DIAGNOSTIC EXAMINATION: RESPIRATORY SYSTEM

DIAGNOSTIC STUDIES
DIAGNOSTIC STUDIES AND THERAPIES
 Nurse should educate:
– the patient on the purpose of the studies.
– what to expect.
– Possible side effects related to prior to testing.
 Nurse should note trends in results;
– provides information about disease.
– progression and response to therapy.
 If the history and physical examination reveal evidence of
respiratory dysfunction, diagnostic tests will help identify and
evaluate the dysfunction.
PULMONARY FUNCTION TEST
Routinely used with chronic respiratory disorder:
A. TUBERCULIN SKIN TEST: MANTOUX TEST
 PPD (Purified Protein Derivative) is used
 Route: Intradermal
 Read: 48 to 72 hours after injection
 Positive: induration of 10 mm or more
 For HIV positive, induration of 5mm is positive
 Mantoux test will possibly give a false positive result for
clients who have received BCG
 QuantiFERON-TB Gold (QFT) is a simple blood test that
aids in the detection of Mycobacterium tuberculosis
How is it performed?
 injecting 0.1 ml of tuberculin Purified Protein derivative into
the inner surface of the forearm
 tuberculin syringe with the needle bevel facing upward
 When placed correctly, the injection should produce a pale
elevation of the skin – wheal

o to aid diagnosis

o to assess respiratory function

o To determine extent of dysfunction

o Response to therapy

o Screening tests How is it read?

 Should be read between 48 to 72 hours after administration  
o be measured in millimeters of the induration
o Used prior to surgery
(palpable, raised, hardened area, or swelling) 
 The reader should not measure erythema (redness).
PULMONARY FUNCTION STUDIES

a.VITAL CAPACITY
The maximum volume of air that can be exhaled after a
maximum inhalation
Normal adult range: 3 to 5 liters (80% because some air
remains in the lungs)
*Reduction oof VC is associated with weak cough,
accumulation of secretions, atelectasis and hypoxemia

b.TIDAL VOLUME
The volume of air inhaled and exhaled with normal quiet
breathing
Normal: approximately 500ml and includes the volume of air
that fills the alveoli and volume of air fills the airways
B. PULSE OXIMETRY
c.  INSPIRATORY RESERVE VOLUME  Pulse oximetry, or SpO2, is a noninvasive method of
continuously monitoring the oxygen saturation of
The maximum volume that can be inhaled following a normal
hemoglobin 
quiet inhalation
 it is an effective tool to monitor for subtle or sudden
Normal: 1900-3300ml changes in oxygen saturation
 can easily be used in the home and various health care
d.  EXPIRATORY RESERVE VOLUME settings
The maximum volume that can be exhaled following a Where it is attached?
normal quiet exhalation
Normal: 800 to 1100ml  A probe or sensor is attached to the fingertip, forehead,
earlobe, or bridge of the nose. 
e.  FUNCTIONAL RESIDUAL CAPACITY
What is the normal value?
The volume of air that remains in the lungs after normal,  Normal SpO2 values are more than 95%
quiet exhalation
 Values less than 90% indicate that the tissues are not
Normal:1800-2200ml receiving enough oxygen, in which case further evaluation is
needed. 
f.   RESIDUAL VOLUME Where it is attached?
The volume of air that remains in the lungs after forceful
exhalation  A probe or sensor is attached to the fingertip, forehead,
earlobe, or bridge of the nose. 
Normal: 1 to 1.2 Liters
What is the normal value?
  Normal value of SpO2 95%- 100%
 Values less than 90% indicate that the tissues are not
receiving enough oxygen, in which case further evaluation is
needed
NURSING CONSIDERATIONS:
 Place the probe or clip over the finger or other intended
sensor site so that the light beams and sensors are opposite
each other.
 Protect the transducer from exposure to strong light. Check
the transducer site frequently to make sure the device is in
place, and examine the skin for abrasion and circulatory
impairment
 Rotate the transducer at least every 4 hours to avoid skin
irritation
C. SPUTUM ANALYSIS/STUDIES
 Analysis of a sputum specimen  5. Assess return of pinkish color on the hands (normal is within 6
 helps diagnose respiratory disease, malignant cells, and
pathogenic organisms
 Taken for patient receiving medications for prolonged
periods
How is it performed?
 A sputum specimen is stained and examined under a
microscope and, depending on the patient’s condition,
sometimes cultured   It also measures your body’s acid-base (pH) level, which is
 Culture and sensitivity testing identify a specific
microorganism and its antibiotic sensitivities.   The test gives your doctor clues about how well
 A negative culture may suggest a viral infection
Nursing Consideration:
 Encourage the patient to increase his fluid intake the night
before sputum collection to aid expectoration
 Taken early in the Morning
 To prevent foreign particles from contaminating the
specimen, instruct the patient not to eat, brush his teeth, or
use a mouthwash before expectorating
 Instruct to clear the nose and the throat and rinse the mouth to
decrease contamination of the sputum and not to simply
spit saliva into the container
 Instruct to cough deeply and expectorates sputum into a
sterile container
 If patient can’t expel, coughing can be induced by
administering aerosolized hypertonic solution via nebulizer
 Other methods: endotracheal or transtracheal aspiration,
bronchoscopic removal
 Before sending the specimen to the laboratory, make sure
it’s sputum, not saliva (more bubble/froth)
 label the specimen and send ASAP to avoid contamination  
D. CULTURES
D. CULTURES
 Specimen culture can identify pathogens responsible for
respiratory infections, such as pharyngitis.  shows the blood’s acidity or alkalinity
 Throat cultures are performed in adults with severe or
ongoing sore throats accompanied by fever and lymph node
enlargement and are most useful in detecting streptococcal
infection   Known as the metabolic parameter, the Bicarbonate
 Rapid strep tests are now available that can provide results
within 15 minutes
 Other sources of infection, such as Staphylococcus aureus or
Influenza, are detected via nasal or nasopharyngeal
cultures
Nursing Consideration:
 Ideally, all cultures should be obtained prior to the initiation
of antibiotic therapy
 Results usually take between 48-72 hours; preliminary
reports available usually within 24 hours
 It may be repeated to assess a patient’s response to therapy
ALLEN’S TEST PRIOR TO ABG
 It is done to assess for the adequacy of collateral circulation
of the hand
 It is a test for the ulnar artery
 This procedure includes arterial puncture or cannulation
and the harvest of the artery alone or as part of a forearm flap
How it is performed?
1. Inform patient and explain the purpose of the procedure
2. Apply pressure on the radial and ulnar arteries
3. Ask patient to close and open hands until the hand becomes
blanched
4. Release ulnar artery
seconds)
6. Do documentation (if return of the pinkish color on the hand is
longer than 6 seconds, there is poor collateral circulation of
the hand. Therefore, the radial artery should not be used for
blood draw for ABG monitoring)
E. ARTERIAL BLOOD GAS (ABG)
 An arterial blood gas (ABG) test measures oxygen and
carbon dioxide levels in your blood 
usually in balance when you’re healthy
your lungs, heart and kidneys are working.
 Aids in assessing the ability of the lungs to provide adequate
oxygen and remove carbon dioxide (which reflects the
ventilation)
 Aids in assessing the ability of the kidneys to reabsorb or
excrete bicarbonate ions tom maintain normal body pH
(which reflects metabolic state)
WHY IS AN ARTERIAL BLOOD GAS TEST DONE?
 Check for severe breathing and lung problems such
as asthma, cystic fibrosis, chronic obstructive
pulmonary disease (COPD), or obstructive sleep
apnea
 Check how treatments for your lung problems are
working
 Check whether you need extra oxygen or other help
with breathing
 Check your acid-base balance. You can have too
much acid in your body from kidney failure, a
severe infection, specific toxic ingestions, or
complications of diabetes (DKA).
How is it performed?
ABG are obtained through an arterial puncture at the radial,
brachial, or femoral artery or through an indwelling arterial
catheter
ABG ANALYSIS INCLUDES SEVERAL MEASURES:
 An indication of hydrogen ion concentration in the blood pH
 Known as the respiratory parameter, partial pressure of
arterial carbon dioxide (PaCO2), reflects the adequacy of
the lung’s ventilation and carbon dioxide elimination
(HCO3) level reflects the kidneys’ ability to retain and
excrete bicarbonate
Why pH important?
  The pH of blood in the arteries should be between 7.35 to
7.45 for the body’s metabolic processes and other systems to
work well.
 These processes produce acids, so the body has a complex
system of feedback and regulation to maintain healthy pH
levels.
What happened if pH is acidic?
 As blood pH drops (becomes acidic), the parts of the brain
that regulate breathing are stimulated to produce faster and
deeper breathing (respiratory compensation)
 Breathing faster and deeper increases the amount of carbon
dioxide exhaled, which raises the blood pH back toward
normal.
What happened if pH is basic?
 Alkalosis occurs when your blood has too many bases.  RESPIRATORY ALKALOSIS
 It can occur due to decreased blood levels of carbon dioxide,
which is an acid.
 It can also occur due to increased blood levels of bicarbonate,
which is base.
Why is PaCO2 important?
 The partial pressure of carbon dioxide (PaCO2) is one of
several measures calculated by an arterial blood gases (ABG)
test often performed on people with lung diseases,
neuromuscular diseases, and other illnesses.   The kidney compensates in response to respiratory alkalosis
 PaCO2 specifically evaluates carbon dioxide (CO2) levels
in the blood reabsorbed by your kidneys
Why HCO3 important?
 Bicarbonate, also known as HCO3, is a byproduct of your
body's metabolism.
 Your blood brings bicarbonate to your lungs, and then it is
exhaled as carbon dioxide.  be used.
 Your kidneys also help regulate bicarbonate. Bicarbonate is
excreted and reabsorbed by your kidneys
How do you know if an acid base is compensated or not?
1. FULLY COMPENSATED: acid/base disorders are that the pH
will be within the normal range of 7.35 to 7.45
2. PARTIALLY COMPENSATED: if the helpers value is
changing
3. UNCOMPENSATED: when there is acidosis or alkalosis and
the helpers value is not changing or within normal
How lung compensate for METABOLIC ACIDOSIS?
 As blood pH drops, the part of the brain that regulate
breathing are stimulated to produce faster and deep breathing
(respiratory compensation)  elevate PaCO2 levels.
 Breathing faster and deeper increases the amount of carbon
dioxide exhaled, which raises the pH back to normal.
METABOLIC ALKALOSIS
  excess of bicarbonate in the body fluids
Causes:
 the use of diuretics and the external loss of gastric secretions
Common example:
 prolonged vomiting, hypovolemia, diuretic use, and
hypokalemia.
How lung compensate for METABOLIC Alkalosis?
 The lung change alkalinity by allowing less carbon dioxide to
escape during breathing
RESPIRATORY ACIDOSIS
 decrease in respiratory rate and/or volume
 a condition that occurs when the lungs cannot remove all of
the carbon dioxide the body produces
Causes:
 Impaired respiratory drive (eg, due to toxins, CNS disease)
 and airflow obstruction 
Common example:
 hypoventilation, due to asthma, COPD, sleep apnea, airway
edema
How kidney compensate for RESPIRATORY ACIDOSIS?
 The kidneys compensate for a respiratory acidosis by tubular
cells reabsorbing more HCO3 from the tubular fluid,
collecting duct cells secreting more H+ ion and generating
more HCO3 
  a condition marked by a low level of carbon dioxide in the
blood due to breathing excessively
Causes:
 over-breathing; occurs when you breathe very deeply or
rapidly
Common example:
 hyperventilation, Anxiety or panic, pulmonary embolism,
asthma
How kidney compensate for RESPIRATORY ALKALOSIS?
by reducing the amount of new of new HCO3- generated by
excreting HCO3
Nursing Consideration:
 Blood for an ABG analysis should be drawn from an arterial
line if the patient has one.
  If a percutaneous puncture is necessary, the site must be
chosen carefully.  The brachial, radial, or femoral arteries can
 After the sample is obtained, apply pressure to the puncture
site for 5 minutes and tape a gauze pad firmly in place.
Regularly monitor the site for bleeding, and check the arm for
signs of complications, such as swelling, discoloration, pain,
numbness, and tingling.
 Make sure you note on the slip whether the patient is
breathing room air or oxygen. If oxygen, document the
number of liters. If the patient is receiving mechanical
ventilation, document the fraction of inspired oxygen.
 Also include the patient’s temperature on the slip; results may
be corrected if the patient has a fever or hypothermia.
 Keep in mind that certain conditions may interfere with test
results for example, failing to properly heparinize the syringe
before drawing a blood sample or exposing the psample to
air.  Venous blood in the sample may lower PaO2 levels and
 Keep in mind that certain conditions may interfere with test
results for example, failing to properly heparinize the syringe
before drawing a blood sample or exposing the sample to air. 
Venous blood in the sample may lower PaO2 levels and
elevate PaCO2 levels.
F. Imaging studies
• Includes: x-rays, computed tomography (CT), magnetic
resonance imaging (MRI), and radioisotope or nuclear
scanning
• may be part of any diagnostic workup, ranging from a
determination of the extent of infection in sinusitis to tumor
growth in cancer
1. Chest x-ray
• Normal pulmonary tissue is radiolucent because it consists
mostly of air and gases; therefore, densities produced by
fluid, tumors, foreign bodies, and other pathologic conditions
can be detected by x-ray examination.
 • The routine chest-xray consists of two views: the
posteroanterior projection and the lateral projection.
How is it performed?
• Chest x-rays are usually obtained after full inspiration
because the lungs are best visualized when they are well
aerated
• During inspiration, the diaphragm is at its lowest level and
the largest expanse of lung is visible
• Patients must be instructed to take a deep breath and hold
it without discomfort
• Chest x-rays are contraindicated in pregnant women
Nursing Consideration:
• Tell the patient that he/she must wear a gown without snaps
and must remove all jewelry from his neck and chest but need
not remove his pants, socks, and shoes
• In order to obtain appropriate view of the chest (sitting,
standing, recumbent position)
• the test is performed in the radiology department
• If it’s performed at the bedside, someone will help him to a
sitting position and a cold, hard film plate will be placed
behind his back.
• He’ll be asked to take a deep breath and to hold it for a few
seconds while the Xray is taken. He should remain still for
those few seconds.
• Reassure the patient that the amount of radiation exposure is
minimal.
• Explain that facility personnel will leave the area when the
technician takes the X-ray because they’re potentially
exposed to radiation many times each day.
2. Computed tomography
• A CT is an imaging method in which the lungs are scanned in
successive layers by a narrow-beam x-ray.
Is it the same with X-ray?
• In CT The images produced provide a cross-sectional view
of the chest. Whereas a chest x-ray shows major contrasts
between body densities such as bone, soft tissue, and air
• a CT scan can distinguish fine tissue density
• A CT scan may be used to define pulmonary nodules and
small tumors adjacent to pleural surfaces that are not visible
on routine chest x-rays
• to demonstrate mediastinal abnormalities and hilar
adenopathy, which are difficult to visualize with other
techniques
Nursing Consideration
• The nurse should inform patients preparing for CT scans that
they will be required to remain supine and still for a short
period, typically less than 30 minutes, while a body scanner
surrounds them and takes multiple images
• Patients typically do not experience claustrophobia during CT
scanning but can be given antianxiety medications pre
procedure if this is a concern.
• If contrast dye is required, patients will need to stay on
NPO for 4 hours prior to the examination.
• the nurse should also assess for allergies to iodine or shellfish
• Contraindications include allergy to dye, pregnancy,
claustrophobia and morbid obesity, whereas potential
complications include acute kidney injury and acidosis
secondary to contrast
3. Magnetic resonance imaging (mri)
• MRI is a noninvasive test that employs a powerful magnet,
radio waves, and a computer to help diagnose respiratory
disorders.
How is it performed?
• It provides high-resolution, cross-sectional images of lung
structures and traces blood flow.
• MRI’s greatest advantage is its ability to “see through’’ bone
and to delineate fluid-filled soft tissue in great detail, without
using ionizing radiation or contrast media.
Is it the same with CT-scan?
• MRI is similar to a CT scan except that magnetic fields and
radiofrequency signals are used instead of radiation.
• MRI is able to better distinguish between normal and
abnormal tissues than CT; yields a much more detailed
diagnostic image
• MRI is used to characterize pulmonary nodules; to help stage
bronchogenic carcinoma (assessment of chest wall invasion)
• to evaluate inflammatory activity in interstitial lung disease,
acute PE, and chronic thrombolytic pulmonary hypertension.
Nursing Consideration
• Tell the patient that he must remove all jewelry and take
everything out of his pockets.
• The nurse should assess for the presence of implanted
metal devices, such as aneurysm clips or a cardiac
pacemaker/defibrillator.
• Explain that no metal can be in the test room; the powerful
magnet may demagnetize the magnetic strip on a credit card
or stop a watch from ticking.
• If he has any metal inside his body, such as a pacemaker,
orthopedic pins or disks, and bullets or shrapnel fragments,
tell him he must notify the practitioner.
• Explain to the patient that he’ll be asked to lie on a table that
slides into an 8 (2.4 m) tunnel inside the magnet.
• Tell him to breathe normally but not talk or move during the
test to avoid distorting the results; the test usually takes 15 to
30 minutes but may take up to 45 minutes.
• Warn the patient that the machinery will be noisy, with
sounds ranging from a constant ping to a loud bang. Tell him
ear protection will be provided.
• He may feel claustrophobic or bored. Suggest that he try to
relax and concentrate on breathing or a favorite image.
• Patients scheduled for MRI should be instructed to remove all
metal items such as hearing aids, hair clips, and medication
patches with metallic foil components (e.g., nicotine patches).
• Patients will be able to communicate with the MRI staff via a
microphone and earphones.
• The nurse should clarify with the physician or the
technologist if the ordered test requires the use of dye or the
patient should remain NPO pre-examination.
• Patients who experience claustrophobia should be offered
anti-anxiety medications pre-procedure or be scheduled in a
facility that uses an open MRI system
• Contraindications for MRI include claustrophobia,
confusion and agitation, and having implanted metal or metal
support devices that are considered unsafe.
4. Fluoroscopic studies
• Fluoroscopy, which allows live x-ray images to be generated
via a camera to a video screen
• it is used to assist with invasive procedures, such as a chest
needle biopsy or transbronchial biopsy, that are performed to
identify lesions.
• It also may be used to study the movement of the chest wall,
mediastinum, heart, and diaphragm; to detect diaphragm
paralysis; and to locate lung masses
5. Pulmonary angiography/ angiogram
• It is used to investigate:
• congenital abnormalities of the pulmonary
vascular tree
• describe a procedure used to identify narrowing or
blockages in the arteries in the body
• to visualize the pulmonary vessels a radiopaque
agent is injected through a catheter, which has been
initially inserted into a vein (e.g., jugular,
subclavian, brachial, or femoral vein) and then
threaded into the pulmonary artery.
• Contraindications include allergy to the radiopaque
dye, pregnancy, and bleeding abnormalities
• potential complications include acute kidney
injury, acidosis, cardiac dysrhythmias, and
bleeding
How is it read performed?
• A radiopaque agent is injected through a catheter
• Inserted into vein (jugular, subclavian, brachial or
femoral vein)
• It is threaded into the pulmonary artery
Nursing Considerations:
• Verify informed consent prior to the procedure
• Assess for known allergies
 • Assess anticoagulation and renal function
• Ensure that patient has not eaten or drink (6 or 8 hours)
• Administer pre-procedure medications (anti-anxiety),
anticholinergics, and antihistamines
• Nurse should instruct patients may experience warm flushing
sensation; chest pain during dye insertion
• Closely monitor vital signs, LOC, O2 saturation and vascular
site bleeding or hematoma
• Perform NVS status
• it is contraindicated with:
• allergy to radiopaque dye
• Pregnancy
• Bleeding abnormalities
H. Endoscopic procedures
• Endoscopic procedures include:
A. Bronchoscopy
B. Thoracoscopy
C. Thoracentesis
BRONCHOSCOPY
• It is the direct inspection and examination of the larynx,
trachea, and bronchi through either a flexible fiberoptic
bronchoscope or a rigid bronchoscope
Purposes: (diagnostic)
 to visualize tissues and determine the nature, location, and
extent of the pathologic process;
 to collect secretions for analysis and to obtain a tissue sample
for diagnosis;
 to determine whether a tumor can be resected surgically; and
 to diagnose sources of hemoptysis
Purposes: (therapeutic)
• remove foreign bodies or secretions from the
tracheobronchial tree
• control bleeding
• treat postoperative atelectasis
• destroy and excise lesions, and
• provide brachytherapy (endobronchial radiation therapy)
Nursing Considerations:
• Before the procedure
• the nurse should verify that informed consent has
been obtained
• Food and fluids are withheld for 4 to 8 hours
before the test
• explains the procedure to the patient
• then administers preoperative medications
(usually atropine and a sedative or opioid) as
prescribed
• patient must remove dentures and other oral
prostheses
• examination is usually performed under local
anesthesia or moderate sedation
• A topical anesthetic such as lidocaine
(Xylocaine) is normally sprayed on the
pharynx or dropped on the epiglottis and
vocal cords and into the trachea
• General anesthesia for rigid
bronchoscope
• patient must remove dentures and other oral
prostheses
• examination is usually performed under local
anesthesia or moderate sedation
• A topical anesthetic such as lidocaine
(Xylocaine) is normally sprayed on the
pharynx or dropped on the epiglottis and
vocal cords and into the trachea
• General anesthesia for rigid
bronchoscope
• After the procedure:
• the patient must take nothing by mouth until the
cough reflex returns
• Once the patient demonstrates a cough reflex, the
nurse may offer ice chips and eventually fluids
• In the older adult patient, the nurse assesses for
confusion and lethargy
• the nurse also monitors the patient’s respiratory
status and observes for hypoxia, hypotension,
tachycardia, dysrhythmias, hemoptysis, and
dyspnea
• any abnormality is reported promptly
• A small amount of blood-tinged sputum and fever
may be expected within the first 24 hours
• the patient is not discharged from the recovery area
until adequate cough reflex and respiratory status
are present
• the nurse instructs the patient and caregivers to
report any shortness of breath or bleeding
immediately.
THORACOSCOPY
• a diagnostic procedure in which the pleural cavity is
examined with an endoscope
• fluid and tissues can be obtained for analysis
• It it performed in the operating room, normally under
anesthesia.
• Small incisions are made into the pleural cavity in
an intercostal space at the location indicated by
clinical and diagnostic findings
• The fiberoptic mediastinoscopy is inserted into the
pleural cavity
• It is primarily indicated in the diagnostic evaluation and
treatment
• pleural effusions
• pleural disease
• tumor staging
• Video- assisted thoracoscopy (VATS) may be used
in the diagnosis and treatment of empyema, pleural
effusion, pulmonary and pleural masses, and
pneumothorax.
Nursing Consideration
• The nurse should follow routine preoperative practices
• ensuring that informed consent is obtained
• the patient remains NPO prior to the procedure.
• Postoperatively, the nurse should monitor vital
signs, pain level, and respiratory status, and should
look for signs of bleeding and infection at the
incisional site.
• Shortness of breath may indicate a pneumothorax
and should be reported immediately
THORACENTESIS
• Thoracentesis is the aspiration of fluid and air from the
pleural space
• it is performed for diagnostic or therapeutic reasons
• Purposes of the procedure include:
• removal of fluid and air from the pleural cavity
• aspiration of pleural fluid for analysis
• pleural biopsy; and
• instillation of medication into the pleural space.
• Studies of pleural fluid include:
• Gram stain culture and sensitivity
• acid-fast staining and culture
• differential cell count (proportion of white cells)
• Cytology (structure of cell)
• pH (concentration of Hydrogen ion)
• total protein, lactic dehydrogenase, glucose,
amylase, triglycerides, and
• cancer markers such as carcinoembryonic antigen
NURSING INTERVENTION
BEFORE THE PROCEDURE:
1. Secure consent; it is an invasive procedure
2. Take initial VS; aspiration of air or fluid from the pleural
space may cause Hypovolemic shock
3. Position: Upright, leaning on overbed table (orthopneic
position)
4. Instruct client to remain still, avoid coughing during insertion
of needle; prevent trauma to the lung
5. Pressure sensation is felt on the insertion needle; topical
anesthesia is used as the site of needle insertion to numb the
area.
AFTER THE PROCEDURE:
1. Turn the client on the unaffected side to prevent leakage of
fluid into the thoracic cavity
2. Bed rest until VS are stable (to prevent postural hypotension)
 3. Check for expectoration of blood. This indicates trauma to
the lung (NOTIFY the physician)
4. Monitor VS and assess signs and symptoms of internal
hemorrhage
• Hemorrhage is manifested by tachycardia,
tachypnea, hypotension, hypothermia

Biopsy

• the excision of a small amount of tissue

• may be performed to permit examination of cells
from the upper and lower respiratory structures and
adjacent lymph nodes
• Local, topical, or moderate sedation, or general
anesthesia, may be given, depending on the site and
the procedure.

Lung Biopsy

• In transbronchial brushing:
• Using fiberoptic bronchoscope is introduced
• Small brush is attached
• Area of suspicion is brushed back and fort
• Cells will slough off and adhere to brush
• Brush may be cut off and sent to pathology for
analysis
• In transbronchial needle aspiration:
• A catheter with needle is inserted into tissue
through the bronchoscope and aspirated
• In transbronchial lung biopsy:
• biting or cutting forceps are introduced by a
fiberoptic bronchoscope to excise the tissue

Nursing Consideration
• After the procedure:
• recovery and home care are similar to those for
bronchoscopy and thoracoscopy
• monitoring the patient for complications such as
shortness of breath, bleeding, or infection.
• In preparation for discharge, the patient and the
family are instructed to report pain, shortness of
breath, visible bleeding, redness of the biopsy site,
or purulent drainage (pus) to the primary provider
immediately
• the nurse must consider this in providing post-
biopsy care and patient education; relive anxiety