Page 45 - Critical Care Nursing Demystified

30 CRITICAL CARE NURSING DeMYSTIFIED

foreign objects and mucus plugs, collecting secretions for cytologic and
bacteriologic culture, and to implant radioactive gold seeds for treating
tumors.
Pre care – This can be done on an outpatient basis. The patient must sign
a consent and remain NPO 12 hours prior to the examination. Explain
the following steps to the patient: Nasal and oral pharynx are locally anes-
thetized. A flexible fiber-optic scope coated with lidocaine is inserted into
the patient’s airways. Local or general anesthesia can be used.
Post care – The patient should remain NPO until the return of a gag reflex.
Monitor for recovery from sedatives and for signs of laryngeal edema.
Complications – Can include hemorrhage and pneumothorax.

5. Lung biopsy
Indications for lung biopsies include suspected malignancies, unexplained
diffuse lung disease, and unidentified infectious processes. Tissue speci-
mens are collected and sent to the laboratory for microbiologic, histologic,
cytologic, and immunologic studies.
Pre care – Establish that consent has been signed and the patient re-
mained NPO prior to the procedure. Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
Post care – A chest x-ray is done after the procedure to assess for pneu-
mothorax. A verification of breath sounds in all lung fields and assessment
for signs of hypoxia must be completed. An open lung biopsy requires
assessment of the patient’s postoperative recovery status: vital signs, pain,
difficulty breathing, and signs of bleeding.
Complications – These include hemorrhage, hypoxia, and pneumothorax.
6. Thoracentesis
Pleural fluid is removed through the chest wall to determine either
pleural effusion or suspected malignancies. Fluid is usually sent to the
laboratory.
Pre care – Establish that a consent has been signed and explain the pro-
cedure to the patient. Position the patient with legs dangling over the side
of the bed and arms and chest resting on the overbed table. Instruct the
patient not to talk or cough. Local anesthesia is given. A large-bore needle
is inserted through the chest wall through the plural space.
Post care – Have patient remain on the affected side after the procedure to
seal the insertion site. Observe for leakage of fluid from the site. Assess for
complications.
Complications – These include hemorrhage and pneumothorax.