FRAGERSTORM TEST, BRONCHOSCOPY, ABG, THORACENTESIS, PULMONARY ANGIOGRAPHY
Bronchoscopy
Is
the direct inspection and examination of the larynx, trachea, and bronchi through either a flexible fiberoptic bronchoscope or a rigid bronchoscope.
Nursing Interventions
Before the procedure
A signed consent form is obtained from the patient. o Food and fluids are withheld for 6 hours before the test to reduce the risk of aspiration when the cough reflex is blocked by the anesthesia.
o
Explains the procedure to the patient to reduce fear and decrease anxiety and administers preoperative medications (usually atropine and a sedative or opioid) as prescribed to inhibit vagal stimulation (thereby guarding against bradycardia, dysrhythmias, and hypotension), suppressthe cough reflex, sedate the patient, and relieve anxiety. The patient must remove dentures and other oral prostheses.
Topical anaesthetic such as lidocaine (xylocaine) may be sprayed on the pharynx or dropped on the epiglottis and vocal cords and into the trachea to suppress the cough reflex and minimize discomfort Sedatives or opioids are administered intravenously as prescribed to provide moderate sedation.
During the procedure
o
o
o o
Assist the physician during the procedure Topical anaesthetic such as lidocaine (xylocaine) may be sprayed on the pharynx or dropped on the epiglottis and vocal cords and into the trachea to suppress the cough reflex and minimize discomfort Assist the positioning of the patient Assist the reaction of the patient Ensure the safety of the client
After the Procedure
o o
Maintains NPO until the cough reflex returns Offer ice chips and eventually fluids In the elderly patient, the nurse assesses for confusion and lethargy, which may be due to the large doses of lidocaine administered during the procedure.
o Monitors
the patients respiratory status and observes for hypoxia, hypotension, and tachycardia, dysrhythmias, hemoptysis, and dyspnea. o Instructs the patient and family caregivers to report any shortness of breathe or bleeding immediately
Thoracentesis
Aspiration
of fluid or air from the pleural space-is performed on patients with various clinical problems, it may be used to
Removal of fluid and air from the pleural cavity Aspiration of pleural fluid for analysis Pleural biopsy Instillation of medication into pleural space
Preprocedure o Ascertain in advance that a chest x-ray has been ordered and completed and the consent form has been signed. o Assess the patient for allergy to the local anesthetic to be used o Inform the patient about the nature of the procedure and
the importance of remaining immobile Pressure sensations to be experienced Minimal discomfort is anticipated after the procedure
Position the patient comfortably with adequate supports. If possible, place the patient upright or in one of the following positions: a) Sitting on the edge of the bed with the feet supported and arms and head on a padded over the-bed table b) Straddling a chair with arms and head resting on the back of the chair c) Lying on the unaffected side with the head of the bed elevated 30 to 45 degrees if unable to assume a sitting position
o
Intraprocedures
o o
Prepare the patient for the cold sensation of skin germicide solution and for a pressure sensation from infiltration of local anesthetic agent Encourage the patient to refrain from coughing Exposed the entire chest
o o
The procedure is performed under aseptic conditions After the needle is withdrawn, pressure is applied over the puncture site and a small, airtight , sterile dressing is fixed in place. Advice the patient that he or she will be on bed rest and a chest x-ray will be obtained after thoracentesis. Record the total amount of fluid withdrawn from the procedure and document the nature of the fluid, its color and viscosity. If indicated, prepare samples of fluid for laboratory evaluation. A container with formalin may be needed for a pleural biopsy.
Postprocedure
o Record
the total amount of fluid withdrawn from the procedure and document the nature of the fluid, its color and viscosity. If indicated, prepare samples of fluid for laboratory evaluation. A container with formalin may be needed for a pleural biopsy.
Monitor the patient at intervals for increasing respiratory rate; asymmetry in respiratory movement; faintness; vertigo; tightness in chest; uncontrollable cough; blood-tinged, frothy mucus; a rapid pulse; and signs of hypoxemia
Instruct the patient and family are instructed to report pain, shortness of breath, visible bleeding, redness of the biopsy site, or purulent drainage (pus) to the health care provider immediately.
