Adult Medical-Surgical Adult Medical-Surgical Nursing Nursing

Respiratory Module: Respiratory Module:

Diagnostic TestsDiagnostic Tests

Pulmonary DiseasePulmonary Disease

Common Clinical Manifestations:Common Clinical Manifestations:

Pulmonary Disease: Pulmonary Disease: Common Clinical ManifestationsCommon Clinical ManifestationsDyspnoeaDyspnoeaOrthopnoeaOrthopnoeaTachypnoeaTachypnoeaApnoea: (respiratory failure)Apnoea: (respiratory failure)Cough, dry or productive, haemoptysisCough, dry or productive, haemoptysisCyanosis: central/ peripheralCyanosis: central/ peripheralClubbing of nails: chronic O2 insufficiencyClubbing of nails: chronic O2 insufficiencyBarrel chest (chronic exertion intercostals)Barrel chest (chronic exertion intercostals)

Altered Pattern of RespirationsAltered Pattern of Respirations

On physical examination:On physical examination:

Stertorous respirations Stertorous respirations

Cheyne-Stokes respirationsCheyne-Stokes respirations

Asymmetrical breathingAsymmetrical breathing

WheezingWheezing

StridorStridor

Pulmonary DiseasePulmonary Disease

Common Diagnostic Tests:Common Diagnostic Tests:

Pulmonary Disease: DiagnosisPulmonary Disease: Diagnosis

Patient history and clinical picturePatient history and clinical picture

Chest auscultationChest auscultation

Laboratory analysisLaboratory analysis

Xrays/ radiographyXrays/ radiography

Diagnostic proceduresDiagnostic procedures

Diagnosis: Clinical PictureDiagnosis: Clinical Picture

Physical examination: Physical examination:

Breathing patternBreathing patternSymmetry in breathingSymmetry in breathingDegree of dyspnoeaDegree of dyspnoeaPresence of cyanosisPresence of cyanosisClubbing of finger nailsClubbing of finger nailsPresence of barrel chestPresence of barrel chest

Chest AuscultationChest Auscultation

Air entryAir entry

Adventitious sounds:Adventitious sounds:

Râles/ crackles: discreet (not continuous) Râles/ crackles: discreet (not continuous) which indicate fluid in the alveoliwhich indicate fluid in the alveoli

Hyper-resonance: air trapped in alveoli Hyper-resonance: air trapped in alveoli (bronchospasm)(bronchospasm)

Wheezes: continuous sounds, especially Wheezes: continuous sounds, especially on expiration indicate bronchospasmon expiration indicate bronchospasm

Laboratory AnalysisLaboratory Analysis

Sputum: Sputum:

Culture: micro-organisms, culture and Culture: micro-organisms, culture and sensitivitysensitivity

Acid-fast bacilli (AFB): Tuberculosis (TB)Acid-fast bacilli (AFB): Tuberculosis (TB)

Throat swab cultureThroat swab culture

Arterial blood gasses (ABG)Arterial blood gasses (ABG)

CBCCBC

Pulmonary Function TestsPulmonary Function Tests

Forced Vital Capacity (“Peak Flow”): the Forced Vital Capacity (“Peak Flow”): the maximal volume maximal volume expiredexpired after maximal after maximal inspiration (best of 3)inspiration (best of 3)

Forced Expiratory Volume in 1 second Forced Expiratory Volume in 1 second (FEV1) as a ratio of Forced Vital Capacity (FEV1) as a ratio of Forced Vital Capacity (FVC) (FVC)

Pulse oximetryPulse oximetry

Diagnostic Xrays/ ScansDiagnostic Xrays/ Scans

Chest Xray (AP/ lateral)Chest Xray (AP/ lateral)

CT scan (computerised tomogram)CT scan (computerised tomogram)

MRI (magnetic resonance imaging)MRI (magnetic resonance imaging)

Fluoroscopy: Fluoroscopy:

Pulmonary angiography (to diagnose Pulmonary angiography (to diagnose Pulmonary Embolism)Pulmonary Embolism)

Lung scan using isotopesLung scan using isotopes

Diagnostic Procedures: Diagnostic Procedures: BronchoscopyBronchoscopy

A flexible, fibre-optic scope with a light A flexible, fibre-optic scope with a light used for:used for:

Examination (under sedation/ anaesthetic) Examination (under sedation/ anaesthetic)

Removal of foreign body/ secretions Removal of foreign body/ secretions

Tissue biopsyTissue biopsy

Sample of secretions for histology/ cultureSample of secretions for histology/ culture

Diagnostic Procedures: Diagnostic Procedures: Chest AspirationChest Aspiration

Performed to:Performed to:

Drain pleural effusion and expand lung Drain pleural effusion and expand lung

Analyse aspirated fluid:Analyse aspirated fluid:

CytologyCytology

CultureCulture