive or gram-
2. This test is usually
negative and, along
performed in the
with the sputum
morning, immediately
culture, provides
after waking up
guidelines for
3. The person is asked to
appropriate
antimicrobial therapy. rinse his/her mouth
11. After gram stain, the with water to prevent
sputum is incubated the sample from being
for 24 hours or longer heavily contaminated
with saliva
on the appropriate
4. After taking several
culture medium and
deep breaths, the
person then coughs
deeply
5. This should bring up
enough of a material
from deep in the lungs
known as sputum
6. The sputum sample is
hen taken to a
laboratory where it is
examined with a
microscope
7. The healthcare
professional provides
instructions on a
sample collection to
the individual having
this test.
8. Usually, sputum
contains some normal
cells.
9. No cells that look like
cancer should be in the
sample.
10. If cancer cells are seen,
the person usually has
lung cancer
11. The healthcare
professional can then
confirm the cancer and
determine the stage
using other tests.
ACID FAST BACILLI SMEAR
AND CULTURE
• Acid-Fast Bacilli (AFB)
smear and culture are
two separate tests always
performed together at
the MSPHL, Tuberculosis
(TB) Unit. AFB smear
refers to the microscopic
examination of a
flourochrome stain of a
clinical specimen. The
AFB culture is the
inoculation of a clinical
specimen culture media
Becton-Dickinson
Mycobacteria Growth
Indicator Tube (B-D MGIT
broth) and Lowenstein-
Jensen (L-J) media slant,
incubation at 37°C for up
to 6 weeks and detection
of growth or no growth
during this incubation
period.
• AFB SMEAR –
fluorochrome staining
• AFB CULTURE – B-D
MGIT system and
conventional culture
media.
SPECIMEN COLLECTION
SPUTUM
An early morning, deep cough
specimen collected on 3
consecutive days is best for
initial diagnosis of • Clinical specimen • Tongue depressor
tuberculosis received greater than 3 • Swab
days from collection • Salt water
If sputa are collected within • Specimen leaking on • Sterile cup
the same 24-hour period, a arrival • Nasal speculum
minimum of 8 hours between
• Insufficient specimen • Emesis basin or clean
specimens is required volume (less than 2ml) container
• Minimum acceptable • When unsatisfactory • Tongue blades
specimen volume is 2mL specimen is obtained by • Penlight
• Ship specimens each day noninvasive means • Facial tissue/gauze
collected to facilitate (sputum), the specimen • Clean gloves
rapid diagnosis; do not is discarded and the
hold until 3 specimens submitter is notified to Procedure on throat culture:
are collected submit a new specimen
1. Confirm the patient’s
• Refrigerate until shipped and request form
identity using two
• When unsatisfactory
patient identifiers
BRONCHIAL WASHING specimen is obtained by
according to facility
invasive procedures, the
• Preferred minimum policy
specimen is held until
acceptable volume is 2. Explain to the patient
consultation with the
2mL that the throat culture
physician is made about
• Refrigerate until shipped is used to identify
processing an
microorganisms that
PLEURAL FLUID unsatisfactory specimen.
may be causing his
COLLECTING NOSE AND symptoms or to screen
• Preferred minimum for asymptomatic
THROAT SPECIMEN FOR
volume is 2ml carriers
CULTURE
• Refrigerate until shipped 3. Inform the patient that
LUNG TISSUE he doesn’t need to
restrict food and fluids
• Add 1-2ml of sterile for the test.
normal saline for 4. Advise the patient that
transport. the specimen will be
• Do not send tissue collected from his
wrapped in gauze or throat. Describe the
paper procedure, and warn
• Refrigerate until shipped him that he may gag
• Storage/Transport during the swabbing
5. Check the patient’s
Possible Results: history for recent
• A throat culture requires
antimicrobial therapy
• AFB SMEAR swabbing the throat,
6. Determine
1+ (Rare) streaking a culture plate,
immunization history
2+ (Few) and allowing the
if it’s pertinent to the
3+ (Moderate) organisms to grow for
preliminary diagnosis
4+ (Many) isolation and
AFB Not found identification of Nursing Responsibilities:
Smear Not Performed pathogens.
• AFB CULTURE • A gram-stained smear ✓ Send the specimen to
Identification of may provide preliminary the laboratory
Mycobacteria specia identification, which may immediately. Unless a
No growth of guide clinical commercial sterile
Mycobacteria after 6 management and collection and
weeks determine the need for transport system is
Unsatisfactory further tests. used, keep the
• AFB smears are reported • Culture reactions must container during the
within 24 hours of be interpreted in light of transport.
receipt; AFB cultures are clinical status, recent
Side Effects:
reported: (1) at 6 weeks antimicrobial therapy,
when no growth occurs and the amount of • Side effects and pain are
or (2) when growth normal flora. rare from a throat
occurs and identification • It is a diagnostic tool for culture, but some people
is made. determining the nature may feel nauseous, or
of the patient’s nose may vomit or cough
UNACCEPTABLE CONDITIONS and/or throat problems
• This can cause Complications:
• No identification on the
specimen container or discomfort to sensitive
• There are no risks or
the container and mucosal membrane.
complications from a
request form • This can also cause
throat culture
identification do not gagging.
match. ABG ANALYSIS
Materials:
 - The sampling of the ALLEN’S TEST (Highlight ni - A fall in systolic blood
blood levels of oxygen Dean) pressure below the pre-
and carbon dioxide exercise level
within the arteries, as - The hand is elevated ✓ Lightheadedness
opposed to the levels and the patient is ✓ Request from patient
of oxygen and carbon asked to make a fist for to terminate test
dioxide in the blood. about 30 seconds
- It may also be used to - Pressure is applied COMPLICATIONS:
determine the pH of over the ulnar and the
radial arteries so as to • Hematoma
the blood, or how • Hemorrhage
acidic it is. occlude both of them.
- Still elevated the hand • Injury to the artery
PURPOSE: is then opened. It • Nosocomial Bacteremia
should appear • Distal Ischemia
✓ Oxygen and Carbon blanched • Numbness of Hand
Dioxide Saturation in - Ulnar pressure is
the arteries not in the MATERIALS:
released and the color
blood, also pH in the should return to ✓ 0.5 mL Sodium Heparin
blood. normal (1:1000 solution)
✓ Measures the levels of
✓ 23 or 25 gauge needle
carbon in the blood to
with safety guard
determine how well
✓ Stoper or Cap
your lungs are working
✓ Lidocaine
✓ Allow evaluation of
✓ Sterile Germicine
response to clinical
✓ Cup or plastic bag with
interventions and
crushed ice
diagnostic exams
✓ Gloves
✓ To evaluate gas
exchange in the lungs PROCEDURES:
✓ Assess the integrity of
the ventilatory control 1. Palpate artery with one
system hand while holding
CONTRAINDICATIONS: properly prepared
✓ Determine acid-base
level of blood • Abnormal Modified syringe and needle with
Allen’s test other hand. Hold
INDICATIONS: syringe like a pencil
• Severe Peripheral
and enter skin at 45
✓ Respiratory Failure- Vascular Disease
degrees. Advance
Acute and Chronic • Absence of an arterial
needle slowly.
✓ Monitoring of Acid- pulse
2. Never redirect needle
Base Status, as in • Arterial Puncture
without first
patient with diabetic should not be
withdrawing to
ketoacidosis (DKA) or performed through a
subcutaneous tissue
insulin infusion lesion or through a
3. Obtain 2-4 mL blood. If
✓ Any severe illness surgical shunt
possible don’t aspirate.
which may lead to • A coagulopathy or
4. Remove air bubbles
metabolic acidosis such medium to high dose
from syringes.
as cardiac anticoagulation therapy
Immediately seal
✓ Determination of • Infection over site
syringe with cap
Arterial Respiratory • Anticoagulant Therapy
5. Place sample in ice
Gases during • History of Clotting
slush. Analyze blood
diagnostic evaluations Disorder (Hemophilia)
sample within 10
such as assessment of • History of Spasms minutes.
the need for home following previous 6. Apply pressure to site
oxygen therapy in punctures until bleeding has
patients with advanced
REASONS FOR TERMINATING stopped.
CPD.
✓ Evaluate your need for TEST:
ABG NORMAL RANGE AND
extra oxygen or help ✓ Electrocardiographic INDICATIONS:
with breathing Abnormalities
✓ Hyperglycemic Patients - pH normal : 7.35-7.45
✓ Angina Indication: Indicates if
in patients with DM ✓ Hypotensive Responses
✓ Poisons with DM patient is acidotic :
- A fall greater than 20
✓ Poison/Toxication <7.35 or alkalemic:
torr in systolic
✓ Sepsis >.7.45
pressure, occurring
✓ Burns - PaO2 (reflects the
after the normal
✓ Sleep studies efficiency of gas
exercise rise exchange)
✓ Ventilated Patients
 Normal: 80-100mmHg
Indication: Low oxygen
indicates that the
patient is not respiring
properly. At a PaO2
less than 60 mmHg,
supplemental oxygen
should be
administered.
- At a PaO2 of less than
26 mmHg the patient is
at risk of death and
must be oxygenated
immediately.
- PaCO2 (reflects
effectiveness of
alveolar ventilation)
Normal: 34-45 mmHg
Indication: It indicates
a respiratory problem.
A high PaCO2 indicates
respiratory acidosis:
>45 mmHg which
means the patient is
experiencing under
ventilation
- A LOW PaCO2 indicates FAGERSTROM TEST
respiratory alkalosis:
<35 mmHg, which
means the patient is
experiencing over
ventilation
- HCO3
Normal: 22-26 mmol/l
Indication: Indicates
whether a metabolic
problem is present. A
low HCO3 indicates
metabolic acidosis,
HIGH HCO3 indicates
metabolic alkalosis.
- Base Excess (used) for
assessment of the
metabolic component
of acid base disorders)
Normal: -3 to +3
mmol/l
Indication: A negative SCORING:
base excess indicates
that the patient has
metabolic acidosis. A
positive base excess
indicates that the
patient.
NURSING CARE:
✓ Record the inspired O2
Concentration
✓ Heparinize the syringe
✓ Blood can be obtained
by any artery but is
most often drawn from
the brachial and
femoral site
✓ Arterial Puncture
should not be
performed through an 4. How many cigarettes
area where peripheral per day do you smoke?
vascular disease or a. 10 or less (0)
infection is present. b. 11-20 (1)
✓ Failure to do so may 5. Do you smoke
result in severe frequently during the
ischemic injury. 1st hrs. After awakening
✓ Send the sample than during the rest of
immediately on the day?
✓ An arterial Line (Sterile a. No (O)
Cannula Inserted into b. Yes (1)
one of the arteries) can 6. Do you smoke even if
be used to avoid you are so ill that you
multiple punctures for are in bed most of the
serial abg analysis and day?
ongoing monitoring a. No (O)
✓ After the test is b. Yes (1)
completed pressure is
applied at the puncture The items are summed to yield
site for 5-10 minutes. a total score of 0-10. The
✓ Inspect the puncture higher the total Fagerstrom
site and assess for cold Score, the more intense is the
hand, numbness patient’s physical dependence
tingling or on nicotine.
discoloration In the clinic, the Fagerstrom
Test maybe used by the
physician to document
- The Fagerstrom Test indications for prescribing
for nicotine medications for nicotine
dependence is a withdrawal.
standard instrument
for assessing the SCORE OF 1-2:
intensity of physical - This score suggest that
addiction to nicotine they may not need NTR
- The test was designed although it is
to provide an ordinal recommended that
measure of nicotine they still be monitored
dependence related to for withdrawal
cigarette smoking symptoms.
- In scoring the
Fagerstrom Test for SCORE OF 3-4:
nicotine dependence,
- This score suggests
yes/no items are
that they have a low
scored from 0 to 1 and
nicotine dependence
multiple choice items
and maybe offered
are scored from 0 to 3.
patches, inhalers, or
gums.
1. How soon after you SCORE OF 5-7:
wake up do you smoke
- A patient that scores 5-
your first cigarette?
7 indicates that they
a. 60 minutes (0)
moderately dependent
b. 31-59 minutes
on nicotine. They
(1)
should be offered
c. 6-30 minutes (2)
patches, inhalers, or
d. Within 5
gums. And they may be
minutes (3)
offered combined
2. Do you find it difficult
therapy of patched
to refrain from
gum or inhalers.
smoking?
3. Which cigarette would SCORE OF 8 AND OVER:
you hate most to give
up? - A patient that scores
a. The first in the an eight or higher
morning (1) indicates that the
b. Any other (0)
 patient is highly
dependent on nicotine

INDICATIONS:

• For patients with

difficulty of breathing
• Smokers with High
nicotine dependence

NURSING PROCEDURES TO
IMPROVE RESPIRATORY
FUNCTION:

✓ To remove retained
secretions and to
improve ventilation

SMOKE ANALYZER

Used to determine how much

carbon monoxide- a poisonous
gas in cigarette-smoke-is in
your body.

PROCEDURES:

1. You breathe into a tube

attached to a handled
monitor. The monitor
then shows the reading
on its screening
2. Patient will be asked to
hold breath for as long
as possible, ideally is
15 seconds then you
will breathe out slowly
into the mouth piece.

10 ppm and over:

- Recent exposure to a
high level of carbon
monoxide and that you
are a smoker

5-9 ppm:

- Recent exposure to a
moderate level of
carbon monoxide and
you are possibly
smoking

1-4 ppm:

- Recent exposure to a
low level of carbon
monoxide. It’s normal
to have a small amount
of carbon monoxide in
your breathe even if
you are not a smoker.