PLEURAL FLUID ANALYSIS
The test is utilizes the procedure called
thoracentesis to get a sample of pleural fluid, to
determine the cause of a pleural effusion, and to
relieve the shortness of breath that a large
pleural effusion can cause.
How the Test is Performed:
The client will sit on the edge of a chair or bed
with his/her head and arms resting on a table.
The health care provider will clean the skin
around the insertion site and drape the area. A
local pain-killing medicine (anesthetic) is
injected into the skin, which stings a bit, but
only for a few seconds.
The thoracentesis needle is inserted above the rib into the pocket of fluid.
Nursing Responsibilities:
Before:
Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or
sensitivities to latex.
Obtain a history of the patient’s immune and respiratory systems, especially any bleeding disorders and
other symptoms, as well as results of previously performed laboratory tests and diagnostic and surgical
procedures.
Record the date of the last menstrual period and determine the possibility of pregnancy in
perimenopausal women.
Review the procedure with the patient. Inform the patient that it may be necessary to remove hair from
the site before the procedure.
Discuss with the patient that the requesting HCP may request that a cough suppressant be given before
the thoracentesis.
Inform the patient that the needle insertion is performed under sterile conditions by an HCP specializing
in this procedure. The procedure usually takes about 20 min to complete.
During :
Ensure that anticoagulant therapy has been withheld for the appropriate number of days prior to the
procedure.
Have the patient remove clothing and change into a gown for the procedure.
Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and
tell the client not to cough, breathe deeply, or move during the test to avoid injury to the lung.
Assist the patient into a comfortable sitting or side-lying position.
Place samples in properly labeled specimen container, and promptly transport the specimen to the
laboratory for processing and analysis.
After:
Monitor vital signs every 15 min for the first hr, every 30 min for the next 2 hr, every hour for the next 4
hr, and every 4 hr for the next 24 hr. Take the patient’s temperature every 4 hr for 24 hr. Monitor intake
and output for 24 hr. Notify the HCP if temperature is elevated. Protocols may vary among facilities.
Observe/assess the patient for signs of respiratory distress or skin color changes.
Observe/assess the thoracentesis site for bleeding, inflammation, or hematoma formation each time vital
signs are taken and daily thereafter for several days.
Inform the patient that 1 hr or more of bed rest (lying on the unaffected side) is required after the
procedure. Elevate the patient’s head for comfort.
Administer antibiotics, as ordered, and instruct the patient in the importance of completing the entire
course of antibiotic therapy even if no symptoms are present.
REFERENCES:
http://nursing.unboundmedicine.com/nursingcentral/ub/view/Davis-Lab-and-Diagnostic-
Tests/425300/6/Pleural_Fluid_Analysis_
http://www.nlm.nih.gov/medlineplus/ency/article/003624.htm
http://ts3.mm.bing.net/images/thumbnail.aspx?
q=393783685326&id=9ad2087ba5e3a0788b6f2467f7ba8d55
EGD - ESOPHAGOGASTRODUODENOSCOPY
is an examination of the lining of the
esophagus, stomach, and upper duodenum
with a small camera (flexible endoscope)
which is inserted down the throat.
How the Test is Performed:
The client will be instructed to lie on his left
side.
Then the client will be given a sedative and an
analgesic (painkiller). A local anesthetic is
sprayed into the mouth to suppress the need to
cough or gag when the endoscope is inserted. A
mouth guard will be inserted to protect your
teeth and the endoscope. Dentures must be
removed.
In most cases, an intravenous line will be
inserted into your arm to administer medications during the procedure.
The endoscope is advanced through the esophagus to the stomach and duodenum. Air is introduced
through the endoscope to enhance viewing.
After the test is completed, food and liquids will be restricted until the gag reflex returns.
The test lasts about 5 to 20 minutes.
Nursing Responsibilities:
Before:
The upper intestinal tract must be empty for the procedure, so patients must not eat or drink anything for
at least six to 12 hours before the exam.
The client is told to stop aspirin and other blood-thinning medications for several days before the test.
After:
Instruct the patient not to eat or drink anything until the gag reflex has returned. Normally, the gag
reflex will return in two to four hours after the procedure. To test if the gag reflex has returned, place a
spoon on the back of the tongue for a few seconds with light pressure.
If the patient does not gag, wait 15 minutes and attempt the maneuver again. Do not use small or sharp
objects.
Advise the patient that hoarseness and a mild sore throat are normal after the procedure.
Encourage cool fluids and gargling to relieve the soreness. Because of the introduction of air during the
procedure, it is normal to have some bloating, belching and flatulence after an EGD.
To prevent pill-induced esophageal injury, advise patients to drink at least 4 ounces of liquid with any
pill, and at least 8 ounces of liquid with pills that can cause injury.
Patients should remain sitting upright for 30 minutes after taking pills that are likely to cause injury.
REFERENCES:
http://www.nlm.nih.gov/medlineplus/ency/article/003888.htm
http://ts4.mm.bing.net/images/thumbnail.aspx?
q=422529469031&id=bdae249ed458ce67ba8e5090a0759d0a
