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Respiratory System Diagnostic Evaluation: Pulmonary Function Tests (PFTs)  Routinely used in patients with chronic respiratory disorders

.  Performed to assess respiratory function and to determine the extent of dysfunction.  Includes measurements of lung volumes, ventilator function, and the mechanics of breathing, diffusion, and gas exchange.
Term Used Forced vital capacity Symbol FVC Description Vital capacity performed with a maximally forced expiratory effort Remarks Forced vital capacity is often reduced in COPD because of air trapping A valuable clue to the severity of the expiratory airway obstruction

Forced expiratory volume (qualified by subscript indicating the time interval in seconds) Ratio of timed forced expiratory volume to forced vital capacity

FEV1 (usually FEVt)

Volume of air exhaled in the specified time during the performance of forced vital capacity; FEV1 is volume exhaled in 1 second FEVt expressed as a percentage of the forced vital capacity

FEVt/FVC%, FEV1/FVC% FEF200-1200 FEF25-75% FEF75-85% MVV

usually

Another way of expressing the presence or absence of airway obstruction An indicator obstruction of large airway

Forced expiratory flow

Mean forced expiratory flow between 200 and 1200 mL of the FVC Mean forced expiratory flow during the middle half of the FVC Mean forced expiratory flow during the terminal portion of the FVC Volume of air expired in a specified period (12 seconds) during repetitive maximal effort

Forced midexpiratory flow

Slowed in small airway obstruction

Forced end expiratory flow

Slowed in obstruction of smallest airway An important factor in exercise tolerance

Maximal voluntary ventilation

Arterial Blood Gas Studies  Analyzed to assess the adequacy of oxygenation, ventilation, and acid-base status  Furnishes accurate, rapid information about how well the lungs and kidneys are working  Indicates qualification of a patient for home oxygenation use  Normal Values: (pH – 7.35 to 7.45, PaCO2 – 35 to 45 mmHg, HCO3 – 22 to 26 mEq/L) Nursing Interventions: Pre-test  Explain the ABG purpose and procedure.  Assure the patient that arterial puncture is similar to other blood tests that she or he might have had and that a local anesthetic can be used if desired. Intratest  The arterial puncture can cause some discomfort, and if the patient is nervous or apprehensive, a local anesthetic (1% lidocaine) can be used. Before injection, assess for allergy to the anesthetic.  During the procedure, if the patient experiences a dull or sharp pain radiating up the arm, the needle should be withdrawn slightly and repositioned. If repositioning does not alleviate the pain, the needle should be completely withdrawn.  Be ready to respond appropriately because some patients may experience lightheadedness, nausea, and in some cases, vasovagal syncope. Posttest  Observe frequently for bleeding. Apply pressure to the site for 5 minutes. A pressure dressing should be applied.  Evaluate outcomes, and assess and monitor the patient appropriately for hypoxemia and for ventilator and acid-base disturbances. Steps in assessing for ABG: These recommended steps to evaluate ABG values. They are based on assumptions that the average values are: pH = 7.4 PaCO2 = 40 mmHg HCO3 = 24 mEq/L

Smeltzer, Suzanne C., et al. 11 ed. “Brunner & Suddarth’s Textbook of Medical-Surgical Nursing”. 2008. Lippincott Williams & Wilkins, a Wolters Kluwer business. Brown, Janet W. 1st ed. “Nurse’s Quick Check: Skills”. 2006. Lippincott Williams & Wilkins, a Wolters Kluwer business. Fischbach, Frances T., Dunning III, Marshall B., 4th ed. “Nurses’ Quick Reference to Common Laboratory & Diagnostic Tests”. 2006. Lippincott Williams & Wilkins, a Wolters Kluwer business.

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then take several deep breaths. Two-distinct acid-base disturbance may occur simultaneously. or normal.1. and all aspects of specimen collection. Posttest Smeltzer. 1st ed. procedure. compensation is underway. using a special clip or adhesive.  Instruct the patient not to touch inside of sputum container. and toe or foot in infants and neonates. Sputum Studies  Obtained for analysis to identify pathogenic organisms and to determine whether malignant cells are present  Indicates for the diagnosis of disease of the LRT  Determine antibiotic or drug sensitivity and course of treatment and evaluate effectiveness of therapy or medication  Normal result: negative culture for pathogenic organisms Procedure:  Instruct the patient to provide a deep-coughed specimen into a sterile container (1-3 mL is generally sufficient)  If the patient is unable to expectorate a satisfactory specimen.  The site is checked every 8 hours and changed every 4 hours. Intratest  Check and change sensor as required. pulmonary emboli. and then cough deeply and forcefully using the diaphragm and expectorates into the sterile container. 4.. Fischbach. et al.  The pulse oximeter displays SpO2 and pulse rate values. or ring finger. low. It can be high. Nursing Interventions: Pre-test  Explain purpose and placement of pulse oximeter sensor. “Nurse’s Quick Check: Skills”. and with adequate tissue oxygenation. Lippincott Williams & Wilkins. “Brunner & Suddarth’s Textbook of Medical-Surgical Nursing”. 11 ed. Brown. and how long sensor will be needed. CNS depression. Pulse Oximetry  A non-invasive method of continuously monitoring the arterial blood oxygen saturation of hemoglobin (SpO 2)  Used to determine need for O2 supplementation and to monitor adequacy of O2 supply  Normal Values: SpO2 – 94% to 98% or 0.94 to 0. Suzanne C. CHF. cirrhosis.98  Decreases occur in hypoxemia. a Wolters Kluwer business. Frances T.. nasotracheal or tracheal suctioning. “Nurses’ Quick Reference to Common Laboratory & Diagnostic Tests”.  Increases with oxygen therapy  SpO2 values obtained by pulse oximetry are unreliable in cardiac arrest and shock Procedure:  The pulse oximeter sensor is applied to index.4 (acidosis) pH = 7. 4th ed. Other types are used on the forehead. This can be identified when the pH does not explain one of the changes. th . 2008. Lippincott Williams & Wilkins.  Sputum specimens are usually not refrigerated. pneumonia. 2006. a Wolters Kluwer business. middle. 2006.4 (alkalosis) pH < 7. Lippincott Williams & Wilkins. Janet W. Dunning III. Intratest  Patient should clear nose and throat and rinse mouth before expectorating. Note the pH. 2. If it is moving in the same direction as the primary value. ear lobe. or bronchoscopy can be used  The best sputum specimens are collected in the early morning Nursing Interventions: Pre-test  Explain the purpose. chest physiotherapy. Posttest  Counsel patient regarding meaning of values. as follows: pH > 7. They should be taken to the laboratory immediately usually within 2 hours. 3. nose. perform a series of short coughs. Marshall B.. Determine if compensation has begun by looking at the value other than the primary disorder. a Wolters Kluwer business. ultrasonic nebulization.4 (normal) Determine the primary cause of disturbance by evaluating the PaCO2 and HCO3 in relation to the pH.

Posttest  Evaluate the outcome. “Nurses’ Quick Reference to Common Laboratory & Diagnostic Tests”. th . and perfusion (Q). heart. if positive. and explain possible further testing. The procedure takes only a few minutes Nursing Interventions: Pre-test  Explain the purpose and procedure of obtaining a chest x-ray and assure the patient that the test is painless. Administer antihistamines to reduce the more severe symptoms. metal snaps. iodine hypersensitivity). and provide the patient with support and counseling. 2008. mediastinum. Marshall B. bony thorax. “Brunner & Suddarth’s Textbook of Medical-Surgical Nursing”.  Screen for pregnancy status and. Because of pretest fasting. 11 ed. a Wolters Kluwer business. bronchoscopy). a Wolters Kluwer business. or subclavian catheters  Follow the progress of disease. Document and inform the physician if there is reaction. the administration of insulin or oral hypoglycemic may be contraindicated. to check for pneumothorax and following biopsy  Normal Values: normal appearing and normally positioned chest. chest wall. diaphragm. cardiac silhouette.  Explain the need for repeat chest x-ray films (if necessary) and follow-up tests (e. Nursing Interventions: Pre-test  Assess for test contraindications (pregnancy.g. which are difficult to visualize with other techniques.  Special attention is necessary for diabetic patients. and aortic arch Procedure:  Clothing is removed to the waist. and thyroid gland  Used to evaluate suspected pulmonary or cardiac disease and trauma to chest  Determine the location of chest tubes.. a Wolters Kluwer business. but make certain that jewelry and metallic objects are removed from the chest area. Suzanne C. Provide monitored care. such as TB  After bronchoscopy. Posttest  Evaluate the outcome. and food and beverage consumed within 4 hours before contrast administration. Janet W. Lippincott Williams & Wilkins.  No preparation is necessary. Check with the x-ray department. 2006. mediastinum.  Explain the examination purpose and procedure.and post-operative evaluation of lung transplants. Lippincott Williams & Wilkins. to assess regional ventilation. bony thorax. 4th ed. Lung Scans (V/Q scans)  Two phases of lung scans: ventilation (V). pleura. feeding tubes. advise the radiology department. “Nurse’s Quick Check: Skills”. soft tissues. with resultant computermanipulated pictures that are not obscured by overlying anatomy  Used to define pulmonary nodules and small tumors adjacent to the pleural surfaces that are not visible on routine chest x-rays and to demonstrate mediastinal abnormalities and hilar adenopathy. Food and fluid restrictions before contrast-enhanced studies are generally indicated. or jewelry  Generally. monitor pulmonary and chest disorders. Fischbach. Intratest  Observe for evidence of reactions such as nausea. pins. rashes. Chest Radiography (X-ray)  Used to demonstrate the appearance of the lungs. Sustained full inspiration is required during the x-ray procedure. lungs. Computed Tomography (CT) Scan  A specialized procedure in which a thin beam of x-rays is directed and moves around the lungs. provide the patient with support and counseling. and hives. 2006. Pretest scan used to quantify lung function for transplant  Provide an estimate of regional pulmonary blood flow  Evaluate COPD and fibrosis Smeltzer.. such as biopsy. Frances T. to assess pulmonary vascular supply  Used to rule out pulmonary emboli  Assess chest pain and respiratory distress  Pre.. Dunning III. Brown. et al. 1st ed. Evaluate patient outcomes and counsel appropriately about treatment and self-care for respiratory illness. X-rays can penetrate through a hospital gown that does not contain any buttons. Lippincott Williams & Wilkins. two views of the chest are taken with the patient in an upright position.

.94 to 0. Remove secretions obstructing the tracheobronchial tree when the patient cannot clear them. or aerosol technetium) through a mask or mouthpiece.  Therapeutic bronchoscopy: 1. 11 ed. and with adequate tissue oxygenation. Bronchoscopy  Direct inspection and examination of the larynx. Posttest  Counsel patient regarding meaning of values.98  Decreases occur in hypoxemia. Dunning III. Lippincott Williams & Wilkins. trachea. Suzanne C. Smeltzer. Pulse Oximetry  A non-invasive method of continuously monitoring the arterial blood oxygen saturation of hemoglobin (SpO 2)  Used to determine need for O2 supplementation and to monitor adequacy of O2 supply  Normal Values: SpO2 – 94% to 98% or 0. a Wolters Kluwer business.. 2. and toe or foot in infants and neonates. To examine tissues or collect secretions. Fischbach. Intratest  Provide encouragement and support. Janet W. 1st ed. Lippincott Williams & Wilkins. pulmonary emboli. xenon. The perfusion scan visualizes blood supply to the lungs  The procedure lasts from 30 to 60 minutes Nursing Interventions: Pre-test  Explain the purpose and procedure. Intratest  Check and change sensor as required. During this time. using a commercial aerosol delivery system for approximately 1 to 4 minutes through a closed.  The patient must be able to follow directions for breathing and holding his or her breath. Nursing Interventions: Pre-test  Explain purpose and placement of pulse oximeter sensor. nonpressurized ventilation system. The ventilation phase requires residual air in the lungs  Radioactive technetium macroaggregated albumin (MAA) particles are slowly injected intravenously while the patient is in a supine position. a Wolters Kluwer business. nose. Other types are used on the forehead. To determine whether a tumor can be resected surgically 4. 4th ed. using a special clip or adhesive. or ring finger. To diagnose bleeding sites. To determine the location and extent of the pathologic process and to obtain a tissue sample for the diagnosis. pneumonia. Brown. Lippincott Williams & Wilkins. et al. and how long sensor will be needed.  Alleviate any fears the patient may have concerning the procedure.  Increases with oxygen therapy  SpO2 values obtained by pulse oximetry are unreliable in cardiac arrest and shock Procedure:  The pulse oximeter sensor is applied to index.  The pulse oximeter displays SpO2 and pulse rate values. CNS depression.  The site is checked every 8 hours and changed every 4 hours. 2006. “Nurses’ Quick Reference to Common Laboratory & Diagnostic Tests”. Marshall B.. Posttest  Evaluate procedure outcomes. and counsel appropriately. Remove foreign bodies from the tracheobronchial tree 2. cirrhosis. 2008. CHF. middle. “Brunner & Suddarth’s Textbook of Medical-Surgical Nursing”. a Wolters Kluwer business. a small amount of radioactive gas (99mTcDTPA or Xenon133 gas with O2) is administered into the system. and bronchi through either a flexible fiberoptic bronchoscope or a rigid bronchoscope.  Diagnostic bronchoscopy: 1. 3. ear lobe. th . 2006. Normal functioning lung: normal pulmonary ventilation and normal pulmonary perfusion Procedure:  The patient is asked to inhale a radioactive gas (krypton. Frances T. “Nurse’s Quick Check: Skills”.

 Sputum specimens are usually not refrigerated. then take several deep breaths. Suzanne C. 4.. “Brunner & Suddarth’s Textbook of Medical-Surgical Nursing”. Intratest  Patient should clear nose and throat and rinse mouth before expectorating. chest physiotherapy. Janet W. “Nurses’ Quick Reference to Common Laboratory & Diagnostic Tests”. Evaluate trauma. Lippincott Williams & Wilkins. and inflammation. 8.  Instruct the patient not to touch inside of sputum container. 2008. nasotracheal or tracheal suctioning. They should be taken to the laboratory immediately usually within 2 hours. and Nocardia species. 4th ed. a Wolters Kluwer business. Posttest  Evaluate patient outcomes and counsel appropriately about treatment and self-care for respiratory illness. 3. 2006. nerve paralysis. 6. a Wolters Kluwer business. Lippincott Williams & Wilkins. et al.  Procedure:  Instruct the patient to provide a deep-coughed specimen into a sterile container (1-3 mL is generally sufficient)  If the patient is unable to expectorate a satisfactory specimen. Legionella. th . 2006. 4. Remove foreign bodies. 1st ed. or bronchoscopy can be used  The best sputum specimens are collected in the early morning Nursing Interventions: Pre-test  Explain the purpose. pathogenic fungi. 7.. Dunning III. Provide monitored care. Use bronchoscopy aspirates to diagnose M. Indications: 1. Marshall B. and all aspects of specimen collection. Assess intubation damage. ultrasonic nebulization. and then cough deeply and forcefully using the diaphragm and expectorates into the sterile container. Diagnose tumors. perform a series of short coughs. a Wolters Kluwer business. procedure. 2. determine surgical resectability. Treat post-operative atelectasis. Smeltzer. stage lung cancer. Lippincott Williams & Wilkins. Destroy and excise lesion. and locate hemorrhage site. “Nurse’s Quick Check: Skills”. Brown.. Perform transbrochial needle biopsy in suspected lung cancer. Assess patient before and after lung transplantation. 3. Fischbach. 5. Frances T. 11 ed. Place large airway stents. Tuberculosis infections.