Diagnostic Tests

1-PULMONARY FUNCTION TESTS (PFTS)

•HE L P T H E P H Y S I C I A N F U R T H E R E VA L U A T E T H E L U N G S .
•HELP IN DETERMINING THE PRESENCE OF PULMONARY DISEASE,
A B N O R M A L I T Y O F L U N G F U N C T I O N , E X T E N T O F A B N O R M A L I T Y, A N D
A P P R O P R I AT E T R E AT M E N T.

•B ODY BOX ………

•D EFINITIONS ………
2- Arterial blood gases (ABGs) ………
3- Pulse oximetry ………
4- Chest X-Ray: Often illustrates the cause of
respiratory dysfunction, and may reveal
abnormalities when there are no signs or symptoms
of pulmonary disease.
CXR studies may be taken:
 1- as part of routine screening procedures.
 2- when pulmonary disease is suspected.
 3- to monitor the status of respiratory disorders.
Routine adult CXR studies are taken with the adult client
sitting or standing facing the X-Ray film. The radiograph
is taken at full inspiration, and the X-Ray penetrates
from the posterior (posteroanterior or PA position).
For clients unable to be transported to the radiology
department, a portable CXR is taken, with the film placed
behind the client and the X-Ray beam penetrates from
the front of the chest (anteroposterior or AP position).
A lateral view is taken from either the right or left side of
the chest. The arms are raised above the head and the
side of the chest is placed against the film.
5- CT ……
6- MRI ……
7- CBC ……
8- Sputum culture: To identify microorganisms and
their sensitivity to antibiotics. Nursing implications
include:
 1. Providing information about the test.
 2. Use sterile technique.
 3. Obtain an early morning specimen.
• 4. If client is unable to cough, obtain an order for suction.
9- Throat culture: Performed to determine the
presence of pathogenic microorganisms and identify
the antibiotics to which they are sensitive. Nursing
implications include:
 1. Providing information about the test.
 2. Passing swab along reddened areas and exudate in the
pharyngeal region.
 3. positioning client upright and leaning slightly forward to
minimize gag reflex.
10- Endoscopy:
 a. Laryngoscopy ……
 b. Bronchoscopy: Is direct visualization of trachea and bronchial
tree. Can be therapeutic, e.g. to remove mucus plugs or foreign
bodies, or diagnostic to obtain a biopsy.
 Prior to the procedure nursing implications include:
 1. Providing information about the test.
 2. Keeping client NPO for 6 – 8 hours.
 3. Administering pre-procedure medications (if ordered).
 During the procedure, the client lies supine with head
hyperextended. The nurse should monitor vital signs and assist the
physician. Vital signs should also be monitored after the procedure.
Local anesthetic is sprayed at the back of the mouth.
After the procedure, observe the client for signs of
respiratory distress such as dyspnea, use of accessory
muscles, abnormal breath sounds. Lung sounds should
be monitored for 24 hours after the procedure.
Inspect expectorated secretions for hemoptysis
(hemoptysis and hoarseness are normal a few hours
after the procedure. Inform physician if they persist).
NPO till swallow, cough, and gag reflex return (1 – 2
hours after the procedure).
 11- Thoracentesis: Is the drainage of fluid or air from the pleural cavity or
space. Procedure during which the pleural cavity is entered and fluid is
withdrawn.
 Diagnostic thoracentesis is performed to determine the cause of an infection.
Therapeutic thoracentesis is done to remove an accumulation of pleural fluid
or air that has caused lung compression and respiratory distress.

 Before the procedure (bedside) the patient is prepared and positioned. Arms
are raised and crossed, and head rests on folded arms (usually on the bedside
table). This position widens the spaces between the ribs to permit easier
access to the pleural space, thus avoiding injury to adjacent structures,
especially the diaphragm.

 The actual site for needle insertion differs in each patient, depending on the
site of the effusion. Instruct the patient to lie STILL during the procedure.
 Nursing interventions before the procedure include …….. . The
procedure is performed using a local anesthetic.
 During the procedure the nurse assists the physician and
maintains a sterile field. The client is observed for alterations in
pulse or respiratory rate, changes in skin color, or dyspnea.
 After the procedure the nurse should apply a pressure dressing
and position the patient on the unaffected side to facilitate lung
expansion.
 Continue monitoring vital signs.
 Report any tachypnea, dyspnea, cyanosis as these may be signs
of pneumothorax. Urgent chest X-Ray has to be performed.
 12- BIOPSY: may be taken from various respiratory tissues
for assessment; may also be performed during
bronchoscopy.
 Pleural biopsies may be performed surgically through a
small thoracotomy incision or during thoracentesis. Needle
biopsy is a simple diagnostic procedure used to determine
the cause of pleural effusion. The needle removes a small
fragment of pleura, which is used for examination and
culture.
 Preparing and positioning the patient for pleural biopsy is
similar to that of thoracentesis.
 Complications include:
 1. Pain
due to nerve injury.
 2. Pneumothorax.

 3. Hemothorax.

 Nursing interventions:
 1. After the procedure observe for complications such as dyspnea, excessive
pain, --- .
 2. have chest tube equipment ready because of the possibility of pnemothorax.

 As with pleural biopsy, lung biopsy may be done by surgical exposure of the
lung or using a needle to remove a specimen of lung tissue, which is then
examine d for abnormality or bacteria. Lung biopsies are most often done to
identify pulmonary tumors .
 Physical Examination: Actually begins during history
taking as the nurse observes the client and his response to
questions. Signs of respiratory distress are noted
(tachypnea, dyspnea, cyanosis, open mouth, flared nostrils,
…). The nurse notes how many sentences the client can say
without taking a breath.
 Physical examination includes inspection, palpation,
percussion, and auscultation. Inspection and palpation are
often performed together.
 Auscultation for breath sounds ……. .
Chest movement is observed during respiration.
Normal RR is 12 – 22 breaths / minute. Rate is
observed for depth of expansion and rhythm.
Use of accessory muscles and symmetry is noted.
Clubbing …… .