6.6
Estudos Endoscópicos I: Broncoscopia e Toracoscopia
A endoscopia é uma técnica médica não cirúrgica usada para examinar os órgãos e vasos internos de uma pessoa. Esta lição se concentrará em dois tipos…
A broncoscopia é um procedimento diagnóstico que visualiza a laringe, traqueia e brônquios.
A broncoscopia diagnóstica permite a visualização e avaliação de tecidos, análise de secreções e coleta de amostras de biópsia.
A broncoscopia terapêutica elimina obstruções, controla o sangramento, trata atelectasias, remove lesões e administra braquiterapia.
As responsabilidades de enfermagem pré-procedimento incluem explicar o procedimento, obter consentimento e manter a NPO do paciente por 6 horas.
Após o procedimento, os enfermeiros devem monitorar os sinais vitais e manter a NPO do paciente até que o reflexo da tosse retorne.
Em seguida, a toracoscopia é um procedimento diagnóstico para examinar a cavidade pleural inserindo um endoscópio através de pequenas incisões.
Ajuda a avaliar derrames pleurais e tumores e coleta amostras de fluidos e tecidos para diagnóstico.
Um dreno torácico pode ser inserido após o procedimento para reexpansão do pulmão.
As responsabilidades de enfermagem pré-procedimento incluem obter consentimento e manter o paciente NPO.
No pós-operatório, os enfermeiros devem monitorar os sinais vitais, verificar se há sangramento ou infecção no local da incisão e monitorar o dreno torácico e o sistema de drenagem.
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Q1: What structures does a bronchoscopy allow a nurse to visualize?
Bronchoscopy enables direct visualization of the larynx, trachea, and bronchi using a flexible fiber-optic or rigid bronchoscope. The fiber-optic bronchoscope is preferred due to its flexibility, small size, and excellent optical system, allowing increased visualization of peripheral airways. This visualization supports both diagnostic assessment and therapeutic interventions.
Q2: What are the main differences between diagnostic and therapeutic bronchoscopy?
Diagnostic bronchoscopy visualizes tissues, determines pathologic processes, collects secretions for analysis, and obtains tissue samples for diagnosis. Therapeutic bronchoscopy removes foreign bodies and secretions, controls bleeding, treats atelectasis, destroys lesions, provides brachytherapy, and inserts stents to relieve airway obstruction. Both procedures use the same equipment but serve distinct clinical purposes.
Q3: Why must patients remain NPO before bronchoscopy?
Patients must abstain from food and drink for at least 6 hours before bronchoscopy to decrease the risk of aspiration. After the procedure, patients should remain NPO until the cough reflex returns, ensuring airway protection during recovery. This precaution prevents aspiration of gastric contents during sedation and the procedure.
Q4: What post-procedure complications should nurses monitor for after bronchoscopy?
Nurses should monitor for hypoxia, hypotension, tachycardia, arrhythmias, hemoptysis, and dyspnea following bronchoscopy. Vital signs and respiratory status require continuous assessment, with abnormalities reported promptly. These complications can indicate adverse reactions to sedation, airway trauma, or bleeding during the procedure.
Q5: How does thoracoscopy differ from bronchoscopy in terms of procedure and access?
Thoracoscopy examines the pleural cavity by inserting an endoscope through small incisions in an intercostal space, whereas bronchoscopy visualizes airways through the nose, mouth, tracheostomy, or artificial airway. Thoracoscopy evaluates pleural effusions, tumors, and collects fluid and tissue samples. A chest tube may be inserted post-thoracoscopy for lung re-expansion.
Q6: What are the key post-operative nursing responsibilities after thoracoscopy?
Postoperatively, nurses must monitor vital signs, pain level, and respiratory status. The incisional site requires assessment for bleeding and infection. Shortness of breath may indicate pneumothorax and should be reported immediately. Chest tube monitoring and drainage system assessment are essential for proper lung re-expansion and patient safety.
Q7: What diagnostic purposes does thoracoscopy serve in respiratory assessment?
Thoracoscopy evaluates pleural effusions and pleural disease, stages tumors, and obtains fluid and tissue samples for analysis. If fluid is present, it is aspirated and sent for culture and sensitivity testing. Future applications include laser treatment of pulmonary nodules and other growths, making thoracoscopy valuable for comprehensive respiratory diagnosis.