DIAGNOSTIC EVALUATION

The respiratory system is vital part of human body

Diagnostic test in respiratory system are mainly divided into:
• Invasive test
• Non-invasive test
Diagnostic tests are performed to find problems as early as possible

NON-INVASIVE DIAGNOSTIC PROCEDURES

PULMONARY FUNCTION TEST

• Pulmonary function tests (PFTs) are noninvasive tests that show how well the lungs are working.
• This information can help your healthcare provider diagnose and decide the treatment of certain lung disorder.
• There are two types of disorders that cause problems with air moving in and out of the lungs: Obstructive and Restrictive

ABG STUDIES
• An arterial blood gas (ABG) test measures oxygen and carbon dioxide levels in your blood. It also measures your body’s acid base (pH) level, which is
usually in balance when you’re healthy.
• The test gives your doctor clues about how well your lungs, heart, and kidneys are working. Every cell in your body needs oxygen to live.
• When you breathe in (inhale) and breathe out (exhale), your lungs move oxygen into your blood and push carbon dioxide out.
PFT can be done with two methods. These two methods may be used together and perform different tests, depending on the information that your healthcare
provider is looking for:
• Spirometry a spirometer is a device with a mouthpiece hooked up to a small electronic machine.
• Plethysmography you sit or stand inside an air tight box that looks like a short, square telephone booth to do the tests.

PULSE OXIMETRY
Pulse oximetry is a test used to measure the oxygen level (oxygen saturation) of the blood. It is an easy, painless measure of how well oxygen is being sent to
parts of your body furthest from your heart, such as the arms and legs. Pulse oximetry is also used to check the health of a person with any condition that affects
blood oxygen levels.

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

SPUTUM STUDIES
A specimen obtained by expectoration or tracheal suctioning to assist in the identification of organisms or abnormal cells.
PRE PROCEDURE POST PROCEDURE
 a. Determine specific purpose of collection and check with a. Transport specimen to laboratory STAT.
institutional policy for appropriate collection of specimen. b. Assist the client with mouth care.
b. Obtain an early morning sterile specimen from suctioning or
expectoration after a respiratory treatment, if a treatment is
prescribed.
c. Instruct the client to rinse the mouth with water before
collection.
d. Instruct the client to take several deep breaths and then
cough deeply to obtain sputum.
e. Always collect the specimen before client begins antibiotic
therapy.

SPUTUM SPECIMEN
• The sample can be collected either by expectoration or by bronchial or tracheal aspiration.
• The sputum may also be tested for gram stain, AFB stain etc.

RADIOLOGICAL IMAGING
• X RAY
• CT SCAN
• MRI (Magnetic resonance imaging)
• PULMONARY ANGIOGRAPHY
• LUNG SCAN- PET SCAN, GALLIUM SCAN, VENTILATION/PERFUSION(V/Q) SCAN

CHEST XRAY NURSING INTERVENTION:

• Used to identify abnormalities in chest structure and lung
tissue
• Done to detect information, effusion, foreign body
• It determines degree of air entry to lungs
• It checks response of patient to treatment
CT SCAN (COMPUTERIZED TOMOGRAPHY)
• Usually taken after deep breathing
• All metallic objects like jewelry should be removed before doing x-ray
• • Pregnancy should be ruled out before the test
NURSING INTERVENTION:

• CT scan is an imaging method in which the lungs are • Informed consent needs to be taken before the procedure.
scanned in by a narrow-beam x-ray. The produced images • H/O (history of) sensitivity to sea foods or iodine needs to be taken.
provide clear vision of lungs • • Renal function test is done before contrast administration.
• Shows major contrast between body densities, such as
bones, soft organs
• Lungs are scanned in successive layers by narrow beam
 Xray.
• The images provide a cross sectional view of the chest.
• • Can define pulmonary nodules and small tumours that
are not visible on X ray.
MRI (MAGNETIC RESONANCE IMAGING) NURSING INTERVENTION:

• It is similar to X ray except that magnetic fields and • Assess for any metallic implants (such as pacemaker, pacemaker wires, or
radiofrequency signals are used. implant).
• It visualizes soft tissues. • • Test will not be performed if present.
• It can be used to stage bronchogenic carcinoma.
• • Evaluate inflammatory activity in interstitial lung
disease.
PULMONARY ANGIOGRAPHY NURSING INTERVENTION:

• It is an X-ray of the blood vessels that supply the lungs. It is • Informed consent needs to be taken before the procedure.
used to find a blood clot, also called a pulmonary embolism, • H/O sensitivity to sea foods or iodine needs to be taken.
in these blood vessels. • Renal function test is done before contrast administration.
• It involves rapid injection of radio opaque agent into • Coagulation profile of the patient is checked before & after the
vasculature into vasculature of lungs to study pulmonary procedure.
vessels • • Monitor injection site and pulses distal to the site after the test.
• A catheter is inserted into the brachial or femoral artery
and dye is injected
• ECG is applied to the chest for cardiac monitoring
• Images of the lungs are taken
LUNG SCAN NURSING INTERVENTION:
A. PET SCAN POSITRON EMISSION TOMOGRAPHY
• Informed consent required
• Used to examine the lungs • No alcohol, coffee, or tobacco is allowed for 24 hours prior to the test.
• Latest technology and minimum radiation to patients • Encourage increased fluid intake post-test to help eliminate the
• It is a radio isotope study to evaluate lung nodules for radioactive material.
malignancy.
• It can distinguish normal tissue from diseased tissue.
• • It is more accurate in determining malignancy
than CT.
b. GALLIUM SCAN NURSING INTERVENTION:

Is a radio isotope scan to detect inflammatory conditions, abscesses, • Renal function test is done before the test.
adhesions, location and size of tumor. • Encourage increased fluid intake after the test.
VENTILATION/PERFUSION (V/Q) SCAN NURSING INTERVENTION:
 Is an imaging test that uses a ventilation (V) scan to measure air flow in
your lungs and a perfusion (Q) scan to see where blood flows in your
lungs. It uses special x ray scanners outside of your body to create
pictures of air and blood flow patterns in your lungs.
Invasive Diagnostic Procedures
ENDOSCOPY PROCEDURES
BRONCHOSCOPY
• A bronchoscopy is the direct visualization of the larynx,
trachea, and bronchi through a bronchoscope to identify
lesions, remove foreign bodies and secretions, obtain
tissue for biopsy, and improve tracheobronchial drainage
• • During the test, a catheter brush or biopsy forceps
can be passed to obtain secretions or tissue for
examination for cancer.
• A perfusion scan is performed by injecting radioactive albumin into a vein
and scanning the lungs.
• A ventilation scan is performed by scanning the lungs while the person
inhales radioactive gas. With a mask over the nose and mouth, the patient
breathes the gas while sitting or lying on the table beneath the scanner
arm.
• Renal function test is done before the test.
• • Encourage increased fluid intake after the test.
NURSING MANAGEMENT:
Before Test
• Provide routine preoperative care as ordered. Bronchoscopy
is an invasive procedure requiring conscious sedation or
anesthesia.
• Obtain informed consent
• Coagulation profile may be checked
• Provide mouth care just prior to bronchoscopy. Mouth care
reduces oral microorganisms and the risk of introducing
them into the lungs
• Bring resuscitation and suction equipment to the bedside.
Laryngospasm and respiratory distress may occur following
the procedure
After Test
• Provide an emesis basin and tissues for expectorating
sputum and saliva. Until reflexes have returned, the client
may be unable to swallow sputum and saliva safely.
• Monitor color and character of respiratory secretions.
Secretions normally are blood tinged for several hours
following bronchoscopy, especially if biopsy has been
obtained.
• Before discharge assess for the return of gag reflex.
• Notify the physician if sputum is grossly bloody. Grossly
bloody sputum may indicate a complication such as

THORACOSCOPY
• It is a diagnostic procedure in which the pleural cavity is
examined with a endoscope.
• It is indicated in diagnostic evaluation of pleural effusion,
pleural diseases etc.
• Patient is constantly monitored for shortness of breath which
may indicate pneumothorax
THORACENTESIS
• It is the aspiration of fluid or air from the pleural space.
• Purposes include
• Aspiration of pleural fluid for analysis. • Pleural biopsy.
• Instillation of medication into the pleural space.
• Position- sitting on edge of bed with the feet supported and
arms kept on a overbed table or Lying on unaffected side with
head end of bed elevated to 30-45 degrees.
perforation.
• Closely monitor vital signs and respiratory status.
• Possible complications of bronchoscopy include
laryngospasm, bronchospasm, bronchial perforation with
possible pneumothorax or subcutaneous emphysema,
hemorrhage, hypoxia, pneumonia or bacteremia, and
cardiac stress.
• Instruct to avoid eating or drinking for approximately 2
hours or until fully awake with intact cough and gag reflexes.
Suppression of the cough and gag reflexes by systemic and
local anesthesia used during the procedure increase the risk
for aspiration.
NURSING MANAGEMENT:
• The patient may have a diagnostic procedure, such as a
chest x- ray, chest fluoroscopy, ultrasound, or CT scan,
performed prior to the procedure to assist the physician in
identifying the specific location of the fluid in the chest that
is to be removed.
• The patient may receive a sedative prior to the procedure to
help the patient relax.
• Asked the patient to remove any clothing, jewelry, or other
objects that may interfere with the procedure.
• The area around the puncture site may be shaved.
• Vital signs (heart rate, blood pressure, breathing rate, and
oxygen level) are to be monitored before the procedure.
BEFORE THE PROCEDURE
• Check the doctor’s order.
• Identify the client.
• Asked patient to sign a consent form. Inform that she will be
 experiencing mild pain on the site where the needle was
pricked
• Inform the client that the procedure takes only few minutes,
depending primarily on the time it takes for fluid to drain
from the pleural cavity.
• Inform the client not to cough while the needle is inserted in
order to avoid puncturing the lung
• Explain when and where the procedure will occur and who
will be present.

During the Procedure

• Support the client verbally and describe the steps of the
procedure as needed.
• Vital signs (heart rate, blood pressure, breathing rate, and
oxygen level) are to be monitored during the procedure.
• The patient may receive supplemental oxygen as needed,
through a face mask or nasal cannula (tube).
• Observe the client for signs of distress, such as dyspnea,
pallor, and coughing
• Place the patient in a sitting position with arms raised and
resting on an overbed table. This position aids in spreading
out the spaces between the ribs for needle insertion. If the
patient is unable to sit, the patient may be placed in a side-
lying position on the edge of the bed on unaffected side.
• The skin at the puncture site will be cleansed with an
antiseptic solution.
• The patient will receive a local anesthetic at the site where
the thoracentesis is to be performed.
• Place a small sterile dressing over the site of the puncture.

After the Procedure

• Observe changes in the client’s cough, sputum, respiratory
depth, and breath sounds, & note complaints of chest pain.
• Position the client appropriately
• Make client lie on the unaffected side with the head of the
bed elevated 30 degrees for at least 30 minutes because this
position facilitates expansion of the affected lung and eases
respirations
• Transport the specimens to the laboratory.
• The dressing over the puncture site will be monitored for
 bleeding or other drainage.
• Monitor patient’s blood pressure, pulse, and breathing until
are stable.
• Document all relevant information. Include date and time
performed; the primary care provider’s name; the amount,
color, and clarity of fluid drained; and nursing assessments
and interventions provided.
BIOPSY NURSING MANAGEMENT BEFORE BIOPSY:

PLEURAL BIOPSY • A chest x ray or CT scan of the chest is used to identify the area
to be biopsied.
• Done by needle biopsy of pleura or by pleuroscopy.
• About an hour before the biopsy procedure, the patient
• Purpose- to examine pleural exudate of undetermined origin. receives a sedative. Medication may also be given to dry up
• For culture and gram staining of pleural fluid.  airway secretions.
• For at least 12 hours before the biopsy, the patient should not
LUNG BIOPSY eat or drink anything.
• To obtain lung tissue for examination when Xray findings are • Prior to these procedures, an intravenous line is placed in a
inconclusive. vein in the patient's arm to deliver medications or fluids as
necessary.
• For cytological evaluation of lung lesion.
• Informed consent must be taken
• For identification of pathogenic organism. • Bring resuscitation and suction equipment to the bedside.
• It is done under sedation. Laryngospasm and respiratory distress may occur following the
procedure.
LYMPH NODE BIOPSY
• The scalene lymph nodes over the scalenus anterior muscle AFTER BIOPSY:
may show histopathological changes from intra thoracic
disease. • Closely monitor vital signs and respiratory status.
• It helps in diagnosis or prognosis of sarcoidosis, tuberculosis, • A chest XRAY may be done.
• Monitor for complications- laryngospasm, bronchospasm,
carcinoma bronchial perforation etc
• Monitor color and character of respiratory secretions. Notify
OPEN BIOPSY the physician if sputum is grossly bloody. Grossly bloody
• The surgeon makes an incision over the lung area, a sputum may indicate a complication such as perforation.
procedure called thoracotomy. • The patient should rest at home for a day or two before
• Some lung tissue is removed and the incision is closed with returning to regular activities, and should avoid strenuous
sutures. Chest tubes are placed. activities for one week after the biopsy.
• A chest x ray is performed

BRONCHO-SCOPIC BIOPSY
• During the bronchoscopy, the physician views the airways,
and is able to clear mucus from blocked airways, and collect
cells or tissue samples for laboratory analysis.
 NEEDLE BIOPSY
• The patient is mildly sedated, but awake during the needle
biopsy procedure.
• The patient is asked to take a deep breath and hold it while
the physician inserts the biopsy needle through the incision
into the lung

NURSING PROCESS OF PATIENT WITH UPPER AIRWAY INFECTION

A health history may reveal signs and symptoms of headache, sore throat, pain around the eyes and on either side of the nose, difficulty in swallowing, cough,
hoarseness, fever, stuffiness, and generalized discomfort and fatigue. It also is important to determine any history of allergy or the existence of a concomitant
illness.

Inspection may reveal swelling, lesions, or asymmetry of the nose as well as bleeding or discharge. Inspects the nasal mucosa for abnormal findings such as
increased redness, swelling, or exudate, and nasal polyps, which may develop in chronic rhinitis.

Palpate the frontal and maxillary sinuses for tenderness, which suggests inflammation, and then inspects the throat by having the patient open the mouth wide
and take a deep breath. The tonsils and pharynx are inspected for abnormal findings such as redness, asymmetry, or evidence of drainage, ulceration, or
enlargement.

Palpate the trachea to determine the midline position in the neck and to detect any masses or deformities. The neck lymph nodes also are palpated for
associated enlargement and tenderness.

DIAGNOSIS PLANNING AND GOALS NURSING INTERVENTIONS EVALUATION

▪ Ineffective airway The major goals for the MAINTAINING A PATENT AIRWAY
clearance related to patient may include ▪ An accumulation of secretions can block
excessive mucus maintenance of a patent the airway in patients with an upper
production secondary to airway, relief of pain, airway infection. As a result, changes in
retained secretions and maintenance of effective the respiratory pattern occur, and the
inflammation means of communication, work of breathing required to get beyond
▪ Acute pain related to normal hydration, knowledge the blockage increases. The nurse can
upper airway irritation of how to prevent upper implement several measures to loosen
secondary to an airway infections, and absence thick secretions or to keep the secretions
infection of complications. moist so that they can be easily
▪ Impaired verbal expectorated.
communication related ▪ Increasing fluid intake helps thin the
to physiologic changes mucus. Use of room vaporizers or steam
and upper airway inhalation also loosens secretions and
 irritation secondary to
infection or swelling
▪ Deficient fluid volume
related to increased fluid
loss sec-notary to
diaphoresis associated
with a fever
▪ Deficient knowledge
regarding prevention of
upper respiratory
infections, treatment
regimen, surgical PROMOTING COMFORT
procedure, or ▪ Upper respiratory tract infections usually
postoperative care
▪ Other helpful measures include topical
▪ Nurses can in-structs the patient in
reduces inflammation of the mucous
membranes. To enhance drainage from
the sinuses. We can instruct the patient
about the best position to assume; this
depends on the location of the infection
or inflammation. For example, drainage
for sinusitis or rhinitis is achieved in the
upright position. In some conditions,
topical or systemic medications, when
prescribed, help to relieve nasal or throat
congestion.
produce localized dis-comfort. In sinusitis,
pain may occur in the area of the sinuses
or may produce a general headache. In
pharyngitis, laryngitis, or tonsillitis, a sore
throat occurs. The nurse encourages the
patient to take analgesics, such as
acetaminophen with codeine, as pre-
scribed, which will help relieve this
discomfort.
anesthetic agents for symptomatic relief
of herpes simplex blisters and sore
throats, hot packs to relieve the
congestion of sinusitis and promote
drainage, and warm water gargles or
irrigations to relieve the pain of a sore
throat. We can encourage rest to relieve
the generalized dis-comfort and fever that
accompany many upper airway conditions
(especially rhinitis, pharyngitis, and
laryngitis).
general hygiene techniques to prevent
the spread of infection. For postoperative
care following tonsillectomy and
adenoidectomy, an ice collar may reduce
swelling and decrease bleeding
PROMOTING COMMUNICATION
▪ Upper airway infections may result in
hoarseness or loss of speech. The nurse
instructs the patient to refrain from
speaking as much as possible and to
communicate in writing instead, if
possible. Additional strain on the vocal
cords may delay full return of the voice.
ENCOURAGING FLUID INTAKE
▪ In upper airway infections, the work of
breathing and the respiratory rate
increase as inflammation and secretions
develop. This, in turn, may increase
insensible fluid loss. Fever further
increases the metabolic rate, diaphoresis,
and fluid loss.
▪ Sore throat, malaise, and fever may
interfere with a patient’s willingness to
eat. The nurse encourages the patient to
drink 2 to 3 L of fluid per day during the
acute stage of airway infection, un-less
contraindicated, to thin secretions and
promote drainage. Liquids (hot or cold)
may be soothing, depending on the
illness.