Bronchoscopy
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Study Tools For Bronchoscopy
Reasons for a Bronchoscopy (Mnemonic)
Bronchoscopy Diagram (Image)
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Outline
Overview
Purpose – to visualize airways to diagnose issues or remove obstructions.
Nursing Points
General
- Indications
- Diagnose
- Persistent Cough
- Hemoptysis
- Abnormal CXR
- Biopsy/Sampling
- Treat
- Washout Sputum
- Remove Obstruction
- Diagnose
Assessment
- Before Procedure
- Informed Consent
- Patient Education
- NPO 6-8 hours prior
- Emergency Equipment at bedside
- IV access for sedation
- Baseline Assessment
- Possible Complications
- Bronchospasm
- Bleeding
- Respiratory Distress
- Aspiration
Therapeutic Management
- During Procedure
- Stay with patient if at bedside
- Conscious sedation
- Continuous telemetry
- Monitor VS and LOC q5 min
- Monitor for Respiratory Distress
- Give O2 as needed
- After Procedure
- High-Fowler’s Position
- NPO until gag reflex returns
- Monitor respiratory status
- Monitor vital signs
- Monitor for bronchospasm
- Monitor for bleeding
Nursing Concepts
- Oxygenation/Gas Exchange
- Monitor respiratory status
- Give O2 as needed
- Safety
- Airway protection
- Prevent Aspiration
- Comfort
- Conscious sedation
- Pain control after
Patient Education
- No driving or heavy machinery x 24 hours
- Procedure may induce cough
- Take medications as prescribed before procedure
- NPO after midnight or at specific time (importance)
- May not be able to swallow x 1-2 hours post procedure
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ADPIE Related Lessons
Related Nursing Process (ADPIE) Lessons for Bronchoscopy
Transcript
Let’s talk about Bronchoscopy and what you need to do for these patients before, during, and after the procedure.
The purpose of bronchoscopy is to visualize the airways. You can see the scope passes through their vocal cords into their bronchi. This could be done for diagnostic purposes if the patient has had a persistent cough or is coughing up blood or maybe had abnormal findings on a chest x-ray. We can also take a sample of secretions or tissue while we’re in there. We will also use this therapeutically to washout deep, thick secretions that we haven’t been able to mobilize or to remove any obstructions like foreign bodies or masses.
Before any procedure we need to make sure informed consent is obtained – remember that is the provider’s job. We want to educate the patient on what to expect and what they need to be prepared for. The patient needs to be kept NPO for 6-8 hours prior to the procedure. We don’t want the patient to vomit and aspirate when they can’t protect their airway. We need to make sure our emergency equipment is at bedside – that’s suction, an ambu bag, and possibly medications if the provider anticipates needing to intubate the patient. This procedure is typically done under conscious sedation if the patient isn’t already sedated, so we need to make sure we have good IV access for that. And then, of course we’ll get a baseline assessment including lung sounds, vital signs, and oxygenation.
Bronchoscopies or “Bronchs” may be done in a special procedure suite or they could be done at the bedside. Typically you only have to stay with the patient if it’s done at the bedside. The nurse is responsible for administering conscious sedation. This also typically requires continuous telemetry and frequent monitoring of blood pressure and level of consciousness – usually every 3-5 minutes. Make sure you follow your facility policy for this. During the procedure we will be monitoring the patient for any signs of respiratory distress since bronchospasm can happen when you’re in here irritating the airways. And of course we’ll give supplemental O2 as needed.
Possible complications, like I said, are bronchospasm, as well as bleeding – especially if they took a biopsy or removed a lesion. Patients might also experience a severe cough or respiratory distress. The patient is also at risk for aspiration because their throat has been numbed during the procedure by a local anesthetic. So they will actually not have a good gag reflex for an hour or two after the procedure. So to protect their airway we sit them in High-Fowler’s position and we do not let them take ANYTHING by mouth until their gag reflex returns. We will also monitor their respiratory status and vital signs according to your facility’s post-procedure vital signs protocol. And we’re going to continue to monitor the patient for bronchospasm or bleeding. It’s common for patients to cough up dark red blood or clots for a few days, but any bright red blood should be reported immediately.
Check out the careplan attached to this lesson for more specific nursing interventions, but let’s look at the priorities. Of course, since we’re entering their airway, we are concerned about oxygenation and gas exchange. Since we are numbing their gag reflex and they’re at risk for aspiration, we will also consider safety as a priority before, during, and after the procedure. And finally this patient needs conscious sedation and may be uncomfortable afterwards, so we will manage those medications as needed.
Some key takeaways are that bronchoscopy is used to visualize the airways to diagnose issues or remove obstructions like secretions or masses. Before the procedure we need to keep the patient NPO, establish IV access, and have emergency equipment available. During the procedure we will manage the conscious sedation and monitor the patient continuously. After the procedure, we keep the patient NPO until their gag reflex returns, usually 1-2 hours, and we monitor closely for complications.
So those are the highlights of nursing care for bronchoscopy. Don’t forget to check out the care plan to learn more. Happy Nursing!
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Study Plan Lessons
Alkalosis and Acidosis Nursing Mnemonic (Kick Up, Drop Down)
Blood Grouping
Blood Plasma
Blood Pressure (BP) Control
Breathing Control
Breathing Movements
Causes of Poor Gas Exchange Nursing Mnemonic (All People Can Value Lungs)
EKG (ECG) Waveforms
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Electrolytes Involved in Cardiac (Heart) Conduction
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Hyperkalemia – Management Nursing Mnemonic (AIRED)
Hyperkalemia – Signs and Symptoms Nursing Mnemonic (Murder)
Hypernatremia – Causes Nursing Mnemonic (MODEL)
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Hypernatremia – Signs and Symptoms 2 Nursing Mnemonic (FRIED)
Hypernatremia – Signs and Symptoms 2 Nursing Mnemonic (SWINE)
Hypernatremia – Signs and Symptoms 3 Nursing Mnemonic (SALT)
Hypertension – Nursing care Nursing Mnemonic (DIURETIC)
Hyperthermia (Thermoregulation)
Hypertonic Solutions (IV solutions)
Hypocalcemia – Definition, Signs and Symptoms Nursing Mnemonic (CATS)
Hypoglycemia
Hypoglycemia symptoms Nursing Mnemonic (DIRE)
Hypokalemia – Signs and Symptoms Nursing Mnemonic (6 L’s)
Hypoglycemia – Signs and Symptoms Nursing Mnemonic (TIRED)
Hypoglycemia Management Nursing Mnemonic (Cool and Clammy – Give ‘Em Candy)
Hyponatremia- Definition, Signs and Symptoms Nursing Mnemonic (SALT LOSS)
Hypoparathyroidism
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Hypovolemic and Distributive Shock for Certified Emergency Nursing (CEN)
Hypoxia – Signs and Symptoms Nursing Mnemonic (RAT BED)
Individualized Physical Assessments for Certified Perioperative Nurse (CNOR)
Informed Consent
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Isoniazid (Niazid) Nursing Considerations
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Levels of consciousness Nursing Mnemonic (Never Carry Dirty Socks Or Smelly Clothes)
Losartan (Cozaar) Nursing Considerations
Macular Degeneration
Malignant Hyperthermia
Management of Pressure Ulcers (Pressure Injuries) Nursing Mnemonic (SKIN)
Management of Glomerulonephritis Nursing Mnemonic (Please Help Deliver Diuretics)
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Medications to Prevent Seizures Nursing Mnemonic (Pretty Little Liars Forever)
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Nursing Care and Pathophysiology for Acquired Immune Deficiency Syndrome (AIDS)
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Nursing Care and Pathophysiology for Distributive Shock
Nursing Care and Pathophysiology for Epididymitis
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Nursing Care and Pathophysiology for Herpes Simplex (HSV, STI)
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Nursing Care and Pathophysiology for Hyperthyroidism
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Nursing Care and Pathophysiology for Hypovolemic Shock
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Nursing Care and Pathophysiology for Pulmonary Edema
Nursing Care and Pathophysiology for Rhabdomyolysis
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Nursing Care and Pathophysiology for Sepsis
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Nursing Care and Pathophysiology for SIRS & MODS
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Nursing Care and Pathophysiology of BPH (Benign Prostatic Hyperplasia)
Nursing Care and Pathophysiology of COPD (Chronic Obstructive Pulmonary Disease)
Nursing Care and Pathophysiology of Diabetic Ketoacidosis (DKA)
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Nursing Care and Pathophysiology of Endocarditis and Pericarditis
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Nursing Care and Pathophysiology of Myocarditis
Nursing Care and Pathophysiology of Nephrotic Syndrome
Nursing Care and Pathophysiology of Osteoarthritis (OA)
Nursing Care Plan (NCP) for Addison’s Disease (Primary Adrenal Insufficiency)
Nursing Care Plan (NCP) for Aspiration
Nursing Care Plan (NCP) for Bronchoscopy (Procedure)
Nursing Care Plan (NCP) for Cardiogenic Shock
Nursing Care Plan (NCP) for Emphysema
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Nursing Care Plan (NCP) for Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)
Nursing Care Plan (NCP) for Hypovolemic Shock
Nursing Care Plan (NCP) for Respiratory Failure
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Nursing Care Plan for Amputation
Nursing Care Plan for Compartment Syndrome
Nursing Care Plan for Distributive Shock
Nursing Case Study for Pneumonia
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Oncology Important Points
Oxygen Delivery Module Intro
Pain and Nonpharmacological Comfort Measures
Pain Assessment Questions Nursing Mnemonic (OPQRST)
Patient Consent for Treatment for Certified Emergency Nursing (CEN)
Patient Communication Techniques for Certified Perioperative Nurse (CNOR)
Patients with Communication Difficulties
Perioperative Nursing Course Introduction
Peritoneal Dialysis (PD)
Pneumonia Concept Map
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Specialty Diets (Nutrition)
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The Medical Team
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Vascular disease – Raynaud’s symptoms Nursing Mnemonic (COLD HAND)
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Who Needs Dialysis Nursing Mnemonic (AEIOU)
Wound Infections for Certified Emergency Nursing (CEN)