Respiratory Assessment Lecture 2b

Assessment of breathing ability Pulmonary function test Pulse oximeter Radiographic exams Lab values

Pulmonary Function Tests Purpose Assess resp. function – Tidal volume – Vital capacity – Rate – Inspiratory force Progress of disease

Pulse Oximeter Purpose Noninvasive O2 Sat Normal % <85%  – Tissue is not receiving enough O2

Pulse oximeter Not reliable in… Cardiac arrest Shock Vasoconstrictive meds Dyes Anemia High CO levels

The most appropriate nursing intervention for a client requiring a finger probe pulse oximeter is to: A.Apply the sensor probe over a finger and cover lightly with gauze to prevent skin breakdown B.Set alarms on the oximeter to at least 100% C.Identify if the client has had a recent diagnostic test using intravenous dye D.Remove the sensor between oxygen saturation readings

Radiographic exams Chesk x-ray CT scan PET Fluroscopy Barium Swallow Angiography Bronchoscopy Thoracoscopy Thoracentesis

Chest x-ray Description 2-d image Purpose Fluid Tumor Foreign bodies

Chest – X-ray Nrs management Call pink ladies Normal heart size & clear lung field

CT Scan Description Computerize Tomography With or without contrast medium Purpose Tissue Tumor Foreign bodies Fluid

CT scan Nrs management Without contrast medium – No prep With contrast medium – NPO 6 hrs – Assess for allergies

Positron Emission Tomography PET Purpose Confirm adequate blood supply Description Radioactive tracers injected IV

Fluoroscopy Purpose Detect movement – Diaphragm paralysis Description X-ray

Barium Swallow Purpose View esophagus and cardiac sphincters Description Drink barium X-ray

Barium swallow Nrs Management NPO Post-procedure – Laxatives – BM  white

Angiography Purpose Pulm. Circulation Description Dye Femoral vein  Heart  Pulm Arteries

Angiography Nrs. Management Pre-op – NPO – Check Allergies Shellfish/iodine Post-op – Lie flat 8 hrs – Sandbag – Check pedal pulses – Assess hemorrhaging – Push fluids Normal pulmonary angiography

Bronchoscopy Description Direct inspection of larynx, trachea & bronchi via flexible tube (fiberoptic) Purpose Examine Tissue sample

Bronchoscopy Nrs Management Pre-op – NPO 6-8 hrs – Sedation  vegal response  cough/gag reflex  anxiety

Bronchoscopy Nrs management Post-op – Side-ling until gag back – NPO till gag back – Check gag – Check bleeding

Thoracoscopy Description Fiber-optic inspection of thoracic cavity Incision Purpose Inspect tissue sample

Thoracentesis Purpose Remove fluid for dx Remove fluid for tx Obtain biopsy Instill meds

Thoracentesis Nrs Management Position patient Support Post-op – Vital signs q 15 – Chest x-ray – Breath sounds – bilateral – Cover site Check bleeding Check drainage

Lab Values Sputum WBC Hemoglobin Hematocrit ABG’s PTT/PT

Sputum studies Check for – Pathogens C&S Acid-fast bacillus – What? TB – Duration 4-6 wks

White Blood Cell Count Normal – 5,000 – 10,000 cell/mm3 Elevated – Bacterial infection Decreased – Leukemia – Viral infection

Hemoglobin Normal Female: g/dl Male:14-18 g/dl Elevated COPD Dehydration Decreased Anemia Hemorrhaging Over hydration

Hematocrit Normal Female: 37-47% Male: 42-52% Elevated Dehydration Burns COPD Decreased Anemia Leukemia

Arterial Blood Gases Purpose Adjust O2 levels Hypoxemia Description Must by arterial blood

Arterial Blood Gases Values pH PaO 2 PaCO 2 HCO 3 - SaO 2

ABG’s pH Normal – Elevate – > 7.45 – Alkalosis Decreased – <7.35 – Acidosis

pH Quiz: Acidosis or alkalosis Arterial blood pH of 7.51? – Alkalosis Arterial blood pH of 7.30? – Acidosis Arterial blood pH of 7.34 – Acidosis Arterial blood pH of 7.43 – Normal / homeostasis

ABG’s PaO 2 Normal – torr Elevated – Hypervenilation Decreased –  resp. function – Hypoxemia

ABG’s PaCO2 Normal – mmHg Elevated – Hypercapnia – Impaired gas exchange Decreased – Hyperventilation

ABG’s HCO3- Normal – SaO2 Normal – % Decreased – Hypoxemia

PTT/PT Partial Thromboplastin Time Prolonged – Liver disease – Vit K deficiency – Anticoagulant – Hemophilia

Quiz? The main function of platelets is to… A.Provide oxygen to tissue B.Fight viral infections C.Fight bacterial infections D.Form a blood clot

A fragile 87 year-old female has recently been admitted to the hospital with increased confusion and falls over last 2 weeks. She is also noted to have a mild left hemiparesis. Which of the following tests is most likely to be performed? A.FBC (full blood count) B.ECG (electrocardiogram) C.Thyroid function tests D.CT scan

A 84 year-old male has been loosing mobility and gaining weight over the last 2 months. The patient also has the heater running in his house 24 hours a day, even on warm days. Which of the following tests is most likely to be performed? A.FBC (full blood count) B.ECG (electrocardiogram) C.Thyroid function tests D.CT scan

A 20 year-old female attending college is found unconscious in her dorm room. She has a fever and a noticeable rash. She has just been admitted to the hospital. Which of the following tests is most likely to be performed first? A.Blood sugar check B.CT scan C.Blood cultures D.Arterial blood gases

A 28 year old male has been found wandering around in a confused pattern. The male is sweaty and pale. Which of the following tests is most likely to be performed first? A.Blood sugar check B.CT scan C.Blood cultures D.Arterial blood gases

A nurse is administering blood to a patient who has a low hemoglobin count. The patient asks how long to RBC’s last in my body? The correct response is. A.The life span of RBC is 45 days. B.The life span of RBC is 60 days. C.The life span of RBC is 90 days. D.The life span of RBC is 120 days.