DIAGNOSTIC EVALUATION/PROCEDURES

Non- Invasive
Pulmonary Function Test
 are non-invasive tests that show how well the lungs are working.
 The tests measure lung volume, ventilatory function capacity, rates of flow, mechanics of
breathing, and gas exchange. This information can help your healthcare provider diagnose and
decide the treatment of certain lung disorders.
 Is routinely used in patients with respiratory conditions such as asthma, bronchitis, and
emphysema.
 Measure whether exposure to chemicals at work affects lung function
 Is performed to assessed respiratory function and the extent of dysfunction, response to therapy
and screening test in hazardous industries such as coal mining exposure to asbestos and other
noxious irritants.
 Used prior to surgery for thoracic and upper abdominal surgical procedures, obese patients
 PFT is performed using a SPIROMETER
 The most frequently used PFT are the following:

Term used Symbol/norma Description Remarks

l
Force Vital Capacity FVC=80-120% Vital capacity performed If the FVC is greater than
with a maximally forced predicted, there is no
expiratory effort restriction.

If FVC is lesser than

predicted/Forced vital
capacity is often reduced in
COPD because of air
trapping, obstruction or
restriction.
Forces Expiratory FEV, (usually Volume of air exhaled in the A valuable clue to the
volume (qualified by FEV1? specified time during the severity of the expiratory
subscript indicating performance of forced vital airway obstruction
the time interval in capacity; FEV1 is volume
seconds) exhaled in 1 second
Ratio of timed force FEV1/FVC%= FEV1 expressed as Another way of expressing
expiratory volume to within 5% of percentage of the force vital the presence or absence of
force vital capacity the predicted capacity airway obstruction
ratio
Force Expiratory Flow FEF 200-1200 Mean forced expiratory flow An indicator of large airway
between 200 and 1200 mL of obstruction
FVC
Forced mid-expiratory FEF25-75% Mean forced expiratory flow Slowed in small airway
flow during the middle half of the obstruction
FVC
Forced end expiratory FEF 75-85% Mean forced expiratory flow Slowed in obstruction of
flow during the terminal portion smallest airways
of the FVC
Maximal voluntary MVV Volume of air expired in a An important factor in
ventilation specified period (12 sec) exercise tolerance.
during repetitive maximal
 effort

 Methods used in PFT include tidal flow volume loops, negative expiratory pressure, forced
oscillation and diffusing capacity for helium or carbon monoxide.

How long does it takes the PFT?

 The average PFT takes about 45 minutes to complete. However, testing time varies depending on
what the doctor requests.
 In most cases, the doctor will review the results with you upon completion.
 There is usually no after affects from the PFTs.

Patients Preparation prior to PFT

 No bronchodilator medication for four hours.
 No smoking for four hours before the test.
 No heavy meals.
 Do not wear any tight clothing.
 The complete pulmonary function test takes around one and a half hours.

Incentive Spirometry
 is a device that measures how deeply you can inhale (breathe in). It helps you take slow, deep
breaths to expand and fill your lungs with air
 it is a device that encourage slow, long breathe to help POP open alveoli sacs, moves secretions
and keep sacs working.
 gently exercise the lungs and aid in keeping the lungs as healthy as possible. The device helps
retrain your lungs how to take slow and deep breaths. An incentive spirometer helps increase
lung capacity and improves patients' ability to breathe
 The incentive spirometer is made up of a breathing tube, an air chamber, and an indicator
 This helps prevent lung problems, such as pneumonia.
 Goal: to keep patient regularly deep breathing/Done to enhance deep inhalationv
 Position: High fowlers position/Sitting
 Instruct the client to take in a slow, easy deep breath from the mouthpiece.

Indications of Spirometer
 Pneumonia, COPD, asthma
 Atelectasis- lung or portion of the lungs collapse, where alveoli are unable to inflate or deflate to
perform gas exchange which is very common after abdominal or thoracic surgery.

Wrong ways in using Spirometer

1. Blowing into the device
2. Quickly inhaling and exhaling into the device

How do you use a spirometer for breathing exercises?

1. Set the goal for the patient with the yellow marker (male- 3100mL/female- 2900mL)
2. Have the patient set up and exhale completely
3. Seal the mouth around the mouth piece tightly
4. Inhale slowly and deeply while making sure to keep yellow indicator within normal range
5. Keep inhaling as deep as possible until no longer to do so
6. Then hold breath for 6 seconds and exhale slowly while allowing the piston to fall completely

Nurses Roles
  Educating on its uses and importance
 Monitor lungs sounds for improvement
 Observe patient meeting goal. Physician order based on age and height

Question
You are providing pre-op teaching to a patient who will be having abdominal surgery. After
discussing with the patient how to use incentive spirometer, you ask the patient to demonstrate how
to use the device. What action by the patient indicates understanding in demonstrating your
teaching?

PULSE OXIMETRY/ SpO2

 Monitor O2 saturation of hgb
 To determine o2 saturation in the blood
 Can detect hypoxemia or hypoxia
 Normal SpO2 is 95-100%
 Value less than 90% indicates tissue hypoxia
 The pulse oximeter sensor is place in the index finger or earlobe, bridge of the nose.
 The sensor should be covered with opaque material. The result is affected by sunlight.
 Accuracy can be affected by sunlight, movement, fluorescent
 Unreliable in cardiac arrest, shock, sepsis, peripheral vascular disease and hypothermia and when
vasoconstrictor medication is used

Skin Test/Mantoux Test

 purified protein derivative (PPD) skin test is a test that determines if you have exposure to
tuberculosis (TB). TB is a serious infection, usually of the lungs, caused by the bacteria
Mycobacterium tuberculosis.
 If you have a positive PPD, it means you have been exposed to a person who has tuberculosis
and you are now infected with the bacteria (mycobacterium tuberculosis) that causes the disease.
 PPD is used
Nursing Considerations
 Route: ID
 48-72 hrs
 Negative- no induration
 POSITIVE- 10mm or more
 HIV patients- 5mm is POSITIVE
 + Mantoux test signifies exposure or infected to Mycobacterium Tubercle Bacilli
 Mantoux Test will be positive for clients who have received BCG

Sputum exam
 To determine the appearance of the sputum
 Rusty sputum- pneumococcal pneumonia
 Greenish sputum- Pseudomonas infection
 Blood tinged- PTB
 Culture and Sensitivity- to detect the actual microorganisms causing respiratory infection
 Cytologic exam- to assess for presence of CA.
 AFB staining- to detect PTB
Nursing considerations
 Collect sputum early in the MORNING before the patient has had anything to eat or drink.
Sputum usually accumulates in the lungs during sleep and can easily be coughed in the morning
 Advise the patient to rinse mouth with plain water. Do not used mouthwash that may destroy
microorganisms
  Advised the client to take a few deep breath cough deeply and expectorate sputum from the lungs
into the container
 If patient cannot expel enough sputum, do the following techniques,
a. Induced couhgin by administering an aerosol hypertonic solution via nebulizer
b. Endotracheal or tracheal aspiration
 Label the specimen and send it to the laboratory ASAP to avoid contamination
 Sterile container should be used. To prevent contamination
 Sputum specimen for C and S is collected before the first dose of antibiotic.
 For AFB- collect sputum for 3 consecutives morning

CULTURES
 Throat, nasal, nasopharyngeal cultures
 Can identify pathogens for respiratory infections, bacterial or fungal infection
 Throat cultures are performed in adults with severe fever and lymph node enlargement
 Most useful in detecting streptococcal infection
 It is collected by swabbing the throat and placing the sample into a special cup (culture) that
allows infections to grow.
 results usually take 48-72 hours for bacterial infections, for a fungus may take about 7 days, for
virus such as COVID, it takes 2-5days. Rapid strep test results are ready in 10 to 15 minutes.
 Should be obtain prior to start the antibiotic therapy
 Can be repeated to assess patients response to therapy.
 It can detect pneumonia, tonsillitis, whooping cough, and meningitis, COVID.

Collect throat 
 swab samples by standard clinical methods.
 Depress the tongue with a tongue blade or spoon. Be careful not to touch the tongue, sides or top
of the mouth with the swab.
 Rub the swab on the back of the throat, on the tonsils, and in any other area where there is
redness, inflammation or pus.
Nasopharyngeal culture
 is a test that examines a sample of secretions from the uppermost part of the throat, behind the
nose, to detect organisms that can cause disease
Nasal – samples are obtain in the nasal cavity

ABG analysis
 to assess ventilation and acid base balance
 It helps to monitor patients response to therapy
 Radial Artery is the common site for withdrawal of specimen
 Allen’s Test is done to assess for adequacy of collateral circulation of the hand
 Use 10 ml heparinized syringed to draw the blood specimen. To prevent blood clotting.
 Place the specimen in a container with ice. To prevent hemolysis. If hemolysis, OXYGEN and
CO2 are release and cannot be measure accurately.

AVOID INACCURATE ABG VALUES

 Be sure to use proper technique
 Avoid delays in getting the sample to the laboratory
 Don’t draw blood for ABG ANALYSIS within 15-20 minutes of a procedure such as suctioning
or administering respiratory treatment
  Remove air bubbles from the syringe because they could affect the oxygen level in the blood
 Don’t get venous blood in the syringe because it could affect the CO2 and O2 levels and pH
ACID BASED IMBALANCE
ACIDS
 Molecules that can GIVE hydrogen molecules to other molecules
 Include solutions with a pH below 7.35
 Carbonic Acid-an acid that naturally occurs in the body
BASES
 Molecules that can ACCEPT hydrogen molecules
 Include solutions with a pH ABOVE 7.35
 Bicarbonate

KEY FACTS
Understanding acids and bases requires to:

Understanding pH
 To assess the pts Acid Base balance, you must know the ph level of the blood.
 Normally, pH ranges (7.35-7.45) which is slightly ALKALINE.
 A pH within that range represents a balance between the percentage of Hydrogen ions and bicarbonate
ions in the blood.
 A solution that contains MORE ACID than Base has MORE Hydrogen ions, it has a lower pH. A pH less
than 7.35 is abnormally ACIDIC
 A solution that contains more Base THAN Acid has fewer hydrogen ions. A pH level greater than 7.45 is
abnormally ALKALINE.
 Arterial blood is usually used to measure the pH.
 A ph below 6.8 or above 7.8 is FATAL

Acid Base Regulators

 When pH rises or falls, three systems work to create acid base balance
 Chemical Buffers- instantly combined with the offending acids or base neutralized the harmful effects
 Respiratory system- uses hypoventilation and hyperventilation to regulate acid excretion or retention
 KIDNEYS- excrete or retain more acids or bases as needed
POINTS TO REMEMBER:

pH 7.35-7.45
paCO2 35-45
HCO3 22-26mEq/L
O2 95%-100%
Saturation
paO2 80-100mmHg

DETERMINE THE PH
 Check the pH, this figure will be the basis for understanding most other figures
 A pH lower than 7.35 is abnormally ACIDIC
 A pH level higher than 7.45 is abnormally ALKALINE
 Figure out if the cause is respiratory or metabolic.

pH Low Below 7.35 Acidosis

High Above 7.45 Alkalosis
DETERMINE THE PaCO2
 paCO2 is the Respiratory Indicator
 35-45 mmHg
 paCO2 provides information about the respiratory component of acid base balance
 CO2 acts as an acid. When combined with Plasma, Carbonic Acid is formed. (CO2 + H2O=H2CO3)
 If the paCO2 value is abnormal, determine if is LOW or HIGH.
 Increase CO2- Resp Acidosis, Decrease CO2- Resp Alkalosis

pH (7.35-7-45) CO2 (35-45) HCO3 (22-26) Interpretation

7.30 Low 47 High 24 Normal Respiratory Acidosis
7.49 High 30 Low 26 Normal Respiratory Alkalosis

WATCH THE BICARBONATE

 Examine the HCO3 value, which provides an information about the metabolic aspect of acid base
balance
 If the HCO3 is abnormal, determine if is LOW or HIGH
 Normal value 22-26mEq/L
 Then determine whether the abnormal result corresponds with a change in pH
 If pH is HIGH, then HCO3 is HIGH- METABOLIC ALKALOSIS
 If pH is LOW, then HCO3 is LOW- METABOLIC ACIDOCIS

pH (7.35-7-45) CO2 (35-45) HCO3 (22-26 mEq/L) Interpretation

Low Normal Low Metabolic Acidosis
High Normal High Metabolic Alkalosis

LOOK FOR COMPENSATION

 Check the relationship or change in the paCO2 and BCO3
 REMEMBER: the LUNGS and KIDNEYS normally attempt to help each other to maintain ACID BASE
BALANCE
 If the LUNGS are unable to maintain acid base balance , the kidneys will attempt to adjust the level of
HCO3
 If the KIDNEYS are unable to maintain acid base balance, the LUNGS will attempt to adjust the levels of
CO2.
 Acid Base Imbalance is COMPENSATED If CO2 and HCO3 levels moves toward the SAME
DIRECTION; ex: both HIGH or LOW.

When is the Acid Base imbalance considered as Partial or Complete Compensation? 

 When the Acid based is COMPENSATED, but the pH is still ABNORMAL: PARTIAL
COMPENSATION.
 Decrease/increase pH
 COMPLETE COMPENSATION occurs when pH is NORMAL.
When is the Acid Base Imbalance considered as UNCOMPENSATED?
 When CO2 and HCO3 levels move towards OPPOSITE DIRECTION. (Worsened)
 Ex: PaCO2 High (Acidosis) HCO3 Low (Alkalosis); PaCO2 LOW; HCO3 HIGH
 When PaCO2 is ABNORMAL and HCO3 remains NORMAL and vice versa, still
UNCOMPENSATED

IMAGING STUDIES
 Includes -rays, CT, MRI, radio isotope or nuclear scanning

CHEST X-RAY
 In can detect densities produced by fluids, tumors, foreign bodies and other pathologic conditions
 It consist of two views: the posteroanterior projection and lateral projection.
 Are usually obtained after inspiration because lungs are best visualized when they are well
aerated.
 X-rays are contraindicated to pregnant women

Nursing Interventions
 Notify the patient that it does not require fasting nor cause pain
 Advised the patient to take a deep breath and hold it without discomfort to best visualize the
lungs
 Instruct the client to hold his breath and not to do breathing during X-Rays
 Position the patient in standing, sitting or recumbent in order to obtain the appropriate view of the
chest
 Asked the patient to wear gown to minimized exposure to radiation
 Remove metals from the chest.

COMPUTED TOMOGRAPHY
 An imaging method in which the lungs are scanned in successive layers by a narrow
beam X-ray.
 It provide a cross sectional view of the chest
 It can distinguished fine tissue density
 Can be used to define pulmonarynodules and small tumors adjacent to pleural surfaces
 It could plain or with contrast
 Contrast agent is used to evaluate the mediastinum and its contents and its vasculature
 Contraindications:
a. Allergy to dye, Pregnancy, Claustrophobia, acute kidney injury due to effects of contrast

Nursing Interventions
 Inform patients that he or she will be required to remain in supine typically less than 30
minutes while the body surrounds them and takes multiple images
 NPO if contrast is used 4 hours prior to examination
 Assess allergy to iodine or seafoods
MRI
 Similar to CT, a magnetic field and radiofrequency signals are used instead of radiation
 Can distinguished between normal and abnormal tissues than CT scan
 Can characterized pulmonary nodules , to help stage bronchogenic carcinoma
(assessment of chest wall invasion), acute PE, and chronic thrombolytic pulmonary
hypertension
 Contraindicated to morbid obesity, claustrophobia, confusion, agitation, and having
implanted metal or metal support device
 Contrast agent is used (gadolinium based contrast)

Nursing Interventions
 Patient should be on NPO, If MRI will use dye or contrast- nausea and vomiting are
effects of the contrast
 Instruct the client to remove all metals items in the body
 Assess patient for presence of implanted devices such as cardiac peace
maker/defibrillator
 Inform patient to lie flat and remain still for 30-90 minutes
 Notify the patient that he/she will hear a loud humming or thumping noise. Ear plugs
should be offered to minimize the noise
 Give anti-anxiety drugs as ordered if patients who experience claustrophobia

PULMONARY ANGIOGRAPHY
 Is used to investigate congenital abnormalities of the pulmonary vascular tree or clinical
suspicious PE
 to visualize the pulmonary vessels a radiopaque agent is injected to a catheter via jugular,
subclavian, brachial or femoral vein and then threaded into the pulmonary artery.
 Contraindications:
a. Allergy to radiopaque isotope dye, pregnancy, bleeding abnormalities, where potential
complications include acute kidney injury, acidosis, cardiac dysrhythmias, and bleeding

NURSING INTERVENTIONS
 Obtain consent
 Assess for allergies to radiopaque (Iodine, shellfish)
 Assess anticoagulation status and renal function
 NPO 6-8 hours
 Administer pre- procedure medications anti-anxiety drugs, secretion reducing agent (Atropine
Sulfate) and anti-histamine.
 Inform that patient my feel warm flushing sensation or chest pain during the injection of the dye
 After the procedure, monitor VS, vascular access site for bleeding or hematoma
 Perform assessment of neurovascular status
LUNG SCAN
 Several types of lung scan- 1. V/Q scan, 2. gallium scan, 3. Positron Emission Tomography
(PET)
 Are performed to assess normal lung functioning, pulmonary vascular supply, and gas
exchange
 Following injection of radioisotope (are used as tracers for diagnostic purposes), scans are taken
with a scintillation camera.
 Measures the blood perfusion through the lungs
 Confirms pulmonary embolism and other blood flow abnormalities
 Instruct the client to remain still during the procedure

V/Q Scan
 Is performed by injecting a radioactive agent into a peripheral vein and then obtaining a scan of
the chest to detect radiation
 The isotope particles pass through the right side of the heart and distributed into the lungs in
proportion to the regional blood flow and measures the blood perfusion through the lungs
 Is used clinically to measure the integrity of pulmonary vessels and to evaluate blood flow
abnormalities as seen in PE
 Imaging time is 20-40 minutes during which the patient lies under the camera with a mask fitted
over the nose and the mouth.
 This is followed by the Ventilation component of the scan. Patient takes a deep breath of a
mixture of oxygen and radioactive gas which diffuses into the lungs. As scan is perform to detect
ventilation abnormalities
 It help to diagnose bronchitis, asthma, inflammatory fibrosis, Pneumonia, Emphysema and Cance

Gallium Scan
 A radio isotope lung scan that can detect inflammatory conditions, abscesses, adhesions and the
presence, location and size of the tumor
 It is used to stage the bronchogenic cancer and to detect tumor regression after chemotherapy or
radiation
 Gallium is injected intravenously and scans are obtained at interval (6, 24,and 48 hours) to
evaluate gallium uptake by the pulmonary tissues.

PET
 Is used to evaluate lung nodules for malignancy
 Can detect normal tissue form disease tissue (cancer)
 Differentiate viable from dead or dying tissue
 More accurate in detecting malignancy than CT
 Has equivalent accuracy in detecting malignant nodules when compared to thoracoscopy

Nursing Interventions
 Inform patient that intravenous access is required
 Sometimes enema is prescribed prior to gallium scan to decreased its uptake in the GI tract
 Chest X ray is perform prior to V/Q scanning
 V/Q and Gallium scans require only a small amount of radioisotope, radiation safety measures ae
not indicated
 Patient may eat or drink prior to V/Q or gallium scan
PET
 Avoid caffeine, alcohol and tobacco for 24 hours prior to PET and NPO for 4 hours prior to scan
 Empty the bladder
 Increased fluid intake after the procedure to excrete the radioisotopes in the urine
ENDOSCOPIC PROCEDURES
 Includes bronchoscopy, thoracoscopy and thoracentesis

BRONCHOSCOPY
 Direct inspection and observation of the larynx, trachea, and bronchi using flexible fiberoptic
bronchoscope or rigid bronchoscope

USES:
 To visualize tissues and determine the nature, location and extent of pathologic process
 To collect secretions for analysis
 To determine pathologic process and collect specimen for biopsy
 To remove aspirated foreign object and excise small lesions.
 To determine whether a tumor can be resected surgically
 To diagnose sources of hemoptysis and control bleeding
 To treat post operative atelectasis
 To insert stent to relieve airway obstruction caused by tumors

Fiberoptic bronchoscope
 a thin flexible bronchoscope that can be directed into the segmental bronchi
 it allows increased visualization of the peripheral airways and ideal for diagnosing pulmonary
lessions
 allows biopsy and can be performed at the bedside. It can also be performed through endotracheal
or tracheostomy tubes of patients on ventilators
 cytologic examinations can be performed without surgical intervention

Rigid Bronchoscope
 a hollow metal tube with a light ta its end
 it is used for removing foreign substances and investigating the source of hemoptysis
 it is performed in the operating room

Possible Complications
 local anesthetic reaction, over sedation, prolong fever, infection, aspiration, laryngospasm,
bronchospasm, hypoxemia, pneumothorax and bleeding.

Nursing Intervention before the Procedure

 Informed consent. Invasive procedure

 NPO 6-8 hrs. To prevent aspiration.
 Atropine sulphate -drying agents and valium as ordered to lessen anxiety
 Remove dentures prostheses and contact lenses. To prevent airway obstruction.
 Topical anesthesia sprayed in the throat followed by local anesthesia in the larynx

Nursing intervention after Procedure

 NPO until gag or cough reflex returns- sedation and local anesthesia impair the laryngeal reflex
and swallowing. Offer ice chips and small amount of fluids once cough reflex returns
 Side lying position- to promote drainage of secretions from the mouth
 Check for cough and gag reflex before giving fluid. To prevent aspiration
  Prepare suction device at the bedside
 Assess confusion and lethargy due to effects of sedation and anesthesia
 Small amount of blood in the sputum and fever is expected
 Report any sign of SOB or bleeding immediately
 Watch for cyanosis, hypotension, tachycardia, arrhythmias, dyspnea and hemoptysis. And notify
the physician. These are signs of perforation of bronchial tree

THORACOSCOPY
 Examination of the pleural cavity with an endoscope and fluid and tissues can be obtained for
analysis
 Indicated in diagnostic evaluation and treatment of pleural effusions, pleural disease and tumour
staging

Procedure
 Done in operating room under anesthesia
 Small incisions are made into the pleural cavity in an ICS
 The fiberoptic mediastinoscope is inserted into the pleural cavity and inspected through the
instrument
 After the procedure, a chest tube is inserted to facilitate lung expansion

Nursing Interventions
Pre Op
 Informed consent
 NPO
Post Op
 Monitor VS, pain level
 Look for signs of bleeding and infection on the incision site
 Observe for SOB may indicate Pneumothorax

THORACENTESIS
 Aspiration of fluid or air from the pleural space
 Instillation of medication in the pleural space
 Fluids can be examine for gram stain, C and S, acid fast staining, cytology, totalprotein, glucose,
triglycirides

Nursing Interventions Before the procedure

 Secure written consent- invasive
 Take V/S- aspiration of air/fluid from the pleural space cause Hypovolemic shock
 Position: upright, leaning on the over bed table/Sitting position
 Topical anesthesia is used at the site of needle insertion
 Pressure sensation is felt on insertion site

Nursing interventions Post Procedure

 Apply pressure to the puncture site
 Turn the client on the unaffected side. To prevent leakage of fluid in the thoracic cavity
 Bed rest. To prevent postural hypotension
 Check for expectoration of blood. Notify the doctor. Indicates trauma to the lung
 Monitor for complications:
 Shock, Pneumothorax, and Respiratory arrest
BIOPSY
 The excision of small amount of tissue to permit examination of cells form the upper and lower
respiratory structures and adjacent to lymph nodes.
 Local, topical moderate sedation or general anaesthesia maybe given
Pleural Biopsy
 It is accomplished by needle biopsy of the pleura, thoracoscopy, pleuroscopy, or through
fiberoptic pleuroscope inserted into the pleural space or thoracotomy
 Is done when there is exudate or where there is a need to culture the tissue to identify tuberculosis
or fungi

LUNG BIOPSY
 To obtain lung tissue for examinations such as cancer and infection

Non-Surgical Lung Biopsy Techniques

TRANSBRONCHIAL BRUSHING
 A fiberoptic bronchoscope is introduced into the bronchus under fluoroscopy
 A small brush attached to the end of the flexible wire is inserted to the bronchoscope.
 The area under suspicion is brushed back and forth causing the cells to slough off and adhere to
the brush

Transbronchial Needle aspiration

 A catheter with a needle is inserted into the lung tissue through bronchoscope and aspirated

Transbronchial Lung Biopsy

 Cutting forceps are introduced by a fiberoptic bronchoscope to excise the tissue

Percutaneous needle biopsy

 A cutting needle or spinal type needle is used to obtain a tissue specimen for histologic study
under the guidance of fluoroscopy or CT
 The skin over the biopsy site is anesthetized and small incision is made
 The biopsy needle is inserted through the incision into the pleura with the patient holding his
breath in midexpiration. The surgeon guides the needle into the periphery of the lesion and obtain
a sample tissue from the mass.

Nursing Interventions
 Monitor SOB, bleeding, infection
 Advised the patient to report SOB bleeding, pus and redness of the biopsy site

LYMP NODE BIOPSY-

 Scalene node biopsy is done to assess the spread of pulmonary disease to the lymph nodes
and to established a diagnosis or prognosis in such diseases such Carcinoma, lymphoma,
sarcoidosis and tuberculosis.

PROCEDURE

Mediastinoscopy
 is the endoscopic examination of the mediastinum for exploration and biopsy of mediastinal
lymph node
 this require a suprasternal incision
  it is carried out to detect mediastinal involvement of pulmonary malignancy

Anterior Mediastinoscopy
 an incision is made in the area of the second or third costal cartilage. The mediastinum is
explored and biopsies are performed on any lymph nodes found
 Chest drainage is required after the procedure

Nursing Intervention

Pre Op

 obtain consent
 clean the site for biopsy
 VS monitored
 Provide O2 as necessary

Post Op
 Provide O2
 Monitor bleeding
 Provide pain relief
 Chest drainage may remove
 Monitor for changes in respiratory status