Question

A 71-year-old man who is married and is still working as a farmer presents to the endoscopy suite clinic. He came to the outpatient clinic two weeks ago with complaints of a progressive cough and chest congestion. Despite a week of antibiotic therapy, he continued to worsen; he experienced progressive dyspnea, a productive cough, and began to have night sweats. He refused to be admitted to the hospital because, “There's no one to look after the cattle.” He agreed to go for a chest x-ray. The radiologist read the chest x-ray as ”left hilar lung mass, probable lung carcinoma.” He has a past medical history of hernia surgery in 1986 and prostate surgery in 2005 for benign prostatic hyperplasia. He does not drink. He has smoked for 40 years and the past three years he has smoked two to three packs per day. He is scheduled for a diagnostic fiber-optic bronchoscopy with endobronchial lung biopsy as an outpatient this morning to confirm the diagnosis. 1. What is a fiber-optic bronchoscopy, and what information will fiber-optic bronchoscopy with endobronchial lung biopsy provide? 2. The nurse who works with pulmonologist is responsible for preparing the client for the bronchoscopy procedure and what to expect following the procedure. What should the nurse include in a teaching plan? 3. Describe nursing care immediately following the bronchoscopy.

Answer 1

1. Fiber optic bronchoscopy

                   It is a clinical examination of tracheobronchial tree and lung tissues with the help of a

                   fiber-optic endoscope.

* Endobronchial lung biopsy with fiber optic bronchoscope provide informations about presence

    of malignant or benign tumors or masses in the lungs.

2. Teaching plan for a patient about bronchoscopy.

               * Instruct the patient that it is an invasive procedure with the help of an endoscope which

                  inserted to the lungs to examine or take samples for diagnosis.

               * Educate the patient that NPO (Nil per oral) for 6 to 12 hours before procedure to reduce

                   the risk of aspiration during procedure.

              * You should remove any prosthesis,dentures before doing the procedure to avoid distractions

                 during the procedure.

              * If you feel any discomfort when doing the procedure inform health care provider to take

               necessary action.

3. Nursing care following bronchoscopy

                * Check vital signs of the patient to identify problems related with respiration.

                * Assess the patient for respiratory distress including dyspnea,changes in respiratory rate

                   and absence of lung sounds.

                * Check for signs of hemoptysis (Presence of blood in sputum).

                * Make sure that patient is NPO untill gag reflex return.

                * Begin with a liquid diet after patient regain gag reflex.

                * Observe lung sounds for first 24 hours.

                * Assess for side effects of anesthetics used for bronchoscopy and inform physician if

                   any adverse reaction occur.