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Prepare Bronchoscopy
page 64-66
By
Arif Muttaqin
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Bronchoscopy
• Bronchoscopy examination conducted by passing
a bronchoscope into the trachea and bronchus.
• Bronchoscopy performed to diagnose also manage the
circumstances in tracheo-bronchial branching.
• Diagnostic purposes include the visualization of the
source of hemoptysis; detect the cause
of wheezing atelectasis local sources, caused
by an obstruction, and to take an examination and
inspection of material damage in patients who
are intubated trachea.
• Indications include the treatment of patients who
experienced flushing excess secretions, foreign
body retrieval, drainage of lung abscess, and retrieval
of food particles on aspiration pneumonia.
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The purpose of
diagnostic bronchoscopy
1. To check the network or collect secretions.
2. To determine the location and extent of the
pathology and to obtain a sample / tissue
samples in order to establish the diagnosis (by
forceps biopsy, curettage, the brush biopsy).
3. To determine whether a tumor is resect able or
not surgically.
4. To diagnose the bleeding (haemoptysiss
ource).
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Rigid bronchoscope
• (Figure 2-19) is a hollow
metal tube with a light at the
tip; bronchoscope is
used primarily to remove a
foreign body, sucking a
very thick secretions, resear
ching the source of
massive hemoptysis, endob
ronchial or peform surgical
procedures.
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Fiberoptic bronchoscope
• Fiberoptic bronchoscope (Figure 2-20) is
better tolerated by patients compared
to the rigid
bronchoscope, allowing tumor biopsies tha
t were previously not achievable, safe to
use for severely ill patients, and can be
done in bed or through the
endotracheal tube.
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Nursing Interventions.
• Letter of permission (informed consent)
• Deferred gift of food and fluids for 6 hours before the
examination to reduce the risk of aspiration
• If the patient has additional tools, such
as dentures will need to be released first.
• Sedative drug administration collaborated
• Patient education
• After the procedure, patient sfasted until
the cough reflex recovered because
of sedation and local anesthesia praoperatif that
damage the protective laryngeal reflex and
swallowing for a few hours.
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PREPARE
Thoracentesis
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Description
• Thoracentesis (also
known
as thoracocentesis
or pleural tap) is an
invasive procedure to
remove fluid or air fro
m the pleural
space for diagnostic
or therapeutic
purposes. A cannula,
or hollow needle, is
carefully introduced
into the thorax,
generally after
administration of local
anesthesia.
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• Thin layer of pleural
fluid normally remain contained in
the pleural cavity.
• Samples of this fluid can be
obtained via thoracotomy
torasentesis or with a
hose. Torakosentesis is the aspiration of
pleural
fluid for diagnostic and therapeutic purpos
es.
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Indications
• This procedure is indicated when unexplained fluid
accumulates in the chest cavity outside the lung. In more
than 90% of cases analysis of pleural fluid yields
clinically useful information. If a large amount of fluid is
present, then this procedure can also be used
therapeutically to remove that fluid and improve patient
comfort and lung function.
• The most common causes of pleural effusions
arecancer, congestive heart failure, pneumonia, and
recent surgery. In countries where tuberculosis is
common, this is also a common cause of pleural
effusions.
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Prepare
• Informed consent
• Education
• VS
• Privacy
• Get the standard thoracentesis kit
• The patient is positioned as shown
in Fig 2-22.

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Prepare Sputum Taking
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Sputum examination
• Sputum was
collected for examination to identify pathogenic
organisms and to determine whether there
are malignant cells or not. Also likely be
used to assess the sensitivity of the situation(where
there is an increase in eosinophils). Sputum examination
may be required periodically to patients
receiving antibiotics,
corticosteroids, and immunosuppressive medication for a
long
time, because these preparations can cause opportunisti
c infections. Generally used in diagnosing sputum
culture, drug sensitivity examination, and as treatment
guidelines.
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Sputum Taking
• If sputum can not be expelled spontaneously, clients
are often stimulated
to cough in a highly attractive aerosol saturated saline,
propylene glycol is an irritant or other agents provided by
ultrasonic nebulizer.
• Other methods of collecting specimens including
endotracheal aspiration, disposal with bronchoscopy, bro
nchial brushing, transtrakeal aspiration, and aspiration
of the stomach,usually for tuberculosis organisms.
• Generally, the deeper specimens obtained in the
morning.
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Sputum 24 hours
• For quantitative examination, the patient is given a
special container for the issue. These containers are
weighed at the end of 24 hours, and the number
and character of the contents recorded and described.
• Specimens like these are treated as a dangerous
biological materials and disposed of in an appropriate
manner.
• To prevent odors, all sputum containers covered.
• Napkins are very smelly mouth discarded and notice the
room is well ventilated. Oral hygiene is often
a nursing priority for clients.
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Lung biopsy

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Definition
• Lung biopsy is a procedure for obtaining a
small sample of lung tissue for
examination. The tissue is usually
examined under a microscope, and may
be sent to a microbiological laboratory for
culture. Microscopic examination is
performed by a pathologist.
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Purpose
• A lung biopsy is usually performed to determine the
cause of abnormalities, such as nodules that appear on
chest x rays. It can confirm a diagnosis of cancer,
especially if malignant cells are detected in the patient's
sputum or bronchial washing. In addition to evaluating
lung tumors and their associated symptoms, lung
biopsies may be used to diagnose lung infections,
especially tuberculosis and Pneumocystis pneumonia,
drug reactions, and chronic diseases of the lungs such
as sarcoidosis and pulmonary fibrosis.
• A lung biopsy can be used for treatment as well as
diagnosis. Bronchoscopy , a type of lung biopsy
performed with a long, flexible slender instrument called
a bronchoscope, can be used to clear a patient's air
passages of secretions and to remove airway blockages.
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Types of lung biopsies
• BRONCHOSCOPIC BIOPSY. During the bronchoscopy, a thin,
lighted tube (bronchoscope) is passed from the nose or mouth,
down the windpipe (trachea) to the air passages (bronchi) leading to
the lungs. Through the bronchoscope, 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. He or she sits in a chair with arms
folded in front on a table. An x ray technician uses a computerized
axial tomography (CAT) scanner or a fluoroscope to identify the
precise location of the suspicious areas. Markers are placed on the
overlying skin to identify the biopsy site. The skin is thoroughly
cleansed with an antiseptic solution, and a local anesthetic is
injected to numb the area. The patient will feel a brief stinging
sensation when the anesthetic is injected.
• PEN BIOPSY. Open biopsies are performed in a hospital operating
room under general anesthesia. Once the anesthesia has taken
effect, the surgeon makes an incision over the lung area, a
procedure called a thoracotomy .
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Preparation
• During a preoperative appointment, usually scheduled within one to
two weeks before the procedure, the patient receives information
about what to expect during the procedure and the recovery period.
A chest x ray or CAT scan of the chest is used to identify the area to
be biopsied.
• About an hour before the biopsy procedure, the patient receives a
sedative. Medication may also be given to dry up airway secretions.
• For at least 12 hours before the open biopsy the patient should not
eat or drink anything
Patients who will undergo surgical diagnostic and treatment
procedures should be encouraged to stop smoking and stop using
tobacco products. The patient needs to make the commitment to be
a nonsmoker after the procedure.
• Informed consent
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Aftercare
• Needle biopsy
– Following a needle biopsy, the patient is allowed to
rest comfortably. He or she may be required to lie flat
for two hours following the procedure to prevent the
risk of bleeding.
– The nurse checks the patient's status at two-hour
intervals. If there are no complications after four
hours, the patient can go home once he or she has
received instructions about resuming normal
activities.
– The patient should rest at home for a day or two
before returning to regular activities, and should avoid
strenuous activities for one week after the biopsy.
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Aftercare
• Bronchoscopic biopsy
– Bronchoscopy is generally safe, and complications
are rare. If they do occur, complications may include
spasms of the bronchial tubes that can impair
breathing, irregular heart rhythms, or infections such
as pneumonia
• Needle biopsy
– Needle biopsy is associated with fewer risks than
open biopsy because it does not involve general
anesthesia. Some hemoptysis (coughing up blood)
occurs in 5% of needle biopsies. Prolonged bleeding
or infection may also occur, although these are very
rare complications.