Respiratory Assessment
Lecture 2b
Assessment of breathing ability
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Pulmonary function test
Pulse oximeter
Radiographic exams
Lab values
Pulmonary Function Tests
Purpose
• Assess resp. function
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Tidal volume
Vital capacity
Rate
Inspiratory force
• Progress of disease
Pulse Oximeter
Purpose
• Noninvasive O2 Sat
Normal
• 95-100%
• <85% 
– Tissue is not receiving
enough O2
Pulse oximeter
Not reliable in…
• Cardiac arrest
• Shock
• Vasoconstrictive meds
• Dyes
• Anemia
• High CO levels
The most appropriate nursing intervention for
a client requiring a finger probe pulse
oximeter is to:
A. Apply the sensor probe over a finger and cover
lightly with gauze to prevent skin breakdown
B. Set alarms on the oximeter to at least 100%
C. Identify if the client has had a recent diagnostic
test using intravenous dye
D. Remove the sensor between oxygen saturation
readings
Radiographic exams
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Chesk x-ray
CT scan
PET
Fluroscopy
Barium Swallow
Angiography
Bronchoscopy
Thoracoscopy
Thoracentesis
Chest x-ray
Description
• 2-d image
Purpose
• Fluid
• Tumor
• Foreign bodies
Chest – X-ray
Nrs management
• Call pink ladies
• Normal heart size & clear lung
field
CT Scan
Description
• Computerize Tomography
• With or without contrast
medium
Purpose
• Tissue
• Tumor
• Foreign bodies
• Fluid
CT scan
Nrs management
• Without contrast
medium
– No prep
• With contrast medium
– NPO 6 hrs
– Assess for allergies
Positron Emission Tomography
PET
Purpose
• Confirm adequate
blood supply
Description
• Radioactive tracers
injected IV
Fluoroscopy
Purpose
• Detect movement
– Diaphragm paralysis
Description
• X-ray
Barium Swallow
Purpose
• View esophagus and
cardiac sphincters
Description
• Drink barium
• X-ray
Barium swallow
Nrs Management
• NPO
• Post-procedure
– Laxatives
– BM  white
Angiography
Purpose
• Pulm. Circulation
Description
• Dye
• Femoral vein 
• Heart 
• Pulm Arteries
Angiography
Nrs. Management
• Pre-op
– NPO
– Check Allergies
• Shellfish/iodine
• Post-op
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Lie flat 8 hrs
Sandbag
Check pedal pulses
Assess hemorrhaging
Push fluids
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Normal pulmonary angiography
Bronchoscopy
Description
• Direct inspection of
larynx, trachea &
bronchi via flexible
tube (fiberoptic)
Purpose
• Examine
• Tissue sample
Bronchoscopy
• Nrs Management
• Pre-op
– NPO 6-8 hrs
– Sedation
• i vegal response
• i cough/gag reflex
• i anxiety
Bronchoscopy
Nrs management
• Post-op
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Side-ling until gag back
NPO till gag back
Check gag
Check bleeding
Thoracoscopy
Description
• Fiber-optic inspection
of thoracic cavity
• Incision
Purpose
• Inspect
• tissue sample
Thoracentesis
Purpose
• Remove fluid for dx
• Remove fluid for tx
• Obtain biopsy
• Instill meds
Thoracentesis
Nrs Management
• Position patient
• Support
• Post-op
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Vital signs q 15
Chest x-ray
Breath sounds – bilateral
Cover site
• Check bleeding
• Check drainage
Lab Values
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Sputum
WBC
Hemoglobin
Hematocrit
ABG’s
PTT/PT
Sputum studies
• Check for
– Pathogens
• C&S
• Acid-fast bacillus
– What?
• TB
– Duration
• 4-6 wks
White Blood Cell Count
• Normal
– 5,000 – 10,000 cell/mm3
• Elevated
– Bacterial infection
• Decreased
– Leukemia
– Viral infection
Hemoglobin
Normal
• Female: 12-16 g/dl
• Male:14-18 g/dl
Elevated
• COPD
• Dehydration
Decreased
• Anemia
• Hemorrhaging
• Over hydration
Hematocrit
Normal
• Female: 37-47%
• Male: 42-52%
Elevated
• Dehydration
• Burns
• COPD
Decreased
• Anemia
• Leukemia
Arterial Blood Gases
Purpose
• Adjust O2 levels
• Hypoxemia
Description
• Must by arterial blood
Arterial Blood Gases
Values
• pH
• PaO2
• PaCO2
• HCO3• SaO2
ABG’s
pH
• Normal
– 7.35-7.45
• Elevate
– > 7.45
– Alkalosis
• Decreased
– <7.35
– Acidosis
pH Quiz: Acidosis or alkalosis
• Arterial blood pH of 7.51?
– Alkalosis
• Arterial blood pH of 7.30?
– Acidosis
• Arterial blood pH of 7.34
– Acidosis
• Arterial blood pH of 7.43
– Normal / homeostasis
ABG’s
• PaO2
• Normal
– 80-100 torr
• Elevated
– Hypervenilation
• Decreased
– i resp. function
– Hypoxemia
ABG’s
PaCO2
• Normal
– 35-45 mmHg
• Elevated
– Hypercapnia
– Impaired gas exchange
• Decreased
– Hyperventilation
ABG’s
HCO3• Normal
– 22-26
SaO2
• Normal
– 95-100%
• Decreased
– Hypoxemia
PTT/PT Partial Thromboplastin Time
• Prolonged
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Liver disease
Vit K deficiency
Anticoagulant
Hemophilia
Quiz?
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A.
B.
C.
D.
The main function of platelets is to…
Provide oxygen to tissue
Fight viral infections
Fight bacterial infections
Form a blood clot
A fragile 87 year-old female has recently been
admitted to the hospital with increased
confusion and falls over last 2 weeks. She is also
noted to have a mild left hemiparesis. Which of
the following tests is most likely to be
performed?
A.
B.
C.
D.
FBC (full blood count)
ECG (electrocardiogram)
Thyroid function tests
CT scan
• A 84 year-old male has been loosing mobility
and gaining weight over the last 2 months. The
patient also has the heater running in his house
24 hours a day, even on warm days. Which of
the following tests is most likely to be
performed?
A.
B.
C.
D.
FBC (full blood count)
ECG (electrocardiogram)
Thyroid function tests
CT scan
• A 20 year-old female attending college is found
unconscious in her dorm room. She has a fever
and a noticeable rash. She has just been
admitted to the hospital. Which of the following
tests is most likely to be performed first?
A.
B.
C.
D.
Blood sugar check
CT scan
Blood cultures
Arterial blood gases
• A 28 year old male has been found wandering
around in a confused pattern. The male is
sweaty and pale. Which of the following tests is
most likely to be performed first?
A.
B.
C.
D.
Blood sugar check
CT scan
Blood cultures
Arterial blood gases
• A nurse is administering blood to a patient
who has a low hemoglobin count. The
patient asks how long to RBC’s last in my
body? The correct response is.
A. The life span of RBC is 45 days.
B. The life span of RBC is 60 days.
C. The life span of RBC is 90 days.
D. The life span of RBC is 120 days.