Respiratory Assessment

Lecture 2b

Assessment of breathing ability

• Pulmonary function test• Pulse oximeter• Radiographic exams• Lab values

Pulmonary Function Tests

Purpose• Assess resp. function– Tidal volume– Vital capacity– Rate– Inspiratory force

• Progress of disease

Pulse Oximeter

Purpose• Noninvasive O2 SatNormal• 95-100%• <85% – Tissue is not receiving

enough O2

Pulse oximeter

Not reliable in…• Cardiac arrest• Shock• Vasoconstrictive meds• Dyes• Anemia• High CO levels

The most appropriate nursing intervention for a client requiring a finger probe pulse oximeter is to:

A. Apply the sensor probe over a finger and cover lightly with gauze to prevent skin breakdown

B. Set alarms on the oximeter to at least 100%C. Identify if the client has had a recent diagnostic

test using intravenous dyeD.Remove the sensor between oxygen saturation

readings

Radiographic exams• Chesk x-ray• CT scan• PET• Fluroscopy• Barium Swallow• Angiography• Bronchoscopy• Thoracoscopy • Thoracentesis

Chest x-ray

Description• 2-d image Purpose• Fluid• Tumor• Foreign bodies

Chest – X-ray

Nrs management• Call pink ladies

• Normal heart size & clear lung field

CT Scan

Description• Computerize Tomography• With or without contrast

mediumPurpose• Tissue• Tumor• Foreign bodies• Fluid

CT scan

Nrs management• Without contrast

medium– No prep

• With contrast medium– NPO 6 hrs– Assess for allergies

Positron Emission TomographyPET

Purpose• Confirm adequate

blood supplyDescription• Radioactive tracers

injected IV

Fluoroscopy

Purpose• Detect movement– Diaphragm paralysis

Description• X-ray

Barium Swallow

Purpose• View esophagus and

cardiac sphinctersDescription• Drink barium• X-ray

Barium swallow

Nrs Management• NPO• Post-procedure– Laxatives– BM white

Angiography

Purpose• Pulm. CirculationDescription• Dye• Femoral vein • Heart • Pulm Arteries

AngiographyNrs. Management• Pre-op

– NPO– Check Allergies

• Shellfish/iodine

• Post-op– Lie flat 8 hrs– Sandbag– Check pedal pulses– Assess hemorrhaging– Push fluids

• Normal pulmonary angiography

Bronchoscopy

Description• Direct inspection of

larynx, trachea & bronchi via flexible tube (fiberoptic)

Purpose• Examine• Tissue sample

Bronchoscopy

• Nrs Management• Pre-op– NPO 6-8 hrs– Sedation

• vegal response• cough/gag reflex• anxiety

Bronchoscopy

Nrs management• Post-op– Side-ling until gag back– NPO till gag back– Check gag– Check bleeding

Thoracoscopy

Description• Fiber-optic inspection of

thoracic cavity• IncisionPurpose• Inspect • tissue sample

Thoracentesis

Purpose• Remove fluid for dx• Remove fluid for tx• Obtain biopsy• Instill meds

Thoracentesis

Nrs Management• Position patient• Support• Post-op

– Vital signs q 15 – Chest x-ray– Breath sounds – bilateral– Cover site

• Check bleeding• Check drainage

Lab Values

• Sputum • WBC• Hemoglobin• Hematocrit• ABG’s• PTT/PT

Sputum studies

• Check for– Pathogens

• C&S• Acid-fast bacillus– What?

• TB

– Duration• 4-6 wks

White Blood Cell Count

• Normal– 5,000 – 10,000 cell/mm3

• Elevated– Bacterial infection

• Decreased– Leukemia– Viral infection

Hemoglobin

Normal• Female: 12-16 g/dl• Male:14-18 g/dlElevated• COPD• DehydrationDecreased• Anemia• Hemorrhaging• Over hydration

Hematocrit

Normal• Female: 37-47%• Male: 42-52%Elevated• Dehydration• Burns• COPDDecreased• Anemia• Leukemia

Arterial Blood Gases

Purpose• Adjust O2 levels• HypoxemiaDescription• Must by arterial blood

Arterial Blood Gases

Values• pH• PaO2

• PaCO2

• HCO3-

• SaO2

ABG’s

pH• Normal– 7.35-7.45

• Elevate– > 7.45– Alkalosis

• Decreased– <7.35– Acidosis

pH Quiz: Acidosis or alkalosis

• Arterial blood pH of 7.51?– Alkalosis

• Arterial blood pH of 7.30?– Acidosis

• Arterial blood pH of 7.34– Acidosis

• Arterial blood pH of 7.43– Normal / homeostasis

ABG’s

• PaO2

• Normal– 80-100 torr

• Elevated– Hypervenilation

• Decreased– resp. function– Hypoxemia

ABG’s

PaCO2• Normal– 35-45 mmHg

• Elevated– Hypercapnia– Impaired gas exchange

• Decreased– Hyperventilation

ABG’s

HCO3-• Normal– 22-26

SaO2• Normal– 95-100%

• Decreased– Hypoxemia

PTT/PT Partial Thromboplastin Time

• Prolonged– Liver disease – Vit K deficiency – Anticoagulant– Hemophilia

Quiz?

• The main function of platelets is to…A. Provide oxygen to tissueB. Fight viral infectionsC. Fight bacterial infectionsD. Form a blood clot

A fragile 87 year-old female has recently been admitted to the hospital with increased confusion and falls over last 2 weeks. She is also noted to have a mild left hemiparesis. Which of the following tests is most likely to be performed?

A.FBC (full blood count)B.ECG (electrocardiogram)C.Thyroid function testsD.CT scan

• A 84 year-old male has been loosing mobility and gaining weight over the last 2 months. The patient also has the heater running in his house 24 hours a day, even on warm days. Which of the following tests is most likely to be performed?

A.FBC (full blood count)B.ECG (electrocardiogram)C.Thyroid function testsD.CT scan

• A 20 year-old female attending college is found unconscious in her dorm room. She has a fever and a noticeable rash. She has just been admitted to the hospital. Which of the following tests is most likely to be performed first?

A.Blood sugar checkB.CT scanC.Blood culturesD.Arterial blood gases

• A 28 year old male has been found wandering around in a confused pattern. The male is sweaty and pale. Which of the following tests is most likely to be performed first?

A.Blood sugar checkB.CT scanC.Blood culturesD.Arterial blood gases

• A nurse is administering blood to a patient who has a low hemoglobin count. The patient asks how long to RBC’s last in my body? The correct response is.

A.The life span of RBC is 45 days.B.The life span of RBC is 60 days.C.The life span of RBC is 90 days.D.The life span of RBC is 120 days.