MSE 2 Respiratory Diagnostics

Respiratory Diagnostics & Upper Respiratory

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  • Overview and introduction to respiratory diagnostics and upper respiratory issues.

Serum Labs & Diagnostics

Hemoglobin

  • What is Hemoglobin?

    • Iron-containing pigment found in red blood cells (RBC).

  • Normal Hemoglobin Levels:

    • Males: 14-18 g/dL

    • Females: 12-16 g/dL

Hematocrit

  • Definition:

    • Measures the percentage of total blood volume made up by RBCs.

  • Normal Hematocrit Ranges:

    • Males: 42-52%

    • Females: 37-47%

  • Decreased Hematocrit Levels:

    • Known as "anemia."

    • Causes include:

    • Bleeding

    • Bone marrow failure

    • Dietary deficiency

    • Renal disease

  • Increased Hematocrit Levels:

    • Known as "polycythemia."

    • Note: Hemodilution or dehydration may affect hematocrit levels.

Nursing Implications: Hemoglobin & Hematocrit

  • Monitoring Trends:

    • Pay attention to changes in hemoglobin and hematocrit levels.

  • Concerns Related to Anemia:

    • Potential lack of adequate oxygenation to tissues and vital organs.

  • Concerns Related to Polycythemia:

    • Risk of thrombosis development.

D-Dimer

What is D-Dimer?

  • A protein fragment present in the blood after a blood clot dissolves.

  • Primarily used to assist in the diagnosis of the following conditions:

    • Venous thromboembolism (VTE)

    • Disseminated intravascular coagulation (DIC)

    • Pulmonary embolism (PE)

Nursing Implications

  • May be required to draw D-Dimer when pulmonary embolism is suspected.

  • It is commonly combined with a physical assessment of PE symptoms, D-Dimer test, and CT scans.

Sputum Samples

Purpose

  • Aim is to identify the bacterial, viral, or fungal cause of a suspected infection and its antibiotic sensitivities.

Indications for Sputum Collection

  • Clinical signs of infection, such as:

    • Productive cough

    • Purulent sputum

    • Signs of systemic infection

    • Fever of unknown origin

Types of Studies Available

  • Acid-fast bacilli (AFB) for tuberculosis

  • Culture and Gram stain for identifying infections

  • Cytology for cellular analysis

Collecting the Sputum Sample

Steps for Collection

  • Positioning the Patient:

    • Upright position in a chair or Fowler position in bed.

  • Using Sodium Chloride Nebulizer:

    • May help loosen secretions before collection.

  • Breathing Technique:

    • Instruct patient to take deep breaths: inhaling through the nose and exhaling through the mouth.

  • Specimen Collection Process:

    • Collect specimen in a designated pot and seal to prevent contamination and cross-infection.

Pulse Oximetry

  • Purpose:

    • Measures the amount of hemoglobin (Hgb) carrying oxygen in blood.

    • Analogous to asking, "How full are those buses?" regarding oxygen transport.

  • Normal Pulse Oximetry Levels:

    • Greater than or equal to 95%.

Nursing Implications

  • Decreased Levels Indicate Potential Issues:

    • Hypoventilation

    • Atelectasis, pneumothorax, or other lung-related issues.

  • Monitoring Methodology:

    • Non-invasive technique, can be intermittent or continuous.

    • Commonly used to titrate oxygen levels in hospitalized patients.

  • Additional Considerations:

    • Remove nail polish before assessment.

    • Ears or toes can be used for measurement if fingernails are not suitable.

Chest X-Ray (CXR)

  • Pre-Procedure Requirements:

    • Remove any metal objects between neck and waist to avoid image distortion.

  • Common Viewing Angles:

    • Posteroanterior (PA) view

    • Lateral view

CT Scan (Computed Tomography)

  • Description:

    • Provides cross-sectional images of structures in the body.

  • Patient Considerations:

    • May need sedation due to the requirement for patients to lie still, especially if they experience claustrophobia.

    • Scanner movement produces clicking noises and utilizes a hard table for the scanning process.

  • Contrast Use:

    • With Contrast Considerations:

    • Assess renal function via BUN and creatinine (Cr) levels.

    • Check for allergies to shellfish as the contrast may be iodine-based.

    • Patient may feel a warm flush during contrast administration.

    • Ensure patients are encouraged to drink fluids post-procedure.

MRI (Magnetic Resonance Imaging)

  • Applications:

    • Employed for assessing lesions that are difficult to visualize via CT scan, such as lung apex regions.

    • Differentiates between vascular and non-vascular structures.

  • Contrast Utilization:

    • Utilizes a contrast medium that is not iodine-based.

  • Sedation Risks:

    • Closed MRI may require sedation for claustrophobic patients.

PET Scan (Positron Emission Tomography)

  • Functionality:

    • Utilizes a radioactive substance called a "tracer" to identify lung diseases or cancers.

    • Focuses on assessing bodily functions rather than just structural details, specifically:

    • Blood flow

    • Oxygen utilization

    • Sugar uptake

Pulmonary Function Tests

  • Objective:

    • Evaluate lung function and assess airflow movement within the lungs.

  • Administration:

    • Conducted by a respiratory therapist.

Lung Volume Measurements (in mL)

  • Total Lung Capacity:

    • Maximum possible inspiration: 6,000 mL

  • Tidal Volume:

    • Normal resting breathing volume.

  • Various capacities such as inspiratory capacity, expiratory reserve volume, and residual volume are assessed according to airflow measurements.

Tuberculin Test (TB Skin Test/Mantoux Test)

Procedure

  • Inspection:

    • Must be read within 48-72 hours; a returning patient is crucial for accurate interpretation.

Result Interpretation

  • A positive test indicates possible exposure but does not confirm an active TB infection; further testing is required, including:

    • Chest X-ray

    • Sputum culture

Induration Measurement

  • Measure only induration (swelling), not redness:

    • 15 mm or more: Positive in all individuals regardless of risk factors.

    • 10 mm or more: Positive if individual is an immigrant, IV drug user, or lives in close quarters, or is a child less than 4.

    • 5 mm or more: Positive in high-risk individuals such as those with HIV or who are in contact with TB.

Common Upper Respiratory Problems

Types:

  • Epistaxis

  • Upper Respiratory Infections (URI) including:

    • Paranasal sinuses

    • Tonsillitis

    • Influenza

    • Rhinitis

    • Laryngitis

    • Pharyngitis

Epistaxis (Nosebleeds)

Causes:

  • Irritation, trauma, infection, foreign bodies, tumors

  • Associated conditions like hypertension or blood pathologies

  • Drug-induced (chemotherapy, anticoagulants)

  • Types: Anterior vs. Posterior

Nursing Management

Anterior Epistaxis

  • Position upright, lean forward, pinch nostrils

  • Provide reassurance and calm the patient

  • Apply lateral pressure or ice to the area

  • Use loose packing if necessary

  • Advise against blowing the nose

Posterior Epistaxis

  • Considered an emergency situation; may require hospitalization

  • Conduct respiratory status assessment

  • Provide humidification, oxygen, bed rest, pain control, and oral care during management.

  • Patient Education:

    • Use saline spray/humidification

    • Avoid aspirin or NSAIDs

    • Refrain from strenuous activities.

Upper Respiratory Infections (URI)

Key Highlights by Condition:

  1. Pharyngitis

    • Mostly viral (70%; includes cold, flu, mono)

    • Fungal infections, particularly candidiasis (10%)

    • Bacterial type caused primarily by β-hemolytic Streptococcus (20%)

    • Untreated cases may lead to severe complications:

      • Acute glomerulonephritis (7 to 10 days)

      • Rheumatic fever (3 to 5 weeks)

  2. Influenza

    • Viral types include A, B, and C

    • Annual flu vaccination recommended, particularly in at-risk groups or those in contact with vulnerable populations.

    • Most common long-term complication: pneumonia

  3. Rhinitis

    • Categories: Allergic vs. Viral/Bacterial

    • Allergic rhinitis defined as hay fever/allergies; viral rhinitis is known as the common cold.

  4. Sinusitis

    • Most often viral; bacterial sinusitis is diagnosed if symptoms persist after 14 days.

  5. Laryngitis

    • Frequently viral; results from an inflammatory process or vocal abuse.

  6. Tonsillitis

    • Can be viral or bacterial; common bacterial cause is group A Streptococcus.

    • Surgical intervention, referred to as T&A (tonsillectomy and adenoidectomy), may be indicated.

Nursing Management for Upper Respiratory Infections

  • Treatment strategies vary by type of infection (“itis” conditions):

    • Remove Causative Agents:

    • If bacterial, initiate antibiotics.

    • If viral, provide supportive care only.

    • Supportive Measures Include:

    • Rest

    • Adequate fluid intake

    • Symptomatic medications:

      • Antihistamines

      • Analgesics

      • Decongestants for sinusitis cases

      • Anti-viral medications (e.g., Tamiflu)