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Bronchoscopy Provide mouth care prior tobronchoscopy

Bring resuscitation and suctionequipment to the bedside.

Closely monitor vital signs andrespiratory status followingprocedure

Instruct to avoid eating ordrinking for approximately 2hours or until fully awake withintact gag reflexes.

Provide an emesis basin andtissues for expectorating sputumand saliva

Monitor color and character ofsecretions

Collect postbronchoscopy sputum

specimen for cytologicexamination as ordered

Client teaching- abouthoarseness and sore throat arecommon after the procedure.

May develop mild fever within thefirst 24 hours.

Notify MD if any abnormalresponse or respiratory distress

Thoracentesis Verify signed consents, assessknowledge and understanding ofpatient regarding procedure.

Administer cough suppressants ifindicated.

Position client upright, leaningforward with arms and headsupported on an anchored overbed table.

Inform client that local anesthesiaprevents pain as needle isinserted, a sensation of pressuremay be felt.

Post procedure care

Monitor pulse, color, oxygensaturation, and other signs duringprocedure

Apply dressing over the puncturesite and position on theunaffected side for 1 hoursallowing the pleural puncture toheal.


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Label obtained specimens withname, date source, and diagnosis

Frequently asses and documentvital signs, respiratory status,puncture sites for bleeding andcrepitus. Obtain Chest Xray ifordered to detect possiblepneumothorax.

Normal activities can be resumedif no evidence of pneumothorax 1hour after the procedure or noother complication is present.

Thoracoscopy Pre Procedure care

Ensure a signed consent for chesttube insertion. Provide additionalinformation as indicated. Explain

local anesthetia will be used andslight pressure may be felt as thetrochar is inserted. Reassure thatbreathing will be easier once thechest tube is in place and thelung expands.

Position either upright orsidelying position depending onthe site of the pneumothorax.

Assist with the tube insertion asneeded

Post procedure care

Asses respiratory status every 4hours

Maintain a closed system. Tapeall connections and secure thechest tube to the chest wall. Toprevent inadvertent tube removaland disruption of the systemintegrity.

Keep the collection apparatusbelow the level of the chest.Pleural fluids drains into thecollection apparatus by flow of

gravity. Check tubes frequently for kinks

or loops that could interfere withdrainage.

Check the water seal frequently.the water lever should fluctuatewith respiratory effort. I fitdoesnt it could mean that the


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system may not be intact.

Measure drainage every 8 hours.Marking the level on the drainagechamber. Report drainage that iscloudy, in excess of 70 ml perhour, red, warm and free flowingwhich indicated haemorrhageand cloudy indicates infection.

Assist with frequent positionchanges and sitting andambulation is allowed.

When chest tube is removed,immediately apply a sterileocclusive petroleum jellydressing. An occlusive dressingprevents air from re-entering thepleural space through the chest

wound.Lung Biopsy Before scheduling a lung biopsy,the physician performs apreoperative history and physicalexamination. Anelectrocardiogram (EKG) andlaboratory tests may beperformed before the procedureto check for clotting problems,anemia, and blood type, in case atransfusion becomes necessary.

Patient education

Patients who will undergo surgicaldiagnostic and treatmentprocedures should beencouraged to stop smoking.Patients able to stop smokingseveral weeks before surgicalprocedures have fewerpostoperative complications.

Before any procedure isperformed, the patient is askedto sign a consent form. The nurse

may review the procedure andanswer questions about theconsent form or procedure. Thenurse will advise the patientpreparing for general anesthesiato refrain from eating or drinkinganything for at least 12 hoursbefore the biopsy.


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Aftercare

Needle biopsy

Following a needle biopsy, thepatient is allowed to restcomfortably. The nurse checksthe patient's status at two-hourintervals. If there are nocomplications after four hours,then the patient can go home.

Patient education

Prior to discharge to home, thenurse instructs the patient aboutresuming normal activities.Patients are advised to rest athome for a day or two beforeresuming regular activities, and

to avoid strenuous activities for aweek after the biopsyPulmonary Function Test For some test the patient will sit

upright and wear a nose clip, hemay sit in a small airtight boxcalled a body plethysmograph,and may not need a nose clip.Warn that they may experienceclaustrophobia. Reassure that hewont suffocate and hell be ableto communicate with thetechnician through the window

box. Explain that he may receive an

aerosolized bronchodilator. Andmay need to receive thebronchodilator more than once toevaluate effectiveness.

Emphasize that the test willproceed quickly if the patientfollows direction, tries hard andkeep a tight seal around themouth piece or tube to ensureaccurate results.

Instruct the patient to loosentight clothing so he can breathefreely. Tell him not to smoke oreat a large meal for 4 hoursbefore the exam.

Arterial blood Gas Patient Preparation1.Explain the arterial blood gas

analysis evaluates how well the lungs


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are delivering the oxygen to the bloodand eliminating carbon dioxide.2.Tell the patient that the test requires

a blood sample.3.Explain to the patient, who willperform the arterial puncture, when it

will occur, and where the puncture sitewill be; radial, brachial, or femoralartery.4.Inform the patient that he may not

need to restrict food and fluids.5.Instruct the patient to breathe

normally during the test, and warn himthat he may experience a briefcramping or throbbing pain at thepuncture site.Intervention1.After applying pressure to the

puncture site for 3 to 5 minutes andwhen bleeding has stopped, tape agauze pad firmly over it.2.If the puncture site is on the arm,dont tape the entire circumferencebecause this may restrict circulation.3.If the patient is receiving

anticoagulants or has acoagulonopathy, apply pressure to thepuncture site longer than 5 minutes ifnecessary.4.Monitor vital signs and observe for

signs of circulatory impairmentSputum test Preparation

1.Inform the patient that his testrequires a sputum specimen.2.Explain that the specimens may be

collected on at least three consecutivemornings if the suspected organism isMyobacterium Tuberculosis.3.Inform the patient that result for TB

cultures take up to 2 months.Nursing Interventions1.Provide mouth care to the patient.2.Monitor his vital signs and respiratory

status.3.Monitor oxygen saturation with a

pulse oximeter.4.If the patient becomes hypoxic or

cyanotic during suctioning, remove thecatheter immediately and give oxygenwhile suctioning pulse oximetry.


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Chest- xray Explain the test to the client. Ifappropriate, inquire whether theclient may be pregnant, toprevent exposure of the fetus tox-ray. The client is generallyrequired to stand for variousviews: if the client is unable tostand, views may be obtainedwith the client in a sittingposition, or portable x-ray maybe obtained. Instruct client toinspire deeply and hold thebreath. Instruct client to removeall metal objects for the chestand neck area.

Computerized tomography Explain the procedure to theclient, Obtain informed consent.

Remove wigs hairpin,clips, andintitiate NPO status 8 hours priorto scan. Assess for Iodine allergy,and observe for signs ofanaphylaxis. Check forclaustrophobia

Inform the client that the test willtake 45 minutes to 1 hour. Theymust lie still on a hard flat tableand will be put in a largemachine.

Pulmonary angiography Explain the procedures to the

client. Assess for iodine orshellfish allergy. Inform client thatan arterial puncture is required,usually at the femoral artery., andthat injection of the dye maycause a flushing or warmsensation due to vasodilation.

After the study, asses the arterialpuncture site frequently forevidence of bleeding.

Asses vital sign and respiratorystatus.

The client may be required to layflat for up to 6 hours if thefemoral artery is used for access.Obtain informed consent.

Radioisotope procedures ( lung scan) Explain procedure to the clientthat they must lie still for 30 to60 minutes and that the machine


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makes clicking noise at times. Nospecial prepartion required.

MRI All metal objects must be removed

from the patient before entering

the scanning room.

If the patient is claustrophobic,

sedation may be ordered before

the test.

Tell the patient that he be asked to

lie on a table that slides into a

tunnel inside a magnet. The test

may take 15 to 30 mintues.

Instruct patient to breathe

normaly but not to talk or moveduring the test to avoid distorting

result

explain that the machinery is

noisy with sounds ranging from

ping to a loud bang.

Clinical Significance Relief Measures

Dyspnea- in general, acute

diseases of the lung produce amore severe grade of dyspnea

than do chronic diseases. Sudden,

dyspnea in a healhty person may

indicate pneumothorax, acute

respiratory obstruction. Dyspnea

with an expiratory wheeze occurs

with COPD. Noisy breathing may

result from a narrowing of the

airway or localized obstruction of

a major bronchus by a tumor orforeign body. The presence of both

inspiratory and expiratory

wheezing usually signifies asthma

if the patient does not have heart

failure.

The management of dyspnea is

aimed at identifying andcorrecting its cause. Relief of

symptoms sometimes achieved by

placing the patient at rest with the

head elevated at high fowler's

position, and in severe cases

administering oxygen.


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Cough may indicate serious

pulmonary disease. The nurse

needs to evaluate the character of

the cough. A dry, irritative cough

is a characteristic of an upper

respiratory tract infection of viralorigin or may be a side effect of

angiotensin converting enzyme

inhibitor therapy.

Laryngotracheitis causes an

irritative, high-pitched cough.

Tracheal lesions produce a brassy

cough. A severe or changing

cough may indicate bronchogenic

carcinoma. Pleuritic chest pain

accompanying coughing mayindicate pleural or chest wall

( musculoskeletal) involvement.

Cough suppressants must be used

with caution because they may

relieve the cough but do not

address the cause of the cough. If

used inappropriately, they may

prevent the patient from clearingmucus from the airways and result

in a delay in seeking indicated

health care. If the cause of the

cough has been addressed, but

the cough persist, cough

suppressants my be given.

Smoking cessation strategies are

indicated if the cough results of

irritation. Drinking warm

beverages may relieve cough

caused by throat irritation

Sputum production-the nature of

the sputum is indicative of the

causal condition. A profuse

amount of purulent sputum or a

change in color probably indicates

bacterial infection. Thin, mucoid

sputum frequently results from

viral bronchitis. A gradual increase

of sputum over time may indicate

the presence of chronic bronchitis,

pink tinged mucoid sputum

material often from the throat

may indicate pulmonary edema.

Foul smelling sputum and breath

point to the presences of a lung

abscess, brochiectasis or a

infection caused by

fusospirochetal or other anearobicorganism.

If the sputum is too thick for the

patient to expectorate, it is

necessary to decrease its viscosity

by increasing fluid intake, or

inhalation of aerosolized solution.

Smoking is contraindicated with

excessive sputum productionbecause it interferes with ciliary

action. Smoking impairs bronchial

drainage.

Encourage oral hygiene and wise

selection of food, measures that

stimulate appetite.Encourage

drinking citrus juices at the

beginning of the meal may

increase the palpability of the rest

of the meal.

Chest pain may occur with

pneumonia, pulmonary embolism

with lung infarction and pleurisy. It

also may be late symptoms of

Analgesic medication may be

effective relieving chest pain, but

care must be taken not to depress

the respiratory centers or a


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bronchogenic carcinoma. In

carcinoma the pain may be dull,

and persistent because the cancer

has invaded the chest wall,

mediastinum, or spine

productive cough. NSAIDs achieve

this goal and are used for pleuritic

pain. A regional anesthetic block

may be performed to relieve

extreme pain.

Wheezing- is often a major finding

in a patient with

bronchoconstriction or airway

narrowing it is heard with or

without a stethoscope, is a high

pitched musical sound heard

mainly on expiration.

Relief measures. Oral inhalant

bronchodilator medications

reverse the wheezing in most

instances

Clubbing of the fingers- is a sign

of lung disease found in patientwith chronic hypoxic conditions,

lung infections and malignancies

in the lung. Manifested initially as

sponginess of the nail ned and

loss of nail bed angle.

Assess the severity of the

clubbing of fingers and determinecauses of symptoms.

Hemoptysis- is a symptom of both

and pulmonary and cardiac

disorders. Onset is usually sudden

and may be intermittent or

continous.

Provide comfort measures and

maintain patent airway. Provide

emesis basin and contain

universal infection protocol

Cyanosis, a bluish coloring of the

skin is a very late indicator of

hypoxia. The presence or absence

of cyanosis is determined by the

amount of unoxygenated

hemoglobin in the blood.

Administer Oxygen, and assess

patients vitals signs

TitleMedical-Surgical Nursing Made Incredibly Easy!

Incredibly Easy! SeriesLWW medical book collectionContributorLippincott Williams & WilkinsEdition2,

illustratedPublisherLippincott Williams & Wilkins, 2007

Nursing Implications for Diagnostic Tests

wps.prenhall.com/wps/media/objects/737/.../bronchoscopy.pdf


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Brunner and Suddarth's Textbook of Medical Surgical Nursing

Author(s): Suzanne C Smeltzer RNC, EdD, FAAN , Brenda G Bare , Janice L HinklePhD, RN, CNRN , Kerry H Cheever PhD, RN

Publication Date: Nov 24, 2009

Format: Book

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Broncho s Copy