Diagnostic and therapeutic procedures for lung disease (Nursing)

Thoracic puncture

 * One-time stabbing of the pleural cavity in order to remove the pathological content.
 * Diagnostic or therapeutic purpose.

Diagnostic purpose

 * Determination of the character of the punctate.
 * Exudate – effusion of inflammatory origin.
 * Transudate – effusion of non-inflammatory origin.
 * Hemorrhagic effusion – suspected tumor, acute myocardial infarction.

Therapeutic purpose

 * Remove air or effusion and allow lung expansion.
 * Fluidothorax – the presence of fluid in the pleural cavity.
 * Hemothorax – blood in the pleural cavity.
 * Chylothorax - means the presence of sap.
 * Empyema – means the presence of pus.
 * Pneumothorax – presence of air in the pleural cavity.

Injection site

 * Pneumothorax – puncture the 2nd intercostal space in the medioclavicular line.
 * Fluidothorax – we puncture the 8th intercostal space in the middle scapular line or in the posterior axillary line.

Patient preparation

 * 1) Familiarizing the patient with the procedure.
 * 2) * The surgeon who will perform the chest puncture will explain everything to the patient and have him sign the informed consent.
 * 3) * Each puncture should be preceded by a chest X-ray.
 * 4) Chest puncture aids:
 * 5) * Sterile: sterile squares and tampons, perforated drape, pean, puncture needle or disposable puncture set, connecting tube with three-way stopcock or pusher, injection needle, syringe, measuring container (to check the amount and nature of the puncture).
 * 6) * Non-sterile: disinfectant solution, plaster, local anesthetic (MESOCAIN 1%), sterile tubes for examination of punctate for microbiological, biochemical and cytological examination.
 * *Tools may vary according to the requirements of individual doctors!!!
 * 1) Patient position:
 * 2) * The patient sits cross-legged on the chair with his chest resting on the backrest.
 * 3) * Lies on the healthy side of the chest.

Workflow

 * 1) The nurse will disinfect the chest, followed by local anesthesia and re-disinfection of the chest.
 * 2) The doctor punctures the pleural cavity with a puncture needle with a connected connecting tube (with the pressure closed).
 * 3) * After correct impaling, a punctate will appear in the tube.
 * 4) The doctor asks the nurse to release the pressure so that the fluid can be released.
 * 5) The end of the puncture tube must always be below the level of the liquid in the container to prevent air from being sucked back in.
 * 6) * After draining the fluid from the chest cavity and taking the necessary sample, we close the connecting tube.
 * 7) The doctor removes the puncture needle and the nurse covers the injection site with a sterile bandage.

Nursing care after the procedure

 * The nurse observes the patient's behavior during and after the procedure.
 * Measures physiological functions and evaluates his overall condition.
 * According to the doctor's office, a control X-ray of the chest is performed on the patient.
 * Place the patient in an elevated position.
 * The nurse will record everything in the documentation (procedure, patient condition, procedure time, amount and nature of punctate, examination for which the punctate was sent, possible complications).
 * He confirms the record with his signature.

Complications

 * Hypotension.
 * Lung damage.
 * Liver damage.

Bronchoscopy

 * Endoscopic examination method, which is used for the optical examination of the lower respiratory tract, i.e. trachea and bronchi.




 * It is performed in an endoscopy clinic or ward, in the department of intensive care and resuscitation - the necessity of monitoring physiological functions.
 * The examination is usually performed on an empty stomach.
 * Before the examination, the patient should have basic samples taken - biochemical blood test, or urine, blood count and coagulation.
 * Bronchoscopy is performed by a doctor under topical or general anesthesia (less common).
 * During the examination, it is possible to take samples for microbiological or histological examination.

Types of bronchoscopes

 * 1) Rigid bronchoscope.
 * 2) * A thin, hollow, about 40 cm long metal tube, which is equipped with optics and a cold (non-burning) light source at the end.
 * 3) * It can be used when taking a large amount of tissue (biopsy) or when removing foreign bodies from the airways.
 * 4) Flexible Bronchoscope.
 * 5) * More often used in practice, it is also suitable for small children.
 * 6) * Diameter 2-3 mm, optical fibers are arranged inside the bronchoscope, which are flexible and at the same time conduct light.
 * 7) * It is used to suck out secretions, blood, pus, remove foreign bodies, apply drugs to the desired places, and find sources of bleeding.

Indication

 * Diagnostic.
 * Microscopic assessment of airways.
 * Checking the position of the ETK, TS cannula.
 * Decrease in SaO2.
 * Clarification of airway narrowing.
 * Sampling of bronchial secretions.
 * Early diagnosis of cancer.
 * Medicinal.
 * Removal of foreign bodies.
 * Building bleeding.
 * Cleansing the bronchi if the patient is unable to clear the cough by himself.

Utilities

 * Bronchoscope, light source, aspirator.
 * Sterile mask, gown.
 * Physiological saline solution.
 * Silicone spray.
 * Tubes for collecting biological material.
 * Sterile gloves.

Patient preparation

 * The doctor explains everything to the patient and has him sign the informed consent → the exception is the patientt unconscious.
 * Place the patient in a horizontal position.
 * We will insert an anti-test insert into the mouth.
 * We apply medicines according to the doctor's office.

Assistance of nurses to doctors

 * The doctor puts on an empyrean, mouthpiece, gloves → the nurse connects the bronchoscope to the light source and the aspirator.
 * Spray the bronchoscope with silicone spray.
 * Holds the test insert, ETI or TS cannula during the examination.
 * Monitors physiological functions, mainly SaO2.
 * Application of medicines to the respiratory tract according to the doctor's office.
 * Collection of biological material.
 * After the bronchoscopy, the nurse cleans the bronchoscope.

Patient care after the procedure

 * The patient is taken to bed and his general state of health, especially BREATHING, is monitored for several hours.
 * The patient has not eaten anything for at least two hours.
 * If the patient will be discharged home, the rest regime must be observed throughout the day.

Nursing Diagnoses

 * 'Fear and restlessness due to ignorance of bronchoscopic or puncture examination.
 * Goal: calm patient.
 * Intervention:
 * Empathetic approach, listening to the patient, answering questions.
 * Inform the patient about the entire examination, its course and subsequent steps after the examination.


 * Risk of infection, sepsis, due to non-compliance with asepsis principles.
 * Goal: prevent sepsis.
 * Intervention:
 * Consistency in observing the principles of hand hygiene, consistent disinfection in the area of the procedure (puncture).
 * Adherence to procedures, nursing standards.
 * Monitor the area around the injection site, pain during puncture X monitor cough, mucus production after bronchoscopy.
 * Record the data found in the documentation.


 * Risk of airway damage during bronchoscopic examination.
 * Goal: respiratory tract damage will not occur X early detection of respiratory tract damage.
 * Intervention:
 * Instructing the patient about the necessity of cooperation during the examination and warning of possible risks.
 * Administration of medicines according to the doctor's office.
 * Proper education of the patient during the procedure, timely response to his difficulties.
 * Ensuring a suitable position and maintaining it throughout the examination.
 * Striving for good psychological well-being of the patient.
 * Agree with the patient in advance the signals by which the patient can communicate with us during the examination.