Content Approach  Anatomy & Physiology Review  Demographics/occurrence  Pathophysiology  Clinical Picture  Medical Management  Nursing Process (APIE) Assessment - Nursing Actions - Education Assessment - Nursing Actions - Education

Alterations in Ventilation Diagnostic Studies  Blood Studies: CBC CBC Arterial Blood Gases Arterial Blood Gases  Sputum Studies: Gram Stain / Culture & Sensitivity Gram Stain / Culture & Sensitivity Acid-fast smear Acid-fast smear Cytology Cytology

Diagnostic Studies  Radiology: Chest x-ray-- posterior-anterior / lateral Chest x-ray-- posterior-anterior / lateral Computed tomography (CT) – cross sections of the lung with and without contrast – used often Computed tomography (CT) – cross sections of the lung with and without contrast – used often Pulmonary angiogram – x-rays after injection of radiopaque dye– used to diagnose pulmonary embolism Pulmonary angiogram – x-rays after injection of radiopaque dye– used to diagnose pulmonary embolism Positron emission tomography (PET) – IV glucose administration – malignant tumors show increased uptake of glucose Positron emission tomography (PET) – IV glucose administration – malignant tumors show increased uptake of glucose Ventilation-Perfusion Scan – Perfusion: isotope administration which outlines pulmonary vasculature; Vent: inhalation of radioactive gas which outlines the alveoli – pulmonary emboli Ventilation-Perfusion Scan – Perfusion: isotope administration which outlines pulmonary vasculature; Vent: inhalation of radioactive gas which outlines the alveoli – pulmonary emboli

Alterations in Ventilation Diagnostic Studies  Pulmonary Function Testing tests to measure lung volumes and used to diagnose pulmonary disease, monitor progress, evaluate disability, evaluate response to bronchodilators – done in pulmonary lab tests to measure lung volumes and used to diagnose pulmonary disease, monitor progress, evaluate disability, evaluate response to bronchodilators – done in pulmonary lab  Skin Testing intradermal planning of test dose to assess skin reaction intradermal planning of test dose to assess skin reaction by measuring mm induration – TB, various lung diseases by measuring mm induration – TB, various lung diseases

Pulmonary Function Test Relationship of Lung Volumes & Capacities

Alterations in Ventilation Diagnostic Studies  Endoscopic Exams (done in x-ray or OR): Bronchoscopy – fiberoptic visualization of bronchi – biopsy; to remove mucous plugs, foreign bodies, obstructions Bronchoscopy – fiberoptic visualization of bronchi – biopsy; to remove mucous plugs, foreign bodies, obstructions Mediastinoscopy – scope through a small incision n the suprasternal notch – visualize mediastinum for tumors, lymph nodes, infections, sarcoidosis Mediastinoscopy – scope through a small incision n the suprasternal notch – visualize mediastinum for tumors, lymph nodes, infections, sarcoidosis  Biopsy: Transbronchial or open lung biopsy – done in OR or X-ray X-ray  Thoracentesis – insertion of a needle into the pleural space – pleural fluid, install medication - done at bedside

Respiratory Diagnostic Testing Fiberoptic Bronchoscopy

Care of the patient undergoing Bronchoscopy  Pre-Procedure: Explanation & consent Explanation & consent CBC, platelet count, INR, chest x-ray CBC, platelet count, INR, chest x-ray  Post-Procedure: Post anesthesia recover room procedures Post anesthesia recover room procedures Stable vital signsStable vital signs Airway managementAirway management Return of gag reflexReturn of gag reflex Assess: breath sounds, pulse oximetry,Assess: breath sounds, pulse oximetry,  Complications: Hypoxemia Hypoxemia Bleeding (hemoptysis) Bleeding (hemoptysis) infection infection

Diagnostic Lung Tests Thoracentesis

Care of the Patient undergoing Thoracentesis  Pre-Procedure: Explanation & consent - bedside Explanation & consent - bedside CBC, platelet count, INR, chest x-ray CBC, platelet count, INR, chest x-ray  During Procedure: Tripod position – no movement during procedure Tripod position – no movement during procedure Local anesthetic – aseptic technique Local anesthetic – aseptic technique Monitor for dyspnea, tachypnea, pain, pallor, diaphoresis, shock Monitor for dyspnea, tachypnea, pain, pallor, diaphoresis, shock  Post-Procedure: Vital signs, ascultate breath sounds, chest x-ray Vital signs, ascultate breath sounds, chest x-ray Check puncture site for leakage or bleeding Check puncture site for leakage or bleeding  Complications: Pneumothorax and mediastinal shift Pneumothorax and mediastinal shift