Diagnostic Studies/Therapies

Mantoux Test
Also known as the PPD (Purified Protein
Derivative) test
Intradermal
Read within 48 to 72 hours after injection
Positive: Induration of 10 mm or more;
signifies exposure to Mycobacterium
tubercle bacilli

Chest X-ray
Radiographic visualization of the chest
Instruct the client to hold his breath and
remove metals from the chest

Lung Scan
Measures blood perfusion through the
lungs.
Helps confirm pulmonary embolism or
other blood-flow abnormalities.
After an injection with a radioisotope,
scans are taken with a camera.
Remain still during the procedure.

Lymph Node Biopsy

To assess lung cancer metastasis.

Bronchography
Radiopaque medium is instilled directly to the
trachea or any part of the bronchial tree to be
visualized through x ray.
Nursing intervention before the procedure are:
1.
Secure informed consent
2.
Check for allergy to food, iodine, anesthesia
3.
NPO for 6-8 hrs
4.
Pre-op meds: Atropine SO4, Valium, topical
anesthesia and anesthesia to be injected into
the larynx
5.
Secure O2, antispasmodic agents at bedside
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Nursing intervention after the procedure

are:
1.
Side-lying position
2.
NPO until cough, gag reflex return
3.
Cough, deep breathing exercise
4.
Low-grade fever is common

Bronchoscopy
Direct inspection and observation of the
larynx, trachea and bronchi through
flexible or rigid scope
Diagnostic uses: to collect secretion, to
determine location of pathologic process
and collect specimen.
Therapeutic uses: remove foreign object
and excise lesions
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Nursing intervention before the

procedure:
1.
Informed consent
2.
Atropine, valium as premeds, topical &
local anesthesia
3.
NPO for 6-8 hrs
4.
Remove dentures, prosthesis, contact
lens
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Nursing intervention after the procedure:

1.
Side lying position
2.
Check for coughing, gag reflex prior to
oral intake
3.
Watch for signs of perforation of the
bronchial tree: cyanosis, hypotension,
tachycardia, hemoptysis, dyspnea

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Sputum Exam
Sputum C & S
AFB staining
Early AM sputum
Rinse mouth with plain water
Use sterile container
Important: specimen for C & S is collected
before the first dose of antibiotic.
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Pulmonary Function Test

Volume

Symbol

Measurement

Tidal Volume (about

500 ml at rest)

TV

Amount of air that moves into and out of the

lungs with each breath.

Inspiratory Reserve
Volume
(approximately 3000
ml)

IRV

Maximum amount of air that can be inhaled

from the point of maximum inspiration.

Expiratory Reserve
Volume
(approximately 3000
ml)

ERV

Maximum volume of air that can be exhaled

from the resting end-expiratory level.

Residual Volume
(approximately 1200
ml)

RV

Volume of air remaining in the lungs after

maximum expiration.

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Functional
Residual
Capacity
(approximately
2300 ml)

FRC Volume of air remaining in the lungs at

end-expiration.
RV + ERV

Inspiratory
Capacity

IC

IRV + TV

Vital Capacity

VC

Maximum amount of air that can be

exhaled from the point of maximum
inspiration.

Total Lung
Capacity

TLC Total amount of air that the lungs can

hold.
The sum of all the volume components
after maximal inspiration.
20-25% less in females

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Thoracentesis
Aspiration of fluid or air from the pleural cavity
May be used for diagnosis or therapy
Nursing intervention before the procedure:
1.
Secure consent
2.
Take initial VS
3.
Position: upright leaning on over bed table
4.
Instruct to remain still during the procedure
5.
Pressure sensation is felt upon needle
insertion
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Nursing intervention after the procedure:

1.
Turn on unaffected side to prevent
leakage from the thoracic cavity
2.
Bed rest
3.
Check for expectoration of blood
4.
Monitor VS

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Physiologic Responses
to Respiratory
Dysfunction

20

Hypoxia
Refers to inadequate cellular oxygenation
May result from:

Insufficient oxygen intake

Insufficient perfusion of oxygen in the
pulmonary system or in the peripheral organs
and tissues
Inability of blood to transport oxygen
Insufficient oxygen-carrying capacity of the
blood.
21

Cyanosis
Bluish discoloration of the skin indicating
hypoxia; it results when oxygenation
does not occur and carbon dioxide does
not leave blood.

Dyspnea
Difficult breathing
22

Increased work of breathing

Occurs when energy expenditure for
respirations is excessive and great effort
is required for breathing

Tachypnea
Rapid breathing with respiratory rates
more than 20 cpm.
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Cough
If effective, it allows the body to expel
excess mucus, keeping the airway clear.
If ineffective, in compromises airway
clearance by preventing mucus from
being expelled.
Along with mucociliary system, cough is
a defense mechanism of the respiratory
system.
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Adventitious breath sounds

These are abnormal breath sounds:
1.
2.

Rales (crackles) - fluid is heard

Rhonchi (gurgles) mucus is heard

25

Clubbing of Fingers
Clubbing is an increase in the normal
angle between the nail and its base (from
160 to 180 degrees or more)
Accompanied by softening of nail base

26

Fatigue
Feelings of tiredness and exhaustion that
usually result when energy requirements
for breathing become excessive

Pain
May or may not be present
Due to rib-cage injury, infection or chest
surgery
27

Hypoventilation
Refers to a ventilation rate that is insufficient
to meet the bodys metabolic needs
May result in respiratory acidosis because
Carbon Dioxide are not expelled off

Hyperventilation
Refers to a ventilation rate that exceeds the
bodys metabolic needs
May result in respiratory alkalosis because
excessive Carbon Dioxide is being expelled
off.

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ALTERATIONS

29

Epistaxis

30

Causes:
Trauma, HPN, cancer, foreign body

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Nursing interventions:
Sit-up, lean forward, head tipped
Pressure application for 5 min
Cold compress or ice pack
Liquid, then soft diet
Avoid oral temp taking
Do not blow nose for 2 days after removal
of nasal pack
Notify MD if epistaxis is persistent or
recurrent
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Sinusitis
(Acute/Chronic)
URTI, cigarette smoking, allergic rhinitis

33

Assessment
Pain
1.
2.
3.
4.

Maxillary cheek, upper teeth

Frontal above eyebrows
Ethmoid in & around eyes
Sphenoid behind eye, occiput, top of
head

General body malaise

Stuffy nose headache
Post nasal drip
Persistent cough
Fever

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Nursing Intervention
Rest
Increase oral fluid intake
Hot wet packs
Codeine, avoid ASA increase risk for
bleeding
Antibiotics (acute: 7 days, chronic: 21
days)
Nasal decongestant use for 72 hrs
Irrigation of maxillary sinus with warm NSS

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Tonsillitis

37

Assessment:
Sore throat
Fever
Snoring
Dysphagia
Mouth breathing
Earache
Frequent head colds
38

Bronchitis
Halitosis
Voice impairment
Noisy respiration
Draining ears

39

Nursing Intervention:
Promote rest
Increase oral fluid intake
Warm saline gargle
Analgesics as ordered
Antimicrobial as ordered

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Pre op Care:
Assess for URTI, coughing &
sneezing may cause bleeding
Check prothrombin Time

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Post op Care:
Prone, head turned to side or lateral position
(awake: semi-fowlers)
Oral airway until swallowing reflex returns
Monitor for hemorrhage
1.

2.
3.

Frequent swallowing
Bright red vomitus
Increased PR

Promote comfort
Ice collar
acetaminophen
Foods & fluids
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Client Education:
Avoid clearing of throat
Avoid coughing, clearing of throat for 2 wks
2-3 L of fluids until mouth odor disappears
Avoid hard scratchy food until throat is
healed
Reports signs of bleeding
Throat discomfort on the 4-8 post op day is
normal
Stool may be black/dark for few days due to
swallowed blood.
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