Seminar presentation

1. DIAGNOSTIC TESTS FOR
RESPIRATORY SYSTEM
DISORDER AND NURSING
RESPONSIBILITIES
RAKCON
BSc (H) Nursing

2. ANATOMY AND
PHYSIOLOGY
 The respiratory system is composed of the upper and lower respiratory
system tract. Together the two tracts are responsible for ventilation.
 The upper respiratory tract (the lungs) can accomplish gas exchange or
diffusion.
 Upper respiratory tract consists of the nose para-nasal sinuses, pharynx,
tonsils, adenoids, larynx, and trachea.
 Lower respiratory tract consists of the lungs which contains the
bronchial and alveolar structures needed for gas exchange.

3. ORZANIZATION OF RESPIRATORY
SYSTEM
 Respiratory system consists of an upper(nose to
larynx ) and lower(trachea onwards) respiratory tract
 Conducting portion – transports air
 Includes the nose , pharynx , larynx , trachea and
progressively smaller airways from the primary
bronchi to terminal bronchi
 Respiratory portion – carries gas exchange
 Composed of small airways called respiratory
bronchioles and alveolar ducts as well as air sacs

4. BREATHING
 Consists of two cyclic phases:
Inhalation – also called inspiration
Draws air inside the lungs
Exhalation – also called expiration
Forces gases out of the lungs

5. 

7. NON-INVASIVE TESTS
MAGNETIC RESONANCE
IMAGING
CHEST X-RAY
COMPUTED
TOMOGRAPHY
PULMONARY FUNCTION
TEST
PULSE OXIMETRY
SPUTUM
EXAMINATION

8. PULSE OXIMETRY(SpO2)
 It is a painless method of continuously monitoring the oxygen saturation of
haemoglobin.
 A probe or sensor is attached to the fingertip, forehead, and earlobe as bridge of the
nose.
 The pulse oximeter passes a bearer of light through the tissue which measures the
amount of light absorbed by the oxygen saturated haemoglobin.
 Normal SpO2:-95-100%
 Value less than 90% indicates that the tissues are not receiving enough oxygen.
 SpO2 values are unreliable in cardiac arrest shock, use of vasoconstrictor
medication, anaemia, abnormal haemoglobin, high CO level, use of drugs if the
patient is having dark skin or is wearing nail polish, bright sight and patient
movement.
 SpO2 values cannot detect hypoventilation when supplemental O2 is in use.

10. Purpose
 -To monitor the oxygen saturation of haemoglobin.
 -To monitor subtle and sudden changes in SpO2 and
can be used in the home easily.

11. NURSING
RESPONSIBILITIES
 -pre-procedure
 Tell the client about the need to monitor.
 Apply probe to fingers, earlobe, forehead or nose.
 Maintain the transducer at heart level.
 Do not select an extremity with an implement to blood
flow.
 Before performing the procedure assess for the
alteration factor for the accuracy of pulse oximeter.
 Prevent the movement of client

12. post-procedure
 Assess patient’s vital signs.
 Notify the physician of any significant change in the
patient’s condition.
 Check the color of nail bed.
 Document the inspired oxygen.

13. SPUTUM
EXAMINATION
-First clear the nose and throat and rinse the mouth to
decrease contamination of the sputum.
- Periodic sputum examination may be necessary for the
patients receiving antibiotics, corticosteroid and
immunosuppressant for prolonged period, because
these agents are associated with opportunistic
infections.

14. Types of sputum examination
There are 4 types of sputum examination:
1. Culture and sensitivity
2. Gram stain
3. Acid fast smear and culture
4. Cytology

15. NURSING
RESPONSIBILITIES
 PRE PROCEDURE
1.obtain the sample early in the morning
2.instruct the patient how to produce a good specimen by
deep coughing.
3. Collect sputum, not saliva, 15 mL of sputum.
4. Always collect the specimen before the client begins
antibiotic therapy.
5. If the sputum is not produced, try to increase fluid
intake unless fluids are restricted, collect specimen in
sterile container.

16.  POST PROCEDURE
1.Inspect the sputum for colour, quantity, quality, and
presence of blood, food particle or any unusual
content.
2. Label the specimen and send it to laboratory
immediately.
3.Assist the client with mouth care.

17. .
.. CHEST
X-RAYS
COMPUTED
TOMOGRAPHY
MAGNETIC
RESONANCE
IMAGING
POSITRON
EMISSION
TOMOGRAPHY
PULMONARY
ANGIOGRAPHY
VENTILATION
PERFUSION
LUNG
SCAN
RADIOLOG
Y

18. PULMONARY FUNCTION
TEST
 It includes measurement of lung volumes, ventilatory
functions and mechanism of breathing, diffusion and gas
exchange.
 It is performed by using a spirometer that has a volume
collecting device attached to a recorder that demonstrates
volume and time.
 Its results are interpreted on the basis of the degree of
deviation from normal taking into consideration the
patient’s height, age and gender.

19.  Spirometry – meaning the measuring of breath
 It is the most common PFTs , measuring lung
function specifically the amount (volume) and speed
(flow) of air that can be inhaled and exhaled

20. LUNG VOLUMES
 Tidal volume – amount of gas inspired or expired with
each breath (300-500mL)
 Inspiratory reserve volume – maximum amount of
additional air which can be inspired at the end of
normal inspiration(3300mL)
 Expiratory reserve volume – maximum amount
of additional air which can be expired at the end
of normal inspiration(700-1200mL)
 Residual volume – volume of air remaining in lung
after a maximal expiration(1200mL)

21.  Total lung capacity – the volume of air contained in
the lungs at the end of maximal inspiration (4-6L)
 Vital capacity – maximum volume of air that can be
forcefully expelled from the lung following a maximal
inspiration (4800mL)
 Functional residual capacity – volume of air remaining
in lung at the end of a normal expiration (1800-
2200mL)

23. Purpose
 -To assess respiratory function and to determine the
extent of dysfunctioning.
 -To assess response to therapy.
 -It is also used prior to surgeries to screen patients who
are scheduled for thoracic and upper abdominal
surgery.

24. NURSING RESPONSIBLITIES
 -pre procedure
 Explain the procedure to the patient.
 Determine whether an analgesic that may depress the
respiratory function is being administered.
 Instruct the client to void before the procedure and to wear
loose cloths.
 Consult with the physicians regarding holding
bronchodilators before testing.
 Instruct the client to refrain from smoking or eating a
heavy meal for 4 to 6 hours before the test.
 Remove dentures.

25. -post procedure
 Client may resume normal diet and any
bronchodilator or respiratory treatment that was held
before the procedure.
 Provide rest after the procedure.

26. CHEST X-RAYS
-normally pulmonary tissues are Radiovalent because it mainly
consist of air and gases.
so, densities produced by fluid, tumour, foreign bodies and other
pathological conditions can be detected by x-rays examination.
the routine chest x-rays consist of - Posteroanterious projection
and lateral projection
-it is performed with the client standing or sitting facing the x-
rays film with the chest and shoulders in direct contact with the
film castle.
-it is painless and exposure to radiation is minimal.
-it is taken after full inspiration because the lungs are best
visualised when they are inflated.
-it takes 5- 10 minutes to complete.
-it is contraindicated during pregnancy.

27. CHEST X-RAY IN
PNEUMONIA
NORMAL CHEST
X-RAY

28. Purposes
 chest x-rays studies may be performed:
 As it provides information regarding the
anatomical location and appearance of the lungs
To monitor the status of respiratory disorder and
abnormalities.
To confirm endotracheal and tracheostomy inter
placement after traumatic chest injury.

29. NURSING
RESPONSIBLITIES
 -PRE PROCEDURE
#Remove all the jewelleries and metallic objects from
the chest area.
#asses the clients ability to inhale and hold his breath.
#Ask women about pregnancy or possibility of
pregnancies.
#Instruct the client about the need of radiologic tests
#instruct the patient to undress and wear the gown.
 -POST PROCEDURE
#Help the client to get dressed up.

30. COMPUTED
TOMOGRAPHY
#A CT scan is imaging method in which the lungs are
scanned in successive layers by narrow beam ray.
#the images produced provide a cross sectional view of
chest.
#it may be used to define pulmonary nodule and small
tumours adjacent to pleural surfaces.
#contraindications include allergy to dye, pregnancy,
claustrophobia and morbid obesity.
#potential complications include acute renal failure
and acidosis.

32. Purpose
 1.to define pulmonary nodule and small tumours
adjacent to pleural surface that are not visible in chest
x-rays.
2.to diagnose lesions.
3. It is now used in place of pulmonary angiography to
diagnose pulmonary embolism.

33. NURSING
RESPONSIBILITIES
 -PRE PROCEDURE
#Remove all the jewelleries and metallic objects from
the chest area.
#Instruct the client about the need of radiologic tests
#instruct the patient to undress and wear the gown.
 -POST PROCEDURE
#Help the client to get dressed up.

34. MAGNETIC RESONANCE
IMAGING
#it is similar to CT scan, except that magnetic and
radio pregnancy signals are used instead of radiation.
#it is able to better distinguish between normal and
abnormal tissue.
#contraindications involve morbid obesity, confusion
and agitation.

36. Purpose
1.it is used to characterise pulmonary nodules.
2. To help stage bronchogenic carcinoma.
3. To evaluate inflammatory activity in interstitial lung
disease.
4. To diagnose lesions.
5. It is most useful when evaluating images near the
lung apex or spine.
6. To distinguish vascular and non vascular structure.

37. NURSING
RESPONSIBILITIES
 -PREPROCEDURE
1.instruct the patient about the need for radiological
testing.
2. Instruct the patient to undress and wear the gown.
3. Remove any jewellery.
4. Instruct the patient not to move in the machine.
5. Nurses should consult with specially trained MRI
personnel’s.
 -POSTPROCEDURE
-Help the client get dressed.

38. INVASIVE
TESTS
POSITRON EMISSION
TOMOGRAPHY
VENTILATION PERFUSION
LUNG SCAN
PULMONARY ANGIOGRAPHY
MEDIASTINOSCOPY
ARTERIAL BLOOD GAS
BRONCHOSCOPY
BIOPSY
THORACENTESIS

39. POSITRON EMISSION
TOMOGRAPHY
 It involves the use of radio nuclides with short half-lives.
-PET produces images of the body by detecting the radiation
emitted from radioactive substances. These radioactive
substances are injected to the body through IV and are usually
tagged with a radioactive atom such as carbon 11. The atoms
decay and do not harm the body.
-PET scans use an IV glucose preparation that can be demonstrated
by increased uptake of glucose in malignant lung cells because
malignant lung cells have increased number of glucose.
-Images from PET scans are now being superimposed on CT and
MR films to enhance the accuracy of diagnosis.

41. Purpose
 -PET test is used to distinguish benign and malignant
lung nodules.
 -To detect and display metabolic changes in tissue.
 -It shows regional blood flow.

42. NURSING
RESPONSIBILITIES
-Pre procedure
 Instruct the client about the need for radiologic
testing.
 Instruct the client to undress and put on gown.
 Remove all the jewellery and other metal objects from
the chest area. No precautions needed because
isotopes(C-11) only transmit radioactivity for brief
interval.
 -post procedure
 Help the client get dressed

43. VENTILATION PERFUSION
LUNG SCAN
-it is performed by injecting a radioactive agent into a peripheral vein
and then obtaining a scan of the chest to detect radiation.
-the isotopic particle passes through the right side of the heart and are
distributed into the lungs.
-the imaging time is 30-40 min. during which the patient lies under the
camera with the mask fitted over the nose and mouth.
-this is followed by ventilation components of the scan which
determines the potency of pulmonary airway and detect abnormality in
ventilation.

45. Purpose
1. To identify areas of lung not receiving air flow
(ventilation) or blood flow (perfusion).
2. To detect ventilation abnormalities
3.to diagnose bronchitis, asthma, inflammatory
fibrosis, pneumonia, and emphysema and lung cancer.

46. NURSING
RESPONSIBILITIES
-PRE- PROCEDURE
1.obtain informed consent.
2. Explain the procedure to client.
3. If the client has dyspnoea while lying down, reassure the
client in sitting position.
4. Assess the client for allergy of dye, iodine or seafood.
5. Administer sedation if required.
6. Have emergency resuscitation equipment available.
-POST PROCEDURE
1.monitor client for reaction to the radionuclide.
2. Instruct the client that radionuclide clears from the body
in about 8 hours.

47. PULMONARY
ANGIOGRAPHY
#it is invasive fluoroscopic procedure.
#in this procedure, a catheter is inserted through the
antecubital femoral artery or one of its branches.
#an injection of iodine and radiopaque contrast into
the vascular system
#a series of x-rays are taken.

48. Purpose
1. To confirm the diagnosis of embolus if finding of
lung scan is inconclusive.
2. To visualise pulmonary vasculature.
3. To locate obstruction or pathologic condition such
as pulmonary embolus.
4. To detect peripheral pulmonary lesion.
5. Destructive effect of emphysema.

49. NURSING
RESPONSIBILITIES
-PRE-PROCEDURE
1.instruct the client about the need of test.
2. Obtain informed consent.
3. Inform the client that the contrast infection may cause
flushing warm sensation and coughing.
4. Maintain NPO status of the client for 8 hours before the
process.
5. Maintain vital signs.
6. Administer sedation as prescribed.

50. -POST PROCEDURE
1 monitor vital signs.
2. Avoid taking BP after 24 hrs in affected extremities.
3. Asses insertion site for bleeding.
4. Monitor for delayed reaction.

51. Arterial blood gas (ABG)
 -ABG levels are obtained through an arterial puncture at the
radial brachial or through an indwelling catheter.
 -Continuous ABG monitoring is also possible via a sensor or
electrode inserted into the arterial catheter.
 -Complication related to ABG is pain, infection and
hemorrhage.

52. Purpose
 -Assess the ability of lungs to provide adequate oxygen
and remove carbon dioxide which reflects ventilation.
 -Assess the need for oxygen therapy
 -Assess changes in oxygen therapy

53. NURSING
RESPONSIBILITIES
 -Pre procedure
 Perform Allen’s test before drawing radial artery specimens
 Have the client rest for 30 minutes before.
 Specimen collection is to insure accurate measurement of body
oxygenation
 Assist with positioning example palm up, wrist slightly hyper extended
if radial artery is used.
 Collect blood into heparinised syringe.
 Avoid suctioning before drawing the ABG sample
 Do not turn off the oxygen unless the ABG sample is ordered to be
drawn with the client breathing room air.
 Multiple puncture should be avoided by using an arterial line.
 To ensure accurate results expel all air bubbles and place the sample in
ice unless it will be analysed unless in less than one minute

54.  post-procedure
 Note the oxygen and type of ventilation that the client is
receiving on laboratory form.
 Apply pressure to artery for 5 minutes after specimen is
collected.
 Transport the specimen to the laboratory within 15 minutes.
 ALLEN's TEST -
 It is a first line standard test used to assess the arterial blood
supply of hand .
 This is performed whenever intravascular access to
the radial artery is planned or for radial artery harvesting .

55. 
ENDOSCOPIC
EXAMINATION
BRONCHOSCOPY MEDIASTINOSCOPY

56. ENDOSCOPIC
EXAMINATION
 1.BRONCHOSCOPY
 -It is the direct inspection and examination of the larynx, trachea
and bronchi through either a flexible fibroptic bronchoscope or
a right bronchoscope.
 It involves passage of lighted bronchoscope into the bronchial
tree.
 -Mainly fibroptic bronchoscope is used.
 Small amounts of sterile saline may be injected through the
scope and with drains and examination for cells bronchi alveolar
lavage.
 - Complications include reaction to the local anaesthetic,
bronchi spasm, pneumo thorax, bleeding and perforation.

58. Purpose
 -To visualize tissue.
 -To collect secretion for analysis and to obtain a tissue
sample for diagnosis.
 -To diagnose sources of haemoptysis.
 -To control bleeding.
 -To destroy lesion.

59. NURSING
RESPONSIBILITIES
-pre procedure
 Explain the procedure to the patient to reduce pain.
 Obtain informed consent.
 Maintain NPO status.
 Obtain vital signs.
 Remove dentures.
 Prepare secretion equipment.
 Have resuscitation equipment readily available.

60. -post procedure
 Monitor vital signs
 Maintain the client in semi fowler’s position.
 Assess for the return of gag reflex.
 Maintain NPO status until gag reflex returns.
 Notify the physician if fever or difficulty in breathing
occurs.

61. MEDIASTINOSCOPY
 In this, a mediastinoscope is inserted through a small
incision in the suprasternal notch and advanced into
the mediastinum.
PURPOSE
 -To inspect lymph in mediastinal area.
 -To perform biopsy of lymph nodes in mediastinal
area.
 -Procedure is performed in operating room and is
given as a general anaesthesia.

63. Nursing responsibilities
-pre procedure
 Explain the procedure to the patient.
 Prepare patient for surgical intervention.
 Obtain signed permit.
-post procedure
 Monitor for bronchoscopy.

64. BIOPSY
(INVASIVE)
 -LUNG BIOPSY:- it may be done transbronchially or as an
open lung biopsy.
 Transbronchial lung biopsy involves passing a forcep or a
needle through the bronchoscope for a specimen.
 Open lung biopsy is used when a pulmonary disease
cannot be diagnosed by another procedure.
 The patient is anaesthetised. The chest is opened with a
thoractomy incision, and a biopsy specimen is obtained.
 Specimen can be cultured or examined for malignant cells.
 Complications include pneumothorax, pulmonary
haemorrhage and emphysema.

66. Purpose
 To obtain specimen for laboratory analysis.
 To diagnose a lung infection.
 To explain why fluid has collected in your lung.
 To identify the cause of inflammation in your lung.

67. NURSING
RESPONSIBILITIES
 -Pre procedure
 Obtain informed consent.
 Maintain NPO status of the client before procedure.
 Inform the client that the local anaesthetic will be used but a sensation
or pressure during needle insertion and aspiration can be felt.
 Administer sedatives as prescribed.
 -Post procedure
 Monitor vital signs.
 Apply a dressing to the biopsy site and monitor for drainage or bleeding
 Monitor for signs of respiratory distress and notify the physician.
 Prepare the client for chest radiography if prescribed.


68. SKIN TESTS
 A skin test is an intradermal injection used to assist in
diagnosing various infectious diseases
NSG RESPONSIBILITIES
Pre procedure
 Determine the hypersensitivity or previous reactions
to skin tests
 During procedure
 Use test injection that is free of excessive body hair ,
dermatitis , and blemish

69.  Apply the injection at the upper one third of inner surface of the
left arm
 Circle and mark the test site
 Document the date , time and test site
 MANTOUX TEST
 The mantoux test also known as mantoux screening test , PPD test
is a tool for screening for TB and for TB diagnosis . It is one of the
major tuberculin skin tests used around the world
 Result interpretation :
• Negative: in duration < 5mm {always}
• Positive: in duration > 5mm not always but conditional e.g. in
immunosuppressed persons
• 10mm in duration to be positive e.g. IV drug abusers , children
under 4 years old , people in high risk areas
• > 15mm in duration to be positive in a healthy persons whose
immune system is normal

70. NSG RESPONSIBILITIES
 Do not give PPD to person who had positive test for TB in the
past
 Chest X- ray is the indicated for testing
 Follow the standard infection control precaution
 Strech the skin taut
 Inject the tuberculin into the superficial layer of the skin to
form a wheat 6mm to 10 mm in diameter

71. THORACENTESIS
 Removal of air or fluid from the pleural space via a
transthoracic aspiration.
 In this procedure, the physician inserts a large bore
needle through the chest wall in pleural space.
 Chest X-ray is always obtained after the procedure to
check for pneumothorax

73. Purpose
 -Removal of fluid and very rarely air from pleural
cavity.
 -Aspiration of pleural fluid for analysis.
 -Instillation of medication into the pleural space.

74. NURSING
RESPONSIBILITIES
 -pre procedure
 Obtain informed consent.
 Monitor vital signs.
 Prepare the client for ultrasound or chest radiograph, if prescribed
before procedure.
 If the client cannot sit up, the client is placed lying on the bed towards
the affected side with head of the bed elevated.
 Instruct the client not to breathe deeply
 -post procedure
 Monitor vital signs.
 Monitor respiratory status
 Apply pressure on dressing and assess the puncture site for bleeding,
air embolism and pulmonary edema.

75. CLINICAL RESEARCH
AUTHOR:- SHEETU SINGH
PLACE:-RAJASTHAN,INDIA
YEAR:-2015
Current trends of management of respiratory diseases by
pulmonologists: Results of National Conference of
Pulmonary Disease - 2015 survey

76. ABSTRACT
Context:
 Respiratory diseases are a common problem in our
country and these are associated with significant
morbidity and mortality.
Aims:
 The aim of the paper was to analyze the pattern of
diagnostic tests used and treatment prescribed for
common respiratory diseases.

77. Result and conclusion
Investigation used for severity assessment and diagnosis
of PTB, was sputum for acid-fast bacilli (83.5%), for
PF(pulmonary fibrosis) was high-resolution computed
tomography chest (85.6%), for severe pneumonia was
arterial blood gas analysis (69.3%), for asthma was
spirometery and peak flow (96.8%) and for COPDs
was spirometry (87.2%). About 67.5% of doctors
preferred hospitalization for patients with severe
pneumonia. About 84.5% pulmonologists ordered
diagnostic tests and 55.5% prescribed treatment as per
current guidelines.

78. SUMMARY AND
CONCLUSION
 Here we have studied about the common respiratory
diseases, invasive and non-invasive tests, with their
nursing interventions including endoscopic
examination and biopsy with their purposes and
nursing responsibilities.

79. BIBLIOGRAPHY
 -Brunner and Siddhartha’s textbook of medical surgical
nursing-13th edition volume. Pg:-463,592,638,681
 -Lewis textbook of medical surgical nursing 6th edition.
Pg:-559, 563
 -linkman textbook of medical surgical nursing. Pg:-
1275, 1293, 1307, 1329
 -black textbook of medical surgical nursing. Pg:- 1637-
1650