Adult 1: Quiz 2 - Respiratory Diagnostic Tools

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oliviawise
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96263
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Adult 1: Quiz 2 - Respiratory Diagnostic Tools
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2011-08-05 17:16:50
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respiratory diagnostic measures
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  1. What is the normal value for SpO2?
    • Healthy person: 90% to 100%
    • Smoker: 94% to 95%
    • COPD: as low as in the 80's up to the 90's
  2. Name some causes of an inaccurate SpO2 measurement?
    • Raynaud's disease
    • Nail polish
    • Incorrect placement/position
    • Cold fingers
  3. Sputum Specimen
    • A good sputum specimen consists of recently-dishcharged material from the bronchial tree, with minimum amounts of oral or nasal discharge
    • Should have a volume of 3-5 mL
    • Best to obtain early in the morning before a pt has eaten
    • Transport as soon as possible
    • If pt is unable to cough productively, suction can be used
  4. Throat Culture
    • Used to determine organism
    • Distinguish viral from bacterial
    • False negative can occur due to poor technique (poor technique is the #1 reason for false negative results)
  5. Throat Culture Technique
    • 1- rub sterile cotton swab over right tonsillar area - moving across the right arch, the uvula - moving across the left arch to the left tonsillar area
    • 2 - remove swab without touching teeth, tongue, or gums
    • 3 - place swab into culture tube and crush the ampule in the tube
    • 4 - send to lab quickly
    • 5 - results usually available within 24-48 hours
  6. What are the different types of pulmonary function tests?
    • FEV1: Forced Expiratory Volume in 1 sec
    • FVC: Forced Vital Capacity
    • TLC: Total Lung Capacity
    • RV: Residual Volume
    • Peak Expiratory Flow Rate (PEFR)
  7. Spirometry
    • Measure the amount and rate of air a person breathis in order to diagnose illness or determine progress in treatment
  8. Peak Flow Meter
    • PEFR: measures how fast a person can breath out (exhale) air
    • Flow meter: small handheld decive with a mouthpeice at one end and a scale with a moveable indicator (usually a small plastic arrow)
    • * Asthmatics
    • Normal value ranges based on a pt's height and weight
    • Green = good
    • Yellow = cautious
    • Red = emergency
  9. Chest Radiograph (X-Ray)
    • Standard: PA/LL (posterior-anterior) & (left lateral)
    • Portable: AP (anterior-posterior), "front to back"
    • Hospital gown replaces all clothing on the upper body; all jewelery must be removed
    • No advanced prep necessary
    • Associated risk: minimal exposure to radition - particularly for pregnant women & children; these patients should use protective lead aprons during procedure
  10. MRI
    • Uses a powerful magnetic field, radio waves, rapidly changing magnetic fields, and a computer to create images that show where or not an injury, disease process, or abnormal condition is present
    • Typically requires no preparation, diet restrictions, shielding, or injections
    • Pts must remove AND & ALL metal objects -- must be removed and placed OUTSIDE of the MRI room
    • Warn about loud tapping noise - can communicate with technologist via intercom
  11. Screen patients for the following prior to having a MRI and check with physician ...
    • shrapnel
    • pregnancy
    • pacemaker
    • hearing aid
    • metal implants
    • dental bridges
    • aneurysm clips
    • surgical staples
    • cochlear implant
    • dorsal column stimulator
    • inferior vena cava
    • * patients with a history of steel working should be screened with plain x-ray flims prior to the MRI becuase tiny metal fragments may be imbedded in their eyes - this is done to prevent any possibility of optic damage.
  12. CAT scan
    • Patients often asked to avoid having food or drink when having a CT that requires oral or IV contrast media
    • Contrast media may be iodine-based - this info must be relayed to the the physician and the imagin staff
    • * ask patient about allergies to shellfish and/or iodine
    • Not recommended during pregnancy unless the benefiits of the CAT scan clearly outweigh the potential risks
    • Hospital gown replaces all clothing on the upper body and all metal objects must be removed to prevent interference with the quality/clarity of the images
  13. Ventilation-Perfusion (V/Q) Scan
    • Small amount of a radioactive drug is injected intravenously into an arm vein and a small amount of radioactive gas is given with an oxygen mask or aerosol device
    • Pt inhales gas, then dye is injected
    • Shows pulmonary circulation
    • Radioactive substances leave the body in approx 8 hours
    • Tell physician is pt is breastfeeding or pregnant
    • Cannot be done if patient has an allergy to eggwhites or albumin
    • Hospital gown replaces all clothing on the upper body, jewelry or metal must be removed from the neck and chest
    • No special prep required
  14. Positron Emission Tomography (PET) Scan
    • Pt receives an injection of radioactive glucose (FDG)
    • * diabetics need to have serum glucose level check prior to study and will need to have special instructions regarding insulin (makes diabetics a big concern)
    • No food 4 hours prior to arrival - water may be consumed during 4 hours of fasting
    • Patients should dress comfortably and warm; no metal/plastic buttons, zippers, or snaps
  15. Bronchoscopy
    • Bronchoscope: used to see the inside of the lungs; can be flexible or rigid (usually fexible)
    • * flexible: tube less than 1/2 inch wide and about 2 feet long
    • Scope is passed through the mouth or nose, through the trachea and then into the lungs
    • Patient must remain NPO 6 to 12 hours before the test
    • IV meds can be given to help the patient relax
    • Local anesthesia is used to ralx the throat muscles - Conscious sedation
    • Gag reflex returns in 1 to 2 hours after test - eating or drinking is not allowed until gag reflex returns
    • Arrange for transportation home
    • Tube may cause trauma to the airway that leads to inflammation and eventual blockage - be aware of any wheezing or shallow respirations
    • Sputum may be slightly bloody afterwards, especially if a biopsy was taken
  16. Laryngoscopy
    • Inirect larygnoscopy: Examination of the larynx with a mirror
    • Direct laryngoscopy: Examination with a laryngoscope
    • Laryngoscope: flexible, lighted tube that is used to look at the inside of the larynx; it is inserted though the mouth into the upper airway
  17. Transbronchial Needle Biopsy
    Transbronchial biopsy needle is used to penetrate the bronchial wall and enter into a mass of subcarinal lymph node or tumor
  18. Thoracentesis
    • A procedure to remove fluid from the space between the lining of the outside of the lungs (pleura) and the wall of the chest
    • Normally - very little fluid is in this space
    • Accumulation of excess fluid between the pleura is called a pleural effusion
    • Local anesthetic is used
    • Feeling of pressure
    • Patient must hold still - must avoid coughing or sudden movement
    • Pressure applied to puncture site & sterile dressing applied
    • Follow up: lung assessment to check breathing * priority (should hear sounds that indicate better ventiallarion; breath sounds will be diminished if fluid buids up again); check for bleeding & infection; monitor for pneumothorax; check for pain at puncture site
  19. Tuberculin Skin Testing
    • Nurse gives PPD via Mantoux Test (intradermal injection)
    • Mesaurment of induration 48-72 hours later
    • Positive skin reaction occurs 2 to 12 weeks after initial infection
    • If exposed to pt with TB, must wait a few weeks to have PPD done
    • Purified protein derivative (PPD) is used to identify TV; given intradermally in forearm & wheal must be read in 48 - 72 hours
    • Positive test: incated by presence of induration, not erythema
    • * < 5 mm induration - positive for immunocomprimised groups
    • * 5-10 mm induration - positive for all other high-risk groups
    • * > 10 mm induration - positive for low-risk groups
    • False positive can occur is pt had BCG vaccine (indicates exposire to bacillus through vaccine) - BCG given in European countries
  20. TST Diagnostic Testing
    • Once acquired - lifetime action
    • Positive reaction = presence of infection (unsure if dormant or active)
    • Two step TST may be required
    • After positive reaction - Chest X-ray: will show calcificatipons or other suspicions but does not diagnose TB
  21. Two Step TST
    • May stimulate the immune system, causing a positive or boosted reaction to the subsequent tests
    • Two-step testing: giving a second TST after initial negative TST reaction
    • Useful for the initial skin testing of adults who are going to be retested periodically (health care workers)
    • Can reduce the likelyhood that a boosted reaction to a subsequent TST will be misinterpreted as a recent infection
  22. Lung Biopsy
    • Performed to obtain tissue for analysis to make a definitive diagnosis (cancer, lung disease, infection)
    • Types: transbronchial needle biopsy, transthoracic (percutaneous), open lung

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