II. Labs and Diagnostic Tests

1. Chest X-Ray

− information on the anatomic location and appearance.

Pre-Procedure Nursing Care:

- Remove jewelries and other metal objects.

- Assess ability to inhale and hold breath.

- Question regarding pregnancy or possibility of pregnancy.

2. Sputum Collection

- Obtained by expectoration, tracheal suctioning, or

bronchoscopy.

Pre-Procedure Nursing Care:

- Determine specific purpose.

- Early morning sterile specimen.

- Rinse mouth with water prior to collection.

- Take several deep breaths and then cough forcefully.

- Collect specimen before giving antibiotics.

Post-Procedure Nursing Care:

- Transport specimen stat.

- Perform oral care.

3. Pulse Oximetry

- A non-invasive test that registers arterial O2 saturation (SaO2).

- Normal values: 95-100%.

- Alerts hypoxemia before clinical signs occur.

Procedure:

- a sensor is placed either on the finger, toe, nose, or earlobe.

- Do not select an extremity with an impediment to blood flow.

- Results lower than 91% call for immediate treatment.

- If the SaO2 is below 85% -hypo-oxygenation. (S/S Mild: restlessness, anxiety, disorientation, confusion, S/S Acute: cyanosis, Cheyne strokes, increased BP, apnea, tachycardia, polycythemia, coma)

- If the SaO2 is below 70% - life threatening situation.

4. Bronchoscopy

- Visual examination of the larynx, trachea, and bronchi with a bronchoscope.

Pre-Procedure:

- Obtain informed consent.

- NPO prior. (6-12h.)

- Assess coagulation studies.

- Remove dentures/eyeglasses.

- Prepare suction.

- Sedatives as ordered.

- Have resuscitation equipment available.

Post-Procedure:

- Vital signs

- High-Fowler’s position.

- Assess gag reflex.

- Monitor for bloody sputum.

- Monitor respiratory status.

- Monitor for complications: bronchospasm, bronchial perforation, crepitus, dysrhythmia, fever, hemorrhage, hypoxemia, and pneumothorax. Notify MD if complications occur.

5. Pulmonary Angiography

- insertion of a fluoroscope via the antecubital or femoral vein into the pulmonary artery.

- Involves iodine or radiopaque contrast material.

- To investigate thromboembolic disease of the lungs such as pulmonary embolism and congenital abnormality of the pulmonary vascular tree.

Pre-Procedure:

- NPO/Vital signs

- Assess coagulation studies and renal system functioning.

- Establish an open line/IV.

- Administer sedation.

- Client must lie still during the

procedure.

- Urge to cough, flushing, nausea, or a salty taste.

- Emergency equipment must be available.

- Assess allergies to dye.

Post-Procedure:

- vital signs/no BP taking for 24 hours in the affected extremity.

- Monitor peripheral neurovascular status.

- Encourage increased oral fluid intake/IVF.

- Assess for bleeding and dye reaction.

6. Thoracentesis

- insertion of a hollow needle or similar instrument into the pleural cavity of the chest to drain pleural fluid, pus, or air.

- To detect disorders such as inflammatory, infectious, or cancerous conditions.

Pre-Procedure:

- Informed consent.

- vital signs

- CXR or UTZ prior to the procedure.

- NPO if patient will receive sedation, otherwise local anesthesia is given.

- Assess coagulation studies.

- Upright position.

- Do not cough, breathe deeply, or move during the procedure.

Post-Procedure:

- vital signs/respiratory status

- Pressure dressing

- assess site for bleeding and crepitus.

- Monitor for signs of complications.

7. Lung Biopsy

- indicated if CXR, CT-Scan, or bronchoscopy have failed to identify the cause of pulmonary lesions.

Pre-Procedure:

- informed consent

- NPO post NOC

- CXR and blood studies

- Anesthetic

- Pressure during insertion and aspiration

- Analgesics and sedatives as ordered.

- Keep calm and quiet.

Post-Procedure:

- vital signs

- Pressure dressing

- Monitor for bleeding and respiratory distress.

- Monitor for complications.

- CXR

8. Ventilation Perfusion Scan

- Determines the patency of the pulmonary airways.

Pre-Procedure:

- informed consent

- assess allergies to dye, iodine, or seafood.

- remove jewelries.

- review breathing methods.

- IV access

- administer sedation.

- Emergency resuscitation equipment must be available.

Post-Procedure:

- monitor reaction to radionuclide.

- handle body secretions carefully.

- wash hands carefully with soap and water.

9. Skin Tests

- determine hypersensitivity.

- Should be on the area without excessive body hair and dermatitis.

- Encircle, document the date, time, and test site.

- Do not scratch nor wash.

- Assess for induration, erythema, and vesiculation.

- Tuberculin test/PPD.

10. Arterial Blood Gas Analysis (ABG)

- measurement of tissue oxygenation, carbon dioxide removal, and acid-base balance.

Quick steps in interpreting the ABG

Results:

LABEL THE pH: Look at the pH and determine if it is moving towards acidosis or alkalosis. In either case, there is a CAUSE! Note that the pH only follows the direction of either PaCO2 or HCO3

FIND THE CAUSE: because the pH only follows whether PaCO2 or HCO3, the cause is only either of the two. If the PaCO2 is the cause, it is RESPIRATORY but if HCO3 is the cause, it is METABOLIC.

DETERMINE THE COMPENSATION: If the cause is respiratory, then the opposite side, the metabolic system will normally compensate and vice versa. If the movement of other value is towards the opposite, there is compensation. If it remains normal, then there is no compensation.

Obtaining Specimen for ABG:

- Do Allen’s test.

- Use heparinized syringe.

- Ensure there are no bubbles in the syringe.

- Send specimen on ice and occlude needle to prevent air from coming in the syringe.

- Check site for hematoma, bleeding, and pain.

11. Pulmonary Function Tests

- pulmonary function laboratory.

- evaluates pulmonary function through a series of spirometric measurements.

- To assess effectiveness of a specific therapeutic regimen, evaluate pulmonary status.

- Nose clip is applied to an unsedated patient then breathes into a spirometer or body plethysmograph.

- Using measured lung volumes, respiratory capacities are calculated to assess pulmonary

status.

Pre-Procedure:

- Informed consent.

- Note and report all allergies.

- Avoid smoking for 12h. prior.

- Avoid heavy meals.