Respiratory Nursing Procedures Quiz

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.

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.