Nursing Management of Thoracentesis and Biopsy

Thoracentesis

• Purpose: remove fluid or air from pleural space
• Types of fluid/biopsies and their meanings
  • Exudative fluid: infection, pulmonary embolism, cancer, trauma, rheumatic disease
  • Transudative fluid: CHF, cirrhosis, nephrotic syndrome
  • WBC: infection
• Pre-op nursing management
  • Consent, pre-medicate
  • Assist to proper position
  • Educate about procedure
• During procedure nursing management and education
  • Maintain position
  • Monitor vital signs
  • Monitor for signs of distress
  • Maintain sterility
  • Provide support and education to patient (remain still, avoid coughing)
• Post-op nursing management
  • Pain management
  • Monitor vital signs
  • Frequent respiratory assessments
  • Educate patient about signs of infections and complications to report
  • Avoid strenuous activity for 24-48 hours

Biopsy

• Purpose: diagnose diseases, infectious agents, guide treatment, presence of cancer
• Post-nursing management (priorities)
  • Main management
    • Monitor for bleeding and complications
    • Infection prevention
    • Rest/activity restrictions

Thoracoscopy

• Purpose: examine lungs, pleura, and other thoracic structures
• Post-nursing management (priorities)
  • Pain management
  • Monitor respiratory function complications
  • Prevent/monitor for infection

Pulmonary Angiography

• Purpose: visualize blood vessels in lungs
• During nursing management (priorities)
  • Consent, monitor vitals
  • Contrast injection
  • Pain management
• Post-nursing management
  • Monitor for bleeding
  • Watch for reactions to contrast
  • Monitor respiratory status
  • Monitor kidney function
  • Cultures (e.g., sputum)

Education on obtaining a sample

• Deep breath, then cough
• Easier to obtain in the morning
• Avoid touching container

Pulmonary Function Tests

• Purpose: assess lung function
• Post nursing management
  • Monitor for respiratory distress
  • Ensure comfort
  • Provide education

Bronchoscopy

• Purpose: visualize airways
• Pre/During/Post nursing management (priorities)
  • Monitor vital signs and airway
  • Assess for complications

Basic Respiratory System Components

• Understand each part, main function, and how it protects the body
• Describe ventilation, perfusion, and diffusion
• Understand what these processes mean in a nursing context

Acid-Base Balance

• pH: 7.35-7.45
• PaCO2: 35-45
• HCO3: 22-28

Recognizing normal/abnormal assessment findings

• Understand terms, definitions, and significance
• Clubbed nails, barrel chest, SOB, lung sounds, etc.
• Priority assessments and related interventions

Recognizing and evaluating respiratory symptoms

• Dyspnea
• Sputum
• Drainage
• RR (rate/effort/rhythm)

Viral pharyngitis

• Symptoms: sore throat, red swollen tonsils, cough, fever, chills, nasal congestion, body aches
• Risk factors: Age (5-15 years), seasonal (fall and winter), weakened immune system, smoking

Bacterial pharyngitis

• Symptoms: similar to viral, difficulty swallowing
• Risk factors: similar to viral
• Severity: mild to moderate, only severe if left untreated, recurrent episodes may lead to chronic conditions

Rhinosinusitis

• Symptoms: nasal congestion, yellow/green drainage, facial pain, pressure, cough, sore throat, fatigue, fever
• Risk factors: upper respiratory infections, allergies

Laryngitis

• Symptoms: hoarseness, dry throat, sore throat, difficulty speaking, cough, mild fever
• Risk factors: Viral/bacterial infections, overuse of voice, allergies, smoking

Care of a patient with Epistaxis (nosebleed)

• Assessments: airway, breathing, signs of shock, frequency of bleeding, underlying conditions, vitals signs
• Interventions: reposition, pinching nose, apply ice, nasal packing
• Medical management: cauterization, topical silver nitrate
• Education: avoid irritants, hydration and humidification

Seasonal allergies

• Treatments: antihistamines, corticosteroids, decongestants, mast cell stabilizers

Tonsillectomy

• Care: pain management, soft diet, oral hydration, bleeding prevention
• Post-operative assessment: airway, bleeding, pain levels, inflammation/infection

Sleep apnea

• Risk factors: Obesity, age (elderly), gender (male), family history, smoking, alcohol, sedative medications, GERD, and HTN

Atelectasis

• Symptoms: decreased breath sounds, tachypnea, dyspnea, tachycardia, cyanosis, hypoxia, coughing, chest pain
• Nursing management: assess respiratory status, O2 management, repositioning, deep breathing, incentive spirometer, encourage mobility, suctioning

Aspiration

• Symptoms: coughing, choking, wheezing or gurgling sounds, SOB, dyspnea, chest pain
• Nursing management: chest X-ray, position upright, airway management (suctioning), oxygen therapy and watch for complications

Pleural effusion

• Accumulation of fluid in the pleural space

Pulmonary Edema

• Symptoms: severe dyspnea/orthopnea, pink frothy sputum, tachypnea, cyanosis, crackles
• Nursing management: raise HOB, oxygen therapy, medications, position changes, fluid restriction, pain relief

Pulmonary embolism

• Symptoms: sudden dyspnea (shortness of breath) / SOB, chest pain, cough, hypoxia, hypotension
• Nursing management: Oxygen therapy, monitor vitals, auscultate, anticoagulants, pain management

Pneumonia

• Symptoms: cough, green/yellow/rusty sputum, dyspnea, fever, chills, tachypnea, crackles, sweetness, sweating
• Nursing management: respiratory assessment, oxygen, antibiotics, pain management, nutrition, and hydration

Chronic Obstructive Pulmonary Disease (COPD) and Asthma

• Chapters 33 (from source) contains information/questions related to COPD and Asthma

Medications

• Silver Nitrate

• Ipratropium and albuterol

• Methylprednisolone

• Beclomethasone inhaler

• Afrin (oxymetazoline)

• Flonase (fluticasone)

This quiz covers essential nursing management practices before, during, and after thoracentesis and biopsy procedures. It includes the purposes of these procedures and important nursing considerations, such as patient education, vital sign monitoring, and post-operative care. Test your knowledge on these critical topics in nursing care.