Thoracentesis

Done to obtain a specimen of pleural fluid for diagnosis
used as a procedure to remove pleural fluid (pleural effusion) or instill medication
fluid removed is limited to 1200-1500 mL at one time to reduce the risk of cardiovascular collapse from rapid removal of too much fluid.

Pre-op:
requires informed consent
upright position,leaning forward w/ arms and head supported on anchored overbed table. This position spreads the ribs, enlarging the intercostal space for needle insertion.
coach patient to hold breathe or breathe out.

Post-procedure:
Chest x-ray is taken to check for pneumothorax, which is a possible complication for thoracentesis

Bronchoscopy

Direct visualization of the larynx, trachea and bronchi thru a bronchoscope to identify lesions, remove foreign bodies and secretions, obtain tissue for biopsy and improve tracheobronchial drainage.

Pre-op:
assess for hypersensitivity to anesthetics, antibiotics iodine or contract dyes
NPO for 8-12 hours
remove dentures, contact lenses, jewelry
assess vitals

Post-op:
assess for complication i.e laryngeal edema, bronchospasm, pneumothorax, cardiac dysrhythmias, bleeding
monitor for s/s of respiratory difficulty and hemoptysis (bloody sputum)
keep on NPO until gag reflex is back
no smoking for at least 6-8 hours cuz it may cause coughing and bleeding

Normal: blood-tinged sputum, hoarseness and sore throat
Report: pain, bleeding, respiratory difficulty

Lab Values

Laboratory Normal Reference Ranges: Metabolic Panel

Laboratory Test	Reference Range
Sodium (Na+)	135-145 mEq/L
Potassium (K+)	3.5-5.5 mEq/L
Chloride (Cl-)	95-110 mmol/L
Glucose (fasting)	70-120 (***double-check)
Blood Urea Nitrogen (BUN)	5-25 mg/dL
Creatinine	0.5-1.5 mg/dL
Calcium (Ca²+)	9-11 mg/dL
Magnesium (Mg²+)	1.5-2 mEq/L
Total bilirubin	0.1-1 mg/dL
Miscellaneous Chemistry Labs
Albumin	3.5-5 g/dL
Prealbumin	15-36 mg/dL
Hemoglobin A1C (HgbA1C)	≤ 7%
Serum Osmolarity	275-295 mOsm/L

Complete Blood Count (CBC)

Laboratory Test	Reference Range
White Blood Cells (WBC)	5,000-10,000/mm³
Band Neutrophils	≤ 8%
Hemoglobin (Hgb)	12-18 g/dL
Hematocrit (Hct)	36-54%
Platelets (Plt)	150,000-400,000/microliter

Arterial Blood Gas (ABG)

Laboratory Test	Reference Range
pH	7.35-7.45
pO₂	75-100 mmHg
pCO₂	35-45 mmHg
HCO₃	22-26 mEq/L