Preparation of the Articles for Bronchoscopy
1. Bronchoscope, either fibre optic or rigid.
2. Biopsy forceps, angled tongue depressor.
3. Suction nozzles, suction tubing and tube anchoring forceps.
4. Pharyngeal spray and topic anaesthetic agent.
5. Specimen bottles with 10 percent formalin.
6. Cytology brush.
8. A container with sterile gauze pieces.
9. Laryngoscope with appropriate size of blades.
10. Kidney tray and paper bag.
11. Mask, gloves, apron etc. for the doctor.
Preparation of the Client
1. Since the bronchoscopy is an unpleasant and uncomfortable experience for the client, a through explanation of the procedure to the client will allay his fear and anxiety.
2. Since the instruments are passed through the mouth and pharynx, the client may be apprehensive about his breathing. So he should practice breathing in and out of the nose with the mouth opened.
3/ He should practice to relax the shoulders and hands while lying on the back. Clenching the fists in fear causes the neck muscles to become tense and it will interfere with the procedure.
4. To lessen the number of bacteria introduced into bronchi from the mouth, the client should pay particular attention to oral hygiene. Examine the mouth before the bronchoscopic examination and report any lesion found in the mouth.
5. The client should be questioned about any loose teeth, if so, it should be reported to the doctor to prevent accidental dislodging of the teeth during the introduction of the tube. If dentures are present, it should be removed and kept safely before sending the client to the endoscopy room.
6. No food or fluids are allowed for 8 to 12 hours preceding the examination, to prevent possible regurgitation and aspiration. When bronchoscopy is performed as an emergency measure to remove a foreign body, the stomach cannot be emptied, but suction should be available for use to prevent aspiration of regurgitated food or fluid.
7. The client should void before the examination to prevent the discomfort of a full bladder and embarrassment during the procedure.
8. Approximately one hour before the examination, the client is given a pre-operative sedation to minimize the stimulating effect of anaesthetic agent and to sedate him. If the examination is done under general anaesthesia, injection. Atropine is given to minimize the bronchial secretions.
9. To lessen the discomforts during the procedure, a local anaesthetic agent is sprayed on the pharynx. The client should be told not to swallow the saliva but to expectorate it in an emesis basin. Signs of toxicity is noticed after the administration of local anaesthetic agent such as rapid pulse rate, excitation, headache, palpitation etc. it should be reported to the doctor and the client is treated promptly to prevent respiratory failure.
10. If general anaesthesia is to be given, a written consent is taken before sending the client to the endoscopy room.
11. The client (under local anaesthesia) should be told to be still while the instrument is passed. Any sudden movement at the time of the insertion of the bronchoscope, can cause trauma to the trachea-bronchial mucosa.
After Care of the Patient
1. If the client had general anaesthesia, the post anaesthetic care should be that of an unconscious client. He should be received in a warm bed, placed flat in bed without a pillow under the head and the head turned to one side for the drainage of secretions from the mouth.
2. The client after local anaesthesia is not allowed oral intake until it is certain that the local anaesthesia has worn off and the client’s gag reflex has been restored.
3. Observe the client for laryngeal spasm or laryngeal oedema resulting laryngeal trauma sustained during intubation. The doctor should be informed of such symptoms as laryngeal stridor, dyspnoea and shortness of breath. Have emergency equipment available including tracheostomy tray. Provide emergency resuscitation as necessary.
4. Observe the client’s sputum for indications of haemorrhage if biopsy was performed. The staining of the sputum with blood is expected after a biopsy. If frank blood appears, it is a sign of haemorrhage and it should be reported immediately.
5. Observe the client for subcutaneous emphysema around the face and neck. If present, it indicates a serious complication of perforation of trachea or bronchus and the air leaking out into the tissues.
6. Observe the client for symptoms of toxicity caused by the local anaesthetic agents.
7. Save all sputum expected for laboratory studies, for cytology and culture because post-bronchoscopic sputums are often positive diagnostically.
8. Tracheal intubations may cause sore throat in the client. An ice collar may be used to reduce the oedema. Lozenges may be given to suck, in order to reduce soreness. Saline gargles may also help to reduce sore throat.
9. Once the gag reflex is present, give sips of water first to see the ability of the client to swallow the fluid. If there is no nausea and vomiting present, small amounts of fluid may be given. A soft diet may be given after 8 to 10 hours. A regular diet may be resumed next day.
10. Instruct the client not to smoke in the post bronchoscopic period, because smoking will stimulate coughing reflex and it may precipitate bleeding from the site of biopsy.
11. Elderly clients may develop pneumonia in the post bronchoscopic period.
12. If bronchogram is done following bronchoscopy, follow the care of the client after bronchogram.
13. Record the procedure in the nurse’s record with date and time. Record the type of anaesthesia used, any complications developed during and after the bronchoscopy.
AUTHOR : MERCY KUTTY
Oesophago-Gastro-Duodenoscopy are procedures done to visualize the inner surface of oesophagus, stomach and even the duodenum. Fibre optic gastroscope allows greater flexibility and permits visualization of all the areas of the oesophagus to duodenum.
An emergency oesophagoscopy may be done to remove any foreign body, but in other cases it will be a planned procedure. The usual indications for oesophago-gastro-duodenoscopy are complaints of dysphagia, oesophageal varices, unexplained haematemesis, presence of gastric and duodenal ulcers, to take biopsy from any growth found in the oesophagus and stomach, to remove a foreign body, or to rule out some malignant diseases in these areas.
Preparation of the Articles for Gastroscopy
1. Fibreoptic gastroscope with its accessories.
2. Plastic mouth guard.
3. Biopsy forceps.
4. Accessories for endoscopic diathermy.
5. Angled tongue depressor.
6. Pharyngeal spray and topical anaesthetic (if necessary)
8. Specimen bottles with formalin 10 percent.
9. Kidney tray and paper bag.
The client is usually sedated with I.V. diazepam. A topical anaesthetic is applied to the pharynx if necessary. A plastic mouth guard is then placed between the gums and teeth. The lubricated fibroscope is passed through the guard over the tongue and the client is asked to swallow. Swallowing opens the upper oesophageal sphincter so that the instrument can be advanced into the oesophagus. No force is employed at any time for the insertion of a gastroscope, because it can cause perforation of the gut.
The examination is started by inflating the oesophagus with air until a view of the lumen is obtained. Successful examination requires nearly a continuous use of air, water and suction to keep the lens clean and the oesophagus distended. The examination will reveal hiatus hernia, oesophagitis, oesophageal varices, strictures and tumours. If necessary, biopsy forceps are introduced and a specimen is taken for histology.
When the examination of the oesophagus is completed, the scope is then introduced into the stomach. Sufficient air is inflated to distend the body of the stomach combined with an intermittent suction to remove secretions and a detailed examinations of the stomach is carried out, paying special attention to lesser curvature the fundus and the cardiac end of the stomach. Operative procedures may include biopsy with a biopsy forceps, brush cytology, removal of foreign body, diathermy excision of polyps etc.
The gastroscope is then passed through the pylorus into the duodenum. The organ is inflated with air and a careful examination is carried out and if necessary, biopsy or brush cytology specimens are taken.
Preparation and After Care of the Client
The preparation and after care of the client are same as that described for bronchoscopy. X-ray examinations of the oesophagus and the stomach are done prior to the examinations. The physician often uses X-ray to guide him in passing the gastroscope.
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It refers to the examination of the tracheobronchial tree and the broncho-pulmonary segments. It may be done under local or general anaesthesia. A brochoscopic examination is performed by passing a fibreoptic bronchoscope into the trachea and bronchi through the trans-oral route. During bronchoscopy, the client lies on his back with his neck and head hyper-extended. A small pillow is placed under his shoulders in such a manner that the head drops back over the edge of pillow. Bronchoscopies are performed for the following purposes:
1. Examination of the tracheo-bronchial tree in cases of haemoptysis, persistent unexplained cough and unexplained X-ray shadows.
2. To obtain samples (biopsy) of pulmonary tissues and cells for cytologic examination.
3. To obtain bronchial secretions or bronchial washing for microscopic examinations or bacteriologic examinations.
4. To instill a radiopaque dye prior to bronchoscopy.
5. To facilitate removal of foreign body or secretions that may obstruct the airway. (To remove the foreign body, a rigid bronchoscope is used).To apply a medication directly to the trachea-bronchial tree.
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