1. RESPIRATORY SYSTEM ASSESSMENT

2. PYRAMID POINTS Respiratory assessment techniques
Risk factors related to respiratory disorders
Preprocedure and postprocedure client instructions for diagnostic tests
Monitoring for complications following diagnostic procedures
Mantoux skin test
Obtaining arterial blood gases
Performing pulse oximetry

3. STETHOSCOPE PLACEMENT FOR AUSCULTATION OF LUNG SOUNDS
From Potter PA, Perry AG: Fundamentals of Nursing, ed. 5, St. Louis, 2001, Mosby.

4. RISK FACTORS FOR RESPIRATORY DISORDERS
Smoking or use of chewing tobacco
Allergies
Frequent respiratory illnesses
Chest injury
Surgery
Exposure to chemicals and environmental pollutants
Crowded living conditions
Family history of infectious disease
Geographic residence and travel to foreign countries

5. CHEST X-RAY (CXR) FILM (RADIOGRAPH)
DESCRIPTION
Provides information regarding the anatomic location and appearance of the lungs

6. NORMAL CHEST X-RAY
From Monahan, F. & Neighbors, M. (1998). Medical-surgical nursing: Foundations for clinical practice, ed 2, Philadelphia: W.B. Saunders.

7. CHEST X-RAY (CXR) FILM (RADIOGRAPH)
PREPROCEDURE
Remove all jewelry and other metal objects from the chest area
Assess the client’s ability to inhale and hold breath
Question females regarding pregnancy or the possibility of pregnancy
POSTPROCEDURE
Assist the client to dress

8. SPUTUM SPECIMEN DESCRIPTION
A specimen obtained by expectoration or tracheal suctioning to assist in the identification of organisms or abnormal cells

9. COLLECTING A STERILE SPUTUM SPECIMEN USING A LEUKENS TUBE
From Ignatavicius, D. & Workman, M. (2002). Medical-surgical nursing: Critical thinking for collaborative care, ed 4, Philadelphia: W.B. Saunders.

10. SPUTUM SPECIMEN PREPROCEDURE
Determine specific purpose of collection and check with institutional policy for appropriate collection of specimen
Obtain an early morning sterile specimen from suctioning or expectoration after a respiratory treatment, if a treatment is prescribed
Obtain 15 ml of sputum

11. SPUTUM SPECIMEN PREPROCEDURE
Instruct the client to rinse the mouth with water prior to collection
Instruct the client to take several deep breaths and then cough deeply to obtain sputum
Always collect the specimen before starting antibiotics

12. SPUTUM SPECIMEN POSTPROCEDURE
If a culture of sputum is prescribed, transport specimen to laboratory immediately
Assist the client with mouth care

13. BRONCHOSCOPY DESCRIPTION
Direct visual examination of the larynx, trachea, and bronchi with a fiberoptic bronchoscope

14. INDIRECT LARYNGOSCOPY
From Black JM, Hawks JH, Keene AM: Medical-surgical nursing: clinical management for positive outcomes, 6th ed., Philadelphia, 2001, W.B. Saunders.

15. BRONCHOSCOPY
From Black, J., Hawks, J., & Keene, A. (2001). Medical-surgical nursing: Clinical management for positive outcomes, ed 6, Philadelphia: W.B. Saunders.

16. BRONCHOSCOPY PREPROCEDURE Obtain informed consent
NPO from midnight prior to the procedure
Obtain vital signs
Assess the results of coagulation studies
Remove dentures or eyeglasses
Prepare suction equipment
Administer medication for sedation as prescribed
Have emergency resuscitation equipment readily available

17. BRONCHOSCOPY POSTPROCEDURE Monitor vital signs
Maintain semi-Fowler's position
Assess for the return of the gag reflex
Maintain NPO status until gag reflex returns
Have an emesis basin readily available for client to expectorate sputum
Monitor for bloody sputum

18. BRONCHOSCOPY POSTPROCEDURE
Monitor respiratory status, particularly if sedation was administered
Monitor for complications, such as bronchospasm, bronchial perforation indicated by facial or neck crepitus, dysrhythmias, fever, bacteremia, hemorrhage, hypoxemia, and pneumothorax
Notify the physician if fever, difficulty breathing, or other signs of complications occur following the procedure

19. PULMONARY ANGIOGRAPHY
DESCRIPTION
An invasive fluoroscopic procedure in which a catheter inserted through the antecubital or femoral vein into the pulmonary artery or one of its branches
Involves an injection of iodine, radiopaque, or contrast material

20. PULMONARY ANGIOGRAPHY
PREPROCEDURE
Obtain informed consent
Assess for allergies to iodine, seafood, or other radiopaque dyes
Maintain NPO status for 8 hours prior to the procedure
Monitor vital signs
Assess results of coagulation studies
Establish an IV access

21. PULMONARY ANGIOGRAPHY
PREPROCEDURE
Administer sedation as prescribed
Instruct the client that he or she must lie still during the procedure
Instruct the client that he or she may feel an urge to cough, flushing, nausea, or a salty taste following injection of the dye
Have emergency resuscitation equipment available

22. PULMONARY ANGIOGRAPHY
POSTPROCEDURE
Monitor vital signs
Avoid taking blood pressures in the extremity used for the injection for 24 hours
Monitor peripheral neurovascular status
Assess insertion site for bleeding
Monitor for delayed reaction to the dye

23. THORACENTESIS DESCRIPTION
Removal of fluid or air from the pleural space via a transthoracic aspiration
PREPROCEDURE
Obtain consent
Obtain vital signs
Prepare the client for ultrasound or chest radiograph if prescribed prior to procedure
Assess results of coagulation studies

24. THORACENTESIS DURING THE PROCEDURE
The client is positioned sitting upright, with the arms and head supported by a table at the bedside during the procedure
If the client cannot sit up, the client is placed lying in bed on the unaffected side with the head of the bed elevated 45 degrees
Inform the client not to cough, breathe deeply, or move during the procedure

25. THORACENTESIS
From Black, J., Hawks, J., & Keene, A. (2001). Medical-surgical nursing: Clinical management for positive outcomes, ed 6, Philadelphia: W.B. Saunders.

26. THORACENTESIS POSTPROCEDURE Monitor vital signs
Monitor respiratory status
Apply a pressure dressing and assess the puncture site for bleeding and crepitus
Monitor for signs of pneumothorax, air embolism, and pulmonary edema

27. PULMONARY FUNCTION TEST (PFT)
DESCRIPTION
Includes a number of different tests used to evaluate lung mechanics, gas exchange, and acid-base disturbance through spirometric measurements, lung volumes, and arterial blood gases

28. PEAK FLOW METERS
From Black, J., Hawks, J., & Keene, A. (2001). Medical-surgical nursing: Clinical management for positive outcomes, ed 6, Philadelphia: W.B. Saunders.

29. USE OF A PEAK FLOW METER
From Black, J., Hawks, J., & Keene, A. (2001). Medical-surgical nursing: Clinical management for positive outcomes, ed 6, Philadelphia: W.B. Saunders.

30. SPIROMETER
From Wilson SF, Thompson JM: Respiratory Disorders, St. Louis, 1990, Mosby.

31. VOLUME PLETHYSMOGRAPH
From Black, J., Hawks, J., & Keene, A. (2001). Medical-surgical nursing: Clinical management for positive outcomes, ed 6, Philadelphia: W.B. Saunders.

32. PULMONARY FUNCTION TEST (PFT)
PREPROCEDURE
Determine if an analgesic that may depress the respiratory function is being administered
Consult with the physician regarding holding bronchodilators prior to testing
Instruct the client to void prior to procedure and to wear loose clothing
Remove dentures
Instruct the client to refrain from smoking or eating a heavy meal for 4 to 6 hours prior to the test

33. PULMONARY FUNCTION TEST (PFT)
POSTPROCEDURE
Resume normal diet and any bronchodilators and respiratory treatments that were held prior to the procedure

34. LUNG BIOPSY DESCRIPTION
A percutaneous lung biopsy is performed to obtain tissue for analysis by culture or cytologic examination
A needle biopsy is done to identify pulmonary lesions, changes in lung tissue, and the cause of pleural effusion

35. LUNG BIOPSY PREPROCEDURE Obtain informed consent
Maintain NPO status prior to the procedure
Inform the client that a local anesthetic will be used but that a sensation of pressure during needle insertion and aspiration may be felt
Administer analgesics and sedatives as prescribed

36. LUNG BIOPSY POSTPROCEDURE Monitor vital signs
Apply a dressing to the biopsy site and monitor for drainage or bleeding
Monitor for signs of respiratory distress, and notify the physician if they occur
Monitor for signs of pneumothorax and air emboli, and notify the physician if they occur
Prepare the client for chest x-ray film if prescribed

37. VENTILATION PERFUSION LUNG SCAN
DESCRIPTION
In the perfusion scan, blood flow to the lungs is evaluated
The ventilation scan determines the patency of the pulmonary airways and detects abnormalities in ventilation
A radionuclide may be injected for the procedure

38. VENTILATION PERFUSION LUNG SCAN
PREPROCEDURE
Obtain informed consent
Assess for allergies to dye, iodine, or seafood
Remove jewelry around the chest area
Review breathing methods, which may be required during testing
Establish an IV access
Administer sedation if prescribed
Have emergency resuscitation equipment available

39. VENTILATION PERFUSION LUNG SCAN
POSTPROCEDURE
Monitor client for reaction to the radionuclide
For 24 hours following the procedure, rubber gloves worn when urine is being discarded should be washed with soap and water before removing; then, the hands should be washed after the gloves are removed
Instruct client to wash hands carefully with soap and water for 24 hours following the procedure

40. SKIN TESTS DESCRIPTION
An intradermal injection used to assist in diagnosing various infectious diseases
PREPROCEDURE
Determine hypersensitivity or previous reactions to skin tests

41. INTRADERMAL INJECTION
From Leahy, J. & Kizilay, P. (1998). Foundations of nursing practice. Philadelphia: W.B. Saunders.

42. SKIN TESTS
PROCEDURE
Use a test site that is free from excessive body hair, dermatitis, and blemishes
Apply at the upper one third of inner surface of left arm
Circle and mark the injection test site
Document the date, time, and test site

43. SKIN TESTS POSTPROCEDURE
Advise the client not to scratch the test site to prevent infection and abscess formation
Instruct the client to avoid washing the test site
Interpret the reaction at the injection site 24 to 72 hours after administration of the test antigen
Assess the test site for the amount of induration (hard swelling) in millimeters and the presence of erythema and vesiculation (small blister-like elevations)

44. ARTERIAL BLOOD GASES (ABGs)
DESCRIPTION
Measures the dissolved oxygen and carbon dioxide in the arterial blood and reveals the acid-base state and how well the oxygen is being carried to the body

45. NORMAL ABG VALUES pH—7.35 to 7.45 PCO2—35 to 45 mmHg
HCO3—22 to 27 mEq/L
PO2—80 to 100 mmHg
O2 saturation—96% to 100%
Oxyhemoglobin dissociation curve—No shift

46. ARTERIAL BLOOD GASES (ABGS)
PREPROCEDURE
Have the client rest for 30 minutes prior to specimen collection
Perform the Allen test prior to drawing radial artery specimens
Avoid suctioning prior to drawing ABGs
Do not turn off oxygen unless the ABGs are ordered to be drawn at room air

47. THE ALLEN TEST
From Black, J., Hawks, J., & Keene, A. (2001). Medical-surgical nursing: Clinical management for positive outcomes, ed 6, Philadelphia: W.B. Saunders.

48. ARTERIAL BLOOD GASES (ABGs)
POSTPROCEDURE
Place the specimen on ice
Note the client’s temperature on laboratory form
Note the oxygen and type of ventilation that the client is receiving on the laboratory form
Apply pressure to the puncture site for 5 to 10 minutes and longer if the client is on anticoagulant therapy or has a bleeding disorder
Transport the specimen to the laboratory within 15 minutes

49. PULSE OXIMETRY DESCRIPTION
A noninvasive test that registers the oxygen saturation of the client’s hemoglobin
This arterial oxygen saturation (SaO2) is recorded as a percentage
The normal value is 95 to 100%

50. PULSE OXIMETRY DESCRIPTION
After a hypoxic client uses up the readily available oxygen (measured as the arterial oxygen pressure, PaO2, on arterial blood gas testing), the reserve oxygen, that oxygen attached to the hemoglobin (SaO2), is drawn on to provide oxygen to the tissues
A pulse oximeter reading can alert the nurse to hypoxemia before clinical signs occur

51. PULSE OXIMETRY
From Black, J., Hawks, J., & Keene, A. (2001). Medical-surgical nursing: Clinical management for positive outcomes, ed 6, Philadelphia: W.B. Saunders. Courtesy of Ohmeda, Boulder, CO.

52. PULSE OXIMETRY PROCEDURE
A sensor is placed on the client’s finger, toe, nose, earlobe, or forehead to measure oxygen saturation, which is then displayed on a monitor
Maintain the transducer at heart level
Do not select an extremity with an impediment to blood flow
Results lower than 91% necessitate immediate treatment
If the SaO2 is below 85%, the body’s tissues have a difficult time becoming oxygenated; an SaO2 of less than 70% is life-threatening