Nursing Care Plan (NCP) for Bronchoscopy (Procedure)

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Outline

Pathophysiology

The purpose for bronchoscopy is to visualize the airways in order to diagnose issues or remove obstructions. Indications include persistent cough of unknown origin, excessive thick secretions (patient unable to clear on their own), abnormal findings on a chest x-ray, coughing up blood (hemoptysis), or a lesion or mass that requires biopsy or sampling.

Etiology

Process – patient is placed under conscious sedation unless they already have an advanced airway in place. The patient’s throat is sprayed with a numbing solution to decrease their gag reflex. A scope is inserted into the airway, through the trachea, into the bronchi and bronchioles. The provider can visualize the airways and wash them out as the procedure goes along – this involves using sterile saline solution to thin any secretions and suction to remove them from the airways. Providers can also take tissue samples for culture or biopsy, as well as remove any obstruction by a foreign body (beads, chicken bones, etc.)

Desired Outcome

To identify the cause of symptoms or abnormal findings, obtain samples as needed, or to clear any airway obstructions like foreign bodies or thick sputum. Minimize the occurrence of any possible complications.

Bronchoscopy (Procedure) Nursing Care Plan

Subjective Data:

Indications

  • Patient reports persistent cough

Complications

  • Shortness of breath
  • Dyspnea
  • Chest tightness
  • Restless/anxious
  • Dysphagia/difficulty swallowing

Objective Data:

Indications

  • Hemoptysis
  • Abnormal findings on chest x-ray (mass/lesion)
  • Known obstruction
  • Excessive secretions, especially if thick
  • Rhonchi or crackles

Complications

  • Coughing when trying to swallow
  • Decreased SpO2
  • Increased RR
  • Hemoptysis
  • Wheezing
  • Rhonchi/Crackles

Nursing Interventions and Rationales

  • Ensure informed consent is obtained and the patient is educated about the procedure

 

Informed consent should be obtained by the provider, including indications, risks, and possible complications of the procedure. You, the nurse, should simply ensure it is done and witness the patient’s signature.

 

  • Keep patient NPO for 6-8 hours prior to the procedure

 

The patient is at high risk for aspiration, which is increased if they have had anything to eat or drink in the last 6-8 hours. Emesis could be aspirated into their lungs.

 

  • Ensure emergency equipment available at bedside

 

As with any procedure involving the airway, emergency equipment should be kept ready at the bedside, including suction, ambu bag, and artificial/advanced airways in case of respiratory distress.

 

  • Insert IV. Administer and manage conscious sedation

 

Sedation should be given to make the patient drowsy and comfortable, but still able to follow commands. Follow facility policy and medication orders from the provider for conscious sedation administration/monitoring.

 

  • Monitor Vital Signs, LOC, Respiratory status before, during, and after procedure per facility policy.

 

  • Obtaining a baseline assessment and set of vital signs helps to know if anything has changed during or after the procedure.  
  • Monitor VS during procedure per facility guidelines for conscious sedation – being alert for possible respiratory distress.
  • Monitor vitals and LOC after procedure to ensure patient wakes up safely from conscious sedation and recovers well.

 

  • Place in High-Fowler’s position and administer supplemental O2 as needed

 

Patient is at risk for aspiration and respiratory distress post-procedure. Placing the patient in high-fowler’s position can improve oxygenation and prevent aspiration.  As patients may still be drowsy or could experience some bleeding in the lungs after the procedure, supplemental O2 can help improve oxygen levels.

 

  • NPO after procedure until gag reflex returns

 

Patients’ throats will be numb because of the numbing spray, this means they may not have a good gag reflex until 1-2 hours post-procedure. Keep NPO until gag reflex returns and patient can safely swallow – prevents aspiration.

 

  • Monitor for possible complications:
    • Bleeding
    • Bronchospasm
    • Respiratory Distress
    • Aspiration

 

  • A slight cough with specks of blood or clots is expected, bright red hemoptysis would be an emergency. Bronchospasm presents as severe dyspnea and anxiety with possible wheezing or stridor.
  • Assess for signs of aspiration or respiratory distress and intervene as needed (artificial airway, suction, O2)

 

  • Educate patient on post-procedure instructions:
    • No driving x 24 hours
    • May have cough
    • Swallow may be impaired x 1-2 hours

 

  • Sedation may impair response times or ability to safely operate a vehicle or heavy machinery.
  • A slight cough is normal but ensure gag reflex has fully returned before eating or drinking, to prevent choking or aspiration.

Writing a Nursing Care Plan (NCP) for Bronchoscopy (Procedure)

A Nursing Care Plan (NCP) for Bronchoscopy (Procedure) starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

This is the nursing care plan for the bronchoscopy procedure. So the purpose for a bronchoscopy is to visualize the airways in order to diagnose issues or remove obstructions. Indications for a bronchoscopy indicate persistent cough of unknown origin, excessive thick secretions, that the patient is unable to clear on their own, abnormal findings on a chest x-ray, coughing up blood or hemoptysis, or a lesion or mass that requires biopsy or sampling. Some nursing considerations are that we want to manage sedation. We want to monitor vital signs, draw labs and frequent respiratory assessment. The desired outcome for a patient undergoing a bronch is that we want to be able to identify the cause of symptoms and abnormal findings. We want to obtain samples as needed. And if needed, we want to clear any airway obstruction like foreign bodies, thick sputum. We want to minimize the occurrence of any possible complications. 

So the bronchoscopy procedure, this is a unique procedure, because this is really speaking on care, why a patient would come in for a bronch, and so we’re going to focus on that. Some of the subjective things that a patient will report, is they may report a persistent cough. So, let’s write that persistent cough. So, some things that we are going to, uh, maybe as a complication is there may be shortness of breath or dyspnea, which is difficulty breathing. There may be some chest tightness. They may be restless or anxious, dysphasia, which is just difficulty swallowing. There may be some hemoptysis, so bloody sputum. There may also be abnormal findings on a chest x-ray that may indicate a need for a bronchoscopy. There may be a known obstruction that could be a thick sputum. We may hear breath sounds. So breath sounds we may auscultate are ronchi, or crackles. Some other complications may be coughing when trying to swallow. So coughing when swallowing. We may see a decreased SATs. We may see increased respirations or hemoptysis. So, this patient presents with a persistent cough. We may see hemoptysis, we may see different complications, maybe a known obstruction, excessive secretions. So, what are some things that we want to do for a patient who is anticipated with all of these things that’s going on? This patient needs a bronch. So, what are we going to do? Well, first thing is we want to keep that patient NPO, nothing by mouth for at least six to eight hours prior. And the reason why is because this patient is at a high risk for aspiration. If you think about it, we are literally taking a scope to go down into the lungs, into the airway that is going to induce a choking, coughing, possible vomiting, so we want to keep them NPO, so there’s nothing to vomit. Emesis could be aspirated into their lungs. The next thing we want to do is to ensure emergency equipment is at the bedside. The reason why is because with any procedure involving the airway, we need to keep that emergency equipment at the bedside. And these things are going to include suction, ambu bag, maybe we want to do an artificial airway, such as an intubation kit or a tracheotomy kit. We want to monitor this patient for signs of respiratory distress. The next thing we want to do is we want to make sure that this patient has an IV. We want to administer and manage conscious sedation. Remember, this is not a procedure where the patient is going to be wide awake. Looking at you, talking to you. This is the procedure, what we want this patient sedated. So, because we want that sedation, we want to ensure that they are drowsy, comfortable, but if necessary, be able to follow commands. 

We want to monitor their vital signs. That includes their level of consciousness, their respiratory status before, during, and after the procedure. We are doing this so that we can get a baseline for the patient. And we get a baseline of vitals. We know if anything has changed, for example, we’re going to get those vitals. Remember, that the level of consciousness after the procedure, we want to ensure the patient wakes up safely from the sedation and recovers well. We want to make sure that they are alert as possible for any possible respiratory distress, especially as a high risk for respiratory distress. Finally, we want to make sure that we put this, you know, this is my favorite position, high Fowler’s, high Fowler’s. We want to set that patient up because this patient is at risk for aspiration of respiratory distress, post-procedure. We want to give them enough room for the chest to properly expand. Remember, patients are coming up from sedation, so they may be drowsy or could experience a bleeding of the lungs after the procedure. We want to make sure to administer any supplemental o2 as necessary to improve their oxygen levels. 

So the key points, what are some path physiology behind this? Remember the goal of the Bronch, is to visualize the airways in order to help diagnose issues or remove any obstructions. The subjective data, the patient is going to report a persistent cough. That could be one of the indicators for a Bronch. Something that we may see that may be an indicator for a Bronch is hemoptysis or bleeding, any known obstruction, thick secretions. Some things we want to do are to keep this patient in NPO. We want to keep them NPO for a procedure. This patient is at a high risk for aspiration. They should be NPO for a minimum of six to eight hours prior to the procedure. We want to do a good respiratory assessment. Remember, pre-op during the operation, and post-op complications include atelectasis, bleeding, respiratory distress, and aspiration. We love you guys here and go out and be your best self today. And as always, happy nursing.

 

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