Chapter 8media.lanecc.edu/users/driscolln/RT116/pdf_CMppt/CMChapter_008.pdf · Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 1 Chapter

1Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

Chapter 8

Other Important Tests and

Procedures


Introduction

Additional important diagnostic studies

include: Sputum examination

Skin tests

Endoscopic examination

Lung biopsy

Thoracentesis

Hematology, blood chemistry, and electrolyte tests


Sputum Examination


Culture and Sensitivity Study

For a culture and sensitivity study, a single

sputum sample is collected in a sterile

container.

This test is performed to diagnose bacterial

infection, select an antibiotic, and evaluate

the effectiveness of antibiotic therapy.

The turnaround time for this test is 48 to 72

hours.


Gram Staining

The Gram staining of sputum is performed to

classify bacteria into gram-negative and

gram-positive types.

The results of the Gram stain tests guide

therapy until the culture and sensitivity results

are obtained.


The Acid-Fast Smear and Culture

The acid-fast smear and culture is performed

to determine the presence of acid-fast bacilli

(e.g., Mycobacterium tuberculosis).

Three early morning sputum samples are

tested.


Cytology

Cytology entails the collection of a single

sputum sample in a special container with

fixative solution.

The sample is evaluated under a microscope

for the presence of abnormal cells that may

indicate a malignant condition.


Box 8-1. Common Organisms Associated With Respiratory Disorders


Skin Test

Skin tests are commonly performed to

evaluate allergic reactions or exposure to

tuberculous bacilli or fungi.

Skin tests entail the intradermal injection of

an antigen.


Skin Test (Cont’d)

Positive test result Exposure to antigen

Negative test result No exposure to antigen


Endoscopic Examinations


Bronchoscopy

The bronchoscope is a flexible fiberoptic

bronchoscope that allows direct visualization

of the upper airways. Nose

Oral cavity and pharynx

Larynx

Vocal cords

Subglottic area

Trachea, bronchi, lobar bronchi, and segmental

bronchi


Bronchoscopy (Cont’d)

Diagnostic bronchoscopy Abnormal x-rays

Persistent atelectasis

Excessive bronchial secretions

Therapeutic bronchoscopy Suctioning of excessive secretions

Removal of foreign bodies

Selective lavage


Figure 8-1. Fiberoptic bronchoscope. A, The transbronchoscopic balloon-tipped catheter andthe flexible fiberoptic bronchoscope. B, The catheter is introduced into a small airway and the balloon inflated with 1.5 to 2 mL of air to occlude the airway. (A from Lewis SM, Heitkemper MM, Dirksen SR: Medical-surgical nursing: assessment and management of clinical problems, ed 6,St Louis, 2004, Mosby; B from Meduri GU, Beals DH, Maijub AG, Baselski V: Protected bronchoalveolar lavage, Am Respir Dis 143:855, 1991.)


Mediastinoscopy

A mediastinoscopy is the insertion of a scope

through a small incision in the suprasternal

notch; the scope is then advanced into the

mediastinum.

The test is used to inspect and biopsy lymph

nodes in the mediastinal area.


Lung Biopsy

A lung biopsy specimen can be obtained by

means of a transbronchial needle biopsy or

an open-lung biopsy.

A transbronchial lung biopsy entails passing

forceps or a needle through a bronchoscope

to obtain a specimen.


Lung Biopsy (Cont’d)

An open lung biopsy involves surgery to

remove a sample of lung tissue.

An incision is made over the area of the lung

from which the tissue sample is to be

collected.


Figure 8-2. Transbronchial needle biopsy. The diagram shows a transbronchial biopsy needle penetrating the bronchial wall and entering a mass of subcarinal lymph nodes or tumor. (Redrawn from DuBois RM, Clarke SW: Fiberoptic bronchoscopy in diagnosis and management, Orlando, 1987, Grune and Stratton.)

Insert Figure 8-2 here


Video-Assisted Thoracoscopy

(VATS)

Insertion of thoracoscope through the

chest wall

Results displayed on a video monitor

Helpful in the diagnosis of: Tuberculosis

Mesothelioma

Metastatic cancer


Thoracentesis

Thoracentesis is a procedure in which excess

fluid accumulation (pleural effusion) between

the chest cavity and lungs (pleural space) is

aspirated through a needle inserted through

the chest wall.

A diagnostic thoracentesis may be performed

to identify the cause of a pleural effusion.


Figure 8-3. Thoracentesis. A catheter is positioned in the pleural space to remove accumulated fluid. Pleural fluid is seen as the dark shadow at the base of the left lung. (From Lewis SM, Heitkemper MM, Dirksen SR: Medical-surgical nursing: assessment and management of clinical problems, ed 6, St Louis, 2004, Mosby.)


Pleurodesis

Pleurodesis is performed to prevent the

recurrence of a pneumothorax or pleural

effusion.

A pleurodesis is achieved by injecting any

number of agents (called sclerosing agents or

sclerosants) into the pleural space through a

chest tube.

Common sclerosant chemicals include a

slurry of talc, bleomycin, nitrogen mustard,

doxycycline, povidone iodine, and quinacrine.


Pleurodesis (Cont’d)

The instilled sclerosing agents cause irritation

and inflammation (pleuritis) between the

parietal and the visceral layers of the pleura.

This action causes the pleurae to stick

together and thereby prevents subsequent

gas or fluid accumulation.


Pleurodesis Risks

Infection

Bleeding

Acute respiratory distress syndrome

Collapsed lung (pneumothorax), and

respiratory failure


Pleurodesis Risks (Cont’d)

Complications may be specific for each

sclerosant. Talc and doxycycline can cause fever and pain.

Quinacrine can cause low blood pressure, fever,

and hallucination.

Bleomycin can cause fever, pain, and nausea.


Hematology, Blood Chemistry,

and Electrolyte Findings


Hematology

The most frequent laboratory hematologic

test is the complete blood count (CBC).

The CBC provides important information

about the patient’s diagnosis, prognosis,

response to treatment, and recovery.


Table 8-1. Red Blood Cell Indices


Table 8-1. Red Blood Cell Indices


White Blood Cell Count (WBC)

The major functions of the WBCs

(leukocytes) are to: 1. Fight against infection

2. Defend the body by phagocytosis against foreign

organisms

3. Produce (or at least transport and distribute)

antibodies in the immune response


Box 8-2. Normal Differential White Blood Cell Count


Table 8-2. Common Causes of WBC Increase


Platelet Count

Platelets are the smallest of the formed

elements in the blood.

They are round or oval, flattened, and disk-

shaped in appearance.

Platelets are produced in the bone marrow

and possibly in the lungs.

Platelet activity is essential for blood clotting. The normal platelet count is 150,000 to

350,000/mm3.


Table 8-3. Blood Chemistry Tests Commonly Monitored in Respiratory Care


Table 8-4. Electrolytes Commonly Monitored in Respiratory Care


(Cont’d)

Table 8-4. Electrolytes Commonly Monitored in Respiratory Care—cont’d

Documents

Chapter 8media.lanecc.edu/users/driscolln/RT116/pdf_CMppt/CMChapter_008.pdf · Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 1 Chapter