REMEDIOS T. ROMUALDEZ MEDICAL FOUNDATION, Inc.

COLLEGE OF NURSING
WORKSHEET IN NCM 109
CONCEPT: OXYGENATION: RESPIRATORY FUNCTION
LABORATORY & DIAGNOSTIC EXAMINATIONS

I. DIAGNOSTIC PROCEDURES:

A. LABORATORY EXAMINATIONS:

1. COLLECTING SPUTUM EXAM FOR CULTURE & SENSITIVITY ( def.)

A sputum culture is a sample of the gooey substance that often comes up from your chest when
you have an infection in your lungs or airways.

PURPOSES:
Test to detect and identify bacteria or fungi that infect the lungs or breathing passages
Doctors use it to figure out what might be causing your illness, whether it’s bacteria, a virus or
something else.

INDICATIONS:
Suspects that a person has a bacterial infection of the lungs or airways, such as bacterial
pneumonia, which usually show changes in the lungs seen on a chest x-ray.
Your cough suggests you have an illness caused by bacteria, such as bronchitis, pneumonia or
tuberculosis (a potentially serious infection that usually affects your lungs and can cause you to
cough up blood).
CONTRAINDICATIONS:
If the patient is unable to produce enough sputum or is in a comatose state.

NORMAL RESULTS
A negative result in which means that a culture has showed no signs of growth in 24 or 48 hours

ABNORMAL RESULTS:
A positive result in which a culture has showed signs of growth

SIGNIFICANCE FOR ABNORMAL RESULTS:

Culture showed signs of growth in 24 or 48 hours and can be caused by the following:
 M. tuberculosis
 M. leprae
 nontuberculous bacteria
 other acid-fast bacteria

EQUIPMENTS/MATERIALS:
a. THROUGH DIRECT EXPECTORATION:
 Sample cup
 gloves

b. THROUGH NOSE/ THROAT SWABS COLLECTION:

 Cotton swab
 Gloves
 mask
c. COLLECTION SPUTUM SPECIMEN BY TRACHEAL SUCTIONING:
 Single sterile glove;
 Suction catheter - of correct size related to lumen of cannula;
 Sputum trap;
 Suction pump or wall-mounted suction unit with suction tubing.

PATIENT PREPARATION:
a. BEFORE SPUTUM SPECIMEN COLLECTION
 The night before the test, drink lots of fluids, such as water or tea. This will help your body make
more sputum overnight.
 Brush your teeth and rinse your mouth without using antiseptic mouthwash.
 You may be instructed to rinse your mouth out with water prior to collection and to avoid food
for 1-2 hours before the sample is collected.
b. DURING SPUTUM SPECIMEN COLLECTION:
1. DIRECT SPUTUM COLLECTION
 Take a couple of long, deep breaths.
 Breathe deeply again and cough hard until sputum comes up.
 Spit out the sputum into the sample cup.
 Keep coughing up sputum until the cup is filled to the marker, which is approximately 1 teaspoon.
 Screw on the cup lid, and wash and dry the outside of it.
 Write your name, your date of birth, and the date of collection on the cup label.

2. THROUGH NOSE/THROAT SWAB

 Seat the patient in the adult’s lap.
 Have the adult encircle the child’s arms and chest to prevent the child from moving.
 Place one hand on the child’s forehead to stabilize the head and to prevent movement.
 Proceed with the technique used for collection of the throat and nose culture as described for
adults.

3. THROUGH TRACHEAL SUCTIONING:

 Obtain informed consent.
 Wash hands.
 Don apron and gloves.
 Set suction to correct level.
 Open sterile glove packet.
 Hold suction catheter in packet in dominant hand.
 Open packet, exposing connection end (Fig 5).
 Attach to suction tubing.
 Pull out half of catheter, forming a loop.
 Don sterile glove on dominant hand.
 Remove rest of catheter with sterile hand.
 Tell patient that the procedure is about to start.
 Feed catheter into tracheal tube (Fig 6).
 At resistance (at the carina) withdraw 1cm without suction.
 Apply suction while withdrawing catheter.
 Repeat as necessary.
 Cap off sputum trap.
 Label as before and send to laboratory.

3. NURSING RESPONSIBILITIES AFTER THE PROCEDURE:

 After tracheostomy suctioning, assess respiratory status: breath sounds, respiratory rate, skin
color, laboured breathing, flared nares or sternal retractions, arterial blood gases.
 The ties holding the tube must also be secured.
 Educate the client on the normal and abnormal results and inform when they can possibly get
the results.

COMPLICATIONS:
 When the patient is not feeling, he/she may have discomfort in expectorating but generally, there is no
complications associated with having a sputum culture.

NURSING CONSIDERATIONS:
Nurses must:
  Be able to decide appropriately on what method they should use according the patient’s age and health
condition.
 Consider the time going to be used on this test.
 be aware of infection control principles involved in collection of tissue and body fluids
 Be able to explain the purpose of the specimen to the patient and the implications for treatment, and to
obtain informed consent
 Understand the importance of accurate record keeping. Documentation should include time the specimen
was collected, results and changes to treatment that occur in response to the results
 Also collect at the right time, using the correct equipment, and also Collected in a manner that reduces risk
to all staff (including laboratory staff)

ILLUSTRATIONS:
Through direct sputum collection

Through nose swab

Through tracheal suctioning
2. SPUTUM EXAM FOR GRAM-STAINING & ACID- FAST BACILLUS ( def. )
Most samples that are submitted for acid-fast bacilli (AFB) testing are collected because the
healthcare practitioner suspects that a person has tuberculosis (TB), a lung infection caused by
Mycobacterium tuberculosis. Mycobacteria are called acid-fast bacilli because they are a group of rod-shaped
bacteria (bacilli) that can be seen under the microscope following a staining procedure where the bacteria
retain the color of the stain after an acid wash (acid-fast). AFB laboratory tests detect the bacteria in a
person's sample and help identify an infection caused by AFB.

PURPOSES:
To help diagnose tuberculosis (TB) and infections caused by other Mycobacterium species, which are known as
acid-fast bacilli (AFB), in people at risk of developing mycobacterial infections; to monitor the effectiveness of
treatment

INDICATIONS:
When you have signs and symptoms of a lung infection, such as a chronic cough, weight loss, fever, chills, and
weakness, that may be due to TB or a nontuberculous mycobacterial (NTM) infection; when you have a positive
IGRA blood test or Tuberculin skin test (TST) and you are in a high-risk group for progressing to active TB; when
you have a skin or other body site infection that may be due to mycobacteria; when you are undergoing treatment for
TB

CONTRAINDICATIONS:
If the patient is unable to produce and cough enough sputum or is in a comatose state.

NORMAL RESULTS:
Negative: Normal oral flora

ABNORMAL RESULTS:
Positive AFB result indicate a probable mycobacterial infection, that symptoms are caused by something other than
mycobacteria, or that the mycobacteria were not present in sufficient numbers to be seen under the microscope.

SIGNIFICANCE OF ABNORMAL RESULTS;

If culture showed signs of life and growth, mycobacterial infection is the most likely present to the person got tested.

EQUIPMENTS/MATERIALS:
a. direct sputum expectoration:
 Sample cup
 gloves

b. nose/throat swab:
 Cotton swab
 Gloves
 mask

c. tracheal suctioning
 Single sterile glove;
 Suction catheter - of correct size related to lumen of cannula;
 Sputum trap;
 Suction pump or wall-mounted suction unit with suction tubing.

PATIENT PREPARATION:
 Inform the patient that the test is primarily used to assist in the diagnosis of tuberculosis
 Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or
sensitivities to latex. Obtain a history of the patient’s exposure to tuberculosis.
 Positively identify the patient using at least two unique identifiers before providing care, treatment, or
services.
  Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and
nutraceuticals.
 Note any recent procedures that can interfere with test results.

PROCEDURE:
BEFORE THE PROCEDURE:
a. direct sputum expectoration
 Additional liquids the night before may assist in liquefying secretions during expectoration the following
morning.
 Assist the patient with oral cleaning before sample collection to reduce the amount of sample
contamination by organisms that normally inhabit the mouth
 Instruct the patient not to touch the edge or inside of the container with the hands or mouth

b. nose/throat swab
 Seat the patient in the adult’s lap.
 Have the adult encircle the child’s arms and chest to prevent the child from moving.
 Place one hand on the child’s forehead to stabilize the head and to prevent movement.
 Proceed with the technique used for collection of the throat and nose culture as described for
adults.

c. tracheal suctioning
 Assist in providing extra fluids, unless contraindicated, and proper humidification to decrease tenacious
secretions. Inform the patient that increasing fluid intake before retiring on the night before the test aids
in liquefying secretions and may make it easier to expectorate in the morning. Also explain that
humidifying inspired air also helps liquefy secretions
 Other than antimicrobial drugs, there are no medication restrictions, unless by medical direction.
 There are no food or fluid restrictions, unless by medical direction.
DURING THE PROCEDURE;
a. direct sputum expectoration
 Ask the patient to sit upright, with assistance and support (e.g., with an overbed table) as needed.
 Ask the patient to take two or three deep breaths and cough deeply. Any sputum raised should be
expectorated directly into a sterile sputum collection container.
 If the patient is unable to produce the desired amount of sputum, several strategies may be attempted.
One approach is to have the patient drink two glasses of water, and then assume the position for postural
drainage of the upper and middle lung segments. Effective coughing may be assisted by placing either the
hands or a pillow over the diaphragmatic area and applying slight pressure
 Another approach is to place a vaporizer or other humidifying device at the bedside. After sufficient
exposure to adequate humidification, postural drainage of the upper and middle lung segments may be
repeated before attempting to obtain the specimen.

b. nose/throat swab
 Seat the patient in the adult’s lap.
 Have the adult encircle the child’s arms and chest to prevent the child from moving.
 Place one hand on the child’s forehead to stabilize the head and to prevent movement.
 Proceed with the technique used for collection of the throat and nose culture as described for
adults.

c. tracheal suctioning
 Obtain informed consent.
 Wash hands.
 Don apron and gloves.
 Set suction to correct level.
 Open sterile glove packet.
 Hold suction catheter in packet in dominant hand.
 Open packet, exposing connection end (Fig 5).
 Attach to suction tubing.
 Pull out half of catheter, forming a loop.
 Don sterile glove on dominant hand.
 Remove rest of catheter with sterile hand.
 Tell patient that the procedure is about to start.
 Feed catheter into tracheal tube (Fig 6).
 At resistance (at the carina) withdraw 1cm without suction.
 Apply suction while withdrawing catheter.
 Repeat as necessary.
 Cap off sputum trap.
 Label as before and send to laboratory.

NURSING RESPONSIBILITIES AFTER THE PROCEDURE:

 A report of the results will be sent to the requesting HCP, who will discuss the results with the patient.
 Monitor vital signs and compare with baseline values every 15 min for 1 hr, then every 2 hr for 4 hr, and
then as ordered by the HCP. Monitor temperature every 4 hr for 24 hr. Notify the HCP if temperature is
elevated. Protocols may vary from facility to facility.
 Emergency resuscitation equipment should be readily available if the vocal cords become spastic after
intubation.
 Observe for delayed allergic reactions, such as rash, urticaria, tachycardia, hyperpnea, hypertension,
palpitations, nausea, or vomiting.
 Evaluate the patient for symptoms of empyema, such as fever, tachycardia, malaise, or elevated white
blood cell count.
 Observe the patient for hemoptysis, difficulty breathing, cough, air hunger, excessive coughing, pain, or
absent breathing sounds over the affected area. Report any symptoms to the HCP.
COMPLICATIONS:
 When the patient is not feeling, he/she may have discomfort in expectorating but generally, there is no
complications associated with having a sputum culture

NURSING CONSIDERATIONS:
 Be able to decide appropriately on what method they should use according the patient’s age and health
condition.
 Consider the time going to be used on this test.
 be aware of infection control principles involved in collection of tissue and body fluids
 Be able to explain the purpose of the specimen to the patient and the implications for treatment, and to
obtain informed consent
 Understand the importance of accurate record keeping. Documentation should include time the specimen
was collected, results and changes to treatment that occur in response to the results
 Also collect at the right time, using the correct equipment, and also Collected in a manner that reduces risk
to all staff (including laboratory staff)

ILLUSTRATIONS:
Through direct sputum collection

Through nose swab

Through tracheal suctioning
SPUTUM COLLECTION FOR CYTOLOGIC EXAM ( def )
Sputum cytology refers to the examination of sputum (mucus) under a microscope to look for
abnormal or cancerous cells. Sputum, or phlegm, is the fluid that is secreted by cells in the lower respiratory
tract such as the bronchi and the trachea

PURPOSES:
Sputum cytology examines a sample of sputum (mucus) under a microscope to determine whether abnormal
cells are present. Sputum is not the same as saliva. Sputum is produced in the lungs and in the airways
leading to the lungs. Sputum has some normal lung cells in it.

INDICATIONS:
Sputum cytology is done to find:
 Lung cancer. But sputum cytology is not used as a screening test for people at risk for developing
lung cancer, such as smokers.
 Non-cancerous lung conditions, such as pneumonia or inflammatory diseases, tuberculosis, or the
buildup of asbestos fibres in the lungs (asbestosis).

CONTRAINDICATIONS:
If the patient is unable to produce and cough enough sputum or is in a comatose state.

NORMAL RESULTS:
Normal lung cells are present in the sputum sample.

ABNORMAL RESULTS:
Abnormal cells are present in the sputum sample.

SIGNIFICANCE:
Abnormal cells may mean lung conditions such as pneumonia, inflammation, the buildup of asbestos fibres in the
lungs (asbestosis), or lung cancer.

EQUIPMENTS/MATERIALS:
a. for direct expectoration of sputum
 cup
 facemask

b. for nose/throat swab

 Cotton swab
 Gloves
 Mask
c. through tracheal suctioning
 Single sterile glove;
 Suction catheter - of correct size related to lumen of cannula;
 Sputum trap;
 Suction pump or wall-mounted suction unit with suction tubing.

PATIENT PREPARATION:
 Before taking a morning sputum sample, it is recommended that you do not eat or drink.
 Do not use mouthwash fluids, as they may contain substances that affect the test results.
 Showering with hot water makes it easier to cough up the contents of the track.
 If the sputum sample is taken during bronchoscopy, your doctor will give you detailed instructions on how
to prepare for this procedure
NURSING RESPONSIBILITES BEFORE THE PROCEDURE:
 Inform the patient that the test is primarily used to assist in the diagnosis of tuberculosis
 Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or
sensitivities to latex. Obtain a history of the patient’s exposure to tuberculosis.
 Positively identify the patient using at least two unique identifiers before providing care, treatment, or
services.
 Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and
nutraceuticals.
 Note any recent procedures that can interfere with test results.
DURING THE PROCEDURE:
a. direct sputum expectoration:
 Ask the patient to sit upright, with assistance and support (e.g., with an overbed table) as needed.
 Ask the patient to take two or three deep breaths and cough deeply. Any sputum raised should be
expectorated directly into a sterile sputum collection container.
 If the patient is unable to produce the desired amount of sputum, several strategies may be attempted.
One approach is to have the patient drink two glasses of water, and then assume the position for postural
drainage of the upper and middle lung segments. Effective coughing may be assisted by placing either the
hands or a pillow over the diaphragmatic area and applying slight pressure
 Another approach is to place a vaporizer or other humidifying device at the bedside. After sufficient
exposure to adequate humidification, postural drainage of the upper and middle lung segments may be
repeated before attempting to obtain the specimen.

b. nose/throat swab
 Seat the patient in the adult’s lap.
 Have the adult encircle the child’s arms and chest to prevent the child from moving.
 Place one hand on the child’s forehead to stabilize the head and to prevent movement.
 Proceed with the technique used for collection of the throat and nose culture as described for
adults.

c. tracheal suctioning
 Obtain informed consent.
 Wash hands.
 Don apron and gloves.
 Set suction to correct level.
 Open sterile glove packet.
 Hold suction catheter in packet in dominant hand.
 Open packet, exposing connection end (Fig 5).
 Attach to suction tubing.
 Pull out half of catheter, forming a loop.
 Don sterile glove on dominant hand.
 Remove rest of catheter with sterile hand.
 Tell patient that the procedure is about to start.
 Feed catheter into tracheal tube (Fig 6).
 At resistance (at the carina) withdraw 1cm without suction.
 Apply suction while withdrawing catheter.
 Repeat as necessary.
 Cap off sputum trap.
 Label as before and send to laboratory.

NURSING RESPONSIBILITIES AFTER THE PROCEDURE:

 Evaluate the patient for symptoms of empyema, such as fever, tachycardia, malaise, or elevated white
blood cell count.
 Observe the patient for hemoptysis, difficulty breathing, cough, air hunger, excessive coughing, pain, or
absent breathing sounds over the affected area. Report any symptoms to the HCP.
 A report of the results will be sent to the requesting HCP, who will discuss the results with the patient.
 Monitor vital signs and compare with baseline values every 15 min for 1 hr, then every 2 hr for 4 hr, and
then as ordered by the HCP. Monitor temperature every 4 hr for 24 hr. Notify the HCP if temperature is
elevated. Protocols may vary from facility to facility.

COMPLICATIONS:
 When the patient is not feeling, he/she may have discomfort in expectorating but generally, there is no
complications associated with having a sputum culture
ILLUSTRATIONS:
Through direct sputum collection

Through nose swab

Through tracheal suctioning

4. CURSCHMANN’S SPIRALS ( def )
Curschmann's spirals are a microscopic finding in the sputum of asthmatics. They are spiral-shaped mucus plugs
from subepithelial mucous gland ducts of bronchi.

PURPOSES:
To test whether the person has a Curschmann's spirals or not.

INDICATIONS:
When the doctor suspects signs and symptoms of bronchial asthma

CONRAINDICATIONS:
If the patient is unable to produce and cough enough sputum or is in a comatose state.

NORMAL RESULTS:
No Spiral-shaped mucus plugs from subepithelial mucous gland ducts of bronchi. 

ABNORMAL RESULTS:
Signs of elongated microscopic mucous casts from small bronchi and are often found in sputum samples from
patients with bronchial asthma.

SIGNIFICANCE:
If Curschmann's spirals are found, there has a high probable of bronchial asthma

EQUIPMENTS/MATERIALS:
 cup
 gloves

PATIENT PREPARATION:
 The night before the test, drink lots of fluids, such as water or tea. This will help your body make
more sputum overnight.
 Brush your teeth and rinse your mouth without using antiseptic mouthwash.
 You may be instructed to rinse your mouth out with water prior to collection and to avoid food
for 1-2 hours before the sample is collected.

PROCEDURE:
 Take a couple of long, deep breaths.
 Breathe deeply again and cough hard until sputum comes up.
 Spit out the sputum into the sample cup.
 Keep coughing up sputum until the cup is filled to the marker, which is approximately 1 teaspoon.
 Screw on the cup lid, and wash and dry the outside of it.
 Write your name, your date of birth, and the date of collection on the cup label.

NURSING RESPONSIBILITIES AFTER THE PROCEDURE:

 A report of the results will be sent to the requesting HCP, who will discuss the results with the patient.
 Recognize anxiety related to test results. Discuss the implications of abnormal test results on the patient’s
lifestyle. Provide teaching and information regarding the clinical implications of the test results, as
appropriate.
 Monitor vital signs
 Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to
another HCP
ILLUSTRATION:
Through direct sputum collection
5. ARTERIAL BLOOD GAS ANALYSIS ( def)
An ABG is a blood test that measures the acidity, or pH, and the levels of oxygen (O2) and carbon
dioxide (CO2) from an artery.

PURPOSES:
An arterial-blood gas test measures the amounts of arterial gases, such as oxygen and carbon dioxide.

INDICATIONS:
An ABG test is often done for a person who is in the hospital because of severe injury or illness. The test can
measure how well the person's lungs and kidneys are working and how well the body is using energy.

CONTRAINDICATIONS:
Contraindicated against areas of skin infection, patients taking anticoagulants, and patient who have poor blood flow
to an area where puncture must be made.

NORMAL VALUES:
7.35-7.45

ABNORMAL VALUES:
Less than 7.35 and/or higher than 7.45

SIGNIFICANCE/ANALYSIS OF ABNORMAL VALUES:

A lower blood pH may indicate that your blood is more acidic and has higher carbon dioxide levels. A higher blood
pH may indicate that your blood is more basic and has a higher bicarbonate level.

EQUIPMENTS/MATERIALS:
• 10-mL glass syringe or plastic luerlok syringe specially made for drawing blood for ABG analysis
• 1-mL ampule of aqueous heparin (1:1000)
• 20G 1" needle
• 22G 1" needle
• Gloves
• antiseptic pad
• two 2" × 2" gauze pads
• rubber cap for syringe hub or rubber stopper for needle
• ice-filled plastic bag • label • laboratory request form
• adhesive bandage
• 1% lidocaine solution (optional)

PATIENT’s PREPARATION BEFORE THE PROCEDURE :

 Preparing children depends on the age of the child. Encourage parents to be truthful about
unpleasant sensations (cramping, pressure, pinching, etc.) the child may experience during the
procedure and to use words that they know their child will understand. Toddlers and preschool-
age children have a very short attention span, so the best time to talk about the test is right
 before the procedure. The child should be assured that he or she will be allowed to bring a
favorite comfort item into the examination room, and if appropriate, that a parent will be with
the child during the procedure.
 Explain to parents and caregivers that special equipment (balloon-tip catheters to assist with
retention of barium during a barium enema, foam wedges used to hold a limb in place during a
nuclear scan, etc.) may be needed to assist with a successful study.

Perform Allen’s Test

ALLEN’s TEST ( def )
In medicine, Allen's test or the Allen test is a medical sign used in physical examination of arterial blood flow to the
hands.
Purpose:
A procedure called the Allen test may be used to find out if the blood flow to your hand is normal.

INDICATION:
This test is performed whenever intravascular access to the radial artery is planned or for selecting patients for radial
artery harvesting, such as for coronary artery bypass grafting or for forearm flap elevation.

NORMAL RESULT/FINDINGS:
Positive Allen test – If the hand flushes within 5-15 seconds it indicates that the ulnar artery has good blood flow;
this normal flushing of the hand is considered to be a positive test.

ABNORMAL RESULT/FINDINGS:
Negative Allen test – If the hand does not flush within 5-15 seconds, it indicates that ulnar circulation is inadequate
or non-existent; in this situation, the radial artery supplying arterial blood to that hand should not be punctured.

SIGNIFICANCE:
The Allen’s test is a simple, reliable procedure that quickly assesses arterial function.

PROCEDURE:
1. Instruct the patient to clench his or her fist; if the patient is unable to do this, close the person's hand tightly.
2. Using your fingers, apply occlusive pressure to both the ulnar and radial arteries, to obstruct blood flow to
the hand.
3. While applying occlusive pressure to both arteries, have the patient relax his or her hand, and check
whether the palm and fingers have blanched. If this is not the case, you have not completely occluded the
arteries with your fingers.
ILLUSTRATIONS:
PROCEDURE FOR ABG (BLOOD EXTRACTION)
1. Confirm the patient’s identity using two patient identifiers according to facility policy
2. Tell the patient that you need to collect an arterial blood sample, and explain the procedure to help ease
anxiety and promote cooperation.
3. Tell the patient that he may feel discomfort from the needle stick but that he must remain still during the
procedure.
4. Wash your hands and put on gloves.
5. Place a rolled towel under the patient’s wrist for support.
6. Locate the artery and palpate it for a strong pulse.
7. Clean the puncture site with antiseptic solution, working outward in a side-to-side motion.
8. Allow the skin to dry.
9. Palpate the artery with the index and middle fingers of one hand while holding the syringe over the
puncture site with the other hand.
10. Hold the needle bevel up at a 30- to 45-degree angle. When puncturing the brachial artery, hold the
needle at a 60-degree angle. (See the Arterial puncture technique box.)
11. Puncture the skin and the arterial wall in one motion, following the artery path.
12. Watch for blood backflow in the syringe. Don’t pull back on the plunger because arterial blood should
enter the syringe automatically.
13. Fill the syringe to the 3-mL mark.
14. After collecting the sample, press a gauze pad firmly over the puncture site for 5 to 10 minutes, until the
bleeding stops.
15. If the patient is receiving anticoagulant therapy or has a blood dyscrasia, apply pressure for 10 to 15
minutes; if necessary, ask a co-worker to hold the gauze pad in place while you prepare the sample for
transport to the laboratory.
16. Check the syringe for air bubbles. If any appear, remove them by holding the syringe upright and slowly
ejecting some of the blood onto a 2" × 2" gauze pad.
17. Insert the needle into a rubber stopper, or remove the needle and place a rubber cap directly on the
syringe tip. This prevents the sample from leaking and keeps air out of the syringe.
18. Put the labelled sample in the ice filled plastic bag or emesis basin.
19. Attach a properly completed laboratory request form, and send the sample to the laboratory
immediately.
20. When bleeding stops, apply a small adhesive bandage to the site.
21. Discard syringes, needles, and gloves in the appropriate containers.
22. Monitor the patient’s vital signs, and observe for signs of circulatory impairment, such as swelling,
discoloration, pain, numbness, or tingling in the arm or leg.
23. Watch for bleeding at the puncture site.

NURSING RESPONSIBILITIES DURING BLOOD

EXPRACTION a. blood extraction to a conscious patient
for ABG
 Uses standard precaution/Sterile technique as appropriate
 Provides emotional and physical support
 Monitors patient (VS, Pulse oximetry, ECG, etc.) Ensures correct labelling, storage and transportation of
specimen

b. blood extraction for ABG to an unconscious patient for ABG

POST TEST CARE:
• Immediately after blood is drawn, pressure is applied (with cotton or gauze) to the puncture site.
• Resume your normal activities and any medications withheld before the test.
• Blood may collect and clot under the skin (hematoma) at the puncture site; this is harmless and
will resolve on its own. For a large hematoma that causes swelling and discomfort, apply ice
initially; after 24 hours, use warm, moist compresses to help dissolve the clotted blood.
• Post procedural recovery interventions, such as achieving adequate hydration, require close
attention. The parents or caregivers must receive education to help them address specific needs
and to be watchful for indications of a developing problem because pediatric patients cannot do
so for themselves.

INTERFERING FACTORS THAT MAY AFFECT RESULT:

 Failure to heparinize syringe, place sample in an iced bag, or send the sample to the laboratory immediately
 Exposing the sample to air (increase or decrease in PaO2 and PaCO2)
 Venous blood in the sample (possible decrease in PaO2 and increase in PaCO2)
 HCO3–, ethacrynic acid, hydrocortisone, metolazone, prednisone, and thiazides (possible increase in
PaCO2)
 Acetazolamide, methicillin, nitrofurantoin, and tetracycline (possible decrease in PaCO2)
 Fever (possible false-high PaO2 and PaCO2)

ILLUSTRATIONS:

a. blood extraction to a Conscious patient for ABG:

b. blood extraction to an unconscious patient:

OTHER TESTS:

1. FAGESTROM TEST ( def )

Purposes:

Indications:

Contraindications:

Normal result:

Abnormal result:

Significance of abnormal result:

Equipment/ Materials:

PATIENT QUESTIONAIRE:
FAGERSTROM TEST FOR NICOTINE DEPENDENCE:
Is smoking just a habit or is the person addicted to smoking? The following questions will
determine the level of dependence of a person on nicotine.
1. How soon after waking up do you smoke your cigarette?
* after 60 mins. ( 0 )
* 31 mins – 60 mins. ( 1 )
* (2)
* within 5 mins. ( 3 )

2. Do you find it difficult to refrain from smoking in places where it is forbidden/ restricted ?
NO(0)
YES(1)
3. WHICH CIGARETTE WOULD YOU HATE MOST TO GIVE UP ?
THE FIRST IN THE MORNING ( 1 )
ANY OTHER ( 0 )
4.How many cigarettes per day do you smoke?
10 or less ( 0 )
11-20 ( 1 )
21–30(2)
31 or more ( 3 )
5. Do you smoke more frequently during the first hours after awakening than during the rest of the
day? NO(0)
YES(1)
6. Do you smoke even if you are so ill that you are in bed most of the day?
NO(0)
YES(1)
TOTAL SCORE:_____________
EQUIVALENT OF RESULT:
THE LEVEL OF DEPENDENCE ON NICOTINE IS:
0-2 VERY LOW DEPENDENCE
3-4 LOW DEPENDENCE
6-7 HIGH DEPEMDEMCE
8-10 VERY HIGH DEPENDENCE
5 MEDIUM DEPENDENCE
BELOW 5 LEVEL OF DEPENDENCE LOW

2. SMOKE ANALYZER ( def )

PURPOSES:

INDICATIONS:

CONTRAINDICATIONS:

NORMAL RESULT:

ABNORMAL RESULT:

SIGNIFICANCE:

EQUIPMENT/MATERIALS:

PATIENT PREPARATION

PROCEDURE:

ILLUSTRATION:
B. DIAGNOSTIC PROCEDURES
NON-INVASIVE PROCEDURES:

1. PULMONARY FUNCTION TEST ( def )

PURPOSES:

INDICATIONS:

CONTRAINDICATIONS:

NORMAL FINDINGS:

EQUIPMENT:
For direct spirography:

For body plethysmography:

PATIENT PREPARATION:

PROCEDURE:
TIDAL VOLUME:

EXPIRATORY RESERVE VOLUME:

VITAL CAPACITY:

INSPIRATORY CAPACITY:

FUNCTIONAL RESIDUAL CAPACITY:

THORACIC GAS VOLUME:

FORCED VITAL CAPACITY AND FORCED EXPIRATORY VOLUME:

MAXIMAL VOLUNTARY VENTILATION:

DIFFUSING CAPACITY FOR CARBON MONOXIDE:

 INTERPRETING PULMONARY FUNCTION TESTS

MEASUREMENT OF PULMONARY METHOD OF

FUNCTION CALCULATION IMPLICATIONS

TIDAL VOLUME ( V1 )(def)

MINUTE VOLUME ( MV) def.

CO2 RESPONSE: def.
INSPIRATORY RESERVE VOL.
( IRV ) def.
EXPIRATORY RESERVE VOL.(ERV) def.
RESIDUAL VOLUME ( RV):
VITAL CAPACITY ( VC):
INSPIRATORY CAPACITY( IC):
THORACIC GAS VOLUME(TGV)def
FUNCTIONAL RESIDUAL CAPACITY ( FRC
)def:
TOTAL LUNG CAPACITY(TLC)def
FORCED VITAL CAPACITY(FVC)def.
FLOW-VOL.CURVE: def.
FORCED EXPIRATORY VOL.FEV)
Def.
FORCED EXPIRATORY FLOW RATE (FEFR)
def.
MAXIMAL VOLUNTARY VENTILATION
(MVV) def
Diffusing capacity for carbon monoxide (
def. )
Forced vital capacity & forced expiratory
vol.( def)

POST-TEST CARE:

INTERFERING FACTORS:

ILLUSTRATIONS:
1. RADIOGRAPHY
CHEST RADIOGRAPHY ( def )

PURPOSES:

INDICATIONS:

CONTRAINDICATIONS:

NORMAL FINDINGS:

ABNORMAL FINDINGS:

SIGNIFICANCE OF RESULTS::

EQUIPMENTS:

PATIENT PREPARATION:

PROCEDURE:
BEFORE THE PROCEDURE:

DURING THE PROCEDURE:

a. for frontal view

b. for left lateral view

c. for recumbent view

d. for an anteroposterior view of a bedridden patient

e. for oblique view

f. for lordodic view

g. for decubitus view

AFTER PROCEDURE
NURSING RESPONSIBILITIES:

NURSING CONSIDERATIONS:

ILLUSTRATIONS:
a. Frontal

b. Lateral

c. Recumbent

d. Oblique

e. Lordotic

f. Decubitus
2. PARANASAL RADIOGRAPHY ( def )

PURPOSES:

INDICATION:

CONTRAINDICATION:

NOR5MAL FINDINGT:

ADNORMAL FINDINGS:

SIGNIFICANCE:

EQUIPMENT:

PATIENT PREPARATION:

PROCEDURE:
BEFORE THE PROCEDURE:

DURING THE PROCEDURE:

AFTER H EPROCEDURE:

INTERFERING FACTORS:

ILLUSTRATION:
3. BRONCHOGRAPHY ( def )

PURPOSES:

INDICATIONS:

CONTRAINDICATIONS:

NORMAL FINDINGS:

ABNORMAL FINDINGS:

SIGNIFICANCE:

EQUIPMENT:

PATIENT PREPARATION:

PROCEDURE:
NURSING RESPONSIBILITIES BEFORE THE PROCEDURE

DURING THE PROCEDURE:

POST PROCEDURE CARE:

INTERFERING FACTORS:

ILLUSTRATION:
4. FLUOROSCOPY ( def )

PURPOSES:

INDICATIONS:

CONTRAINDICATIONS:

NORMAL FINDINGS:

ABNORMAL FINDINGS:

SIGNIFICANCE:

EQUIPMENT:

PATIENT PREPARATION:

PROCEDURE:
NURSING RESPONSIBILITIES BEFORE THE PROCEDURE:

DURING THE PROCEDURE:

POST TEST CARE: NONE

INTERFERING FACTORS AFFECTING RESULT OF PROCEDURE:

ILLUSTRATION:
5. CHEST TOMOGRAPHY (def)

PURPOSES;

INDICATION:

CONTRAINDICATION:

NORMAL RESULTS:

SIGNIFICANCE OF ABNORMAL RESULTS:

EQUIPMENT:

PATIENT PREPARATION:

PROCEDURE:

POST TEST CARE: NONE

PATIENT’s PREPARATION:

INTERFERING FACTORS:

ILLUSTRATION:
6. PULMONARY ANGIOGRAPHY ( def)

PURPOSES:

INDICATION:

CONTRAINDICATION:

NORMAL FINDINGS:

SIGNIFICANCE OF ABNORMAL RESULTS:

EQUIPMENT:

PATIENT PREPARATION:

PROCEDURE:

POST-TEST CARE:

ILLUSTRATION:
7. MEDIASTINOSCOPY ( def)

PURPOSES:

INDICATION:

CONTRAINDICATION:

NORMAL RESULT;

EQUIPMENT:

PATIENT PREPARATION:

PROCEDURE:

POST-TEST CARE:

COMPLICATIONS:

ILLUSTRATION:
9. THORACOSCOPY (def)

PURPOSE4S:

INDICATION:

CONTRAINDICATION:

NORMAL RESULT:

SIGNIFICANCE OF ABNORMAL RESULTS:

POST-TEST CARE:

INTERFERING FACTORS:

ILLUSTRATION:
10. LARYNGOSCOPY ( def)

TYPES:

a. INDIRECT LARYNGOSCOPY ( def)

b. FIBER-OPTIC LARYNGOSCOPY
(def) c. DIRECT LARYNGOSCOPY (def)

PURPOSES

INDICATION:

CONTRAINDICATION:

NORMAL RESULT:

SIGNIFICANCE OF ABNORMAL FINDINGS:

EUIPMENT:

PATIENT PREPARATION:

PROCEDURE:

a. INDIRECT LARYNGOSCOPY

b. FIBER OPTIC LARYNGOSCOPY

c. DIRECT LARYNGOSCOPY

POST-TEST CARE:

INTERFERING FACTORS:

COMPLICATIONS:

ILLUSTRATION:
11. LUNG PERFUSION SCAN ( def)

PURPOSES:

INDICATION:

CONTRAINDICATION:

NORMAL RESULT:

SIGNIFICANCE OF ABNORMAL FINDINGS:

EQUIPMENT:

PATIENT PREPARATION:

PROCEDURE:

POST-TEST CARE:

ILLUSTRATION:
12. VENTILATION SCAN (def)

PURPOSES:

INDICATION:

CONTRAINDICATION:

NORMAL RESULT:

SIGNIFICANCE OF ABNORMAL RESULTS:

EQUIPMENT:

PATIENT PREPARATION:

PROCEDURE:

POST-TEST CARE:

ILLUSTRATION:
13. THORACIC COMPUTED TOMOHRAPHY ( def )

PURPOSES:

INDICATION:

CONTRAINDICATION:

NORMAL RESULT:

SIGNIFICANCE OF ABNORMAL RESULT:

EQUIPMENT:

PATIENT PREPARATION:

PROCEDURE:

POST-TEST CARE:

ILLUSTRATION:
14. THORACIC COMPUTED TOMOGRAPHY (def)

PURPOSES:

INDICATION:

CONTRAINDICATION:

NORMAL FINDING:

SIGNIFICANCE OF ABNORMAL FINDINGS:

EQUIPMENT:

PATIENT PREPARATION:

PROCEDURE:

POST-TEST CARE:

INTERFERING FACTORS:

ILLUSTRATION:
15. CAPNOGRAPHY (def)

PURPOSES:

INDICATION:

CONTRAINDICATION:

NORMAL RESULT:

SIGNIFICANCE OF ABNORMAL RESULT:

EQUIPMENT:

PATIENT PREPARATION:

PROCEDURE:

POST-TEST CARE: NONE

ILLUSTRATION:
15. MAGNETIC RESONANCE IMAGING (def)

PUPOSES:

INDICATION:

CONTRAINDICATION:

NORMAL FINDINGS:

ABNORMAL FINDINGS:

EQUIPMENT:

PATIENT PREPARATION:

PROCEDURE:

POST-TESTC ARE:

ILLUSTRATION:
16. POSITION EMISSION TOMOGRAPHY OF THE LUNGS ( def)

PURPOSES:

INDICATION:

CONTRAINDICATION:

NORMAL FINDINGS:

SIGNIFICANCE OF ABNORMAL FINDINGS:

EQUIPMENT:

PATIENT PREPARATION:

PROCEDURE:

POST-TEST CARE:

ILLUSTRATION:
16. LUNG BIOPSY (def)

TYPES OF LUNG BIOPSY:

a. BROCHOSCOPIC BIOPSY
( def) b. NEEDLE BIOPSY (def)

c. OPEN BIOPSY ( def)

PURPOSES:

INDICATION:

CONTRAINDICATION:

NORMAL FINDINGS:

SIGNIFICANCE OF ABNORMAL RESULT:

EQUIPMENT:

PATIENT PREPARATION:

PROCEDURE:

a. BROCHOSCOPIC BIOPSY

b. NEEDLE BIOPSY

c. OPEN BIOPSY

POST-TEST CARE:

INTERFERING FACTORS:

ILLUSTRATION:

a. BRONCHOSCOPIC BIOPSY b. Needle biopsy c. OPEN BIOP[SY

17. PURIFIED PROTEIN DERIVATIVES ( PPD): def.

PURPOSE:

INDICATION:

CONTRAINDICATION:

NORMAL RESULT:

SIGNIFICANCE OF ABNORMAL RESULT:

EQUIPMENTS/MATERIALS:

PATIENT PREPARATION:

PROCEDURE:

POST-TEST CARE:

SPECIFIY INSTRUCTIONS TO BE GIVEN REGARDING INTERPRETATION OF PPD READING/RESULT.

ILLUSTRATION