Patient Interview Overview On Assessment PDF

PATIENT INTERVIEW  Techniques of Communication  During the interview, the patient should be addressed by...

PATIENT INTERVIEW  Techniques of Communication  During the interview, the patient should be addressed by his or her surname, and the examiner should introduce him or herself and state the purpose for being there.  Verbal techniques of communication used by the examiner to facilitate the interview may include the skillful use of open-ended questions, closed or direct questions, and responses.  Open-Ended Questions  An open-ended question asks the patient to provide narrative information. The examiner identifies the topic to be discussed but only in general terms.  This technique is commonly used (1) to begin the interview, (2) to introduce a new section of questions, or (3) to gather further information whenever the patient introduces a new topic. PATIENT HISTORY PATIENT INTERVIEW  Closed or Direct Questions  Biographic data (age, gender, occupation)  A closed or direct question asks the patient for specific information. This type of  The patient’s chief complaint or reason for seeking care, question elicits a short one- or two-word answer, a yes or no, or a forced choice. including the onset, duration, and characteristics of the signs  The closed question is commonly used after the patient’s narrative to fill in any and symptoms details the patient may have left out.  Present health or history of present illness  Closed or direct questions speed up the interview and are often useful in emergency situations when the patient is unable to speak in complete sentences.  Past health, including childhood illnesses, accidents or injuries,  The use of only open-ended questions is unwieldy and takes an unrealistic amount serious or chronic illnesses, hospitalizations, operations, obstetric of time, causing undue stress in the patient. history, immunizations, last examination date, allergies, current medications, and history of smoking or other habits PATIENT HISTORY PATIENT INTERVIEW  The patient’s family history  Responses  Facilitation encourages patients to say more, to continue with the story.  Review of each body system, including skin, head, eyes, ears, Silence communicates that the patient has time to think and organize what he or and nose, mouth and throat, respiratory system, cardiovascular  she wishes to say without interruption by the examiner. system, gastrointestinal system, urinary system, genital system,  Reflection is used to echo the patient’s words. The examiner repeats a part of and endocrine system what the patient has just said to clarify or stimulate further communication  Functional assessment (activities of daily living), including  Empathy is defined as the identification of oneself with another and the resulting activity and exercise, work performance, sleep and rest, capacity to feel or experience sensations, emotions, or thoughts similar to those being experienced by another person. It is often characterized as the ability to nutrition, interpersonal relationships, and coping and stress “put oneself into another’s shoes.” management strategies  Clarification is used when the patient’s choice of words is ambiguous or confusing. PATIENT INTERVIEW PATIENT INTERVIEW  Nonverbal Techniques of Communication  The interview is a meeting between the respiratory care practitioner and the  Physical Appearance: The examiner’s general personal appearance, grooming, and choice of patient. It allows the collection of subjective data about the patient’s feelings clothing send a message to the patient. regarding the condition.  Posture: An open position shows relaxation, physical comfort, and a willingness to share information  During a successful interview, the practitioner performs the following tasks:  Gestures: Nodding of the head or an open hand with the palms turned upward can show 1. Gathers complete and accurate data about the patient’s impressions acceptance, attention, or agreement. about his or her health, including a description and chronology of any  Facial Expression: The examiner should work to convey an attentive, sincere, and interested symptoms expression  Eye Contact: The examiner should work to maintain good eye contact but not stare the patient down 2. Establishes rapport and trust so the patient feels accepted and with a fixed, penetrating look. comfortable in sharing all relevant information  Voice: Nonverbal messages are reflected through the tone of voice, intensity and rate of speech, 3. Develops and shows an understanding about the patient’s health state, pitch, and long pauses. which in turn enhances the patient’s participation in identifying problems  Touch: the examiner should not touch patients during interviews unless he or she knows the patient well and is sure that the gesture will be interpreted correctly  PATIENT INTERVIEW  Closing the Interview Blood Pressure  The interview should end gracefully.  is the force exerted by the circulating volume of blood on  If the session has an abrupt or awkward closing, the patient may be left with a negative the walls of the arteries. impression.  The pressure peaks when the ventricles of the heart  This final moment may destroy any rapport gained during the interview contract and eject blood into the aorta and pulmonary arteries.  The examiner may choose to summarize or repeat what was learned during the interview. This serves as a final statement of the examiner’s and the patient’s  The blood pressure measured during ventricular assessment of the situation. contraction (cardiac systole) is the systolic blood pressure.  The examiner should thank the patient for the time and cooperation provided during  During ventricular relaxation (cardiac diastole), blood the interview. pressure is generated by the elastic recoil of the arteries and arterioles. This pressure is called the diastolic blood pressure. Body Temperature Oxygen Saturation  is routinely measured to assess for signs of inflammation or  considered the fifth vital sign infection.  used to establish an immediate  varies widely in response to environmental conditions and baseline SpO2 value.  physical activity, the temperature inside the body, the core  It is an excellent monitor by which to temperature, remains relatively constant—about 37° C (98.6° F). assess the patient’s response to respiratory care interventions.  Pyrexia or Hyperthermia- above normal temp  Hypothermia– below normal temp. Inspection Pulse  is an ongoing observational process that  is generated through the vascular system with each ventricular begins with the history and continues contraction of the heart (systole). throughout the patient interview, taking of  a pulse is a rhythmic arterial blood pressure throb created by vital signs, and physical examination. the pumping action of the ventricular muscle.  inspection consists of a series of observations  can be assessed at any location where an artery lies close to to gather clinical manifestations—signs and the skin surface and can be palpated against a firm symptoms— that are directly or indirectly underlying structure, such as muscle or bone. related to the patient’s respiratory status Respiration Palpation  The normal respiratory rate varies with age. In the newborn the normal respiratory rate varies between 30 and 60 breaths per minute.  is the process of touching the patient’s chest to evaluate the In the toddler the normal range is 25 to 40 breaths per minute. The symmetry of chest expansion, the position of the trachea, skin normal range for the preschool child is 20 to 25 breaths per minute, temperature, muscle tone, areas of tenderness, lumps, and the normal adult range is 12 to 20 breaths per minute depressions, and tactile and vocal fremitus.  Ideally the respiratory rate should be counted when the patient is not aware.  Chest excursion  Tachypnea--An increased breathing rate and is commonly seen in  Tactile and vocal fremitus patients with fever, metabolic acidosis, hypoxemia, pain, or anxiety.  Crepitus  Bradypnea--A respiratory rate below the normal range and may occur with hypothermia, head injuries, and drug overdose.  Percussion ABNORMAL SPUTUM PRODUCTION  performed to determine the size, borders, and consistency  Excessive sputum production is of air, liquid, or solid material in the underlying lung. commonly seen in respiratory diseases  dull percussion note is heard when the chest is percussed over that cause an acute or chronic areas of pleural thickening, pleural effusion, atelectasis, and inflammation of the tracheobronchial consolidation. tree  hyperresonant note is commonly elicited in the patient with  Depending on the severity and nature of chronic obstructive pulmonary disease or pneumothorax the respiratory disease, sputum (trapped gas) production may take several forms. Auscultation USE OF THE ACCESSORY MUSCLES OF EXPIRATION  provides information about the heart, blood vessels, and air  Because of the airway narrowing and collapse associated flowing in and out of the tracheobronchial tree and alveoli. with chronic obstructive pulmonary disorders, the  Abnormal lung sounds (ALS) are atypical, or uncharacteristic, lung accessory muscles of exhalation are often recruited when sounds that are not normally heard over a specific area of the thorax. airway resistance becomes significantly elevated  Fine crackles  When these muscles actively contract, intrapleural  Medium crackles pressure increases and offsets the increased airway  Coarse crackles resistance  Wheezing  Pursed-lip breathing  Stridor  Substernal and intercostal retractions  Pleural friction rub COUGH NASAL FLARING  A cough is a sudden, audible expulsion of air from  often seen during inspiration in infants the lungs. It is commonly seen in respiratory experiencing respiratory distress. It is likely to be a disease, especially in disorders that cause facial reflex that enhances the movement of gas inflammation of the tracheobronchial tree. into the tracheobronchial tree.  In general, a cough is preceded by (1) a deep  The dilator naris, which originates from the maxilla inspiration, (2) partial closure of the glottis, and (3) and inserts into the ala of the nose, is the muscle forceful contraction of the accessory muscles of responsible for this clinical manifestation. When expiration to expel air from the lungs. activated, the dilator naris pulls the alae laterally and widens the nasal aperture, providing a larger orifice for gas to enter the lungs during inspiration. COUGH CHEST PAIN  Nonproductive Cough  Pleuritic chest pain is usually described as a sudden, sharp, or stabbing pain. The pain generally intensifies  Common causes of a nonproductive cough include (1) irritation of the airway, (2) inflammation of the airways, (3) mucous during deep inspiration and coughing and diminishes accumulation, (4) tumors, and (5) irritation of the pleura. during breath holding or splinting. The origin of the  Productive Cough pain may be the chest wall, muscles, ribs, parietal pleura, diaphragm, mediastinal structures, or  Is the cough strong or weak? intercostal nerves.  A productive cough should be evaluated in terms of its frequency, pitch, and loudness.  Nonpleuritic chest Pain is described as a constant  Sputum of a productive cough should be monitored and evaluated pain that is usually located centrally. It is not generally frequently in terms of amount (teaspoons, tablespoons, cups), worsened by deep inspiration. The pain may also consistency (thin, thick, tenacious), odor, and color radiate.  Abnormal Extremity Findings ALTERED SKIN COLOR  mucous membranes appear ashen or pallid could be caused by anemia or acute blood loss.  eyes, face, trunk, and arms have a yellow, jaundiced appearance may be caused by increased bilirubin in the blood and tissue  redness of the skin or erythema often caused by capillary congestion, inflammation, or infection  Cyanosis is the term used to describe the blue-gray or purplish discoloration of the mucous membranes, fingertips, and toes whenever the blood in these areas contains at least 5 g/dL of reduced hemoglobin Abnormal Extremity Findings DIGITAL CLUBBING  observed in patients with chronic respiratory disorders characterized by a bulbous swelling of the terminal phalanges of the fingers and toes.  The contour of the nail becomes rounded both longitudinally and transversely, which results in an increase in the angle between the surface of the nail and the dorsal surface of the terminal phalanx Abnormal Extremity Findings  The results of pulmonary function studies are used to PERIPHERAL EDEMA  (1) evaluate pulmonary causes of dyspnea,  Bilateral, dependent, pitting  (2) differentiate between obstructive and edema is commonly seen in restrictive pulmonary disorders, patients with congestive heart  (3) assess severity of the pathophysiologic failure, cor pulmonale, and hepatic impairment, cirrhosis.  (4) follow the course of a particular disease,  (5) evaluate the effectiveness of therapy,  (6) assess the patient’s preoperative status Abnormal Extremity Findings Restrictive Lung Disorders: Lung Volume and Capacity Findings DISTENDED NECK VEINS   Restrictive lung disorders result in an increased lung rigidity, which in turn  In patients with left-heart failure (congested heart decreases lung compliance. failure), right-heart failure (cor pulmonale), severe  When lung compliance decreases, the ventilatory rate increases and the tidal flail chest, pneumothorax, or pleural effusion, the volume (VT) decreases. major veins of the chest that return blood to the right  Obstructive Lung Disorders: Lung Volume and Capacity Findings side of the heart may be compressed.  In obstructive lung disorders, the gas that enters the alveoli during inspiration  The reduced venous return may also cause the (when the bronchial airways are naturally wider) is prevented from leaving the patient’s cardiac output and systemic blood alveoli during expiration (when the bronchial airways narrow). pressure to decrease. In severe cases, the veins over  As a result, the alveoli become overdistended with gas, a condition known as the entire upper anterior thorax may be dilated. air trapping.   Acute Alveolar Hyperventilation (Acute Respiratory Alkalosis)  The most common cause of acute alveolar hyperventilation is  Oxygen Transport Review hypoxemia.  The decreased PaO2 seen during acute alveolar hyperventilation usually  Oxygen transport between the lungs and the metabolizing cells develops from a decreased ventilation-perfusion ratio (V/Q ratio), is a function of the blood itself and the cardiovascular system capillary shunting (or a relative shunt or shuntlike effect), and venous (blood vessels and heart). admixture associated with the pulmonary disorder  Oxygen is carried in the blood in two ways:  Acute Ventilatory Failure (Acute Respiratory Acidosis)  (1) as dissolved oxygen in the blood plasma, and  Acute ventilatory failure is not associated with a typical ventilatory pattern.  (2) bound to the hemoglobin (Hb). Most oxygen is carried to the tissue cells bound to hemoglobin.  The patient may demonstrate apnea, severe hyperpnea, or tachypnea. The bottom line is that acute ventilatory failure can develop in response to any ventilatory pattern that does not provide adequate alveolar ventilation  Chronic Ventilatory Failure (Compensated Respiratory Acidosis)  Hypoxemia versus Hypoxia  Hypoxemia refers to an abnormally low arterial oxygen tension (PaO2) and is frequently  chronic ventilatory failure is most commonly seen in patients with severe associated with hypoxia, which is an inadequate level of tissue oxygenation. Although the chronic obstructive pulmonary disease, it is also seen in several chronic presence of hypoxemia restrictive lung disorders (e.g., severe tuberculosis, kyphoscoliosis).  Hypoxemia is commonly classified as mild hypoxemia, moderate hypoxemia, or severe hypoxemia. Clinically, the presence of mild hypoxemia generally stimulates the oxygen peripheral chemoreceptors to increase the patient’s breathing rate and heart rate  Acute Ventilatory Changes Superimposed on Chronic Ventilatory Failure  Hypoxia refers to low or inadequate oxygen for aerobic cellular metabolism. Hypoxia is  acute ventilatory changes (i.e., hyperventilation or hypoventilation) are characterized by tachycardia, hypertension, peripheral vasoconstriction, dizziness, and frequently seen in patients who have chronic ventilatory failure mental confusion.  the patient with chronic ventilatory failure can acquire an acute shunt-  When hypoxia exists, alternate anaerobic mechanisms are activated in the tissues that producing disease (e.g., pneumonia)—and hypoxemia. produce dangerous metabolites—such as lactic acid—as waste products.  Lactic acid is a nonvolatile acid and causes the pH to decrease.  Metabolic Alkalosis  is seen more often than metabolic acidosis. Indeed, it is the most common metabolic acid-base abnormality seen in most blood gas laboratories.  Metabolic Acidosis  acute metabolic acidosis (caused by lactic acid) often further compromises the patient’s ABG status.  This is because oxygenation is inadequate to meet tissue metabolism, so alternate biochemical reactions that do not use oxygen are activated. Pathophysiologic Conditions Associated with Chronic Hypoxia  Cor Pulmonale:  Polycythemia  Hypoxic Vasoconstriction of the Lungs  Invasive Hemodynamic Monitoring Assessments  Electrocardiogram  Arterial Catheter  monitors, both visually and on recording paper, the  The arterial catheter (referred to as an a-line) is the most commonly used mode of invasive hemodynamic monitoring. electrical activity of the heart  It is generally inserted in the radial artery for patient comfort and convenient access.  The indwelling arterial catheter allows  (1) continuous and precise measurements of systolic, diastolic, and mean blood pressure;  (2) accurate information regarding fluctuations in blood pressure; and  (3) guidance in the decision to up-regulate or down-regulate therapy—for example, hypotension or hypertension.  The arterial catheter is also useful in patients who require frequent or repeated arterial blood gas samples Noninvasive Hemodynamic Monitoring Assessments Invasive Hemodynamic Monitoring Assessments  Heart Rate (Pulse), Cardiac Output, and Blood Pressure  Central Venous Pressure Catheter  Increased heart rate, pulse, and blood pressure develop frequently during the  readily measures the CVP and the right ventricular filling pressure. acute stages of pulmonary disease.  It serves as an excellent monitor of right ventricular function.  This can result from the indirect response of the heart to hypoxic stimulation of the peripheral chemoreceptors, primarily the carotid bodies.  An increased CVP reading is commonly seen in patients who  increased cardiac output is a compensatory mechanism that at least partially  (1) have left ventricular heart failure (e.g., pulmonary edema), counteracts the hypoxemia produced by the pulmonary shunting in respiratory  (2) are receiving excessively high positive-pressure mechanical breaths, disorders.  (3) have cor pulmonale, or  Other causes of increased cardiac output and blood pressure include severe anemia, high fever, anxiety, massive hemorrhage, certain cardiac arrhythmias, and  (4) have a severe flail chest, pneumothorax, or pleural effusion. hyperthyroidism. Noninvasive Hemodynamic Monitoring Assessments  Perfusion State  can be evaluated by examining the patient’s skin color, capillary refill, and sensorium.  Skin and mucosa areas may appear cyanotic or mottled, when poor perfusion and tissue hypoxia is likely to be present.  skin is diaphoretic (wet), cool, or clammy, local perfusion is inadequate.  when the patient is disoriented as to person, place, and time, a decreased perfusion state and cerebral hypoxia may be present Invasive Hemodynamic Monitoring Assessments  Fundamentals of Radiography  Pulmonary Artery Catheter  X-rays are created when fast-moving electrons with sufficient energy collide  Swan-Ganz catheter is a balloon-tipped, flow-directed catheter that is inserted at the patient’s with matter in any form. Clinically, x-rays are produced by an electronic bedside; the respiratory therapist monitors the pressure waveform as the catheter, with the balloon device called an x-ray tube. inflated, is guided by blood flow through the right atrium and right ventricle into the pulmonary artery  The x-ray tube is a vacuum-sealed glass tube that contains a cathode and a rotating anode.  used directly to measure the  (1) right atrial pressure (via the proximal port),  Dense objects such as bone absorb more x-rays (preventing penetration) than objects that are not as dense, such as blood and the air-filled lungs.  (2) pulmonary artery pressure (via the distal port),  low-density objects strike the film at full force and produce a black image on  (3) left atrial pressure (indirectly via the pulmonary capillary wedge pressure), the film.  (4) cardiac output (via the thermodilution technique),  (5) oxygenation levels in the central venous blood to be used for oxygen transport studies Standard Positions and Techniques of Chest Radiography  Posteroanterior Radiograph  The standard PA chest radiograph is obtained by having the patient stand (or sit) in the upright position.  The anterior aspect of the patient’s chest is pressed against a film cassette holder, with the shoulders rotated forward to move the scapulae away from the lung fields.  The distance between the x-ray tube and the film is 6 feet. The x-ray beam travels from the x-ray tube, through the patient from back to front, and to the x-ray film. Standard Positions and Techniques of Chest Radiography  Anteroposterior Radiograph  A supine AP radiograph may be taken in patients who are debilitated, immobilized, or too young to tolerate the PA procedure.  The AP radiograph is usually taken with a portable x-ray unit at the patient’s bedside.  The film is placed behind the patient’s back, with the x-ray unit positioned in front of the patient, approximately 48 inches from the film.  the heart and superior portion of the mediastinum are significantly magnified in the AP radiograph. Standard Positions and Techniques of Chest Radiography  Computed Tomography  Lateral Radiograph  The same basic principles used in film radiography apply to computed tomography (CT) scanning—namely the  lateral radiograph is obtained to complement the PA radiograph. absorption of x-rays by tissues that contain anatomic structures and organs of different atomic number.  It is taken with the side of the patient’s chest compressed against the cassette. The patient’s arms are raised, with the  A CT scan provides a series of cross-sectional forearms resting on the head. (transverse) pictures (called tomograms) of the  To view the right lung and heart, the patient’s right side is structures within the body at numerous levels. placed against the cassette. To view the left lung and heart, the  The procedure is painless and noninvasive and requires patient’s left side is placed against the cassette. Therefore, a no special preparation. right lateral radiograph would be selected to view a density or lesion that is known to be in the right lung.  The patient simply lies on the examination table, and this  Lateral radiograph provides a view of the structures behind the moves the patient through the opening of the CT heart and diaphragmatic dome scanner Standard Positions and Techniques of Chest Radiography  Positron Emission Tomography  Lateral Decubitus Radiograph  The PET scan shows both the anatomic structures and the metabolic activity of the tissues and organs scanned.  obtained by having the patient lie on the left or right side rather than standing or sitting in the upright  Used in conjunction with a chest x-ray and CT scan for comparison, position. the PET scan is an excellent diagnostic tool for early detection of cancerous lesions.  The naming of the decubitus radiograph is determined by the side on which the patient lies; thus,  The unique aspect of the PET scan is its ability to evaluate highly a right lateral decubitus radiograph means that the metabolic cells that may be cancerous. patient’s right side is down.  In other words, the PET scan is able to detect cancerous cells in the  is useful in the diagnosis of a suspected or known fluid tissues of the body before changes develop in the anatomic shape accumulation in the pleural space (e.g., a pleural of the organ. effusion) that is not easily seen in the PA radiograph.  Magnetic Resonance Imaging  Brochography  uses magnetic resonance as its source of energy to  entails the instillation of a radiopaque material take cross-sectional (transverse, sagittal, or coronal) into the lumen of the tracheobronchial tree. images of the body. It uses no ionizing radiation.  A chest radiograph is then taken, providing a  The patient is placed in the cylindric imager, and film called a bronchogram. the body part in question is exposed to a magnetic field and radiowave transmission.  The contrast material provides a clear outline of  The MRI produces a high-contrast image that can the trachea, carina, right and left main stem detect subtle lesions bronchi, and segmental bronchi.  MRI is superior to CT scanning in identifying complex  Bronchography is occasionally used to congenital heart disorders, bone marrow diseases, adenopathy, and lesions of the chest wall. diagnose bronchogenic carcinoma and determine the presence or extent of  MRI is an excellent supplement to CT scanning for study of the mediastinum and hilar region. bronchiectasis  Pulmonary Angiography  useful in identifying pulmonary emboli or arteriovenous  Sputum Examination malformations.  can be obtained by expectoration,  It involves the injection of a radiopaque contrast medium tracheal suction, or bronchoscopy. through a catheter that has been passed through the right side of the heart and into the pulmonary artery.  In addition to the analysis of the amount, quality, and color of the sputum the sputum  The injection of the contrast material into the pulmonary circulation is followed by rapid serial pulmonary sample may be examined for angiograms.  (1) culture and sensitivity,  The pulmonary vessels are filled with radiopaque contrast  (2) Gram stain, material and therefore appear white.  (3) acid-fast smear and culture, and  CT pulmonary angiogram with intravenous contrast has  (4) cytology. largely replaced pulmonary angiography and is fast becoming the first-line test for diagnosing suspected pulmonary embolism.  Ventilation-Perfusion Scan  can be used in determining the presence of a pulmonary embolism.  Skin Tests  The perfusion scan is obtained by injecting small particles of albumin,  Skin tests are commonly performed to evaluate allergic called macroaggregates, tagged with a radioactive material such reactions or exposure to tuberculous bacilli or fungi. Skin tests as iodine-131 or technetium-99m. entail the intradermal injection of an antigen.  The radioactive particles that travel through unobstructed arteries  A positive test result indicates that the patient has been become trapped in the pulmonary capillaries because they are 20 exposed to the antigen. However, it does not mean that active to 50 μm in diameter and the diameter of the average pulmonary disease is actually present. capillary is approximately 8 to 10 μm. Lungs are then scanned with a gamma camera that produces a picture of the radioactive  A negative test result indicates that the patient has had no distribution throughout the pulmonary circulation. exposure to the antigen. A negative test result may also be  The perfusion scan is supplemented with a ventilation scan. During seen in patients with a depression of cellmediated immunity the ventilation scan the patient breathes a radioactive gas such as (anergy), such as that which develops in human xenon-133 from a closed-circuit spirometer. A gamma camera is immunodeficiency virus (HIV) infections. used to create a picture of the gas distribution throughout the lungs. Endoscopic Examinations  Fluoroscopy  Brochoscopy  a technique by which x-ray motion pictures of  allows direct visualization of the upper airways (nose, the chest are taken. Fluoroscopy subjects the oral cavity, and pharynx), larynx, vocal cords, subglottic patient to a larger dose of x-rays than does area, trachea, bronchi, lobar bronchi, and segmental standard radiography. bronchi down to the third or fourth generation.  Therefore, it is used only in selected cases, as  Mediastinoscopy in the assessment of abnormal diaphragmatic movement (e.g., unilateral phrenic nerve  the insertion of a scope through a small incision in the suprasternal notch; the scope is then advanced into the paralysis) or for localization of lesions to be mediastinum. biopsied during fiber-optic bronchoscopy.  The test is used to inspect and biopsy lymph nodes in the mediastinal area. This procedure is performed to diagnose carcinoma, granulomatous infections, and sarcoidosis. Endoscopic Examinations Hematology, Blood Chemistry, and Electrolyte Findings  Lung Biopsy  Blood Chemistry  lung biopsy sample can be obtained by means of a transbronchial needle  A basic knowledge of blood chemistry, normal values, and common biopsy or an open-lung biopsy. health problems that alter these values is an important cornerstone of  A transbronchial lung biopsy entails passing a forceps or needle through a patient assessment. bronchoscope to obtain a specimen  Electrolytes  lung biopsy is usually performed to diagnose abnormalities identified on a chest radiograph or computed tomography (CT) scan that are not readily  For the cells of the body to function properly, a normal concentration of accessible by other diagnostic procedures, such as bronchoscopy. electrolytes must be maintained—especially for normal cardiac function.  A lung biopsy is especially useful in investigating peripheral lung  Therefore, the monitoring of electrolytes is extremely important in the abnormalities, such as recurrent infiltrates and pleural or subpleural lesions. patient whose body fluids are being endogenously or exogenously manipulated (e.g., intravenous therapy, renal disease, diarrhea)  Thoracentesis  a procedure in which excess fluid accumulation (pleural effusion) between the chest cavity and lungs (pleural space) is aspirated through a needle inserted through the chest wall  performed to identify the cause of a pleural effusion. The analysis of the pleural fluid may be useful in the diagnosis and staging of a suspected or known malignancy. A pleural biopsy may also be performed during a thoracentesis to collect a tissue sample from the inner lining of the chest wall  Therapeutic thoracentesis may be performed to relieve shortness of breath or pain caused by a large pleural effusion, to remove air trapped between the lung and chest wall, or to administer medication directly into the lung cavity to treat the cause of the fluid accumulation or to treat cancer.  Pleurodesis  performed to prevent the recurrence of a pneumothorax or pleural effusion.  Pleurodesis is achieved by injecting any number of agents (called sclerosing agents or sclerosants) into the pleural space through a chest tube.  The instilled sclerosing agents cause irritation and inflammation (pleuritis) between the parietal and the visceral layers of the pleura. This action causes the pleurae to stick together and thereby prevents subsequent gas or fluid accumulation. Hematology, Blood Chemistry, and Electrolyte Findings  Hematology  RBC count,  hemoglobin (Hb),  hematocrit (Hct),  the total WBC count,  platelet count.  Various types of anemia (e.g., iron deficiency, pernicious anemia, and sickle cell anemia) are all diagnosed by visual examination of the peripheral blood smear  END