laboratory and diagnostic procedures part1
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TRANSCRIPT
REDUCTION OF RISK POTENTIAL:
LABORATORY AND DIAGNOSTIC PROCEDURES
Mr. Jaime R. Soriano. RN. RM.
OBJECTIVES OF THE SEMINAR
To identify different laboratory and diagnostic procedures according to body system.
To describe the appropriate preparation, teaching, and post test management for patients who are undergoing diagnostic and laboratory testing
DIAGNOSTIC AND LABORATORY PROCEDURES
1. Indications and Purposes2. Pre-test Preparation3. What will the patient feel?4. Post-test Management5. Nursing Considerations
NERVOUS SYSTEM
Skull and Spinal X-rayLumbar Puncture
CT ScanMRI
Electroencephalography
SKULL X-RAY
Radiographs of the skull:izehapeuture separationome calcificationhows erosion and fracture
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SKULL X-RAY
SPINAL X-RAYSpinal radiographs:
bnormal spine and dislocationone degenerationompressioneformed curvaturerosionracture
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SPINAL X-RAY
SKULL AND SPINAL X-RAY
-clude metal items from body parts
-eassure nursing support-ccurate documentation if
with thick and heavy hair
-ou immobilize
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LUMBAR PUNCTURE
LUMBAR PUNCTURE
Insertion of a spinal needle through the L3-L4
interspace into the lumbar subarachnoid space to
obtain cerebrospinal fluid, measure CSF fluid or
pressure, or instill air, dye, or medications.
LUMBAR PUNCTUREDIAGNOSTIC• Suspected meningitis• Subarachnoid hemorrhage• Hydrocephalus• Benign Intracranial hypertensionTHERAPEUTIC• Spinal anesthesia• Chemotherapy
LUMBAR PUNCTURE
CONTRAINDICATIONS
-coliosis-CP unidentified-oagulopathy-yphosis
SSIICCKK
LUMBAR PUNCTUREPRETEST
orm of informed consent
ree of urine bladderetal position
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LUMBAR PUNCTURE
INTRATEST
hrimp or Fetal positionpecimens to be collected terile vials- 4trict asepsis
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LUMBAR PUNCTUREPOSTTESTlat 12-24 hrsor vital signs and LOC
monitoringorce fluid unless
contraindicateduncture site for bleeding, CSF
leakageerform CMS assessment
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LUMBAR PUNCTURE
COMPLICATIONSpinal Headache
-lat-luids-ain Management
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CT SCANScans the following in
successive layers by a narrow beam of x-rays:
ngiogramelly and Pelvichest’ heartxtremities
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CT SCAN
CT SCANPRETEST:ssess allergies to iodine and seafoodse sure to obtain informed consentonscious sedation for claustrophobiao remove jewelries and hair pinsxplain hot flushed sensation and metallic
taste in the mouth when dye is injectedluids and hydrationive instruction to lie supine with small pillow
under the headold if pregnantt takes 20 minutes
ABCDE
FG
HI
CT SCANPOSTTEST:llergic reaction checke sure to replace fluidMSistal pulse checkxtremity color checkind bleeding and hematoma
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MRI
-RI is nonivasive-eveals types of tissue,
tumors and vscular abnormalities
-s similar to CT scan
MMRR
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MRI
MRIPRETEST-etal objects must be removed-ssess for ineligibility and contraindications-ive instruction to lie supine with small pillow
under the head-ormal audible humming, thumbing, grating, or
knocking sounds-ncourage conscious sedation for
claustrophobia-akes 45 to 60 minutes-nformed consent-ompletely enclosed in scanner
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MRIPOSTTEST
Resume normal activitiesFluids and hydration
MRIIneligible to undergo MRI:• Automatic Internal Defibrillator• Cerebral Aneurysm Clip• Cochlear Implant• Hip Replacement• Knee Replacement• Non-removable dental prosthesis• Pacemaker• Prosthetic Valve Replacement• Soldiers
EEG
EEG• graphic recording of electrical activity
of the brain by several small electrodes placed on the scalp
To diagnose:bnormal firing of electrical activityrain tumorsertain psychiatric disordersegenerative disordersnflammation of brain and spinal cord
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EEGPRETEST
ash the client’s hairssure that electrodes will not
cause electric shocktimulants and depressants
avoided for 24 to 48 hoursypoglycemia prevention, do not
omit breastfeeding
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EEGPOSTTEST
Wash the client’s hairMaintain side rails and safety
precaution, if the client was sedated
EEG
Sleep Deprivation EEG
CARDIOVASCULAR SYSTEMElectrolytes
Coagulation StudiesErythrocyte Studies
White Blood Cell CountSerum Enzymes and Cardiac Markers
Serum LipidsECGCVP
Pericardiocentesis
ELECTROLYTES
SODIUM-bsorbed from the small intestine
and excreted in the urine in amounts dependents dependent on dietary intake
-ustains osmotic pressure and acid base balance
-s major extracellular cation-ormal daily requirement is 15 mEq
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ELECTROLYTES
SODIUM
Nursing Consideration:• Drawing blood samples
soon after an intravenous infusion of sodium chloride will increase the level, producing an inaccurate result.
ELECTROLYTES
POTASSIUM-romote cellular water balance,
electrical conduction in muscle cells, and acid base balance
-btains K through dietary ingestion and the kidneys preserve or excrete K
-o evaluate cardiac, renal, and gastrointestinal function
- major intracellular cation
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ELECTROLYTES
POTASSIUMNursing Consideration:-ccurate note if the patient is
receiving K supplement-lood should not be drawn from site
where an IV infusion exists-lenching and unclenching of hand
can increase the level-o identify elevated WBC and
platelet counts
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ELECTROLYTESCHLORIDE
-ighly abundant body anion in the extracellular fluid
-ounterbalance cations and buffer
-ets digestion and maintenance of osmotic pressure and water balance
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ELECTROLYTES
CHLORIDENursing Consideration:-raw blood from an extremity that does
not have normal saline infusing into it
-o not allow the client to clench and unclench his or her hand before drawing blood
-iarrhea and prolong vomiting will alter cholride results
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ELECTROLYTES
MAGNESIUM
lotting mechanismontrols neuromuscular activityofactor that modifies activity
of many enzymesalcium metabolism
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ELECTROLYTES
MAGNESIUMNursing Consideration:-rolong use of magnesium
products will cause increased serum levels
-arenteral nutrition therapy or excessive loss of body fluids may decrease serum levels
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ELECTROLYTESCALCIUM
-one formation-n conversion of prothrombin
to thrombin-ransmission of nerve impulse-n contraction ok skeletal and
myocardial muscles
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ELECTROLYTES
CALCIUMNursing Consideration:Instruct the client to eat a diet
with a normal calcium level (800 mg/day) for 3 days before the test.
Instruct the client that fasting may be required for 8 hours before the test
COAGULATION STUDIESACTIVATED PARTIAL
THROMBOPLASTIN TIME (APTT)-mount of time it takes in seconds for
recalcified plasma to clot after partial thromboplastin is added
-erformed for patient receiving heparin-est for deficiencies and inhibitors of
clotting factors-ime: 20 to 36 seconds
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COAGULATION STUDIESACTIVATED PARTIAL THROMBOPLASTIN
TIME (APTT)Nursing Consideration:-spirate blood sample 1 hour before next
scheduled heparin dose-erform blood exraction from arm into which
heparin is not infusing-ransport specimen to the laboratory
immediately-ime: 1.5 to 2.5 times normal if on heparin
therapy
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COAGULATION STUDIESPROTHROMBIN TIME (PT) and
INTERNATIONAL NORMALIZED RATIO (INR)
-rothrombin is a vitamin K dependent glycoprotein produced by the liver for fibrin clot formation
-o monitor response to warfarin sodium (Coumadin)
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COAGULATION STUDIESPROTHROMBIN TIME (PT) and
INTERNATIONAL NORMALIZED RATIO (INR)
Normal Values:PT:
– 9.6 to 11.8 secs (male)– 9.5 to 11.3 secs (female)
INR:– 2.0 to 3.0 (standard warfarin tx)– 3.0 to 4.5 (high dose warfarin tx)
COAGULATION STUDIESPROTHROMBIN TIME (PT) and
INTERNATIONAL NORMALIZED RATIO (INR)
Nursing Considerations:- baseline PT should be drawn before anticoagulation
therapy-e sure to apply direct pressure to the venipuncture site-oncurrent warfarin therapy with heparin therapy can
lengthen the PT-iets high in green leafy vegetables can shorten PT-xpect 1.5 to 2 times longer PT if on anticoagulation therapy-or PT greater than 30 secs, initiate bleeding precautions
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COAGULATION STUDIESCLOTTING TIME
-lient should not receive heparin 3 hours before specimen collection
-ong on any anticoagulation therapy
-n thrombocytopenia-ime: 8 to 15 minutes
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COAGULATION STUDIESPLATELET COUNT
Plug formationClot retractionCoagulation factor
activation
COAGULATION STUDIESPLATELET COUNT 150T – 400T
cells/mm3
• <PLT – thrombocytopenia (risk for bleeding)
• >PLT – thrombocytosis (risk for clot) – prophylaxis of Anicoagulant - Lovenox
COAGULATION STUDIESPLATELET COUNT
Nursing Considerations:B-leeding precautions should be
instituted in clients with low platelet
M-onitor venipuncture siteC-hronic cold weather, high altitudes,
and exercise increase platelet count
ERYTHROCYTE STUDIES
ERYTHROCYTE SEDIMENTATION RATE (ESR)- 0 to 30 mm/hr
ndirectly measures how much inflammation is in the body.
pecial preparations not needed, but fatty meal may cause plasma alterations
ate at which erythrocytes settle out of anticoagulated blood in 1 hour
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ERYTHROCYTE STUDIES
RED BLOOD CELLSRED BLOOD CELLS
-esults in the delivery of oxygen to the body tissues
-lood diseases diagnosis-irculate for 120 days and are removed
from the blood via the liver, spleen, and bone marrow
-pecial preparation not needed
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ERYTHROCYTE STUDIES
RED BLOOD CELLS 4.5-5.5 million/mm3
• <RBC – Anemia (Faitgue, SOB)• >RBC – Polycythemia
(erythrocytosis) – management phlebotomy
ERYTHROCYTE STUDIES
HEMOGLOBIN and HEMATOCRITHemoglobin is the main component
of erythrocytes and serves as the vehicle for transporting O2 and CO2
Normal Values:– 14 to 16.5 g/dl (male)– 12 to 15 g/dl (female)
ERYTHROCYTE STUDIES
HEMOGLOBIN and HEMATOCRITHematocrit represents red blood cell
mass and is an important measurement in the identification of anemia or polycythemia
Normal Values:– 42% to 52% (male)– 35% to 47% (female)
WHITE BLOOD CELL COUNT
WHITE BLOOD CELLWHITE BLOOD CELLImmune defense system of the body
WBC 5,000-10,000 cells/mm3– <WBC – leukopenia (risk for
infection)– >WBC – leukocytosis
(infection/inflammation)– >100,000 – incapable of
phagocytosis (leukemia)
WHITE BLOOD CELL COUNT
WHITE BLOOD CELLWHITE BLOOD CELLNursing Consideration:SHIFT TO THE LEFT: increased number of
immature neutrophils is present on the blood
SHIFT TO THE RIGHT: cells have more than usual number of nuclear segments, found in liver disease, Down syndrome, pernicious anemia, and megaloblastic anemia
CARDIAC MARKERS
CREATINE KINASE (CK)
Found in:CK-MB (Cardiac)--- 0% to 5%CK-BB (Brain)--- 0%CK-MM (Muscles)--- 95% to 100%
CARDIAC MARKERS
CREATINE KINASE (CK)
R: 6 hoursP: 18 hoursN: 2 to 3 days
CARDIAC MARKERS
CREATINE KINASE (CK)Nursing Considerations:CK-MM: Avoid strenuous physical
activity for 24 hours before the testAvoid ingestion of alcohol for 24 hours
before the testInvasive procedures and intramuscular
injections may falsely elevate CK levels
CARDIAC MARKERS
LACTASE DEHYDROGENASE (LDH)
R: 24 hoursP: 48 to 72 hoursN: 7 to 14 days
CARDIAC MARKERS
LACTASE DEHYDROGENASE (LDH)
Nursing Considerations:LDH isoenzyme levels should
be interpreted in view of the clinical findings
Testing should be repeated on 3 consecutive days
CARDIAC MARKERS
TROPONIN
- and I-egulatory protein found in
striated muscle-n bloodstream when an
infarction causes damage to the myocardium
TTRR
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CARDIAC MARKERS
TROPONIN I>1.5 ng/ml… MI
R: 3 hoursN: 7 to 10 days
CARDIAC MARKERS
TROPONIN T>0.1 to 0.2 ng/ml… MI
R: 3 hoursN: 7 to 14 days
CARDIAC MARKERS
TROPONIN
Nursing Considerations:Testing is repeated in 12
hours, followed by daily testing for 3 to 5 days.
Rotate venipuncture sites.
CARDIAC MARKERS
MYOGLOBIN
Oxygen-binding protein found in striated muscle that releases oxygen at very low tensions
Injury to skeletal muscle will cause a release of myoglobin into the blood
CARDIAC MARKERS
MYOGLOBIN >90 mcg/L… MI
R: 1 to 2 hoursP: 4 to 6 hoursN: 24 to 36 hours
SERUM LIPIDS
Total Cholesterol--- 140 to 199 mg/dl
Low Density Lipoprotein (LDL)--- <130 mg/dl
High Density Lipoprotein (HDL)--- 30 to 70 mg/dl
Triglycerides--- < 200 mg/dl
SERUM LIPIDS
Nursing Considerations:
o oral contraceptivesPO except water for 12 to 14
hourso alcohol for 24 hourso high cholesterol foods the
evening meal before the test
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ECG-valuates heart rate and the
regularity of heartbeats. -ardiac dysrhythmias, MI,
and cardiac hypertrophy- raph of the electrical
impulses moving through the heart.
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ECGNursing Consideration:-lectrical shock will not occur-ardiac medications of the
patient should be documented-ive instructions to lie still,
breathe normally, and refrain from talking during the test
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BASIC ECG INTERPRETATIONNormal Sinus Rhythym
Sinus TachycardiaSinus BradycardiaAtrial TachycardiaAtrial Fibrillation
Atrial FlutterVentricular TachycardiaVentricular Fibrillation
Asystole
STANDARD LEAD PLACEMENTPRECORDIAL LEADS
White: Right ArmBlack: Left ArmGreen: Right LegRed: Left Leg
STANDARD LEAD PLACEMENTLIMBS LEADS
BASIC ECG INTERPRETATION
BASIC ECG INTERPRETATION
• P WAVE: Atrial depolarization• PR INTERVAL: AV conduction time• QRS COMPLEX: Ventricular
depolarization• ST SEGMENT: Time interval
between complete depolarization of ventricles and repolarization of ventricles
• T WAVE: Ventricular repolarization
NORMAL CARDIAC RHYTHM PARAMETERS
• NORMAL SINUS RHYTHM: 60 TO 100 bpm
• SINUS BRADYCARDIA: <60 bpm• SINUS TACHYCARDIA: >100 bpm• QRS WIDTH: 0.08 to 0.12 sec• PR INTERVAL: 0.12 to 0.20 sec• QT INTERVAL: 0.30 to 0.40 sec
FIGURING HEART RATE
1. 1500 method2. RR method3. 6-second method
FIGURING HEART RATE
1. 1500 method
FIGURING HEART RATE
2. RR method
FIGURING HEART RATE
3. 6-second method
NORMAL SINUS RHYTHM
Rate Rhythm P Waves P-R QRS60 to 100 Regular Present 0.12 to
0.20 secs0.08 tp
0.12 secs
SINUS TACHYCARDIA
Rate Rhythm P Waves P-R QRS>100 BPM Regular Present 0.12 to
0.20 secs0.08 to
0.12 secs
SINUS BRADYCARDIA
Rate Rhythm P Waves P-R QRS<60 BPM Regular Present 0.12 to
0.20 secs0.08 to
0.12 secs
ATRIAL TACHYCARDIA
Rate Rhythm P Waves P-R QRS150 to 250
bpmRegular Present Short
<0.12 0.08 to
0.12 secs
ATRIAL FIBRILLATION
Rate Rhythm P Waves P-R QRSVariable Irregularly-
IrregularAbsent Non-
discernibleNarrow
ATRIAL FLUTTER
Rate Rhythm P Waves P-R QRS250 to 350
bpmUsually regular
Sawtooth pattern
Non- discernible
Usuallynarrow
VENTRICULAR TACHYCARDIA
Rate Rhythm P Waves P-R QRS100 TO 220
BPMUsually regular
Absent NA Wide>0.12 sec
VENTRICULAR FIBRILLATION
Rate Rhythm P Waves P-R QRS350 TO
450BPMCompletely chaotic and disorganized
Absent NA Absent
ASYSTOLE
Rate Rhythm P Waves P-R QRSNo Rate No Rhythm Absent NA Absent
CVP-atheter is attached to an IV
infusion and H2O manometer by a three way stopcock
-eins external jugular, antecubital, or femoral
- ressure within the superior vena cava
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CVPNormal Value: 3 to 8 mmHgPosition:Cardiac Disease: Semi Fowler’sDressing or Tubing Change: Flat or
TrendelenburgCVP Reading and Monitoring: Flat,
Supine, or Dorsal RecumbentAir Embolism: Left Side Lying
CVP
1. Maintain zero point of manometer always at level of right atrium (intersection between midaxillary line and 4th ICS, also referred to as the phlebostatic axis)
2. Determine patency of catheter by opening IV infusion line
3. Turn stopcock to allow IV solution to run into manometer to a level of 10-20cm above expected pressure reading
4. Turn stopcock to allow IV solution to flow from manometer into catheter; fluid level in manometer fluctuates with respiration
5. Stop ventilatory assistance during measurement of CVP
6. After CVP reading, return stopcock to IV infusion position
7. Record CVP reading and position of client (angle of recline)
PERICARDIOCENTESIS
ericardial effusionunctureericardial sacericardial fluid
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PERICARDIOCENTESIS
PREPROCEDURE
erform blood analysisCGestriction of food and water is
recommended for six hours before the test.
V line for sedation
PPEERR
II
PERICARDIOCENTESISINTRAPROCEDUREvail emergency resuscitative
equipment at bedsideed is elevated to 45 to 60
degreesardiac activity monitoringone in emergency room, ICU,
or at the bedside
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PERICARDIOCENTESISPOSTPROCEDURE
pical pulse monitoringlood pressureVPetect complications:
Ventricular or coronary artery puncture, dysrhythmias, pleural laceration, gastric puncture, myocardial trauma
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RESPIRATORY SYSTEMChest X-ray
Sputum SpecimenBronchoscopyThoracentesisLung BiopsyABG Analysis
Incentive SpirometerPeak Flow Meter
CHEST X-RAY
A-natomyA-natomyA-ppearance A-ppearance
CHEST X-RAYPREPROCEDURE:emove all jewelry and other metal
objects from the chest areassess the client’s ability to inhale
and hold his or her breathou question women regarding
pregnancy or possibility of pregnancy
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CHEST X-RAY
POSTPROCEDURE:Help the client get dressed
SPUTUM SPECIMENpecimen thru
expectorationuctioning of the
tracheaputum amount: 15
ml
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SPUTUM SPECIMENPREPROCEDURE:-lways collect the specimen
before antibiotic therapy-e sure that the client rinse
mouth with water-lient to take several deep
breaths and then cough deeply
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SPUTUM SPECIMEN
POSTPROCEDURE:
If a culture of sputum is prescribed, transport the specimen to the laboratory immediately
Assist the client with mouth care
BRONCHOSCOPYTo visualize:
LL BBTTarynx rachea ronchi
BRONCHOSCOPY
BRONCHOSCOPY
Purposes:-pply medications-rush biopsy-arefully remove
foreign objects-irect visualization
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BRONCHOSCOPYPREPROCEDURE:tain informed consentemove dentures or eyeglassesbtain vital signsPO postmidnightoagulation studies result must be checkedave emergency resuscitation equipment
readily vailable give IVF and medication for sedationuction equipment at bedside
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BRONCHOSCOPYPOSTPROCEDURE:ag reflex return ssess for bloody sputumive instruction that sore throat is commonespiratory status must be monitoredmesis basin at bedsideowler’s semi positionook out for complications like
bronchospasm or bronchial perforationlevated temperature and DOB- Notify!amine vital signs
GGAAGGRREEFFLL
EEXX
THORACENTESIS
Insertion of a needle through the chest wall:
• Obtain specimen• Remove pleural fluid
accumulation• Instill medication
THORACENTESIS
THORACENTESISPREPROCEDURE:o obtain informed consentealth teaching: not cough, breathe deeply, or
move during the testn doctor's office, in the X-ray department, ER,
OR or at bedsideidden on bed: Sidelying towards the unaffected
side with HOB elevatedmbulatory: Sit upright with arms and shoulders
supported by a table-ray or ultrasound before the procedure
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THORACENTESIS
POSTPROCEDURE:Monitor vital signsMonitor respiratory statusApply a pressure dressing Assess the puncture site for bleeding
and crepitusMonitor for signs of pneumothorax,
air embolism, and pulmonary edema
LUNG BIOPSYCC-ulture
CC-ytological exam
PP-ulmonary lesion
PP-leural effusion
LUNG BIOPSYPREPROCEDURE:-et the patient signs informed
consent-se of local anesthesia, pressure
during insertion of needle-PO-ive analgesics and sedatives as
prescribed
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LUNG BIOPSYPOSTPROCEDURE:-ital signs must be monitored-nspect biopsy site for drainage or
bleeding-n biopsy site dressing must be applied-neumothorax and air embolism-igns of respiratory distress must be
monitored-ou prepare the patient for chest x-ray
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ABG ANALYSISMeasurementOxygenCarbon dioxideArterial bloodAcid base state
ABG ANALYSISPREPROCEDURE:-llen’s test before drawing
radial artery specimens-efore specimen collection,
client to rest for 30 minutes-iving suction before drawing
ABG sample is avoided
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ABG ANALYSIS
POSTPROCEDURE:Place the specimen on iceNote the client’s temperature
on the laboratory formNote the oxygen and type of
ventilation that the client is receiving on the laboratory form
ABG ANALYSIS
POSTPROCEDURE:Apply pressure to the puncture
site for 5 to 10 minutes or longer if the client is taking anticoagulant therapy or has a bleeding disorder
Transport the specimen to the laboratory within 15 minutes
ABG ANALYSIS
Normal Arterial Blood Gas Values:
pH 7.35 to 7.45
PCO2 35 to 45 mmHg
HCO3 22 to 26 mmHg
PO2 80 to 100 mmHg
O2 sat 96% to 100 %
ABG ANALYSIS
R-espiratory O-ppositeM-etabolicE-qual
INCENTIVE SPIROMETERSustainedMaximalInspiration
INCENTIVE SPIROMETER
INCENTIVE SPIROMETERINDICATIONS:Upper-abdominal surgeryThoracic surgerySurgery in patients with chronic
obstructive pulmonary disease Pulmonary atelectasisPresence of a restrictive lung defect
associated with quadraplegia and/or dysfunctional diaphragm.
INCENTIVE SPIROMETERNursing ConsiderationsPREPROCEDURE-void smoking or eating heavy meal for 4
to 6 hours before the test-e sure to remove dentures-onsult with the physician regarding
holding bronchodilators before testing-etermine whether analgesic that may
depress the respiratory function is being administered
-ncourage to void and wear loose clothing
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INCENTIVE SPIROMETERNursing Considerations
POSTPROCEDURE
Resume:• Diet• Bronchodilators• Respiratory treatments
PEAK FLOW METER
determines the effectivity of bronchodilator for asthmatic patients
PEAK FLOW METERManagement:1. Diary2. Weeks period that the child is
well3. BlowsResults:GREEN: 80 to 100%... Very GoodYELLOW: 50 to 80%... Beginning
AttackRED: <50%... Bring to ER