| A | B |
|---|
| Pulse Oximetry 95% or higher Pulse oximetry is a noninvasive test used to evaluate and monitor oxygen saturation (SaO2,the percentage of arterial hemoglobin that is combined with oxygen) of blood. The sensor evaluates oxygen saturation by measuring the amount of red and infrared light absorbed by hemoglobin. | sensor is applied to a fingertip, the forehead, nose, or earlobe in adults (see Figure 21-8). Lower SaO2 values indicate impaired lung ventilation and/or gas exchange. Promptly report values of 90% or lower. |
| Arterial Blood Gases pH 7.35–7.45 PaCO2 35–45 mm Hg PaO2 75–100 mm Hg HCO3 24–28 mEq/L Base excess (BE) +2 to – 2 mEq/L Arterial blood gases are used to assess acid–base imbalances caused by a respiratory or a metabolic disorder.The PaCO2 reflects air movement into and out of the alveoli.The PaO2 shows how much oxygen is available to combine with hemoglobin and be transported to the cells.The HCO3 and BE are used to evaluate bicarbonate, the major buffer in the blood. | Apply pressure to the site for at least 5 minutes after arterial puncture. Arteries are high-pressure vessels that may bleed into the tissue after puncture. Promptly report ABG results to the charge nurse or physician, particularly when values are abnormal or outside of the expected range for the client. |
| Serum Alpha1- Antitrypsin ( 1AT) 78–200 mg/dL (0.78–2.0 g/L) Alpha1-antitrypsin levels are used to determine whether a deficiency of this protein may have caused emphysema and COPD. Inflammatory processes, exercise, and oral contraceptives increase blood levels. | Food and fluids (except water) are restricted for 8 hours before the test. Oral contraceptives are held for 24 hours before testing.Note the name of the oral contraceptive on the lab slip. |
| Sputum Studies Culture and sensitivity (C&S) Gram stain No pathogens present Culture and sensitivity testing is done on a single sputum specimen to identify the infecting organism and to help determine which antibiotic will eradicate it. Gram stain may be used to rapidly identify organisms by their staining qualities (gram-positive or gram-negative). | f possible, collect the specimen in the early morning. Use Universal or Standard Precautions and sterile technique when collecting the specimen. If the client is unable to produce sputum, an induced sputum specimen may be ordered.The client inhales a saline mist, which stimulates a cough. Clearly label the specimen as “induced specimen”to alert the laboratory. |
| Acid-fast stain Negative for acid-fast bacillus Used to show the presence or absence of acid-fast bacillus (e.g., tuberculosis) when tuberculosis is suspected | Three sputum specimens, collected in the early morning, are advised when tuberculosis is suspected. |
| Cytology No abnormal cells detected Sputum is examined microscopically to detect the presence of abnormal (cancer) cells. | See above. May require several specimens. Sputum may be collected by bronchoscopy (see Box 21-4 later in the chapter). |
| X-ray of the head and neck | Used to evaluate the sinuses, larynx, or other tissues of the head and neck. |
| Chest x-ray | Used to evaluate the lungs, mediastinum, chest wall, and diaphragm. Detects masses, abscesses, and lung disorders such as pneumonia, obstructive lung disease, and atelectasis. |
| Computed tomography (CT) scan of the head and neck or chest | Provides computer-generated images with more detail than standard x-rays. May be done with or without contrast media. |
| Nursing precautions for x rays and CT Scans | Have the client remove jewelry (earrings, necklaces). If contrast is injected, ask about allergies (specifically to iodine or seafood) before the exam; ensure good hydration before and after the exam to reduce the risk of kidney damage. Ask women of childbearing age about possible pregnancy before the exam. Ask the client to remove jewelry. If contrast is used, inquire about allergies (to iodine and seafood in particular) and ensure that the client is well hydrated to reduce the risk of kidney damage. Explain the procedure and address fears about exposure to radioactivity (the amount is small and no special precautions are required). Some discomfort may occur during injection of the isotope. Obtain an accurate weight before the procedure. |
| bronchoscopy, a flexible bronchoscope is used to visualize the trachea, bronchi, and selected bronchioles | This procedure is done to identify tumors or other structural disorders, obtain tissue for biopsy or sputum for examination, or perform therapeutic proce- dures, such as removing a foreign body. |
| Nursing Implications for a Bronchoscopy | Keep resuscitation and suction equipment at the bedside. Closely monitor vital signs and respiratory status. Maintain NPO status until cough and gag reflexes have returned. Provide emesis basin and tissues for expectorating sputum and saliva. Monitor color and character of respiratory secretions. Sputum may be blood tinged for several hours; notify physician if sputum is grossly bloody. |
| Teaching for Bronchoscopy | Client and Family Teaching The procedure takes about 30 to 45 minutes and may be done in the client’s room, in a procedure room, or in surgery. There will be little pain or discomfort. An anesthetic will be given. Breathing continues during the procedure, but talking is not possible . A sore throat and hoarse voice are common after the procedure.Throat lozenges or warm saline gargles can help relieve sore throat. A fever may develop during the first 24 hours after the procedure. It is important to report persistent cough, bloody or purulent sputum, wheezing, shortness of breath, difficulty breathing, or chest pain to the doctor. |
