Respiratory: diagnostics and URI

Respiratory Diagnostics & Upper Respiratory

Page 3: Serum Labs

Hemoglobin

  • Definition: Iron-containing pigment of red blood cells (RBCs).

  • Normal Ranges:
      - Male: 14-18 g/dL
      - Female: 12-16 g/dL

Hematocrit

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

  • Normal Ranges:
      - Male: 42-52%
      - Female: 37-47%

  • Decreased Levels (Anemia):
      - Definition: Condition characterized by a deficiency in the number or quality of red blood cells.
      - Causes: Bleeding, bone marrow failure, dietary deficiency, renal disease.

  • Increased Levels (Polycythemia):
      - Definition: Increased concentration of red blood cells in the blood.
      - Effect of Hemodilution/Dehydration: May affect hematocrit levels due to dilution of RBCs through plasma volume changes.

Page 4: Nursing Implications: Hemoglobin & Hematocrit

  • Importance of monitoring trends in hemoglobin and hematocrit levels over time.

  • Anemia:
      - Concerns about adequate oxygenation to the tissues and vital organs.

  • Polycythemia:
      - Concerns about possible thrombosis due to increased blood viscosity.

Page 5: D-Dimer

Definition

  • What It Is: A test that detects D-dimer in blood.

  • Characteristics of D-dimer:
      - It is a protein fragment produced when a blood clot dissolves in the body.

  • Clinical Use: Often aids in the diagnosis of venous thromboembolism (VTE), disseminated intravascular coagulation (DIC), and pulmonary embolisms (PEs).

Nursing Implications

  • May be requested to draw this lab test when a pulmonary embolism is suspected.

  • Importance of combining diagnostics with physical assessments:
      - Symptoms of PE, D-Dimer test results, and CT scans.

Page 6: Sputum Samples

Purpose

  • Identify the bacterial, viral, or fungal cause of a suspected infection and its sensitivities to antibiotics.

Indications for Specimen Collection

  • Clinical signs of infection, including:
      - Productive cough and purulent sputum.
      - Signs of systemic infection.
      - Fever of unknown origin.

Types of Studies

  1. AFB (Acid-Fast Bacilli): For tuberculosis detection.

  2. Culture & Gram Stain: For identifying infections.

  3. Cytology: For cellular analysis.

Page 7: Collecting the Sample Procedure

  • Patient Positioning:
      - Position the patient upright in a chair or bed in the Fowler position.

  • Techniques to Loosen Secretions:
      - Ask the patient to take deep breaths in through the nose and out through the mouth.
      - Consider using a sodium chloride nebulizer to assist in loosening secretions.

  • Specimen Collection:
      - Collect the specimen in a pot and seal it to prevent contamination and reduce the risk of cross-infection.

Page 8: Pulse Oximetry

  • Definition: Measures the amount of hemoglobin carrying oxygen.
      - Analogy: “How full are those buses?”

  • Normal Range: Oxygen saturation of ≥ 95%.

Nursing Implications

  • Decreased Levels:
      - Hypoventilation.
      - Atelectasis, pneumothorax, or other lung problems.

  • Characteristics:
      - Non-invasive, available in intermittent or continuous monitoring formats.
      - Commonly used to titrate O2 levels in hospitalized patients.

  • Considerations:
      - Remove nail polish for accurate readings.
      - Alternative sites include earlobe or toe.

Page 9: Chest X-Ray (CXR)

  • Preparation:
      - Remove all metal objects between neck and waist.

  • Common Views:
      - PA (Posteroanterior) and lateral views.

Page 10: CT Scan (Computed Tomography)

  • Purpose: Shows structures in cross-section.

  • Considerations:
      - May require sedation due to the need for the patient to remain still or in case of claustrophobia.
      - Description: Hard table with a scanner that revolves around the body making clicking noises.

Contrast Use

  • Options: “With or without contrast”.
      - If “with contrast”:
        - Assess BUN (blood urea nitrogen) and creatinine levels.
        - Assess for allergy to shellfish (iodine-based contrast).
        - Patients may feel a warm flush.
        - Encourage fluid intake after the procedure.

Page 12: Magnetic Resonance Imaging (MRI)

  • Use Cases:
      - Evaluates lesions difficult to assess by CT scan (e.g., lung apex) and distinguishes vascular from nonvascular structures.
      - CT is typically preferred for lung evaluations unless special cases arise.

  • Contrast Medium: Uses a medium not based on iodine.

  • Considerations:
      - Patients may need sedation for closed MRIs due to claustrophobia.
      - Importance of removing all metal from patient.

Page 13: Positron Emission Tomography (PET) Scan

  • Functionality: Utilizes a radioactive substance called a “tracer” to look for lung disease or cancer.
      - Comparison with CT/MRI: While CT/MRI focus on structure, PET assesses body function including:
        - Blood flow.
        - Use of oxygen.
        - Uptake of sugar.

Page 14: Pulmonary Function Test

  • Purpose: Evaluates lung function by measuring air movement in the lungs.

  • Administration: Conducted by a respiratory therapist.

Lung Volume Measurements

  • Maximum possible inspiration: 6,000 mL.

  • Inspiratory reserve volume: 3,000 mL.

  • Tidal volume: Varies (normally around 500 mL).

  • Expiratory reserve volume: Estimated (varies).

  • Residual volume: Generally estimated without exact values.

  • Key Capacity Measurements:
      - Vital capacity, Functional residual capacity, and Total lung capacity are included as total measures of lung capabilities.

Page 17: TB Skin Test/Mantoux Test

  • Procedure: Must be read within 48-72 hours; the patient must return for the reading. If not returned, test must be repeated.

  • Interpretation: A positive result indicates exposure to TB but does not confirm active infection.

  • Induration Measurement: Induration is measured in millimeters (mm); redness itself is not measured.

  • Positive Interpretations:
      - 15 mm or more: Positive in all individuals.
      - 10 mm or more: Positive if at-risk (immigrants, IV drug users, tight living quarters, children < 4).
      - 5 mm or more: Positive if immunocompromised (HIV, contact with TB patient, organ transplant patients).

Page 19: Common Upper Respiratory Problems

Epistaxis

  • Definition: Nosebleeds.

  • Causes:
      - Irritation, trauma, infection, foreign bodies, tumors.
      - Hypertension or blood dyscrasias.
      - Drug-induced (e.g., anticoagulants, chemotherapy).
      - Classification: Anterior (more common) vs. Posterior (emergency).

Nursing Care for Epistaxis
Anterior

  • Position: Upright, lean forward, pinch nostrils together.

  • Interventions: Reassure the patient; apply lateral pressure and ice; consider loose packing; guide against blowing the nose.

Posterior

  • Emergency situation; may need hospitalization.

  • Assess respiratory status, provide humidification, oxygen, bed rest, pain control, and oral care.

  • Patient Education:
      - Use saline spray or humidification.
      - Avoid aspirin or NSAIDs.
      - Limit strenuous activities.

Page 21: Upper Respiratory Infections

  • Types of Infections:
      - Tonsillitis
      - Influenza
      - Rhinitis
      - Laryngitis
      - Pharyngitis
      - Sinusitis

URI: Key Highlights
Pharyngitis

  • Predominant Causes:
      - Viral (most adults - 70%): cold, flu, mono.
      - Fungal: Especially candidiasis (10%).
      - Bacterial: β-hemolytic Streptococcus (20%).

  • Complications of Untreated Pharyngitis:
      - Acute glomerulonephritis (7 – 10 days post-infection).
      - Rheumatic fever (3 – 5 weeks post-infection).

Influenza

  • Viral Infection: Types A, B, or C.

  • Vaccine: Administered annually; targets at-risk groups and those who may transmit the flu to high-risk individuals.

  • Common Complications: Pneumonia.

Rhinitis

  • Types:
      - Allergic (e.g., hay fever) vs. Viral/Bacterial (common cold).

Sinusitis

  • Viral Etiology: Most common cause; bacterial infections may arise after 14 days.

Laryngitis

  • Infectious Cause: Most often viral; inflammatory processes in the larynx may also occur.

Tonsillitis

  • Etiologies: Viral or bacterial (with group A strep as a common culprit).

  • Surgical Intervention: Tonsillectomy and adenoidectomy (T&A) are common treatments for severe cases.

Page 23: Nursing Management

  • Management Strategies Based on Etiology (“itis”):
      - Remove the causative agent where applicable.
      - If bacterial infection: initiate antibiotics.
      - If viral infection: supportive measures include rest, fluids, and medications:
        - Antihistamines.
        - Analgesics for pain relief.
        - Decongestants for sinusitis relief.
        - Anti-virals (e.g., Tamiflu) as needed.

  • Patient Focus: Treat symptoms effectively!