Respiratory Assessment

1
Respiratory Assessment

• Lecture 2b

2
Assessment of breathing ability

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

3
Pulmonary Function Tests

• Purpose
• Assess resp. function
• Tidal volume
• Vital capacity
• Rate
• Inspiratory force
• Progress of disease

4
Pulse Oximeter

• Purpose
• Noninvasive O2 Sat
• Normal
• 95-100
• lt85 ?
• Tissue is not receiving enough O2

5
Pulse oximeter

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

6

• The most appropriate nursing intervention for a
  client requiring a finger probe pulse oximeter is
  to
• Apply the sensor probe over a finger and cover
  lightly with gauze to prevent skin breakdown
• Set alarms on the oximeter to at least 100
• Identify if the client has had a recent
  diagnostic test using intravenous dye
• Remove the sensor between oxygen saturation
  readings

7
Radiographic exams

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

8
Chest x-ray

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

9
Chest X-ray

• Nrs management
• Call pink ladies
• Normal heart size clear lung field

10
CT Scan

• Description
• Computerize Tomography
• With or without contrast medium
• Purpose
• Tissue
• Tumor
• Foreign bodies
• Fluid

11
CT scan

• Nrs management
• Without contrast medium
• No prep
• With contrast medium
• NPO 6 hrs
• Assess for allergies

12
Positron Emission TomographyPET

• Purpose
• Confirm adequate blood supply
• Description
• Radioactive tracers injected IV

13
Fluoroscopy

• Purpose
• Detect movement
• Diaphragm paralysis
• Description
• X-ray

14
Barium Swallow

• Purpose
• View esophagus and cardiac sphincters
• Description
• Drink barium
• X-ray

15
Barium swallow

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

16
Angiography

• Purpose
• Pulm. Circulation
• Description
• Dye
• Femoral vein ?
• Heart ?
• Pulm Arteries

17
Angiography

• Nrs. 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

18
Bronchoscopy

• Description
• Direct inspection of larynx, trachea bronchi
  via flexible tube (fiberoptic)
• Purpose
• Examine
• Tissue sample

19
Bronchoscopy

• Nrs Management
• Pre-op
• NPO 6-8 hrs
• Sedation
• i vegal response
• i cough/gag reflex
• i anxiety

20
Bronchoscopy

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

21
Thoracoscopy

• Description
• Fiber-optic inspection of thoracic cavity
• Incision
• Purpose
• Inspect
• tissue sample

22
Thoracentesis

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

23
Thoracentesis

• Nrs Management
• Position patient
• Support
• Post-op
• Vital signs q 15
• Chest x-ray
• Breath sounds bilateral
• Cover site
• Check bleeding
• Check drainage

24
Lab Values

• Sputum
• WBC
• Hemoglobin
• Hematocrit
• ABGs
• PTT/PT

25
Sputum studies

• Check for
• Pathogens
• CS
• Acid-fast bacillus
• What?
• TB
• Duration
• 4-6 wks

26
White Blood Cell Count

• Normal
• 5,000 10,000 cell/mm3
• Elevated
• Bacterial infection
• Decreased
• Leukemia
• Viral infection

27
Hemoglobin

• Normal
• Female 12-16 g/dl
• Male14-18 g/dl
• Elevated
• COPD
• Dehydration
• Decreased
• Anemia
• Hemorrhaging
• Over hydration

28
Hematocrit

• Normal
• Female 37-47
• Male 42-52
• Elevated
• Dehydration
• Burns
• COPD
• Decreased
• Anemia
• Leukemia

29
Arterial Blood Gases

• Purpose
• Adjust O2 levels
• Hypoxemia
• Description
• Must by arterial blood

30
Arterial Blood Gases

• Values
• pH
• PaO2
• PaCO2
• HCO3-
• SaO2

31
ABGs

• pH
• Normal
• 7.35-7.45
• Elevate
• gt 7.45
• Alkalosis
• Decreased
• lt7.35
• Acidosis

32
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

33
ABGs

• PaO2
• Normal
• 80-100 torr
• Elevated
• Hypervenilation
• Decreased
• i resp. function
• Hypoxemia

34
ABGs

• PaCO2
• Normal
• 35-45 mmHg
• Elevated
• Hypercapnia
• Impaired gas exchange
• Decreased
• Hyperventilation

35
ABGs

• HCO3-
• Normal
• 22-26
• SaO2
• Normal
• 95-100
• Decreased
• Hypoxemia

36
PTT/PT Partial Thromboplastin Time

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

37
Quiz?

• The main function of platelets is to
• Provide oxygen to tissue
• Fight viral infections
• Fight bacterial infections
• Form a blood clot

38

• 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?
• FBC (full blood count)
• ECG (electrocardiogram)
• Thyroid function tests
• CT scan

39

• 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?
• FBC (full blood count)
• ECG (electrocardiogram)
• Thyroid function tests
• CT scan

40

• 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?
• Blood sugar check
• CT scan
• Blood cultures
• Arterial blood gases

41

• 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?
• Blood sugar check
• CT scan
• Blood cultures
• Arterial blood gases

42

• A nurse is administering blood to a patient who
  has a low hemoglobin count. The patient asks how
  long to RBCs last in my body? The correct
  response is.
• The life span of RBC is 45 days.
• The life span of RBC is 60 days.
• The life span of RBC is 90 days.
• The life span of RBC is 120 days.