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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
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Name some causes of an inaccurate SpO2 measurement?
- Raynaud's disease
- Nail polish
- Incorrect placement/position
- Cold fingers
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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
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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)
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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
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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)
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Spirometry
- Measure the amount and rate of air a person breathis in order to diagnose illness or determine progress in treatment
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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
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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
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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
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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.
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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
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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
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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
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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
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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
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Transbronchial Needle Biopsy
Transbronchial biopsy needle is used to penetrate the bronchial wall and enter into a mass of subcarinal lymph node or tumor
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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
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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
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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
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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
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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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