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PULMONARY FUNCTION TEST A non-invasive test to measure the lung functions and capacities to diagnose certain types of lung disease (especially asthma, bronchitis, and emphysema) to determine the cause of shortness of breath to measure whether occupational exposure to contaminants affects lung function used after the administration of medications to assess their effect, and to measure progress in disease treatment some temporary shortness of breath or light-headedness may be experienced Pre-Test: Teaching: no smoking for 3 days; only light meal 4 hours before the test. Intra-Test: Position: sitting; bronchodilator; noseclip and mouthpiece. (fatigue and dyspnea during the test) Post-Test: Adequate rest periods; loosen tight clothing
E About 500 ml About 1 200 ml

L U N G V O L U M TIDAL VOLUME Amount of air inhaled during (TV) normal breathing RESIDUAL VOLUME Amount of air in the lungs after (RV) forced expiration EXPIRATORY RESERVE VOLUME Amount of air that can be (ERV) exhaled after normal expiration INSPIRATORY RESERVE VOLUME Air in excess of TV that moves (IRV) into the lung on maximum inspiration VITAL CAPACITY Equal to TV + IRV + ERV (VC) FUNCTIONAL RESERVE VOLUME Equal to RV + ERV (FRV) Volume of air in lungs after normal respiration INSPIRATORY CAPACITY Equal to IRV + TV (IC) TOTAL LUNG CAPACITY Equal to IRV + TV + ERV + RV (TLC)

About 1 200 ml About 3 100 ml 4 800 ml

2 400 ml 3 600 ml 6 000 ml

Note: RV is decreased by restrictive lung disease RV is increased by obstructive lung diseases

Lung Volumes

Lung Capacities

Tidal Volume (TV) Inspiratory Reserve Volume (IRV) Expiratory Reserve Volume (ERV) Residual Volume Inspiratory Capacity (IC) Vital Capacity (VC) Functional Residual Capacity (FRC) Total Lung Capacity (TLC)

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PULSE OXIMETRY offers an easy and non-invasive measurement of oxygen saturation Normal Level: 95-100% Oxygen saturation (SpO2) is a measurement of the percentage of hemoglobin molecules carrying a full load of oxygen. Oxygenated hemoglobin (HbO2) absorbs more infrared light than red light, while deoxygenated hemoglobin (Hb) absorbs more red light. By comparing the relative amounts of different light absorbed, the oxygen saturation (SpO2) can be determined. Hypoxia/hypoxemia Possible Causes of Erroneous Readings: Motion artifact: Movement (shivering or tremors) or improper fit of the sensor can cause erroneously low readings. Hypotension (due to cardiac arrhythmias, blood loss or peripheral vascular disease) and peripheral vasoconstriction (caused by hypothermia, smoking or sickle cell disease) can alter readings. Smoke inhalation or carbon monoxide poisoning can cause high levels of carboxyhemoglobin and also skew pulse oximetry readings. Response delay: A technical limitation that requires additional time to detect hypoxemia (SpO2 less than 90 percent). The length of delay can be affected by poor sensor site perfusion and vasoactive drugs. Pre-Test: Assess the patient. The sensor site should be assessed regularly for skin breakdown, cyanosis, pulse rate and temperature. Intra-Test: Sensor should be covered with opaque material. Post-Test: Record the findings.

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VENTILATION PERFUSION SCAN Alternative Names Perfusion Lung Scan, Aerosol Lung Scan, Ventilation Lung Scan, Xenon Lung Scan, Ventilation/Perfusion Scanning (VPS), Pulmonary Scintiphotography, Or Most Commonly, V/Q Scan A lung perfusion scan assesses blood flow to the lungs. A lung ventilation study reveals the distribution of air space within the lungs. chest pain, for those coughing up blood (hemoptysis), or

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for those having difficulty breathing (dyspnea) The amount of radioactivity a person is exposed to during these tests is very low and is not harmful. There are no complications associated with these tests. Pre-Test: patient is injected intravenously with radioactive particles, known as Tc 99m MAA (macroaggregated albumin) Intra-Test: patient inhales a radioactive gas through a mask placed over the nose and mouth. Images of the ventilation lung scan show the distribution of the gas in the lungs; patient usually sits up while the images are taken. o The first stage is the initial, or ventilation stage, which reflects the rate of ventilation of the different lung segments. o Second is the equilibrium stage, which represents gas volume of the lungs. o The third stage is the wash-out phase, which demonstrates any gas trapping that may occur in obstructive diseases. Images are typically obtained posterior, although additional views may also be performed. o test takes approximately 15 to 30 minutes Post-Test: No special aftercare is needed. The patient may resume normal activities immediately. CHEST X-RAY (RADIOGRAPH) Painless diagnostic test that evaluates structure of bones and soft tissues Involves exposing a part of the body to a small dose of ionizing radiation to produce images of the inside of the body show the structures in and around the chest. The test is used to look for and track conditions of the heart, lungs, bones, and chest cavity create two-dimentional pictures done to find the cause of symptoms such as shortness of breath, chest pain, chronic cough (a cough that lasts a long time), and fever pneumonia, heart failure, lung cancer, lung tissue scarring, and sarcoidosis to see how well treatments for certain conditions are working used before surgery to look at the structures in the chest The amount of radiation is very small Gives out a radiation dose similar to the amount of radiation you're naturally exposed to over 10 days Pre-Test: a. Practice the client on how to hold his breath and to do deep breathing b. May be asked to undress from the waist up and

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wear a gown c. Instruct to avoid wearing jewelry and other metal objects d. Let the x-ray technician (a person specially trained to do x-ray tests) know if you have any body piercings on your chest; if pregnant (contraindicated) Intra-Test: a. Usually takes about 15 minutes b. You'll stand, sit, or lie c. May cover you with a heavy lead apron to protect certain parts of your body from the radiation d. May feel some discomfort from the coolness of the exam room and the x-ray plate Post-Test: can go back to your normal routine right after

Radiodensity the thickness as well as composition of different internal structures absorbs gamma rays in varying amounts which results in different shades in the x-ray film Radiopaque greater density Radioluscent lesser density Detector Plate measures transmission of X-rays X-rays that pass through the body to the film render the film dark (black) X-rays that are totally blocked do not reach the film and render the film light (white)

R A D I O D E N S I T Y Radioluscent Black Dark Gray Medium Gray Light Gray Bone Very Light Gray Contrast Barium Radiopaque Almost White Heavy Metals/ Lead

Air

Fat/Liver Water/Blood

Principle of X-ray: 1. An x-ray source emits radiation that penetrates the body 2. The penetrating radiation is then received by a x-ray detector (photographic plate) LUNG CT SCAN Other Names for Chest CT Scans Lung Imaging Test Computed Axial Tomography (CAT) Scan Helical CT Scan (another name for spiral CT scan) imaging technique that uses x-rays and advanced computer methods to produce images of the body in

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cross section rather than the overlapping images typically produced by conventional X-ray exams provides detailed pictures of the size, shape, and position of your lungs and other structures in your chest Follow up on abnormal results from standard chest xrays. Find the cause of lung symptoms, such as shortness of breath or chest pain. Find out whether you have a lung problem, such as a tumor, excess fluid around the lungs, or a pulmonary embolism (a blood clot in the lungs). used to check for other conditions, such as tuberculosis, emphysema, and pneumonia. tumors, excess fluid around the lungs, and pulmonary embolism (a blood clot in the lungs). The scan also checks for other conditions, such as tuberculosis, emphysema, and pneumonia Radiation; allergic reaction Pre-Test: a. Wear loose-fitting, comfortable clothing for the test. Sometimes the CT scan technician (a person specially trained to do CT scans) may ask you to wear a hospital gown. b. May want to avoid wearing jewelry and other metal objects. You'll be asked to take off any jewelry, eyeglasses, and metal objects that might interfere with the test. c. May be asked to remove hearing aids and dentures as well. Let the technician know if you have any body piercing on your chest. d. You also should tell your doctor whether: You're taking any medicines You have any allergies You've recently been ill You have any medical conditions (for example, heart disease, asthma, diabetes, kidney disease, or thyroid problems) These factors or conditions may raise your risk of having a bad reaction to the test. e. Explain the procedure. Ask if claustrophobic (might be given medication to relax) If with contrast dye: a. feel some discomfort when the needle is inserted. As the dye is injected, you also may feel warm and have a metallic taste in your mouth. These feelings last only a few minutes b. May ask you to not eat or drink for a few hours before the test, especially if contrast dye is part of the test. Tell if you have allergy to iodine. Intra-Test: a. takes about 30 minutes, which includes preparation time b. CT scanner is a large, tunnel-like machine that

has a hole in the middle. You'll lie on a narrow table that moves through the hole. c. While you're inside the scanner, an x-ray tube moves around your body. You'll hear soft buzzing, clicking, or whirring noises as the scanner takes pictures. d. The CT scan technician who controls the machine will be in the next room. He or she can see you through a glass window and talk to you through a speaker. e. Moving your body can cause the pictures to blur. The technician will ask you to lie still and hold your breath for short periods. This will help make the pictures as clear as possible. f. The scan itself doesn't hurt, but you may feel anxious if you get nervous in tight or closed spaces. Your doctor may give you medicine to help you relax. Post-Test: a. Can return to your normal routine right after b. If you got medicine to help you relax during the CT scan, your doctor will tell you when you can return to your normal routine. The medicine may make you sleepy, so you'll need someone to drive you home. c. If contrast dye was used during the test, you may have a bruise where the needle was inserted. Your doctor may give you special instructions, such as drinking plenty of liquids to flush out the contrast dye. d. If you're breastfeeding, the contrast dye can be passed to your baby through your breast milk. Ask your doctor how long you should wait after the test before you breastfeed. You may want to prepare for the test by pumping and saving milk for 24 to 48 hours in advance. You can bottle-feed your baby in the hours after the CT scan. Diagnostic Test: MRI (MAGNETIC RESONANCE IMAGING) OF THE LUNGS a diagnostic scanning technique based on the principles of nuclear magnetic resonance. It produces tomographic images by means of magnetic fields and radio waves. MRI uses no radioactivity or x-rays. gives detailed pictures of structures within the chest cavity, including the mediastinum, chest wall, pleura, heart and vessels, from almost any angle. MRI also provides movie-like sequential imaging to assess the health and function of structures assess abnormal masses, including cancer of the lungs or other tissues, which either cannot be assessed adequately with other imaging modalities (typically CT) or which are particularly well-suited to MR imaging.

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determine tumor size, extent, and the degree of spread to adjacent structures. assess the anatomy and function of the heart and its component structures (valves, etc.). assess myocardial perfusion (blood flow to the heart) and myocardial infarct (scar in the heart muscle due to prior obstruction of blood flow). determine blood flow dynamics in the vessels and heart chambers. display lymph nodes and blood vessels, including vascular and lymphatic malformations of the chest. assess disorders of the chest bones (vertebrae, ribs and sternum) and chest wall soft tissue (muscles and fat). assess for pericardial (thin sac around the heart) disease. characterize mediastinal or pleural lesions seen by other imaging modalities, such as chest x-ray or CT. The MRI examination poses almost no risk to the average patient when appropriate safety guidelines are followed. If sedation is used, there are risks of excessive sedation. The technologist or nurse monitors your vital signs to minimize this risk. Although the strong magnetic field is not harmful in itself, implanted medical devices that contain metal may malfunction or cause problems during an MRI exam. There is a very slight risk of an allergic reaction if contrast material is injected. Such reactions usually are mild and easily controlled by medication. If you experience allergic symptoms, a radiologist or other physician will be available for immediate assistance. Nephrogenic systemic fibrosis is currently a recognized, but rare, complication of MRI believed to be caused by the injection of high doses of gadolinium contrast material in patients with very poor kidney function. Manufacturers of intravenous contrast indicate mothers should not breastfeed their babies for 24-48 hours after contrast medium is given Pre-Test: a. If out-patient, ask patient to change into a hospital gown before the procedure to avoid possible magnetic interference from buckles, snaps, zippers, earrings, or silk screening. b. If a dye or contrast medium is to be used, patient may need to fast four hours before the test. Otherwise, no special preparation is needed. c. Explain to the patient that they are not allowed to wear anything metallic during the exam (e.g. watch, jewelry, hairpins, coins, eyeglasses, hearing aid etc.) Note: Some cosmetics contain metals; ask patient not to wear make-up before the procedure. d. Thoroughly screen the patient for internal metallic objects. (e.g. cardiac pacemaker, implanted cardiac defibrillator, aneurysm clips,

 a. Nursing Intervention: b.

c.

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carotid vascular clamp, neurostimulator, insulin or infusion pump, implanted drug infusion device, bone growth/fusion stimulator, cochlear, otologic, or ear implant) Intra-Test: Explain that during the procedure, patient will: Be asked to lie down on a narrow table, which will move through a donut-shape ring. Be able to communicate with the radiologist or technician through intercom at all times and that he/she is always in the line or sight of the technologist and staff. Hear loud sounds when the machine is taking images (the patient may be given earplugs to wear during the examination). Be asked to lie very still for most of the scan, which could become uncomfortable. The procedure will lasts up to 90 minutes. Experience no pain during the procedure. That part of the body examined may feel warm during the MRI which is normal. Be given a sedative to help him/her relax if claustrophobic. Post-Test: May be asked to remain on the exam table while the radiologist reviews the images to determine if additional images are needed. Patient can expect to resume his/her normal activities immediately, including driving, unless sedative was given.

DIFFERENCE BETWEEN CT SCAN AND MRI CT SCAN MRI COST Cheaper More expensive RADIATION EXPOSURE Moderate-high radiation None PRINCIPAL USED FOR Uses X-rays for imaging Uses magnets and radio IMAGING waves to create the images TIME TAKEN FOR COMPLETE Shorter Longer SCAN 30 minutes 90 minutes DETAILS OF SOFT TISSUES Less as compared to MRI Much higher detail in the soft tissues DETAILS OF BONY Provide good details about Less as compared to CT scan STRUCTURES bony structures LUNG PET SCAN Alternative Names Chest PET scan; Lung positron emission tomography; PET - chest; PET - lung; PET - tumor imaging an imaging test that uses a radioactive substance (called a tracer) to look for disease in the lungs A computer changes the results into 3-D pictures. The images are displayed on a monitor for your doctor to

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read Unlike magnetic resonance imaging (MRI) and computed tomography (CT) scans, which reveal the structure of the lungs, a PET scan shows how well the lungs and their tissues are working Help diagnose lung cancer See if lung cancer has spread to other areas of the body Help determine if a growth in the lungs (seen on a CT scan) is cancerous or not Determine how well cancer treatment is working amount of radiation used in a PET scan is low. It is about the same amount of radiation as in most CT scans. Also, the radiation doesn't last for very long in your body. an allergic reaction to the radioactive substance, (some people have pain, redness, or swelling at the injection site) Pre-Test: a. may be asked not to eat anything for 4 - 6 hours before the scan. You will be able to drink water. b. Tell your health care provider if: o You are afraid of close spaces (have claustrophobia). You may be given a medicine to help you feel sleepy and less anxious. o You are pregnant or think you might be pregnant. o You have any allergies to injected dye (contrast). o You have take insulin for diabetes. You will need special preparation. Always tell your health care provider about the medicines you are taking, including those bought without a prescription. Sometimes, medications may interfere with the test results. Intra-Test: a. scan requires a small amount of radioactive material (tracer). This tracer is given through a vein (IV), usually on the inside of your elbow b. need to wait nearby as the tracer is absorbed by your body. This usually takes about 1 hour. c. lie on a narrow table, which slides into a large tunnel-shaped scanner d. must lie still during test. Too much movement can blur images and cause errors. e. The test takes about 90 minutes. f. may feel a sharp sting when the needle containing the tracer is placed into your vein. g. causes no pain. The table may be hard or cold, but you can request a blanket or pillow. h. An intercom in the room allows you to speak to someone at any time. i. There is no recovery time, unless you were given

a medicine to relax. Post-Test: a. May be asked to remain on the exam table while the radiologist reviews the images to determine if additional images are needed. b. Patient can expect to resume his/her normal activities immediately, including driving, unless sedative was given.

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LARYNGOSCOPY Alternative Names Laryngopharyngoscopy; Indirect laryngoscopy; Flexible laryngoscopy; Mirror laryngoscopy; Direct laryngoscopy; Fiberoptic laryngoscopy an examination of the back of your throat, including your voice box (larynx). Your voice box contains your vocal cords and allows you to speak. Bad breath that does not go away Breathing problems, including noisy breathing (stridor) Chronic cough Coughing up blood Difficulty swallowing Ear pain that does not go away Feeling that something is stuck in your throat Long-term upper respiratory problem in a smoker Mass in the head or neck area with signs of cancer Throat pain that does not go away Voice problems that last more than 3 weeks, including hoarseness, weak voice, raspy voice, or no voice Acid reflux (GERD), which can cause redness and swelling of the vocal cords Cancer of the throat or voice box Nodules on the vocal cords Polyps (benign lumps) on the voice box Inflammation in the throat Thinning of the muscle and tissue in the voice box (presbylaryngis) Allergic reaction to anesthesia, including breathing and heart problems Infection Major bleeding Nosebleed Spasm of the vocal cords, which causes breathing problems Ulcers in the lining of the mouth/throat Injury to the tongue or lips Considerations Indirect mirror laryngoscopy should NOT be done: In infants or very young children

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If you have acute epiglottis, an infection or swelling of the flap of tissue in front of the voice box If you cannot open your mouth very wide Pre-Test: a. If it is being done under general anesthesia, you may be told not to drink or eat anything for several hours before the test. b. Informed consent/permit needed. (invasive procedure) c. Atropine sulphate and Valium pre-procedure as prescribed; topical anesthesia sprayed into the throat followed by local anesthesia injected into larynx. d. NPO for 6-8 hours. e. Remove dentures, prostheses, contact lenses. (to prevent airway obstruction and to avoid losses of valuable) Intra-Test: a. Indirect laryngoscopy using a mirror can cause gagging. For this reason it is not often used in children under age 6 - 7 or those who gag easily. b. Fiberoptic laryngoscopy can be done in children. It may cause a feeling of pressure and a feeling like you are going to sneeze. Post-Test: a. may experience soreness of the throat or cough up small amounts of blood until the irritation subsides b. should ingest nothing by mouth until the gag reflex returns (once the reflex returns, fluid intake should be encouraged because it promotes the expectoration of secretions) c. lozenges or gargles may be used relieve a sore throat d. Vital signs should be assessed frequently for 24 hours to detect bleeding or complications such as difficult or labored respiration (dyspnea).

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BRONCHOSCOPY direct inspection and observation of the larynx, trachea, and bronchi through a bronchoscope. Diagnostic Uses: 1. To collect secretions 2. To determine location of pathologic process and collect specimen for biopsy. Therapeutic Uses: 1. To remove aspirated foreign objects 2. To excise small lesions Place medicine in a lung to treat a lung problem. Insert a stent (small tube) in an airway to hold it open. A stent might be used if a tumor or other condition blocks an airway. A tumor

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Signs of infection Excess mucus in the airways The site of bleeding A blockage (such as a piece of food) in your airway A drop in your oxygen level during the procedure. Your doctor will give you oxygen if this happens. Minor bleeding, infection, and fever. Pneumothorax (rare) Pre-Test: a. Informed consent/permit needed. (invasive procedure) b. Atropine sulphate and Valium pre-procedure as prescribed; topical anesthesia sprayed into the throat followed by local anesthesia injected into larynx. c. NPO for 6-8 hours. d. Remove dentures, prostheses, contact lenses. (to prevent airway obstruction and to avoid losses of valuable) Intra-Test: a. takes about 30 minutes b. Your doctor also will squirt or spray a liquid medicine into your nose and throat to numb them. This helps prevent coughing and gagging when the bronchoscope (long, thin tube) is inserted. c. As the tube enters your mouth, you may gag a little. Once it enters your throat, that feeling will go away. d. During the procedure, your doctor may take a sample of lung fluid or tissue for further testing. Post-Test: a. Side-lying position. (to promote drainage of secretions from the mouth) b. Check for the return of cough and gag reflex before giving fluids per orem. (to prevent aspiration) c. Watch for cyanosis, hypotension, tachycardia, arrhythmias, hemoptysis, and dyspnea. (signs and symptoms that indicates perforation of bronchial tree) d. You may have a chest x ray if your doctor took a sample of lung tissue. This test will check for a pneumothorax and bleeding. A pneumothorax is a condition in which air collects in the space around the lungs. This can cause one or both lungs to collapse. e. A nurse will check your breathing and blood pressure. f. You can't eat or drink until the numbness in your throat wears off, which will take about 12 hours. o Your doctor will let you know when you can return to your normal activities, such as driving, working, and

physical activity. o For the first few days, you may have a sore throat, cough, and hoarseness. Call your doctor right away if you: Develop a fever Have chest pain Have trouble breathing Cough up more than a few tablespoons of blood Diagnostic Test: Definition: LUNG BIOPSY a medical procedure performed to obtain a small piece of lung tissue for examination under a microscope. confirming a diagnosis of cancer may be ordered to examine other abnormalities that appear on chest x-rays, such as lumps (nodules) It is also helpful in diagnosing symptoms such as coughing up bloody sputum, wheezing in the chest, or difficult breathing. to evaluate lung tumors and their associated symptoms used in the diagnosis of lung infections, especially tuberculosis, drug reactions, and such chronic diseases of the lung as sarcoidosis. Needle biopsy Needle biopsy is a less risky procedure than an open biopsy, because it does not involve general anesthesia. Very rarely, the lung may collapse because of air that leaks in through the hole made by the biopsy needle. If the lung collapses, a tube will have to be inserted into the chest to remove the air. Some coughing up of blood occurs in 5% of needle biopsies. Prolonged bleeding or infection may also occur, although these are very rare. Open biopsy Possible complications of an open biopsy include infection or lung collapse. Death occurs in about 1 in 3000 cases. If the patient has very severe breathing problems before the biopsy, breathing may be slightly impaired following the operation. If the person's lungs were functioning normally before the biopsy, the chances of any respiratory problems are very small. Mediastinoscopy Complications due to mediastinoscopy are rare; death occurs in fewer than 1 in 3000 cases. More common complications include lung collapse or bleeding caused by damage to the blood vessels near the heart. Injury to the esophagus or voice box (larynx) may sometimes occur. If the nerves leading to the larynx are injured, the patient may be left with a permanently hoarse voice. All of these complications are very rare. Pre-Test: Before scheduling any lung biopsy, the doctor will check to see if the patient is taking any prescription medications, if he or she has any medication allergies, and if there is a history of

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bleeding problems. Blood tests may be performed before the procedure to check for clotting problems and blood type, in case a transfusion becomes necessary. If an open biopsy or a mediastinoscopy is being performed, the patient will be asked to sign a consent form. Since these procedures are done under general anesthesia, the patient will be asked to refrain from eating or drinking anything for at least 12 hours before the biopsy. Post-Test: Needle biopsy Following a needle biopsy, the patient is allowed to rest comfortably. He or she will be checked by a nurse at two-hour intervals. If there are no complications after four hours, the patient can go home. Patients are advised to rest at home for a day or two before resuming regular activities, and to avoid strenuous activities for a week after the biopsy. Open biopsy or mediastinoscopy After an open biopsy or a mediastinoscopy, patients are taken to a recovery room for observation. If no other complications develop, they are taken back to the hospital room. Stitches are usually removed after seven to 14 days. If the patient has extreme pain, light-headedness, difficulty breathing, or develops a blue tinge to the skin after an open biopsy, the doctor should be notified immediately. The sputum may be slightly bloody for a day or two after the procedure. If, however, the bleeding is heavy or persistent, it should be brought to the attention of the doctor.

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THORACENTESIS Pleural fluid aspiration for obtaining a specimen a pleural fluid for analysis, relief of lung compression and biopsy specimen collection Therapeutic 1. In treatment of hydrothorax, when absorption of fluid fails to occur. 2. To relieve pain, dyspnea, and other pressure symptoms caused by accumulation of the fluids. 3. To introduce medication For diagnostic purpose Pleural Effusion o Your doctor will diagnose a pleural effusion based on your medical history, a physical exam, and test results. Medical History Your doctor will ask about your symptoms, such as trouble breathing, coughing, and hiccups. He or she also may ask whether you've ever: Had heart disease Smoked Traveled to places where you may have been exposed to tuberculosis Had a job that exposed you to asbestos (a mineral that, in

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the past, was widely used in many industries) Physical Exam Your doctor will listen to your breathing with a stethoscope and tap lightly on your chest. If you have a pleural effusion, your breathing may sound muffled. Your doctor also may hear a dull sound when tapping on your chest. Diagnostic Tests You may have one or more of the following tests to diagnose a pleural effusion. Chest x-ray. This test creates a picture of the structures inside your chest, such as your heart and lungs. A chest xray may show air or fluid in the pleural space. The test also may show the cause of the pleural effusion, such as pneumonia or a lung tumor. To get more detailed pictures, the x-ray might be done while you're in various positions. Ultrasound. This test uses sound waves to create a picture of the structures in your body, such as your lungs. Ultrasound may show the location of fluid in your chest. Sometimes the test is used to find the right place to insert the needle or tube for thoracentesis. Chest computed tomography scan, or chest CT scan. This test creates a computer-generated picture of the lungs that can show pockets of fluid. A chest CT scan may show fluid even if a chest x-ray doesn't. A CT scan also may show signs of pneumonia or a tumor. Pneumothorax or a collapsed lung Pain, bleeding, bruising, or infection at the spot where the needle or tube was inserted Liver or spleen injury (very rare) Pre-Test: a. Secure written consent. (invasive procedure) b. Take initial vital signs. Aspiration of air or fluid from the pleural space may cause hypovolemic shock. c. Position: upright, leaning on overbed table d. Instruct client to remain still, avoid coughing during insertion of needle. (to prevent trauma to the lungs) e. Pressure sensation is felt on insertion of needle. Topical anesthetic is used at the site of needle insertion. Intra-Test: position the patient sitting with arms on a table or side-lying fowlers, instruct not to cough, breathe deeply or move Post-Test: a. Turn the patient on the unaffected side to prevent leakage of fluid in the thoracic cavity. b. Bes rest. (to prevent postural hypotension) c. Watch the sputum for streaks of blood. (indicates trauma to the lungs notify the physician) d. Monitor for vital signs. (to assess for signs and symptoms of internal hemorrhage) Internal

hemorrhage is manifested by tachycardia, tachypnea, hypotension, hypothermia (low body temperature). e. Watch and observe patients color, pulse and respiration for the treatment involves one of the vital organs of the body.

1. SPUTUM CULTURE AND SENSITIVITY TEST

a test to detect and identify bacteria or fungi (plural of fungus) that are infecting the lungs or breathing passages. Sputum is a thick fluid produced in the lungs and in the airways leading to the lungs. A sample of sputum is placed in a container with substances that promote the growth of bacteria or fungi. If no bacteria or fungi grow, the culture is negative. If organisms that can cause infection (pathogenic organisms) grow, the culture is positive. The type of bacterium or fungus will be identified with a microscope or by chemical tests. If bacteria or fungi that can cause infection grow in the culture, other tests may be done to determine which antibiotic will be most effective in treating the infection. This is called susceptibility or sensitivity testing. This test is done on a sample of sputum that is usually collected by coughing. For people who can't cough deeply enough to produce a sample, they can breathe in a mist solution to help them cough. Sputum can be: a. Bloody (Hemoptysis) 1. blood-streaked sputum - inflammation of throat, bronchi; lung cancer; 2. Pink sputum - sputum evenly mixed with blood, from alveoli, small bronchi; 3. massive blood cavitary tuberculosis of lung, lung abscess, bronchiectasis, infarction, embolism. b. Rusty colored - usually caused by pneumococcal bacteria (in pneumonia) c. Purulent - containing pus. The color can provide hints as to effective treatment in Chronic Bronchitis Patients: 1. a yellow-greenish (mucopurulent) color suggests that treatment with antibiotics can reduce symptoms. Green color is caused by Neutrophil Myeloperoxidase. 2. a white, milky, or opaque (mucoid) appearance often means that antibiotics will be ineffective in treating symptoms. (This information may correlate with the presence of bacterial or viral infections, though current research does not support that generalization.) d. Foamy white - may come from obstruction or even edema. e. Frothy pink - pulmonary edema Why It Is Done? A sputum culture is done to: a. Find and identify bacteria or fungi that are causing an infection (such as pneumonia or tuberculosis) of the lungs or the airways leading to the lungs. Symptoms of a lung infection may include difficulty breathing, pain when breathing, or a cough that produces bloody or greenish brown sputum. b. Identify the best antibiotic to treat the infection (sensitivity testing). c. Monitor treatment of an infection. How To Prepare? Do not use mouthwash before collecting a sputum sample because it may contain antibacterial substances that could affect your results.

If bronchoscopy will be used to collect your sputum sample, your doctor will tell you how soon before the test to stop eating and drinking. Follow the instructions exactly about when to stop eating and drinking, or your surgery may be canceled. If your doctor has instructed you to take your medicines on the day of surgery, please do so using only a sip of water. Tell your doctor if you have recently taken any antibiotics. How It Is Done? Usually, the sputum sample is collected early in the morning before you eat or drink anything. In some cases (especially if you may have tuberculosis), three or more morning samples may be needed. If you wear dentures, you will need to remove them before collecting a sputum sample. Then rinse your mouth with water, take a deep breath, and then cough deeply to produce a sample of sputum. The health professional collecting the sample may tap on your chest to help loosen the sputum in your lungs before you cough. If you still have trouble coughing up a sample, you may be asked to inhale an aerosol mist to help you cough. Some people may need bronchoscopy to collect a sputum sample. During bronchoscopy, a thin, lighted tube (bronchoscope) is inserted through your mouth or nose into the airways leading to your lungs. You will be given medicine that numbs your throat and nose so you do not feel discomfort from the bronchoscope. You may also be given a sedative to make you sleepy during the procedure. To collect the sputum sample, a salt solution may be washed into the airway and then suctioned into a container. A small, thin brush may be used to collect a sample. A sputum sample can also be collected using suction. During this procedure, a soft, flexible tube (called a nasotracheal catheter) is inserted through the nose and down the throat. Suction is applied for up to 15 seconds to collect the sputum sample. This method of collecting a sputum sample is often used for people who are very sick or unconscious. In rare cases, a sputum sample may need to be collected by inserting a needle through the neck into the windpipe (trachea). This is called a transtracheal aspiration. Before a transtracheal aspiration, a local anesthetic is injected into the site where the needle will be inserted. Oxygen may be used before and after a transtracheal aspiration to help with breathing. This method of collecting a sputum sample may be used for people who are very sick and in the hospital. Once the sputum sample is collected, it will be placed in a container with substances (growth medium or culture medium) that promote the growth of infecting organisms (bacteria or fungi). Bacteria usually need 2 to 3 days to grow. Fungus often takes a week or longer to grow. The organism that causes tuberculosis may take 6 weeks to grow. Any bacteria or fungi that grow will be identified under a microscope or by chemical tests. Sensitivity testing, to determine the best antibiotic to use against the organism that grows, often takes 1 to 2 additional days. How It Feels? If you have discomfort when taking a deep breath or when coughing, obtaining a sputum sample may be uncomfortable. If you need to inhale the aerosol mist to produce a sputum sample, you will often feel a deep, uncontrollable urge to cough. During bronchoscopy or collection of a sputum sample using a catheter, you may feel a strong urge to cough as the bronchoscope or catheter passes into the back of your throat. You may also feel as if you cannot breathe. Try to relax and breathe slowly while the bronchoscope

or catheter is in place. If you are given medicine to numb your throat and nose, you may feel as if your tongue and throat are swollen and that you cannot swallow. In rare cases, a transtracheal aspiration is used to collect a sputum sample. The doctor will inject a local anesthetic to keep you from feeling any pain when the needle is inserted into your trachea. When you are given the local anesthetic, you will feel sharp stinging or burning that lasts a few seconds. When the needle is inserted into the trachea, you will again feel a sharp pain for a few seconds, similar to having your blood drawn. The doctor may ask you to hold your breath during key moments of the procedure. Risks Your throat may feel sore following bronchoscopy or collection of a sputum sample using a nasotracheal catheter. If you have severe asthma or bronchitis, you may find it hard to breathe during collection of a sputum sample using a nasotracheal catheter. In rare cases, a transtracheal aspiration may damage your voice box (larynx) or cause an infection, excessive bleeding, or air to leak from your windpipe (trachea) into the tissues of your neck. Results A sputum culture is a test to detect and identify bacteria or fungi that are infecting the lungs or breathing passages. Some types of bacteria or fungi grow quickly in a culture and some grow slowly. Test results may take from one day to several weeks, depending on the type of infection suspected. Some organisms (such as Chlamydophila pneumoniae and mycoplasma) do not grow in a standard culture and need a special growth medium to be detected in a sputum culture. Sputum culture Normal: Sputum that has passed through the mouth normally contains several types of harmless bacteria, including some types of strep (Streptococcus) and staph(Staphylococcus). The culture should not show any harmful bacteria or fungi. Normal culture results are negative.

Abnormal: Harmful bacteria or fungi are present. The most common harmful bacteria in a sputum culture are those that can cause bronchitis, pneumonia, or tuberculosis. If harmful bacteria or fungi grow, the culture is positive. If test results point to an infection, sensitivity testing may be done to determine the best antibiotic to kill the bacteria or fungus. What Affects the Test? Reasons you may not be able to have the test or why the results may not be helpful include: Recent use of antibiotics, which may prevent the growth of bacteria or fungi in the culture. Contamination of the sputum sample. An inadequate sputum sample. Waiting too long to deliver the sample to the laboratory. Use of mouthwash before collecting a sputum sample.

2. NOSE AND THROAT CULTURE

Throat and nose cultures are done to identify the bacterial or viral organism causing a respiratory tract infection, and are used to diagnose strep throat, whooping cough, diphtheria, or meningitis. Throat and nose cultures are also done to screen for staph infections, flu, the common cold, and RSV (respiratory syncytial virus). The culture is grown in the lab, and preliminary results are available in one day; final results are available in two to three days. The test may be repeated following treatment, to ensure complete recovery. Strep throat can be diagnosed with the Rapid-Strep Test; a culture is not required, test results are available within 15 minutes and are very accurate. Precautions Gargling to clear the throat or treatment with antibiotics will affect culture results and may make identification of the bacteria impossible. The child should not gargle immediately before the culture. The child's throat should be swabbed and the culture performed before any antibiotics are taken. The laboratory should be informed if the patient has recently taken antibiotics for the current infection or any other infection. After the culture, however, the physician may initiate early treatment by prescribing a broad spectrum antibiotic to be started before results of the culture are available. After the organism has been identified and sensitivity testing has indicated the most effective antibiotic, a different, more specific antibiotic can be prescribed. The child's immunization history should be checked to evaluate the possibility that diseases other than strep are causing the sore throat. The care provider should wash his or her hands carefully after swabbing the throat and handling the specimen to prevent the spread of any infectious organisms. Hand washing should be done at home also to reduce contact with infective material. Spreading is usually from contact with droplets of material from the nose and throat of affected individuals. Preparation There is no special preparation involved before performing a throat culture. The individual does not need to avoid food or fluids before the test. Aftercare There are no special care recommendations after throat swab and culture have been performed. There are no unusual effects expected from having the throat swabbed, though the child may have a mild sensation of something present in the throat for several hours after it has been swabbed. Risks Healthcare professionals, parents, or other contacts are at risk of exposure to the child's illness. Strep throat is highly contagious and easily spread through contact with droplets from the nose or throat. Normal Results Normal results would include finding organisms that grow in healthy throat tissues (normal flora). These organisms include non-hemolytic and alpha-hemolytic streptococci, some Neisseria species, staphylococci, diphtheria and hemophilus organisms, pneumococci, yeasts, and Gram-negative rods. Abnormal Results In addition to S. pyogenes, other disease agents may be identified in the throat culture. Besides other varieties of strep organisms, these organisms may include Candida albicans,

which can cause thrush; Corynebacterium diphtheriae, which can cause diphtheria; and Bordetella pertussis, which can cause whooping cough. Inaddition, the appearance of a specific normal organism in very high numbers may also be regarded as an abnormal result. Parental Concerns Parents may be concerned that effective treatment will be delayed because of waiting for the throat culture results, which can take up to 48 hours. Physicians may prescribe a broad spectrum antibiotic as initial treatment rather than waiting for culture results. When the culture results are available and sensitivity tests indicate a more effective antibiotic, the physician will likely prescribe a new antibiotic specific for the strep or other organism identified.

3. ABG ANALYSIS
To assess ventilation and acid-base balance Radial artery most common site for withdrawal of blood specimen Materials: 1. Ice 2. Alcohol wipe 3. Sterile gauze swab 4. Plaster 5. Paper 6. Apron 7. Gloves/goggles Procedure: 1. Prepare the necessary materials and explain procedure to the patient/family. 2. Wash hands thoroughly and glove. 3. Locate arterial puncture site of choice of pulsation with two fingers. If radial artery is chosen assess first for adequate ulnar artery circulation. o ALLENS TEST

4. Palpate arterial pulse then clean skin over the arterial puncture site. 5. Hold the syringe like you would hold a pencil or a dart then insert at 30 (60 for femoral). Use your other hand to palpate the arterial pulse and will serve as a guide to mark insertion site. (use 10ml pre-heparinized syringe to draw blood specimen to prevent clotting of specimen) Note: If BP is adequate, the syringe will fill itself; in hypotensive patients or children, the sample will need to be aspirated. 6. Remove needle, apply pressure for 5 minutes or until bleeding is controlled. 7. Expel any small bubbles from the syringe immediately. Put the syringe with arterial blood specimen on ice then submit to laboratory. (to prevent hemolysis. If hemolysis occurs, oxygen and carbon dioxide are released and cannot be measured immediately.) SYSTEMIC ABG (Arterial Blood Gas) ANALYSIS Step 1. Remember the normal values. Blood pH PaCO2 HCO3 PaO2 O2 Saturation Step 2. Look at the pH. 7.35 7.45 7.40 Middle Range Acidosis Alkalosis 7.35 7.45 35 45 mmHg 22-26 mEq/L 80 100 mmHg 95 100%

Step 3. Look at the PaCO2. (respiratory indicator) CO2 acts as an acid when CO2 combines with plasma. Carbonic Acid is formed. (CO2 + H2O = H2CO3) 35 45 40 Middle Range Respiratory Alkalosis Respiratory Acidosis

Step 4. Look at the HCO3. (metabolic indicator) 22 26 24 Middle Range Metabolic Acidosis Metabolic Alkalosis

Step 5. Determine the primary Acid-Base disturbances. The change that matches the pH is the PRIMARY ACID-BASE DISTURBANCE. pH and PaCO2 pH PaCO2 pH PaCO2 Match: Respiratory Acid-Base Imbalance Acidosis Respiratory Acidosis Acidosis Alkalosis Respiratory Alkalosis Alkalosis

pH and HCO3 pH HCO3 pH HCO3 R O M E

Match: Metabolic Acid-Base Imbalance Alkalosis Metabolic Alkalosis Alkalosis Acidosis Metabolic Acidosis Acidosis espiratory pposite etabolic qual

Step 6. Look at the degree of compensation. Check the relationship between PaCO2 and HCO3. Remember: the lungs and kidneys normally attempt to help each other to maintain acid-base balance. If the lungs are unable to maintain acid-base balance, the kidneys will attempt to adjust levels of HCO3. If the kidneys are unable to maintain acid-base balance, the lungs will attempt to adjust levels of CO2. PaCO2 HCO3 PaCO2 HCO3 Acidosis Alkalosis Alkalosis Acidosis

Compensated (same direction)

pH

Abnormal or Normal

Partial Compensation Full/Complete Compensation

PaCO2 HCO3 PaCO2 HCO3

Uncompensated (opposite direction)

Acidosis Acidosis Alkalosis Alkalosis

PaCO2 HCO3 PaCO2 HCO3

Abnormal or Normal Normal Abnormal or

Uncompensated