Nursing Care Plan for Bronchoscopy (Procedure)

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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

  1. Ensure informed consent is obtained and the patient is educated about the procedure

  2. 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.

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

  4. 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.

  5. Ensure emergency equipment available at bedside

  6. 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.

  7. Insert IV. Administer and manage conscious sedation

  8. 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.

  9. 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.

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

  11. 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.

  12. NPO after procedure until gag reflex returns

  13. 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.

  14. 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)

  15. 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.


References

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