Chapter 28
Respiratory Care
561
KNOWLEDGE CONNECTION What areas will you inspect when assessing a patient with impaired oxygenation? When you palpate, what two eval- uations are you making? How can you tell if the patient is becoming hypoxic or hypoxemic?
Diagnostic Tests In addition to your assessment, certain diagnostic tests help clearly explain the patient’s oxygenation status. Table 28.1 lists the types of diagnostic tests and the signi fi cance of abnormal results. Obtain sputum specimens and throat cul- ture specimens when ordered by the health-care provider to help diagnose respiratory conditions. SPUTUM SPECIMENS. When you obtain a sputum specimen, keep in mind that the best time to do this is fi rst thing in the morning. Patients may have mucus that has pooled during the night, making it easier to obtain a specimen. There are two ways to obtain a sputum specimen: 1. The patient coughs and brings up mucus from the lungs and expectorates it into a sterile specimen container. 2. You suction the throat or trachea and trap the mucus in a specimen container attached to the suctioning tubing. The results of sputum testing help diagnose infection, tuberculosis, bleeding, and fl uids in the lungs. Skill 28.1 gives the steps needed to obtain a sputum specimen. THROAT CULTURE SPECIMENS. Specimens from the throat for culture and sensitivity are frequently obtained by nurses in health-care providers’ of fi ces and clinics, but sometimes they are ordered in home health care and hospitals as well. Generally a throat culture is ordered to detect a Streptococcus infection in the throat, commonly referred to as strep throat, so that it may be treated promptly. If such an infection is pres- ent and is not treated, it can lead to other illnesses, including rheumatic fever and rheumatic heart disease. Skill 28.2 gives the steps in obtaining a throat culture specimen. Laboratory and Diagnostic Connection Arterial Blood Gases Arterial blood gases (ABGs) are drawn from an artery rather than a vein, as are other blood tests. The most commonly used arteries are the radial, femoral, and brachial. A glass or plastic syringe is used; the syringe has a small amount of heparin added, which is an anticoagulant to prevent the blood from clotting. After testing for collateral circulation, the health- care professional inserts the needle into the artery at a 90-degree angle. Unlike other blood samples, no vacuum tube is used for ABGs. Instead, the pressure of the blood in
FIGURE 28.1 This patient shows evidence of retractions in the neck and shoulders as he inhales (from Williams LS, Hopper PD. Understanding Medical-Surgical Nursing. 6th ed. Philadelphia, PA: FA Davis; 2019).
in Chapter 21 to refresh yourself on patterns of respiration, including tachypnea, bradypnea, eupnea, Kussmaul, Cheyne- Stokes, Biot, and apnea.) As you listen with the stethoscope to both the anterior and posterior chest, assess for adventi- tious breath sounds. If the patient has fl uid in the lungs or airways, the sound is described as crackles. It is similar to the sound a soft drink makes after you pour it into a glass because it is the sound of air moving through fl uid. Refer to Chapter 21 for a review of adventitious lung sounds. To lis- ten to adventitious lung sounds, go to the online resources for this book at https://www.fadavis.com/home. OXYGENATION STATUS. When beginning to assess the patient’s oxygenation status, determine the patient’s orienta- tion to time, place, and person. Note restlessness and unusual irritability or confusion. Even minor changes can indicate hypoxia. Safety: Remember that changes in level of conscious- ness can indicate decreased oxygen reaching the brain. OXYGEN SATURATION. Determine oxygen saturation using a pulse oximeter. (Refer to Chapter 17 for the pro- cedure for using pulse oximetry.) The pulse oximeter is used to measure the oxygen saturation of capillary blood (SaO 2 ). The normal range for SaO 2 is 95% to 100%. In healthy people, a saturation of 94% or below is cause for concern. Safety: Remember that nail polish, especially a dark color, and artificial nails will cause inaccurate pulse oximetry results. Also be aware that these readings may be inaccurately high in people with dark skin tones. Remove nail polish or use an alternative site such as the earlobe or forehead. You can check a patient’s oxygen saturation without a health-care provider’s order. Be alert to subtle signs and symptoms of hypoxemia, and check the oxygen saturation when indicated.
Powered by FlippingBook