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217 Cards in this Set
- Front
- Back
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used routinely in patients with chronic respiratory functions
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Pulmonary Function tests
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Used when managing patients with respiratory problems and adjusting oxygen therapy is needed
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Arterial blood gas studies
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noninvasive method of continuously monitoring oxygen saturation of hemoglobin (SaO2)
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Pulse Oximetry
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Normal SpOx Values
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95% to 100%
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Which value using pulse oximetry indicates that tissues are not receiving enough oxygen, and further evaluation is needed
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values less than 85%
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When are pulse oximetry readings not reliable
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in cardiac arrest and shock, if dyes orvasoconstrictor medications have been used or if pt has sever anemia or a high carbon monoxide level
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When are throat cultures performed
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to identify organisms responsible for pharyngitis. May also identify organisms that cause infection of lower respiratory tract
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When are sputum studies performed
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for analysis to identify pathogenic organisms and to determine whether malignant cells are present.
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When are periodic sputum studies performed
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patients recieving antibiotics, corticosteroids, and immunosuppressive meds for prolonged periods, because these agents are associated with opportunistic infections
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What is the usual method for collecting a sputum speciman called
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expectoration
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How is an expectoration (sputum specimen) performed
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pt instructed to clear nose and throat and rinse the mouth to decrease contamination of the sputum. Take a few deep breaths and coughs using the diaghragm.
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Other than expectoration, how can a sputum specimen be collected?
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endotracheal aspiration, bronchoscopic removal, bronchial bruching, transtracheal aspiration, and gastric aspiration - for TB tests
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When should a sputum specimen be delivered to the lab?
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within 2 hours by the patient or nurse.
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Why should the sputum specimen be delivered to lab within 2 hour time frame?
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Allowing the specimen to stand for several hours in a warm room results in overgrowth of contaminant organisms.
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what does a chest x-ray show?
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dinsities produced by fluid tumors, foreign bodies, and other pathologic conditions.
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What does a CT scan show
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defines pulmonary nodules and small tumors adjacent to pleural surfaces that are not visible on routine chest x-rays
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When is an MRI performed
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MRI is similar to CT scan MRI yeilds a much more detailed diagnostic image than CT. Used to help stage bronchogenic carcinoma (assessment of chest wall invastion, and to evaluate inflammatory activity in interstitial lung disease, acute pulmonary embolism and chronic thrombolytic pulmonary hypertension.
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Why is a pulmonary angiography used
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most commonly used to to investigate thromboembolic disease of the lungs and pulmonary emboli.
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What are some radioisotope diagnotic procedure
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V/Q scans, gallium scans and positron emission tomography (PET) scan
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Why are V/Q scans, PET scans performed
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To assess normal lung functioning, pulmonary vascular supply and gas exchange
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What are some pathologies the V/Q scan might detect?
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bronchitis, asthma, inflammatory fibrosis, pneumonia, emphysema and lung cancer.
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Ventilation without perfusion is characteristic of which disorder
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pulmonary emboli
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What are gallium studies used for
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detection of inflammatory conditions, such as abscessed, adhesions,a nd the presence, location and size of tumors.
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Why are PET scans performed
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To dectect abnormal from normal tissue.
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What is a bronchoscopy?
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Endoscopic procedure which allows direct inspection of the larynx, trachea, and bronchi through either a flexible fiberoptic or rigid bronchoscope.
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What are the purposes of diagnostic bronchoscopy?
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1. to examine tissues or collect secretions
2. determine the location and extent of the pathologic process and to obtain a tissue sample for diagnosis 3. determine whether a tumor can be resected surgically 4. diagnose bleeding sites (source of hemoptysis). |
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What is the purpose of Therapeutic bronchoscopy?
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1. remove foreign bodies form the tracheobronchial tree
2. remove secretions obstructing the tracheobronchial tree when pt. can not clear them. 3. treat postoperative atelectasis. Destroy and excise lesions. |
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Where is a fiberoptic bronchoscopy performed vs rigid bronchoscopy?
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fiberoptic bronchoscopy can be performed at bedside, rigid bronchoscopy performed in the operating room.
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What are some possible complications to bronchoscopy?
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reaction to the local anethetic
2. infection 3. aspiration 4. Bronchospasm 5. Hypoxemia 6. pneumothorax 7. bleeding and perforation |
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Sedation medication given to patients with respiratory insufficiency may result in?
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respiratory arrest.
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Which medication is sprayed or dropped on the epiglottis and vocal cords to suppress cough reflex and minimize discomfort?
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Lidocaine (Xylocaine)
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What is a thoracoscopy
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diagnostic procedure in which pleural cavity is examined with an endoscope.
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Why is a throacoscopy performed?
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to aspirate any fluid present in the pleural cavity. Chest tube may in inserted and pleural cavity is drained by negative pressure water-seal drainage.
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What is the nursing interventions following a thoracoscopy?
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monitoring pt for shortness of breath (pneumothorax) & monitoring chest tube drainage site.
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Why is a thoracentesis performed?
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to obtain a sample of the pleural fluid. Pt sitting position at end of bed with feet supported and arms and head on a padded over the bod table. or lying on unaffected side with HOB elevated 30 - 45 degrees
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When is a pleural biopsy performed?
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when there is a need to culture or stian the tissue to identify TB or fungi, or when there is pleural exudate of undetermined origin.
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After a lung biopsy, pts are instructed to:
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hold a finger or thumb over the puncture site while coughing to prevent air from leaking into surrounding tissues.
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which lymph nodes are involved in draining the lungs and mediastinum and may show histologic changes
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scalene lymph nodes.
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What are nursing interventions after a biopsy of lungs?
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1. adequate oxygenation
2. monitoring for bleeding 3. Providing pain releif. |
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Movement of air in and out of the airways
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Ventilation
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Direct examination of larynx, trachea, and bronchi using endoscope
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Bronchoscopy
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expectoration of blood from respiratory tract
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hemoptysis
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decrease in arterial exygen tension in the blood
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hypoxemia
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decrease in oxygen supply to the tissues and cells
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hypoxia
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amount of physiological dead space
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150 ml
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Epithelial cells that form the alveolar walls
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Type I alveorlar cells
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Cells that secrete surfactant, a phospholipid that lines the inner surface and prevents alveolar collapse
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Type II alveolar cells
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large phagocytic cells that ingest foreign matter and act as an important defense mechanism
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Type III alveolar cells
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process of gas exchange between the atmospheric air and the blood and between the blood and cells of the body
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respiration
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process by which oxygen and carbon dioxide are exchanged at the air-blood interface
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Diffusion
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Actual blood flow through the pulmonary circulation
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Pulmonary perfussion
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Amount of blood pumped by the right ventricle which does not perfuse the alveolar capillaries
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2%
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True or False
The pulmonary circulation is considered a low pressure system |
True
It is considered a low pressure system because the systolic blood pressure in the pulmonary artery is 20-30 mm Hg and the diastolic pressure is 5-15 mm Hg |
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What determines the patterns of perfusion
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Pulmonary artery pressure, gravity, and alveolar pressure
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Which part of the brain controls the rate and depth of ventilation to meet the body's metabolic demands
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Medulla Oblongata and Pons
1. apneustic center in lower pons stimulates deep breathing 2. pneumotaxic center in the upper pons controls patterns of respiration |
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At what age do alveoli begin to lose their elasticity
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50 years old
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Risks for respiratory disease
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smoking *** #1
exposure to secondhand smoke personal or family history genetic make up allergens and environmental pollutants Recreational/occupational exposure |
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psychosocial risks for respiratory disease
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anxiety
role changes family relationships financial problems employment status coping strategies |
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Major signs and symptoms of respiratory disease
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1. dyspnea
2. cough 3. sputum production 4. chest pain 5. wheezing 6. clubbing of fingers 7. hemoptysis 8. Cyanosis |
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Sudden dyspnea in a healthy person would indicate what
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1. pneumothorax
2. acute respiratory obstruction 3. ARDS |
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Sudden dyspnea in immobilized person might indicate what?
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Pulmonary embolism
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Dyspnea with an expiratory wheeze indicates:
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COPD
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Presence of inspiratory and expiratory wheeze indicates:
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Asthma if the patient does not have heart failure.
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Genetic conditions that effect gas exchange
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1. Asthma
2. Chronic obstructive Pulmonary Disease 3. Cystic Fibrosis 4. Alpha-1 antitrypsin deficiency |
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Relief measures for dyspnea
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1. identify and correct cause
2. place pt at rest w/ HOB elevated (high fowler's position) 3. administering Oxygen |
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What can impair cough reflex
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1. paralysis of respiratory muscles
2. prolonged inactivity 3. presence of nasogastric tube 4. depressd medullary centers in brain |
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dry irritative cough =
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upper respiratory tract infection or possibly side effect of ACE inhibitor therapy
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irritative, high pitched cough=
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laryngotracheitis
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Brassy cough=
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tracheal lesions
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severe or changing cough may indicate
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bronchogenic carcinom
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Pleuritic chest pain w/ cough=
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pleural or chest (musculoskeleton) involvement
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Coughing at night
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onset of left-sided heart failure or bronchial asthma
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morning cough with sputum production may indicate:
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bronchitis
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cough that worsens when the patient is supine suggests:
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postnasal drip (sinusitis)
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coughing after food intake may indicate
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aspiration of material into tracheobronchial tree
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cough of recent onset is:
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usually from an acute infection
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If cough is a result of irritation, what interventions should be implemented?
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1. smoking cessation
2. drinking warm beverages |
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What is an acute cough?
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a cough that lasts for less than 3 weeks
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What is a subacute cough
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A cough that lasts 3 to 8 weeks
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What is a chronic cough
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A cough that lasts for more than 8 weeks
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What is the treatment for acute or upper airway cough secondary to rhinosinus disease (postnasal drip)
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First generation antihistamines with a decongestant instead of over the counter cough expectorants or suppressants
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Violent coughing may result in what 3 conditions
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1. bronchial spasm
2. obstruction 3. irritation of bronchi and may result in syncope |
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profuse amount of purulent sputum (thick and yellow, green, or rust-colored) or a change in color of sputum indicates what
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common sign of a bacterial infection
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thin, mucoid sputum results in?
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viral bronchitis
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gradual increase of sputum over time may indicate=
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presence of chronic bronchitis or bronchiectasis
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pink tinged mucoid sputum suggests
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lung tumor
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profuse frothy, pink material often welling up into the throat indicates=
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pulmonary edema
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Foul smelling sputum and bad breath indicate
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lung abscess, bronchiectasis, or infection caused by fusospirochetal or other anaerobic organisms
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Relief measures for cough
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1. adequate hydration
2. inhalation of aerosolized solutions (nebulizer) 3. no smoking adequate oral hygiene 4. food that stimulates appetite |
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Why might a patient with cough be encouraged to drink citrus drink before meal
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may increase palatability of the meal because juices cleanse the palate of the sputum taste
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where might chest pain be referred
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neck, back or abdomen
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In what conditions might chest pain be present?
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pneumonia, pulmonary embolism with lung infarction
and pleurisy |
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signs and symptoms of pleuritic pain from irritation of parietal pleura
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sharp and seems to "catch" on inspiration., "like the stabbing of a knife"
pt more comfortable laying on affected side, b/c this splints the chest wall, limits expansion and contraction of the lung and reduces friction between diseased plurae |
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how can you reduce pain associated with cough?
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by manually splinting the rib cage.
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Relief measures for cough
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1. analgesic medications, however careful not to depress respiratory center or productive cough
2. NSAID's used for pleuritic pain 3. regional anesthetic block may be used for extreme pain |
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high pitched musical sound heard mainly on expiration
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Wheezing
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Treatment for wheezing
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oral or inhalant bronchodilator medications
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sign of lung disease that is found in patients with chronic hypoxic conditions, chronic lung infections or malignancies of the lung
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clubbing of the fingers
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**S and S of hemoptysis
(May be both pulmonary and cardiac disorders) |
blood stained sputum
sudden hemorrhage **always merits investigation** |
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Causes of hemoptysis
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1. pullmonary infection
2. Carcinoma of lung 3. abnormalities of heart or vessels 3. pulmonary artery or vein abnormalities 4. pulmonary embolus and infarction |
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S & S of hemoptysis from lungs
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1. bright red, frothy and mixed with sputum
2. tickling sensation in throat 4. salty taste 5. burning or bubbling sensation in chest 6. chest pain |
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hemoptysis is reserved for coughing up blood arising from a pulmonary hemorrhage. What pH does this blood have
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alkaline pH (greater than 7.0)
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S & S of hemorrhage in stomach
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1. blood is vomited (hematemesis) rather than coughed up
2. blood in contact with gastric juices has acid pH (less than 7.00 3. dark and referred to as coffee grounds. |
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a very late indicator of hypoxia
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Cyanosis
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how is cyanosis clinically determined?
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when there is at least 5 g/dL of unoxygenated hemoblobin. A pt with 15 g/dL does not demonstrate cyanosis until 5g/dL of that becomes unoxygenated (2/3 the normal)
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Why is cyanosis not a reliable indicator for hypoxia
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because a pt with anemia rarely manifests cyanosis and a pt with polycythemia may look cyanotic even if ok.
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In the presence of pulmonary condition, how is central cyanosis assessed?
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by observing the color or tongue and lips, which indicates a decrease in oxygen tension in blood
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during nose and sinus assessment, what are the internal structures of the nose inspected for?
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mucosa inspected for
1. color 2. swelling 3. exudate 4. bleeding |
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Characteristics of nose polyps
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1. gray appearance
2. gelatinous 3. freely movable |
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Which sinuses are palpated?
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supraorbital ridges (frontal sinuses) and the cheek area adjacent to the nose (maxillary sinuses)
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Tenderness in palpation of sinuses indicates:
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inflammation
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When using transillumination of the sinuses, if the light fails to penetrate through, what might this indicate
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the cavity likely contains fluid or pus.
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If a tongue blade is used for visualization of pharynx and mouth, where is it placed in the mouth
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firmly beyond the midpoint of the tongue to avoid a gagging response.
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Which disorder might displace the the trachea?
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pleural or pulmonary disorders, sucha s pneumothorax
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What information is provided by inspecting the thorax
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1. muscoloskeletal structure
2. pt nutritional status 3. respriatory system |
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What is the normal ratio of the anteroposterior diameter to the lateral diameter
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1:2
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What are the four main deformities of the chest associated with with respiratory disease that alter AP diameter
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1. Barrell Chest- results of overinflation of lungs (emphysema)
2. Funnel Chest (Pectus excavatum) depression in lower portion of sternum (rickets or marfans syndrome) 3. Pigeon chest (pectus carinatum) displacement of sternum. increase in diameter (rickets, marfans syndrome, kyphoscoliosis. 4. kyphoscoliosis - elevation of scapula and s shaped spine- limits lung expansion (osteoporosos/skeletal deformities) |
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Normal respiratory rate
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12-18 breaths per minute
regular in depth and rhythm |
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What is eupnea
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normal pattern of respirations. 12-18 b/p/m regular depth and rhythm
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slow breathing associated with increased intracranial pressure, brain injury and drug overdose
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bradypnea
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rapid breathing
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tachypnea
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What conditions is tachypnea associated with?
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pneumonia, pulmonary edema, metabolic acidosis, septicemia, severe pain, rib fracture.
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Shallow, irregular breathing
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hypoventilation
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Increase in depth of respirations
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hyperpnea
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Increase in both rate and depth of respirations that results in a decreased arterial PaCO2 level
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Hyperventilation
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hyperventilation that is marked by an increase in rate and depth, associated with severe acidosis of diabetic or renal origin
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Kussmaul's respiration
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varying periods of cessation of breathing
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apnea
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alternating episodes of apnea (cessation of breathing) and periods of deep breathing.
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Cheyne-stokes respirations
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Deep respirations become increasingly shallow, followed by apnea that may last approximately 20 seconds
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Cheyne-stokes respirations
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Cheyne-Stokes respiration is usually associated with what disorder?
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heart failure and damage to respiratory center.
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cluster breathing, cycles of breathing that vary in depth and have varying periods of apnea
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Biot's respirations
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Bulging of intercostal spaces during expiration implies:
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Emphysema
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Retraction on inspriation, particularly if asymmetric implies:
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blockage of branch of respiratory tree
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Asymmetrical bulging of intercostal space on one side or other implies?
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increase in pressure within hemithorax. trapped air under pressure within pleural cavity, fluid within pleural space (pleural effusion)
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Normal breathing at 12-18 b/p/m
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Eupnea
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slower than normal rate (<10 b/p/m) with normal depth and regular rhythm
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Bradypnea
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Rapid, shallow breathing (>24 b/p/m)
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tachypnea
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shallow, irregular breathing
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hypoventilation
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increased rate and depth of breathing (called kussmaul's respiration if caused by diabetic ketoacidosis)
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hyperventilation
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Period of cessation of breathing. Time duration varies;
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apnea
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regular cycle where the rate and depth of breathing increase, then decrease until apnea (usually about 20 seconds) occurs
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cheyne-stokes
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periods of normal breathing (3-4 breaths) followed by a varying period of apnea (usually 10-60 seconds)
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Biot's respirations
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Respiratory excursion landmarks
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thumbs on costaql margins on anterior chest wall
thumbs on level of tenths rib posteriorly. |
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Decreased chest excursion caused by
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chronic fibrotic disease.
Asymetrical excursion caused by pleurisy, fractured ribs, trauma, bronchial obstruction. |
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The detection of of vibration on the chest wall by touch?
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tactile fremitus
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factors influencing tactile fremitus
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1. thickness of chest wall
2. obesity |
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Why is mens voices more pronounced in tactile fremitus than womens
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becuase lower pitched sounds travel better through the normal lung and produce greater vibration of the chest wall. Men have lower pitched voices.
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How do you perform tactile fremitus?
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asking pt to repeat "ninety-nine" or "one, two, three" or "eee, eee, eee" as the nurse moves hands down patients thorax. vibrations detected by palmar surfaced . **bony areas not tested***
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Conditions of tactile fremitus test
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air does not conduct sound well, but solid tissue does, provided that its elasticity is not compressed. Increase in solid tissue enhances fremitus, increase in air impedes lung sounds.
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In performing tactile fremitus, what type (increased or decreased) would you expect in a pt with emphysema
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emphyseam results in rupture of alveoli and air trapping, therefore almost no tactile fremitus
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a pt with consolidation of a lobe of the lung from pneumonia would have what type of tactile fremitus
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increased tactile fremitus, due to increased consolidation.
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Sets the chest wall and underlying structure in motion, producing audible and tactile vibrations
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Thoracic percussion
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Why does a nurse use thoracic percussion?
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to determine whether underlying tissues are filled with air, fluid, or solid merial. Also to estimate the size and location of certain structures within the thorax.
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Where does a nurse begin thoracic percussion on the body
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posterior thorax, with the patient in a sitting position with the head flexed forward and arms crossed on the lap.
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What sound is normally heard during chest percussion
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resonance
* dullness heard over 3rd and 5th intercostal spaces is normal (location of heart), as well as 5th intercostal to rght costal margin (Liver) |
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Dullness heard during percussion of the lungs might indicate?
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air-filled lung tissue replaced by fluid or solid tissue.
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What is the normal maximal excursion of the diaghragm?
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8-10 cm (2-2.75 inches) in men or (2 cm (.75 inches) normal
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Decreased diaghramic excursion may be caused by:
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1. pleural effusion
2 emphysema |
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Percussion sound that is:
soft in intensity High in pitch short in duration |
Flatness
*may signal large pleural effusion** |
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Percussion sound that is :
medium in intensity medium in pitch medium in duration |
Dullness
***may signal lobar pneumonia*** |
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Percussion sound that is:
Loud in intensity, low in pitch, long in duration and normally heard in lung |
Resonnance
*may signal simple chronic bronchitis** |
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Percussion sound that is:
very loud in intensity lower in pitch longer in duration |
Hyperresonance
*emphysema, pneumothorax** |
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Percussion sound that is:
soud in intensity High in pitch |
Typany
*large pneumothorax** |
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Why is thoracic auscultation performed?
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to assess flow of air through bronchial tree, and in evaluating presence of fluid or obstruction in lungs
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How is thoracis auscultation performed
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pt breathes slowly and deeply through mouth.
Corresponding areas from apices to bases and along midaxillary lines **It is often necessary to listen to two complete full inspirations and expirations at each anatomic landmark for valid interpretation of the sound heard. |
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What can the nurse do to avoid pt hyperventilating during chest auscultation
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allow pt rest and to breathe normally periodically during examination.
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Breath sounds
inspiratory sounds last longer than expiratory sounds soft intensity of exp. sound relatively low pitch of exp sound |
Vesicular sounds
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Where are tracheal sounds normally heard
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over the tracha in the neck
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where are bronchial sounds heard?
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over the manubrium, if heard at all, **If heard anywhere else, siginifes pathology (Pneumonia, heart failure)
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Where are vesicular breath sounds heard?
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Over the entire lung field except over the upper sternum and between scapulae
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Where are broncho-vesicular breath sounds heard?
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often in the 1st and 2nd interspaces anteriorly and between the scapulae (over main bronchus) *anywhere else signifies pathology**
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Breath sounth that are:
Inspiratory and expiratory equal intermediate intensity of exp sounds intermediate pitch of expiratory sound |
broncho-vesicular breath sounds
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breath sounds that:
expiratory sounds last longer than inspiratory sounds loud intensity of expiratory sound relatively high pitch of expiratory sound |
Bronchial breath sounds
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Breath sounds that are:
inspriatory and expiratory sounds are about equal very loud intensity of expiratory sound relatively high pitch of expiratory sound |
Tracheal breath sounds
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2 categories of adventitious sounds
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1. discrete, noncontinuous sounds (crackles)
2. continuous musical sounds (wheezes) ***duration of the sound is the important distinction to make in identifying the sound |
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discrete, noncontinuous sounds that result from delayed reopening of deflated airways
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Crackles (rales)
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soft, hgih pitched discontinuous popping sounds that occur during inspriation
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Crackles in general
*fluid in airways or alveoli, or opening of collapsed alveoli** |
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discontinuous popping sounds heard in early inspiration; harsh, moist sound originating in the large bronchi
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Coarse crackles
*associated with obstructive pulmonary disease |
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discontinuous popping sounds heard in late inspiration; sounds like hair rubbing together; originates in alveoli
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Fine crackles
**interstiial pneumonia, restrictive pulmonary disease (fibrosis) Fine crackles in early inspiration are associated with bronchitis or pneumonia |
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Deep, low-pitched rumbling sounds heard primarily during expiration; caused by air moving through narrowed tracheobronchial passages
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sonorous wheezes (rhonchi)
**secretions or tumor** |
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Continuous, musical, high pitched, whistle-like sounds heard during inspiration and expiration caused by air passing through narrowed or partially obstructed airways; may clear with coughing
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sibilant wheezes
*bronchospasm, asthma, buildup of secretions** |
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harsh, crackling sound, like two peices of leather being rubbed together; heard during inspiration alone or during both; may subside when pt hold breath. Coughing will not clear sound
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Pleural friction rub
*inflammation and loss of lubricating pleural fluid** |
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Where is a friction rub best heard?
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lower lateral anterior surface of thorax
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sound heard through the stethoscope as the patient speaks
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vocal resonance
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How is vocal resonance performed?
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have pt repeat "ninety-nine" or "eee" while nurse listens with stethoscope from apices to bases
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vocal resonnance that is more intense and clearer than normal
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bronchophony
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vocal resonnance sound that are distorted when heard through stethoscope E sound is distorted to a clear A sound
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egophony
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vocal resonnance sound that transmits high frequency components of sound enhanced by consolidated tissue. Whispered words are heard loud and clear.
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whispered pectoriloquy
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agitation, restlessness, nasal flaring, excessing use of intercostal and accessory muscles, uncoordinated movement of the chest and abdomes and a report of dyspnea in acutely or critically ill signifies what?
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respritory distress
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What are the signs and symptoms of carbon dioxide levels increasing in acutely ill
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lethargy and somnolence **should not be considered insignificant"
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What assessment finding are common in pneumonia
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1. increased tactile fremitus
2. dull percussion 3. bronchial breath sounds, crackles, bronchophony, egophony, whispered pectoriloquy |
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what assessment findings are common to bronchitis
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1. normal tactile fremitus
2. resonant percussion 3. normal to decreased breath sounds, wheezes |
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what assessment findings are common to emphysema
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1. decreased tactile fremitus
2. hyperresonant percussion 3. decreased intensity of breath sounds, usually with prolonged expiration |
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What assessment findings are common to asthma
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1. normal to decreased tactile fremitus
2. resonant to hyperresonant percussion 3. wheezes |
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Normal breath sounds
resonant percussion crackles at lung bases, possibly wheezes indicates? |
pulmonary edema
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absent tactile fremitus,
dull to flat percussion decreased to absent breath sounds, bronchial breath sounds and bronchophony, egophong, and whispered pectoriloquy above effusion over area of compressed lung signifies what?` |
pleural effusion
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decreased tactile fremitus
hyperresonant percussion absent breath sounds indicate what? |
pneumothorax
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absent tactile fremitus
flat percussion decreased to absent breath sounds indicate what? |
atelectasis
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what assessments are critical for the acutely ill/critically ill patient?
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1. auscultation
2. percussion 3. palpation |
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True or false:
one should not rely only on visual inspection of the rate and depth of a patient's respiratory excursions to determine the adequacy of ventilation. |
True: excursions may appear normal or exaggerated due to an increased work of breathing but the pt may actually be moving only enough air to ventilate dead space. *auscultation or pulse ox (or both) should be used.
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what are the risk factors for hypoventilation
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1. limited neurologic impulses transmitted from the brain to the respiratory muscles, as in spinal cord trauma, tumors, drug overdose
2. depressed respiratory center in the medulla, as with anesthesia, sedation, and drug overdose 3. Limited thoracic movement (kyphoscoliosis), limited lung mmovement (pleural effusion, pneumothorax) or reduced functional lung tissue (chronic pulmonary diseases, severe pulmonary edema) |
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Vital capacity at what level would require patient to recieve respiratory assistance due to inability to sustain spontaneous ventilation
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vital capacity of less than 10 mL/kg
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noninvasive method of continuously monitoring oxygen saturation of hemoglobin (SaO2)
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Pulse oximetry
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where can a pulse ox probe be placed on the body?
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1. fingertip
2. forehead 3. earlobe 4. bridge of the nose |
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What value of pulse ox is dangerous and needs further evaluation
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85%
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When is a pulse ox not valid?
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unreliable in cardiac arrest and shock
if dyes or vasoconstricotr meds have been used pt has severe anemia or a high carbon monoxide level. Not reliable detectors of hypoventilation if pt is receiving ox supplements |
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What are sputum tests used for?
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diagnosis, drug sensitivity testing and to guide treatment
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How is sputum culture collected?
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1. pt. instructed to clear nose and throat and rinse mouth to decrease contamination of sputum.
2. take a few deep breaths 3. coughs (rather than spits) using diaghragm, 4. expectorates into a sterile container. |
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what is the time frame for delivering sputum culture to lab?
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within 2 hours.
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what test is commonly used to investigate thromboembolic disease of the lungs such as pumonary edema?
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Pulmonary angiography
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What PFT is used to scan and detect inflammatrry conditions, abscesses, adhesions,a nd presence, location, and size of tumors?
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Gallium scan
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Type of PFT that is the direct inspection and examination of the larynz, trachea, and bronchi
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bronchoscopy - 2 types
1. fiberoptic bronchoscope 2. rigid bronchoscope |
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diagnostic procedure in which pleural cavity is examined with an endoscope?
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Thoracoscopy
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When is a thoracoscopy indicated for use
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1. evaluation of pleural effusions
2. pleaural disease 3. tumor staging |
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what pft is used to aspirate pleural fluid for diagnostic and therapeutic purposes?
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Thoracentesis
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what position should pt be in for a thoracentesis?
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sitting upright or on edge of bed with feet suported and arms and head on a padded over-the-bed table.
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in what procedure is the patient advised to hold a finger or thumber over puncture site while coughing to prevent air from leaking into surroungding tissues
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Lung biopsies (bronchial brushing)
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