ATI Chp17 – Flashcard

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Respiratory diagnostic procedures
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Used to evaluate the clients respiratory status by checking indicators such as -Oxygenation of the blood – lung functioning – integrity of the airway
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Respiratory diagnostic procedures
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– Pulmonary function test – ABGs – bronchoscopy – thoracentesis
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Pulmonary function test
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Determine lung function and breathing difficulties
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PFTs
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-Measure lung volumes and capacities – diffusion capacity – gas exchange – flowrates – airway resistance along with disturbance of ventilation
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PFTs
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– Identify lung disease – dyspnea – can be performed before surgical procedures (identify patients with respiratory risks) – do not smoke 6 to 8 hours prior to testing – withholding inhalers 4-6Hours prior to testing
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Arterial puncture post procedure
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-Hold direct pressure at least 5minutes(20 minutes for patients receiving anticoagulant therapy)
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Arterial puncture
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Frequently done by respiratory therapist in hospital setting
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Air embolism treatment(ABG complication)
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Client on left side in Trendelenburg position Monitor S OB – decreased Sat – chest pain – anxiety – air hunger
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Bronchoscopy
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Permits visualization of the larynx , trachea, and bronchi through either a flexible fiber-optic bronchoscope or rigid bronchoscope
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Bronchoscopy
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Can be performed on clients who are receiving mechanical ventilation by inserting the scope through ET tube
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Indications for bronchoscopy
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– Visualization of abnormalities such as tumors, inflammation, strictures
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Indication for bronchoscopy
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Biopsy of suspicious tissue (lung cancer) – higher risk for bleeding and or perforation with biopsy
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Indications for bronchoscopy
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Aspiration of deep sputum or lung abscess for culture and sensitivity or cytology (pneumonia)
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Bronchoscopy
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Performed for Therapeutic reasons such as – removal of foreign bodies and secretions from tracheobronchial tree – treating postoperative atelectasis – to destroy and excise lesions
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Preprocedure nursing actions bronchoscopy
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– allergies/anticoagulant use – informed consent – remove dentures – NPO usually 8 to 12 hours before procedure reduced risk of aspiration(cough reflex blocked by anesthesia) – Give medications such as viscous lidocane or local anesthetic throat sprays
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Intra-procedure nursing actions bronchoscopy
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– Sitting position – give meds such as sedative, anti-anxiety, atropine to reduce oral secretions as ordered – assist in collecting/labeling specimens – monitor vital signs respiratory pattern oxygenation status
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Post procedure nursing actions bronchoscopy
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-Assess level of consciousness – presence of gag reflex – ability is swallow prior to resuming oral intake usually takes about 2hours
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Post procedure nursing actions bronchoscopy
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Monitor for development of significant fever – productive cough – significant hemopytsis indicative of hemorrhage – hypoxemia
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Postprocedure bronchoscopy
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Patient not discharged from recovery room until adequate cough reflex and respiratory effort are present
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Client education bronchoscopy
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-Gargle with salt water – use throat lozenges may provide comfort for sore throat
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Complications of bronchoscopy
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-Laryngospasm – pneumothorax – aspiration
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Laryngospasm
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Uncontrolled muscle contractions of the laryngeal cords that impede clients ability to inhale
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Humidification
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What can decrease the likelihood of laryngeal edema
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Pneumothorax
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What can occur following a rigid bronchoscopy
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Aspiration
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What can occur if the patient chokes on oral or gastric secretions
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Thoracentesis
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Surgical perforation of the Chest wall and plural space with large bore needle
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Thoracentesis
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What is performed to obtain specimens for – diagnostic evaluation – instill medications pleural space – remove fluid or air from pleural space for therapeutic relief of pleural pressure
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Ultrasound
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What is used for guidance to decrease the risk of complications during a thoracentesis
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Indications for thoracentesis
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-Transudates – exudates – empyema – pneumonia – blunt, crushing, penetrating chest injuries
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Patient presentation for thoracentesis
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– Large amounts of fluid in Pleural space compressed lung tissue – can cause pain, shortness of breath, cough
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Pre-thoracentesis to locate effusion and insertion site
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-Percussion – auscultation – radiography – sonography
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Fat deposits and older clients
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What makes it difficult for the provider to identify landmarks for insertion of Thoracentesis needle
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Thoracentesis nursing actions preprocedure
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Position patient sitting upright, arms and shoulders raised, supported on pillows over bed table, well supported feet and legs
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Thoracentesis nursing actions preprocedure
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-Informed consent – gather supplies – obtain x-ray to locate pleural effusion determine needle insertion site
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Thoracentesis nursing actions intraprocedure
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– Assist in aseptic technique – prep patient for pressure of needle insertion and fluid removal – monitor vital signs, skin color, O2 sat – measure record amount of fluid removed – take specimens directly to lab
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Thoracentesis
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Fluid removed is limited to 1L at a time to prevent cardiovascular collapse
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Thoracentesis nursing actions post procedure
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-Apply dressing over puncture site – assess dressing for bleeding and drainage – monitor vital signs respiratory status hourly for for several hours
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Thoracentesis nursing actions post procedure
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– Auscultate lungs for reduced breath sounds on the side of thoracentesis – encourage deep breathing (assist with lung expansion) – obtain chest x-ray check resolution of effusions and rule out pneumothorax
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Complications of thoracentesis
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– Mediastinal shift – pneumothorax – bleeding – infection
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Mediastinal shift
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Shift of thoracic structures to one side of the body
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Nursing action mediastinal shift
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-Monitor vital signs – auscultate lungs for decrease or in absence of breath sounds
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Pneumothorax
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Collapsed lung that can occur due to injury or during thoracentesis
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Nursing action pneumothorax
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– Monitor for signs diminished breath sounds – Monitor chest x-ray results – educate patient on indications within 24 hours post procedure
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Signs of Pneumothorax
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– Deviated Trachea – pain on expected side that worsens upon exhalation – affected side does not move in or out upon inhalation/exhalation – increased heart rate – rapid shallow respirations – Nagging cough or a feeling of air hunger
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Thoracentesis post procedure Bleeding nursing actions
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– Monitor for coughing or hemopytsis – monitor vital signs lab results for evidence of bleeding (hypotension, reduced hemoglobin level) – Assess thoracentesis site for bleeding
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Infection post procedure thoracentesis
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– Ensure sterile technique maintained – monitor patient temperature following procedure

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