RESPIRATORY PROBLEMS
Diagnostic Studies:
• Oximetry à pulse ox
o SpO2: indicates the O2 sat of Hgb as measured by pulse oximetry
§ Normal à 94-99%
o Factors influencing the reading:
§ HR/rhythm
§ Motion
§ Low perfusion
§ Anemia
§ Cold extremities
§ Thick acrylic nails/ nail polish
§ Dark skin
o When in doubt of the reading à obtain ABG analysis to verify values
• Arterial blood gases (ABG's)
o Arterial blood specimen
o Assesses:
§ Acid-base balance
§ Ventilation status
§ Need/change for oxygen therapy
§ Change in ventilator seings • Pull syringe to 2mL à fills itself
o Nursing responsibilities: • Blood should be bright red
§ Assist with position à palm up – stick into radial artery
§ Heparinized syringe à keeps blood from cloing
§ Pressure 5' post procedure
§ Blood to lab usually on ice immediately
§ Need to perform Allen test à make sure there is good blood supply in artery
• Hold the radial and ulnar arteries at the same time
• Release the ulnar
• Skin should return pink = good flow
• CO2 monitoring:
o CO2 can be monitored using transcutaneous CO2 and end-tidal CO2 capnography
o Noninvasive method of estimating pressure of CO2
o Previously mainly used in surgery and postop
o Now useful in diagnostics for assessing ventilation status
§ Quicker reading of CO2 level
§ Used for patients that are on a PCA pump
• Put on while intubating
• Shows you are in lungs not esophagus
• Transcutaneous Gold at gold= lungs
o gold :
In
, • Sputum/ skin
o Sputum:
§ Culture, sensitivity (see what is growing), cytology, gram stain, AFB
§ Observe à color, volume, viscosity, blood
§ Obtained à expectant, tracheal suctioning, bronchoscopy
• Best time is in the morning
• Need pt to cough à use incentive spirometer
o Skin:
§ TB or fungi that can lead to respiratory disorders
§ Allergies
§ Must be done timely and correctly to avoid false results
• Radiology:
o Chest X-ray
§ Used to screen, diagnose, and evaluate changes
§ Have patient remove any jewelry from neck to waist
• Shows fluid in the lungs à outline should be black not gray or white
o Computed tomography:
§ Diagnoses lesions difficult to assess by X-ray
§ Post procedure push fluids for flushing dye à dye is hard on kidneys
§ Lay flat, still hard table, may hear clicking noises, may feel warmth and flushing à may feel like pee
§ CTA= gold standard for PE
§ Why it's done…
• Study more closely finding on XR or inconclusive XR à check
BUN/creatinine d/t dye load
• Allergies to shellfish or iodine-based dyes
o Magnetic resonance imaging (MRI)
§ Used for dx of lesions difficult to assess by CT
§ Distinguishes vascular from nonvascular structures
§ Why it's done…
• More in depth look at structure à arteries/vascular vs. nonvascular
differentials
§ Ask à metal fragments, implanted devices, metal stents, ortho hardware, checklist
prior to procedure
• Have you done any welding or grinding?
• Are you claustrophobic? à need to give meds to sedate
• Endoscopy:
o Bronchoscopy: flexible fiberoptic scope
§ Diagnosis
§ Biopsy
§ Specimen collection
§ Assessment of changes
§ Lavage
§ Foreign body removal
§ Mucous plug removal
o Place stents, laser therapy, electrocautery
Diagnostic Studies:
• Oximetry à pulse ox
o SpO2: indicates the O2 sat of Hgb as measured by pulse oximetry
§ Normal à 94-99%
o Factors influencing the reading:
§ HR/rhythm
§ Motion
§ Low perfusion
§ Anemia
§ Cold extremities
§ Thick acrylic nails/ nail polish
§ Dark skin
o When in doubt of the reading à obtain ABG analysis to verify values
• Arterial blood gases (ABG's)
o Arterial blood specimen
o Assesses:
§ Acid-base balance
§ Ventilation status
§ Need/change for oxygen therapy
§ Change in ventilator seings • Pull syringe to 2mL à fills itself
o Nursing responsibilities: • Blood should be bright red
§ Assist with position à palm up – stick into radial artery
§ Heparinized syringe à keeps blood from cloing
§ Pressure 5' post procedure
§ Blood to lab usually on ice immediately
§ Need to perform Allen test à make sure there is good blood supply in artery
• Hold the radial and ulnar arteries at the same time
• Release the ulnar
• Skin should return pink = good flow
• CO2 monitoring:
o CO2 can be monitored using transcutaneous CO2 and end-tidal CO2 capnography
o Noninvasive method of estimating pressure of CO2
o Previously mainly used in surgery and postop
o Now useful in diagnostics for assessing ventilation status
§ Quicker reading of CO2 level
§ Used for patients that are on a PCA pump
• Put on while intubating
• Shows you are in lungs not esophagus
• Transcutaneous Gold at gold= lungs
o gold :
In
, • Sputum/ skin
o Sputum:
§ Culture, sensitivity (see what is growing), cytology, gram stain, AFB
§ Observe à color, volume, viscosity, blood
§ Obtained à expectant, tracheal suctioning, bronchoscopy
• Best time is in the morning
• Need pt to cough à use incentive spirometer
o Skin:
§ TB or fungi that can lead to respiratory disorders
§ Allergies
§ Must be done timely and correctly to avoid false results
• Radiology:
o Chest X-ray
§ Used to screen, diagnose, and evaluate changes
§ Have patient remove any jewelry from neck to waist
• Shows fluid in the lungs à outline should be black not gray or white
o Computed tomography:
§ Diagnoses lesions difficult to assess by X-ray
§ Post procedure push fluids for flushing dye à dye is hard on kidneys
§ Lay flat, still hard table, may hear clicking noises, may feel warmth and flushing à may feel like pee
§ CTA= gold standard for PE
§ Why it's done…
• Study more closely finding on XR or inconclusive XR à check
BUN/creatinine d/t dye load
• Allergies to shellfish or iodine-based dyes
o Magnetic resonance imaging (MRI)
§ Used for dx of lesions difficult to assess by CT
§ Distinguishes vascular from nonvascular structures
§ Why it's done…
• More in depth look at structure à arteries/vascular vs. nonvascular
differentials
§ Ask à metal fragments, implanted devices, metal stents, ortho hardware, checklist
prior to procedure
• Have you done any welding or grinding?
• Are you claustrophobic? à need to give meds to sedate
• Endoscopy:
o Bronchoscopy: flexible fiberoptic scope
§ Diagnosis
§ Biopsy
§ Specimen collection
§ Assessment of changes
§ Lavage
§ Foreign body removal
§ Mucous plug removal
o Place stents, laser therapy, electrocautery
