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42 Cards in this Set

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SPUTUM ANALYSIS
specimen is obtained for microbiology(gram stain, culture,& sensitivity) or cytology

-performed to identify infectious organisms and appropriate antimicrobial therapy
-may be neccessary for patients recieving:

-antibiotics,
-cortosteroids, &/or
-immunosuppressive meds
for prolonged periods; these meds are associated w/ opportunist infections

-In general, sputum cultures are used in:

-diagnosis,
-drug sensitivity testing, &
-to guide treatment
collection procedure
sputum is obtained by:

-expectoration
-tracheal suctioning
-bronchoscopy

for patients who can cooperate:
-have patient clear their nose & throat, and rinse mouth prior to attempting to obtain expectorated specimen to decrease contamination of the sputum. After taking a few deep breathes, the patient coughs(rather than spit)using the diaphragm, and expectorates into a sterile container.
ACID-FAST BACTERIUM (AFB)

(mycobacterium tuberculosis)
-may be collected on 3 different days
-collection after a long sleep period (early morning) is desirable because of greater concentration
AFB (gastric specimen?)
if unable to obtain a sputum specimen, gastric specimen may be obtained because mycobacterium tuberculosis is not altered by acidic gastric contents
CHEST X-RAY
-performed to visualize structures, fluid, and air in the thoracic cavity

-normal pulmonary tissue is radiolucent; because of this
`foriegn bodies
`infiltrates
`fluids
`tumors &
`other abnormalities appear as densities(white areas) on a chest x-ray.

*it is most useful when compared to patient's previous films(easier to detect changes)

-anterior/posterior and lateral views are the most common

-appropriate use of lead shielding reduces overall exposure to x-rays
posterier-anterior(PA)
x-rayed from back to front of thorax
anterior-posterior(AP)
x-rayed front front to back of thorax
(usually done with patient in bed)
lateral(LA)
x-ray taken from the side of thorax
what can x-rays show
-location & size of lesions and
-identify structural abnormalities that influence ventilation and diffusions
abnormalities visible on x-ray
`pneumothorax (collection of air or gas in the pleural cavity)

`fibrosis (formation of scar tissue)

`atelectasis (collapsed lung)

`infiltrates (shadow assumed to represent blood, pus, or other fluid)
COMPUTED TOMOGRAPHY(CT)
`provides a cross-sectional visualization of examined tissues

`allows assessment of tracheal and bronchial abnormalities, masses, lesions, & abnormal shadows

`identifies slight variations in tissue thickness so it may detect lesions by x-ray

`performed w/ or w/out contrast (*check allergies to iodine or seafood if contrast is used)

`computerized images are greatly enchanced compared to traditional x-rays
FLUOROSCOPY
`a continuos stream of x-rays passes thru the pt. casting shadows of the heart,lungs, and diaghragm on a fluorescent screen.

`assesses respiratory structures and their motion

`cardiopulmonary motion is observed
when is fluoroscopy used
fluoroscopy exposes the pt. to high levels of radiation and reveals less detail than standard chest radography, its
indicated only when diagnoses depends on visualizing physiologic or pathologic MOTION of thoracic contents
what is fluoroscopy used for
it can be used to rule out paralysis in pts. w/diapragmatic elevation.

`diminished diaphramatic movement may indicate pulmonary disease.

`> lung transcluency(not transparent but permitting light passage) may indicate elasticity loss or bronchiolar obstruction
Magnetic resonance imaging(MRI)
`a non-invasive test that employs a powerful magnet, radiowaves, & a computer to help dx resp. disorders

`it provides high resolution, cross sectional images of lung structures & traces of blood flow
MRI's greatest advantage
ability to "see through" bones & to delineate fluid- filled soft tissue in great detail, w.out using ionizing radiation or contrast media
MRI's uses
`characterize pulmonary nodules

`stage bronchogenic carcinoma
(assessment of chest wall invasion)

*evaluate inflammatory activity in:

`interstitial lung disease

`acute pulmonary embolism

`chronic thrombolytic pulmonary hypertension
PULMONARY ANGIOGRAPHY

also referred to as 'pulmonary arteriography'
allows radiographic examination of the pulmonary circulation.
most common use of pulmonary angiography
*used to investigate thromboembolic disease of the lungs, such as:

`pulmonary emboli &

`congenital abnormalities of the pulmonary vascular tree
How is pulmonary angiography done?
it involves the rapid injection of a radiopaque agent into the vasculature of the lungs for radiographic study of the pulmonary vessels.
injection site
`an be injected into a vein in one or both arms (simultaneously) or into the femoral vein, w/ a needle or catheter

`it can also be injected into a catheter that has been inserted into the main pulmonary artey or its branches
RADIOSOTOPE DIAGNOSTIC PROCEDURES (lung scans)
include:

`ventilation-perfusion scan

`gallium scan

`positron emission tomography

they are used to detect:

`normal lung functioning,

`pulmonary vascular supply,&

`gas exchange
VENTILATION-PERFUSION LUNG SCAN
`indicates lung perfusion and ventilation

`used to measure the integrity of the pulmonary vessels relative to blood flow and to evaluate blood flow abnormalities, as seen in PULMONARY EMBOLI
galium scan
a radio isotope lung scan used to detect:

`inflammatory conditions

`abscesses

`adhesions &

`the prescence, location, & size of tumors

*also used to:

`stage bronchogenic cancer &

`record tumor regression after chemotherapy or radiation(detect how effective cancer tx has been)
positron emission tomography(PET)
*a radiographic study w/ advanced diagnostic capabilities

`used to evaluate lung nodules for malignacy

`can detect and display metabolic changes in tissue

`can distinquish normal tissue from tissue that are diseased(such as in cancer)
bronchoscopy
the direct inspection & examination of the larynx, trachea, & bronchi thru a fiberoptic scope
purposes of bronchoscopy

(Diagnostic)
`to examine tissues of collect secretions

`to determine the location and extent of the pathologic process & to obtain a tissue sample for diagnosis

`to determine if a tumor can be resected surgically

`to diagnose bleeding sites
bronchoscopy (therapeutic)
`remove foriegn bodies from the trachealbronchial tree

`remove secretions obstructing the trachealbronchial tree when the pt. cannot clear them

`tx post-op ateletasis

`destroy & exercise lesions
what source of air supply does the pt. need during procedure
may be performed on pts:

`on individual breathing room air,

`supplemental O2, or

`receiving mechanical ventilaton
pre op care
`NPO 6-12h before

`requires informed consent

`admin analgesia(usually atropine)/sedation as ordered
to inhibit vagal stimulation(guarding against bradycardia,dysrthmias, & hypotension)

`local/topical anesthesia applied to nasal, pharyngeal areas (to suppress cough reflex & minimize discomfort)
post op care
`pt to be in upright position(semifowler)

`should be no cough initially, unless otherwise stated.

`if biopsy was done, can expect pink tinge saliva, but nothing significant

`any bleeding from lungs needs to reported immediately

`priority is airway maintenance

`assess for return of gag reflex
NPO till return of gag reflex
ice chips 1st,
eventually fluids

`assess for laryngeal edema:
hoarseness
sridor
dyspnea
vital signs
chest pains

`assess for confusion and lethargy in elderly (may be due to large doses of lidocaine)

`also monitor respiratory status & observe for:

`hypoxia
`hypotension
`tachycardia
`dysrhtymias
`hemoptysis
`dyspnea
Thoracoscopy
`a diagnostic procedure in which the pleural cavity is examined w/ a fiber-optic endoscope (small incision is made into pleural cavity in an intercostal space)(local anesthesthia)

**video assisted examination is a recent assition to the test

**allows visualization of the:

`visceral & parietal pleural

`pleural spaces

`mediastinum

`thoracic walls &

`pericardium

**can also be used to perform:

`laser procedures

`to assess pleural effusion

`tumor growth

`emphysema

`inflammatory disease

`conditions that would predispose the pt. to pneumothorax

**also:
`biopsies of the pleura,
mediastinal lymph nodes,
& lungs can be confirmed
Thoracentesis
*the introdruction of a needle into the thoracic cavity for diagnostic and/or therapeutic reasons
thoracentesis may be used for
`removal of fluid & air from the pleural cavity

`aspiration of pleural fluid for analysis

`pleural biopsy

`instillation of medication into the pleural space
studies of the pleural fluid include:
`gram's stain culture & sensitivity
`acid-fast staining & culture
`differential cell count
`cytology
`pH
`specific gravity
`total protein
`lactic dehydrogenase
nursing activities
vital signs(before starting)(for comparison later)
`
`monitor vs during procedure(hr,rr,color,skin condition)

`make sure x-rays have been ordered(PA & lateral are used to localize fluid)
`admin sedation as ordered
`Explain procedure(must stay immobile)
`position pt.(best to sit on edge of bed, leaning over table)or(lying on unaffected side w/bed elevated 30-45 degrees if unable to assume a sitting position
nursing activities cont'd
`support & reassure pt.
`encourage pt. not to cough (can traumatize the visceral pleural and lung)
how much fluid will be removed
`don't remove more than 1500cc/30min

`after catheter is removed, an air occlusive dressing is used ,then gauze
bed rest after thorancentesis
`pt placed on unaffected side w/ punture side up (easier for wound to heal &leakage may occur otherwise)
`HOB up for comfort
`if resp. distress HOB up & close monitoring
chest x-ray
verifies there is no pneumothorax
(routine)
Document
`physical appearance
`VS-before,during,& after
`location of puncture
`amt of fluid w/drawn
`color, viscosity, & clarity
`lab (specimen where sent)
Signs of complications

infection doesn't occur till the 3rd day
`increasing respiratory rate
`asymmetry in respiratory movement
`faintness
`vertigo
`tightness in chest
`uncontrollable cough
`blood-tinged frothy mucus
`rapid pulse
`signs of hypoxemia