Diagnostic studies and therapies

Skin test: Mantoux test

✔ PPD (Purified Protein Derivative)
✔ Intradermal
✔ Read 48 to 72 hours after injection
✔ (+) Mantoux test is induration of 10 mm or more
✔ For HIV positive clients, induration of 5 mm is considered positive
✔ (+) Mantoux test signifies exposure to Mycobacterium tubercle bacilli

Chest x-ray
✔ Practice the client on how to hold his breath and to do deep breathing
✔ Instruct the client to remove metals from the chest
 Fluoroscopy
✔ Studies the lung and chest in motion

Bronchography
✔ A radiopaque medium is instilled directly into the trachea and bronchi and the entire
bronchial tree or selected areas may be visualized through x-ray.
✔ Nursing interventions before bronchography
• Secure written consent
• Check for allergies to seafoods or iodine or anesthesia
• NPO for 6 to 8 hours
• Pre-op meds: atropine SO4 and valium, topical anesthesia sprayed; followed by local
anesthetic injected into larynx
• Have oxygen and antispasmodic agents ready
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✔ Nursing interventions after bronchography
• Side lying position
• NPO until cough and gag reflexes return
• Cough and deep breathe client
• Low grade fever common

Bronchoscopy
✔ The direct inspection and observation of the larynx, trachea and bronchi through a
flexible or rigid bronchoscope
✔ Diagnostic uses
✔ To collect secretions
✔ To determine location of pathologic process and collect specimen for biopsy
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✔ Therapeutic uses
• Remove foreign objects
• Excise lesions

✔ Nursing intervention before bronchoscopy

• Informed consent
• Atropine and valium pre-procedure; topical anesthesia sprayed followed by local
anesthetic injected into larynx
• NPO for 6 to 8 hours
• Remove dentures, prostheses, contact lenses
✔ Nursing interventions after bronchoscopy
• Side lying position
• Check for the return of cough and gag reflexes before giving fluid per orem.
• Watch for cyanosis, hypotension, tachycardia, arrhythmias, hemoptysis, dyspnea

Lung scan
✔ Following injection of radioisotope, scans are taken with a scintillation camera, measure
blood perfusion through the lungs, confirm pulmonary embolism or other blood flow
abnormalities
• Remain still during the procedure
Sputum examination
✔ Gross appearance
✔ Sputum Culture and Sensitivity
✔ Acid Fast Bacilli staining
✔ Cytologic examination/Papanicolaou examination
✔ Nursing intervention for sputum examination
• Early morning sputum specimen is to be collected
• Rinse mouth with plain water
• Use sterile container
• Sputum specimen for C and S is collected before the first dose of antimicrobial
• For AFB staining , collect sputum specimen for 3 consecutive mornings
Biopsy of lung
✔ Transbronschopic biopsy - done during bronchoscopy
✔ Percutaneous needle biopsy
✔ Open lung biopsy

Lymph node biopsy

✔ Scalene or cervicomediastinal
• To assess metastasis of lung cancer
Pulmonary function studies
✔ Vital capacity - the maximum volume of air that can be exhaled after a maximum
inhalation - reduced in COPD
✔ Tidal volume - the volume of air inhaled and exhaled with normal quiet breathing
✔ Inspiratory reserve volume - the maximum volume that can be inhaled following a normal
quiet exhalation
✔ Expiratory reserve volume - the maximum volume that can be exhaled following a normal
quiet inhalation
✔ Functional residual capacity - the volume of air that remains in the lungs after normal
quiet inhalation
✔ Residual volume - the volume of air that remains in the lungs after forceful exhalation.
Arterial Blood Gas Studies
✔ Purpose, to assess ventilation and acid -base balance
✔ Radial artery is the common site for withdrawal of blood specimen
✔ Allen’s test is done to assess for adequacy of collateral circulation of the hand
✔ 10 ml pre-heparinized syringe
Thoracentesis
✔ Aspiration of fluid or air from the pleural space
✔ Nursing intervention before thoracentesis
• Secure consent
• Take initial VS
• Position - upright leaning on overbed table
• Instruct to remain still, avoid coughing during insertion of needle
• Pressure sensation is felt on insertion of needle
✔ Nursing intervention after thoracentesis
• Turn on the affected side (to prevent leakage of fluid in the thoracic cavity)
• Bed rest until VS is stable
• Check for the expectoration of blood , notify the physician
• Monitor VS