NURSINGBULLETS:

RESPIRATORY SYSTEM –
DIAGNOSTIC PROCEDURES
RISK FACTORS FOR RESPIRATORY
DISORDERS
• Smoking
• Use of chewing tobacco
• Allergies
• Frequent respiratory illnesses
• Chest injury
• Surgery
• Exposure to chemicals & environmental
pollutants
• Family history of infectious disease
• Geographic residence & travel to foreign
countries
 DIAGNOSTIC PROCEDURES
AND EXAMS
Chest x-ray film (radiograph)
1. Description: provides information regarding the
anatomical location and appearance of the
lungs.
2. Preprocedure
a. Remove all jewelry and other metal objects
from the chest area.
b. Assess the client’s ability to inhale and hold
breath.
c. Question females regarding pregnancy or the
possibility of pregnancy.
3. Postprocedure:
Assist the client to dress.
 Nursingbullets: SPUTUM
SPECIMEN
1. Description: a specimen obtained by
expectoration or tracheal suctioning to assist in
the identification of organisms or abnormal cells.
2. Preprocedure
a. Determine specific purpose of collection and
check with institutional policy for appropriate
collection of specimen.
b. Obtain an early morning sterile specimen from
suctioning or expectoration after a respiratory
treatment, if a treatment is prescribed.
 c. Obtain 15 ml of sputum.
d. Instruct the client to rinse the mouth
with water before collection.
e. Instruct the client to take several deep
breaths and then cough deeply to obtain
sputum.
f. Always collect the specimen before
client begins antibiotic therapy.
3. Postprocedure
a. Transport specimen to laboratory STAT.
b. Assist the client with mouth care.
 Nursingbullets: SUCTIONING
PROCEDURE -- SPUTUM SPECIMEN
• Aseptic technique
• Hyperoxygenate
• Lubricate the catheter with sterile water
• Tracheal suctioning:
suctioning 4 inches
• Nasotracheal suctioning:
suctioning insert to induce
cough reflex
• Don’t apply suction while inserting
• Suction intermittently for 10-15 seconds
• Rotate and withdraw
• Hyperoxygenate & deep breaths
Nursingbullets: BRONCHOSCOPY
1. Description: direct visual examination of
the larynx, trachea, and bronchi with a
fiberoptic bronchoscope
2. Preprocedure
a. Obtain informed consent.
b. Maintain NPO status for client from
midnight before the procedure.
c. Obtain vital signs.
 d. Assess the result of coagulation
studies.
e. Remove dentures or eyeglasses.
f. Prepare suction equipment.
g. Administer medication for sedation as
prescribed.
h. Have emergency resuscitation
equipment readily available.
3. Postprocedure
a. Monitor vital signs.
b. Maintain client in semi-Fowler position.
c. Assess for the return of the gag reflex.
d. Maintain NPO status until gag reflex returns.
e. Have an emesis basin readily available for
client to expectorate sputum.
f. Monitor for bloody sputum.
g. Monitor respiratory status, particularly if
sedation was administered
h. Monitor for complications, such as
bronchospasm, bronchial perforation indicated
by facial or neck crepitus, dysrhythmias, fever,
bacteremia, hemorrhage, hypoxemia, and
pneumothorax.
i. Notify the physician if fever, difficulty in
breathing, or other signs of complications occur
following the procedure.
 Nursingbullets: PULMONARY
ANGIOGRAPHY
1. Description
a. Pulmonary angiography is an invasive
fluoroscopic procedure in which a catheter
is inserted through the antecubital or
femoral vein into the pulmonary artery or
one of its branches.
b. Pulmonary angiography involves an
injection of iodine or radiopaque or
contrast material.
2. Preprocedure
a. Obtain informed consent
b. Assess for allergies to iodine, seafood, or
other radiopaque dyes.
c. Maintain NPO status of client for 8 hours
before procedure.
d. Monitor vital signs
e. Assess results of coagulation studies
f. Establish and intravenous access
g. Administer sedation as prescribed
h. Instruct the client to lie still during the
procedure
 i. Instruct the client that he or she may feel an
urge to cough, flushing, nausea, or salty taste
following injection of the dye
j. Have emergency resuscitation equipment
available
3. Postprocedure
a. Monitor vital signs
b. Avoid taking blood pressures for 24 hours in
the extremity used for injection
c. Monitor peripheral neurovascular status of the
affected extremity
d. Assess insertion site for bleeding
e. Monitor for delayed reaction to the dye
Nursingbullets: THORACENTESIS
1. Description: removal of fluid or air from the
pleural space via a transthoracic aspiration
2. Preprocedure
a. Obtain informed consent
b. Obtain vital signs
c. Prepare the client for ultrasound or chest
radiograph, if prescribed, before procedure
d. Assess results of coagulation studies
e. Note that the client is positioned sitting
upright, with the arms and head supported
by a table at the bedside during the
procedure.
f. If the client cannot sit up, the client is
placed lying in bed on the unaffected side
with the head of the bed elevated 45
degrees
g. Instruct the client not to cough, breath
deeply, or move during the procedure.
3. Postprocedure
a. Monitor vital signs
b. Monitor respiratory status
c. Apply a pressure dressing, and assess
the puncture site for bleeding and crepitus.
d. Monitor for signs of pneumothorax, air
embolism, and pulmonary edema
 Nursingbullets: LUNG BIOPSY
1. Description
a. A percutaneous lung biopsy is
performed to obtain tissue for analysis by
culture or cytological examination
b. A needle biopsy is done to identify
pulmonary lesions, changes in lung tissue,
and the cause
2. Preprocedure
a. Obtain informed consent
b. Maintain NPO status.
c. Inform the client that a local anesthetic will be used
but that sensation of pressure during needle insertion
and aspiration may be felt.
d. Administer analgesics and sedatives as prescribed
3. Postprocedure
a. Monitor vital signs
b. Apply dressing to the biopsy site and monitor for
drainage or bleeding
c. Monitor for signs of respiratory distress, and notify
physician if they occur
d. Monitor for signs of pneumothorax and air emboli, and
notify physician if they occur
e. Prepare the client for chest radiography if prescribed
 Nursingbullets: VENTILATION
PERFUSION LUNG SCAN
1. Description
a. The perfusion scan evaluates blood flow to the lungs.
b. The ventilation scan determines the patency of the
pulmonary airways and detects abnormalities in
ventilation.
c. A radionucleotide may be injected for the procedure
2. Preprocedure
a. Obtain informed consent
b. Assess client for allergies to dye, iodine, or seafood
c. Remove jewelry around the chest area
d. Review breathing methods that may be required
during testing.
 e. Establish an intravenous access
f. Administer sedation if prescribed
g. Have emergency resuscitation
equipment available.
3. Postprocedure
a. Monitor client for reaction to nucleotide
b. Instruct client to wash hands carefully
with soap and water for 24 hours following
the procedure.
 Nursingbullets: SKIN TEST
1. Description: A skin
test is an intradermal
injection used to
assist in diagnosing
various infectious
diseases
2. Preprocedure:
Determine
hypersensitivity or
previous reactions to
skin tests
3. Procedure
a. Use test injection test that is free of
excessive body hair, dermatitis, and
blemishes.
b. Apply the injection at the upper one
third of inner surface of the left arm
c. Circle and mark the test site
d. Document the date, time, and test site
4. Postprocedure
a. Advise the client not to scratch the test site so
as to prevent infection and abscess formation
b. Instruct the client to avoid washing the test
site.
c. Interpret the reaction at the injection site 48
to72 hours after administration of the test
antigen
d. Assess the test site for the amount of
induration (hard swelling) in millimeters and for
the presence of erythema and vesiculation
(small blisterlike elevations)
Nursingbullets: ARTERIAL BLOOD
GASES
1. Description: measurement of the dissolved
oxygen and carbon dioxide in the arterial blood
to reveal the acid-base state and how well the
oxygen is being carried to the body
2. Preprocedure
a. Perform Allen’s test before drawing radial
artery specimens.
b. Have the client rest for 30 minutes before
specimen collection.
c. Avoid suctioning before drawing ABG sample.
d. Do not turn off oxygen unless the ABG
sample is ordered to be drawn with client
breathing room air.
3. Postprocedure
a. Place the specimen on ice.
b. Note the client’s temperature on laboratory
form.
c. Note the oxygen and type of ventilation that
the client is receiving on the laboratory form.
d. Apply pressure to the puncture site for 5 to 10
minutes and longer if the client is taking
anticoagulant therapy or has a bleeding
disorder.
e. Transport the specimen to the laboratory
within 15 minutes.
Nursingbullets: PULSE OXIMETRY
1. Description
a. Pulse oximetry is a noninvasive test that
registers the oxygen saturation of the
client’s hemoglobin.
b. This arterial oxygen saturation (SaO2) is
recorded as a percentage.
c. The normal value is 95% to 100%.
d. After a hypoxic client
uses up the readily
available oxygen
(measured as the arterial
oxygen pressure, PaO2, on
ABG testing), the reserve
oxygen, that oxygen
attached to the hemoglobin
(SaO2), is drawn on to
provide oxygen to the
tissues.
e. A pulse oximeter reading
can alert the nurse to
hypoxemia before clinical
signs occur.
2. Procedure
a. A sensor is placed on the client’s finger, toe,
nose, ear lobe, or forehead to measure oxygen
saturation, which then is displayed on a monitor.
b. Maintain the transducer at heart level.
c. Do not select an extremity with an
impediment to blood flow.
d. Results lower than 91% necessitate
immediate treatment.
e. If the SaO2 is less than 85%, the tissues of
the body have a difficult time becoming
oxygenated; an SaO2 of less than 70% is life
threatening.
 Nursingbullets: CHEST
PHYSIOTHERAPY
• Best time - morning upon arising, 1 hr before
meals or 2-3 hrs after meals
• Stop if pain occurs
• Provide mouth care

CONTRAINDICATIONS OF CHEST
PHYSIOTHERAPY (CPT)
• Increased respiratory distress
• History of fractures
• Chest incisions
• POSTURAL DRAINAGE: use of the
gravity

• NURSING CARE
• Position the client
• Best time – A.M. upon arising, 1 hr before
meals, 2-3 hrs after meals
• Stop if cyanosis or exhaustion occurs
• Maintain position 5-20 mins after
• Provide mouth care after the procedure
• CONTRAINDICATIONS OF POSTURAL
DRAINAGE
• Unstable V/S
• Increased ICP

• CLIENT INSTRUCTIONS FOR INCENTIVE

SPIROMETRY
• Use the lips to form seal around the mouth
piece
• Inspire deeply
• Hold inspiration for a few seconds
• Forcefully exhale
• Avoid the use of spirometry at mealtime - it may
cause nausea
 Nursingbullets: Chest Tube
Thoracotomy
Chest Tubes/Water seal drainage
B.Insertion of a catheter into the intrapleural space
to maintain constant negative pressure when
air/fluid have accumulated
C.Chest tube is inserted to underwater drainage to
allow for the space of air/fluid and prevent reflux
of air into the chest
D.For evacuation of air, chest tube is placed in the
second or third intercostal space, anterior or
midaxillary line (air rises to upper chest)
A. For drainage of fluid, chest tube is place in the
eight or ninth intercostal space, midaxillary
line.
B. Chest tube is connected to tubing for the
collection system; the distal end of the
collection tubing must be placed below the
water level in order to prevent atmospheric air
from entering the pleural space.
C. Drainage system: water-seal drainage system
can be set up using one, two, or three bottles;
or a commercial, disposable device (e.g.,
Pleur-evac) may be used.
One-Bottle System
 2. Two-bottle system
a. One bottle serves as a drainage collection
chamber, the other as a water seal.
b. The first bottle is the drainage collection and
has two short tubes in the rubber stopper. One of
these tubes is attached to the drainage tubing
coming from the client; the other is attached to the
underwater tube of the second bottle (the water-
seal bottle). The air vent of the water-seal bottle
must be left open to the atmospheric air. If suction
is used, the first bottle serves as drainage
collection and water-seal chamber, and the
second bottle serves as the suction chamber
Two-way Bottle System
Nursing care: without suction
1. Examine the entire system to ensure air
tightness and absence of obstruction from kinks
or dependent loops of tubing
2. Note oscillation of the fluid level within the
water-seal tube. It will rise on inspiration and fall
on expiration due to changes in the intrapleural
pressure. If oscillation stops and system is
intact, notify physician.
3. Check the amount, color, and characteristics
of the drainage. If drainage ceases and system
is not blocked, assess for signs of respiratory
distress from fluid/ air accumulation
 Three-Bottle System
a. This system has a drainage collection, a water
seal, and a suction-control bottle.
b. The third bottle controls the amount of
pressure in the system. The suction control
bottle has three tubes inserted in the stopper,
two short and one long. One short tube is joined
with the tubing to former air vent of the water-
seal; the second short tube is connected to
suction. The third (long) tube (or suction-control
tube) is located between the short tubes and has
one end open to the atmosphere and other
below the water level.
Nursing care: with suction
1. Attach suction tubing to suction apparatus,
and chest catheter to drainage system
2. Open suction slowly until a stream of bubbles
is seen in the suction chamber. There should be
continuous bubbling in this chamber and
intermittent bubbling in the waters seal. Check
for an air leak in the system if bubbling in water
seal is constant; notify physician if air leak
3. Check drainage, keep drainage system below
level of client’s chest, keep Vaseline gauze at
bedside, encourage coughing and deep
breathing, and provide ROM
4. Always keep drainage system lower than the
level of the client’s chest
5. Keep Vaseline gauze at bedside at all times in
case chest tube falls out
6. Encourage coughing and deep breathing to
facilitate removal of air and drainage from
pleural cavity
7. Never clamp chest tubes.
8. Removal of the chest tube: instruct the client
to perform Valsalva maneuver; apply Vaseline
pressure dressing to the site
9. If the water-seal bottle should break,
immediately obtain some type of fluid-filled
container to create an emergency water seal
until a new unit can be obtained
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