Respiratory Nursing Procedures Quiz

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Questions and Answers

What is the primary position the patient should be in during nasotracheal suctioning?

Prone position

Lateral position

Supine position

Sitting position (correct)

Which imaging study is specifically indicated to check for atelectasis or pleural effusion?

Fluoroscopic Studies

Chest x-ray (correct)

CT scan

MRI

Why should a patient take a deep breath before a chest x-ray?

To ensure the lungs are collapsed

To prevent movement during the x-ray

To reduce the exposure time

To enhance visualization of the lungs (correct)

What is one of the main advantages of using a CT scan over a chest x-ray?

It provides detailed three-dimensional images Signup and view all the answers

What is a crucial nursing intervention to consider before performing a chest x-ray?

Remove metallic objects Signup and view all the answers

What is the primary function of a pulse oximeter?

Continuously monitoring oxygen saturation of hemoglobin Signup and view all the answers

Which condition could lead to inaccurate readings from a pulse oximeter?

Vasoconstriction Signup and view all the answers

What principle allows a pulse oximeter to differentiate between oxygenated and deoxygenated hemoglobin?

Absorption of light at specific wavelengths Signup and view all the answers

What are the typical oxygen saturation levels indicated by a pulse oximeter for a healthy individual?

95% - 100% Signup and view all the answers

What role does the light detector in a pulse oximeter play?

It detects and measures light absorption Signup and view all the answers

How do blood pressure measurements potentially interfere with pulse oximeter readings?

By compressing the artery Signup and view all the answers

What is an expected use case for conducting a throat culture?

To identify organisms responsible for infections Signup and view all the answers

Which factor can affect the amount of light that a pulse oximeter sensor absorbs?

The concentration of substances between light beams Signup and view all the answers

What is the purpose of performing a gram stain on a sputum specimen?

To determine if organisms are gram-negative or gram-positive Signup and view all the answers

What is the primary purpose of thoracentesis?

To remove air or excess fluid from the pleural cavity Signup and view all the answers

What is the main reason for using a sensitivity test in sputum studies?

To determine antibiotic resistance of the bacterial strain Signup and view all the answers

Where should a needle be inserted for thoracentesis if air is present in the pleural cavity?

At the second intercostal space anteriorly Signup and view all the answers

Which method is NOT typically used for collecting sputum specimens?

Swabbing the mouth Signup and view all the answers

How should sputum be collected for analysis to ensure better results?

Early in the morning while still in bed Signup and view all the answers

What is a key component of pulmonary function tests (PFTs)?

A spirometry device Signup and view all the answers

What is the maximum time allowed for transporting sputum specimens to the laboratory?

2 hours Signup and view all the answers

Which of the following is NOT an instruction given to patients before pulmonary function tests?

Eat a large meal within 2 hours of the test Signup and view all the answers

Which of the following is a characteristic of a nasopharyngeal culture?

Identifies Staphylococcus and Haemophilus Influenza Signup and view all the answers

What do blood gas studies primarily assess in patients with respiratory disorders?

Oxygen and carbon dioxide levels in the blood Signup and view all the answers

Which factor is considered when interpreting blood gas analysis results?

Partial pressure of oxygen Signup and view all the answers

What should a patient do before providing a sputum sample using the direct method?

Brush their teeth and gargle Signup and view all the answers

Which situation may warrant the use of gastric lavage to obtain a sputum sample?

A young child suspected of having a malignancy Signup and view all the answers

Why are pulmonary function tests useful prior to surgeries?

To evaluate pulmonary function for anesthesia and recovery Signup and view all the answers

What is the primary purpose of chest fluoroscopy?

To evaluate how well the lungs are functioning Signup and view all the answers

What is the primary outcome measured by blood gas studies?

pH level of the blood Signup and view all the answers

Which intervention is essential for patients undergoing pulmonary angiography?

Obtaining informed consent and checking for iodine allergies Signup and view all the answers

What is a common procedure performed using fluoroscopy?

Identifying diaphragm paralysis Signup and view all the answers

What type of imaging test is a V/Q scan?

Nuclear imaging Signup and view all the answers

What precaution should be taken before performing a V/Q scan?

Kidney function tests should be evaluated Signup and view all the answers

Which isotope is most commonly used for lung V/Q scans?

Technetium Signup and view all the answers

What major risk should be monitored after administering contrast during pulmonary angiography?

Risk of hematoma and bleeding at the injection site Signup and view all the answers

What is the role of a perfusion scan in a V/Q study?

To assess the distribution of blood flow through the lungs Signup and view all the answers

What is the normal pH range that the body maintains in plasma?

7.35 to 7.45 Signup and view all the answers

Which mechanism is NOT involved in the regulation of pH in the body?

By cellular metabolism Signup and view all the answers

What is the primary buffer system in the human body?

Bicarbonate-carbonic acid buffer system Signup and view all the answers

What ratio of bicarbonate to carbonic acid is considered normal for maintaining pH balance?

20:1 Signup and view all the answers

During which procedure is Allen's test performed?

ABG sampling Signup and view all the answers

What should be done with the blood sample after drawing it for ABG analysis?

Place it on ice Signup and view all the answers

What does a pH of 7.51 with a PaCO2 of 41 indicate?

Non-compensatory metabolic alkalosis Signup and view all the answers

Which of the following indicates mixed metabolic and respiratory alkalosis?

pH = 7.48, PaCO2 = 25, HCO3 = 34 Signup and view all the answers

Study Notes

Chapter 3: Diagnostic Evaluation

This chapter covers diagnostic procedures for evaluating respiratory conditions.

3-Pulse Oximeter

A noninvasive method for continuously monitoring hemoglobin oxygen saturation (SaO2).
A disposable probe is attached to the fingertip, earlobe, or nose bridge.
Normal SaO2 ranges from 95% to 100%.
False or inaccurate readings can occur in shock states, vasoconstriction, hypothermia, artery compression during blood pressure measurement, elevated lipid levels, and elevated venous pressure.

How a Pulse Oximeter Works

A noninvasive device that indirectly measures oxygen saturation (SpO2) and detects hypoxemia.
Consists of a light source and detector.
Measures the pulsatile changes in light absorption by oxygenated and deoxygenated blood in a tissue.
Oxygenated hemoglobin absorbs more infrared light, while deoxygenated hemoglobin absorbs more red light.
The ratio of red to infrared light absorption determines the oxygen saturation level.

Factors Affecting Pulse Oximeter Readings

The concentration of substances between the light beams and the detector.
The length of the light path.
The amount of oxygenated hemoglobin.
The amount of deoxygenated hemoglobin.

Nursing Intervention for Pulse Oximetry

Apply the probe on the nail bed.
Ensure there is good circulation and a visible red light from the sensor.
Attach the probe to a monitoring device.

4-Throat Culture

Performed to identify pathogens causing pharyngitis or lower respiratory tract (LRT) infections.
Involves a throat swab or nasal swab that may accompany fever and lymphadenopathy.
Rapid strep tests are performed within 15 minutes and are useful in detecting Staphylococcus or Haemophilus Influenza that are routinely detected through nasopharyngeal cultures.
Cultures usually take 48-72 hours and are helpful in determining a patient's response to treatment.

5-Sputum Studies

Includes culture and sensitivity (C/S) and Gram stains to diagnose bacterial infections and identify pathogens.
Cultures take 24-48 hours.
Gram stains provide quick results and aid in antibiotic selection until culture results are available.
Expectoration is the usual method for collecting samples.

Sputum Collection Technique

Collected in the early morning (when most concentrated due to pooling during sleep).
Placed directly into a sterile container.
Transported to the lab within 2 hours.

Collection of Sputum: Direct and Indirect Methods

Direct Method: Patient voluntarily coughs up sputum.
Indirect Method (Deep Tracheal Aspiration (DTA)): Used if coughing fails to produce sputum. A nasotracheal tube is inserted into the trachea.
In uncooperative patients or those who are critically ill, gastric lavage may be used.

Nursing Care for Sputum Collection

Note the color, consistency, odor, and amount of sputum.
Have the patient brush teeth and gargle to reduce mouth bacteria.
Instruct the patient to cough directly into the container.
For nasotracheal suctioning, assist the patient into a sitting position. Administer oxygen and monitor cardiovascular and respiratory status.

6-CT Scan (Computed Tomography)

Provides cross-sectional images of the chest.
Offers more detailed images compared to standard chest X-rays.
Useful for detecting small tumors not visible on X-rays, differentiating fine tissue density, and detecting pulmonary nodules or small tumors.
Contrast agents may be used in certain cases.

CT Scan Preparation

Removal of any metallic objects from the examination area.
Adequate hydration.
Fasting for 4-6 hours before the procedure to prevent vomiting.
Laboratory tests (creatinine and urea) to assess renal function.
Informed consent.

7-Magnetic Resonance Imaging (MRI)

Similar to CT scans but uses magnetic fields and radio waves instead of X-rays.
Provides detailed images of soft tissues.
Used to visualize soft tissue, bronchogenic carcinoma, pulmonary nodules, characterize inflammatory activity, evaluate pulmonary embolism and chronic thromboembolic pulmonary hypertension.
Metal implants or pacemakers are contraindications to MRI.

8-Fluoroscopic Studies

Imaging test using X-rays to reveal lung function and other respiratory structures.
Provides more details and less radiation compared to CT scans and radioisotope lung scans.
Useful for assessing chest wall movement, mediastinum, heart, diaphragm function, detecting diaphragm paralysis, locating lung masses or performing fine-needle aspiration biopsy.

9-Pulmonary Angiography

Used to evaluate thromboembolic lung disease and congenital abnormalities in the pulmonary vascular tree.
A radiopaque contrast agent is injected into the pulmonary vasculature (e.g., arm or femoral vein).
Precaution for patients with iodine allergies.
Evaluation of kidney function before the scan.
Encourage fluid intake after the scan to flush out the contrast material.
Monitoring of the coagulation profile.
Monitoring of injection site and distal pulses.

10-Lung Scans or Radioisotope

Detect or evaluate arterial blood flow to the lungs. Measure airflow distribution in the lungs.
Uses radioactive substances (radioisotopes) for imaging the lungs.
Two types: Ventilation (V) scans and Perfusion (Q) scans (or V/Q scans).
V/Q scans are useful for detecting blood flow distribution and ventilation.

14-Biopsy

To permit examination of cells from the pharynx, larynx, and nasal passages, as well as pleural, lung or lymphatic tissue.
May be performed under local, topical, or general anesthesia.

Nursing Interventions (Various Procedures)

Monitor for breathlessness, bleeding, infection.
Encourage reporting of pain, shortness of breath, visible bleeding, or changes in the biopsy/insertion site to healthcare providers.
Consider the patient's anxiety.

Diagnostic Procedures—Additional Information

Diagnostic Evaluation: Includes a variety of tests, including physical exams, pulse oximetry, throat cultures, sputum studies, CT scans, MRIs, fluoroscopy, pulmonary angiography, lung scans, biopsies, and pulmonary function tests.
Nursing Care: Involves patient monitoring, assessing for complications, providing education, implementing appropriate interventions, and maintaining a safe environment for all procedures.

Acid-Base Imbalances

PH, PaCO2, and HCO3 are assessed for determining if the imbalances are respiratory or metabolic.
An imbalance occurs if any of these values are outside the normal range.

2-Blood Gas Studies

Essential for diagnosing and monitoring respiratory disorders and adjusting oxygen therapy.
Assess the lungs' ability to provide adequate oxygen and remove carbon dioxide.
Evaluate the kidneys' ability to maintain blood pH.
Determine patency of lungs or damage from chest trauma.
ABG analysis involves measuring pH, partial pressure of oxygen (pO2), partial pressure of carbon dioxide (pCO2), and bicarbonate (HCO3).

Pulse Oximetry Equipment and Procedure for Performing ABG

Procedure involves a tray, kidney basin, betaine swabs, plaster, disposable gloves, a sharps box, an heparinized syringe, and absorbent gauze.
Place the patient in a comfortable position with proper supports.
Perform the Allen's test to assess circulation in the ulnar and radial arteries. Place the artery in the area being tested and occlude the ulnar artery to see if the color changes.
Palpate the artery, apply antiseptic agent, and slowly insert the needle.
Aspirate fluid, remove the needle, and place gauze pressure over the puncture site.
Label and transport specimen to the lab on ice for analysis.

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Description

Test your knowledge on key nursing procedures and techniques related to respiratory care, including nasotracheal suctioning, imaging studies, and the use of pulse oximeters. This quiz covers essential questions that nurses should know to provide effective patient care.