Nursing Procedures and Complications Quiz

Nursing Care of Clients with Respiratory Disorders

• This presentation covers nursing care for clients with respiratory disorders.
• It reviews anatomy and physiology related to the respiratory system.
• It also examines diagnostic procedures for evaluating respiratory status.

Review of Anatomy and Physiology

• The respiratory system involves the nasal cavity, mouth, pharynx, larynx, trachea, bronchi, and lungs.
• The lungs contain alveoli where gas exchange occurs.
• Oxygen is taken in and carbon dioxide is released.
• The diaphragm and intercostal muscles are involved in breathing.
• The pulmonary artery carries blood to the lungs and the pulmonary vein carries blood from the lungs to the heart.

Review of Anatomy and Physiology (Continued)

• The diagrams show the different parts of the respiratory system and the process of gas exchange in the alveoli.
• The diagrams illustrate the flow of air from the nose and mouth into the lungs via the trachea, bronchi, and bronchioles to the alveoli.

Review of Anatomy and Physiology (Continued)

• Diagrams illustrate the structures and their roles, emphasizing the flow.
• Diagrams show the upper and lower respiratory tracts and their components.

Review of Anatomy and Physiology (Continued)

• Diagrams show the lobes of the lungs, and the position of lymph nodes.

Alveolus Gas Exchange

• The alveoli are small air sacs in the lungs where gas exchange occurs.
• Oxygen diffuses into the blood, and carbon dioxide diffuses out of the blood.

Respiratory Diagnostic Procedures

• Diagnostic procedures evaluate a client's respiratory function.
• This includes oxygenation of the blood, lung function, and the integrity of the airway.
• The key procedures include Pulmonary Function Tests (PFTs), ABGs, Bronchoscopy, and Thoracentesis.

Pulmonary Function Test (PFT)

• PFTs measure lung volumes and capacities.
• It assesses diffusion capacity and gas exchange, flow rates, and airway resistance
• Identification of lung disease, helpful for clients with shortness of breath.
• Performed pre-surgical to evaluate respiratory risk.
• Clients who smoke need to abstain x hours before testing.
• Inhalers should be stopped for a specific time period before testing.

Pulmonary Function Test (PFT) (Continued)

• Indicated for clients with shortness of breath or to evaluate disease severity and treatment response
• It can also be used to determine suitability for surgery (e.g., thoracic surgery/lung resection).
• Includes measures like spirometry, lung volumes, diffusion capacity, gas exchange, and other lung function tests including airway responsiveness, respiratory muscle testing, and lung compliance

Arterial Blood Gas (ABG)

• ABGs measure the amount of free hydrogen ions (pH), partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), bicarbonate concentration (HCO3), and the percentage of oxygen bound to hemoglobin (SaO2).
• ABG testing assesses oxygenation and acid-base balance.
• Possible causes of blood pH imbalance include respiratory, renal, malnutrition, electrolyte imbalances, endocrine, or neurological issues
• Helpful for monitoring treatment effectiveness, guiding oxygen therapy, and evaluating client response to weaning.

Arterial Blood Gas (ABG) (Continued)

• Pre-procedure: Allen's test verifies radial and ulnar circulation before arterial puncture.
• Post-procedure: Hold direct pressure over the puncture site and monitor for complications like bleeding, loss of pulse, swelling, discoloration, and changes in temperature.
• Report results promptly to the healthcare provider.
• Potential complications include hematoma.
• Potential complications include air embolism.

Bronchoscopy

• Bronchoscopy allows visualization of the larynx, trachea, and bronchi.
• It's performed as outpatient procedure under general anesthesia, or locally. • Bronchoscopy can be used for diagnosis (biopsy of suspected tumors/cancer). • Can be used to remove foreign objects from the airway.
• It may be used for treating conditions like pneumonia or postoperative atelectasis.

Bronchoscopy (Continued)

• Pre-procedure: Evaluate for anesthetic agent allergies and anticoagulant use, ensure informed consent is signed, remove dentures.
• Intra-procedure: Position the patient; administer sedatives/anxiolytics or atropine, monitor, collect and label tissue samples.
• Post-procedure: Monitor level of consciousness, gag reflex, and ability to swallow before allowing oral intake, monitor for complications.
• Post-procedure: Monitor for complications like fever, cough, hemoptysis, and laryngospasm.

Bronchoscopy complications

• Potential complications include laryngospasm.
• Potential complications include pneumothorax.
• Potential complications include aspiration.

Thoracentesis

• Thoracentesis is the surgical perforation of the chest wall and pleural space with a large-bore needle
• Performed to remove pleural fluid or air for diagnostic evaluation.
• Performed under local anesthesia at bedside/procedure room
• Use of ultrasound guidance minimizes complications
• Position patient upright, with arms and shoulders supported to minimize risk during the procedure.

Thoracentesis (Continued)

• Pre-procedure: Ensure informed consent; obtain pre-procedure X-ray; gather supplies.
• Intra-procedure: Assist the provider with the procedure; monitor patient vital signs; monitor for complications.
• Post-procedure: Apply a dressing; monitor vital signs and respiratory status; provide oral hygiene; encourage deep breathing; obtain a post-procedure CXR to evaluate for complications; monitor for complications like pneumothorax, bleeding, or infection.

Thoracentesis Complications

• Complications include: Mediastinal shift
• Complications include: Pneumothorax
• Complications include: Bleeding
• Complications include: Infection

Chest Tube Insertion and Monitoring

• Chest tubes drain fluid or air from the pleural space, reestablishing negative pressure and facilitating lung expansion
• Chest tubes can be inserted in the emergency department, operating room, or bedside.
• Chest tubes are removed when lung expansion is complete and drainage ends.

Chest Tube Systems

• Drainage systems usually consist of three parts: The drainage collection chamber, the water-seal chamber, and the suction control chamber.
• The water-seal chamber prevents air from re-entering the pleural space.

Chest Tube Insertion Nursing Responsibilities

• Pre-procedure: Verify consent, reinforce client teaching (breathing, allergies), position client, prepare equipment.
• Intra-procedure: Set up the drainage system, assist the healthcare provider with the insertion, monitor patient, position the chest tube.
• Post-procedure: Monitor vital signs hourly, respiratory status; encourage deep breathing; evaluate and record the client's response.

Test your knowledge on critical nursing procedures such as thoracentesis and bronchoscopy. This quiz covers immediate actions for complications, assessments, and indications for various nursing interventions. Get ready to evaluate your understanding of these essential topics in nursing care.