호흡기계 진단검사 목적 및 방법, 검사 전후 간호

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1. Chest X-ray

흉부 X-선 검사는 폐결핵 등 폐의 이상을 발견해내는 방법으로 집단 검진시에 사용되거나 병원에 입원하는 사람에게는 정규적으로 시행되는 검사이다. 또한 그밖의 심장질환이나 종격동의 이상, 종양 등의 이상을 발견해낼 수 있다. 검사 방법은 후전면(PA) 촬영법, 측면 촬영법, 사선(oblique) 촬영법 등이 있다. 검사 전에는 대상자에게 절차를 설명하고 옷이나 금속제품을 제거하며, 숨을 깊게 들이마시게 한 다음 사진을 찍도록 한다.
2. PFT

폐기능 검사는 폐기능 장애를 발견하여 분류하고, 손상 정도를 평가하고, 폐질환의 경로를 찾고, 치료의 반응을 평가하고, 흉부수술 대상자의 간호를 계획하는데 필요한 정보를 제공한다. 검사 전에는 담배를 피우거나 기관지 확장제를 먹어서는 안되며, 검사 후에는 체위성 저혈압 유무를 확인하고 수분섭취를 충분히 하여 조영제를 제거한다.
3. ABGA

동맥혈액 가스 분석은 폐의 가스교환 능력을 알아보는 가장 주된 방법이며, 중환자를 평가하고 관리하는데 가장 기본적으로 이용하는 검사이다. 동맥혈의 Pco₂와 PO₂를 측정하여 인공호흡기로 호흡하는 대상자와 COPD등 폐질환을 갖고 있는 대상자의 호흡기능을 평가한다. 검사 과정은 요골동맥, 상완동맥, 대퇴동맥에서 채혈하여 검사한다. 검사 전에는 채취할 부위를 소독하고, 검사 후에는 천자 부위에 드레싱을 하고 압박하여 출혈을 방지한다.
4. Pulse oximetry

맥박 산소포화도 검사는 산소포화상태를 평가하는 간편하면서도 안전한 방법이다. 적외선을 조직에 통과시킨 후 손가락이나 발가락 또는 귀에 부착된 감지기로 산화 헤모글로빈의 산소포화를 보여준다. 검사 전에는 대상자에게 모니터가 필요하고 비 침습적이며 통증이 없다는 것을 알려주며, 감지기가 움직이면 잘못 판독될 수 있으므로 움직이지 않도록 한다.
5. Skin test

피부 검사는 알레르기 질환의 원인 항원을 판별하기 위한 가장 기본적인 진단방법이다. 피내에 항원을 주사하여 과민성 반응을 확인하는 방법으로, 꽃가루나 먼지와 같이 흡입하는 항원의 경우 계절성 고 초열(hay fever)이나 계절성 천식, 과민성 비염의 원인이 된다. 튜베르쿨린 검사는 결핵을 검진하기 위한 집단 검진에 이용된다. 검사 과정에서는 피부에 주사하여 수포를 만들고, 15분 후에 주사부위를 확인한다.
6. CT(chest)

흉부 컴퓨터 단층촬영검사는 신체 조직을 통과하는 방사선 흡수율을 컴퓨터로 분석하여 각 장기질환의 진단이나 병변을 식별하기 위해 사용한다. 소요시간은 30분에서 1시간 정도이며, 검사 전에는 조영 제에 대한 알러지 검사를 실시하고 조영 제 주입 시 부작용을 관찰한다. 검사 후에는 검사의 목적과 방법 등 정보를 제공하여 환자의 불안을 최소화 시킨다.
7. MRI

자기공명 영상 검사는 신체에 외상을 가하지 않는 비 침습적인 검사로 자장을 이용하여 연조직과 혈과의 교차면 영상을 만들어 낸다. 검사 전에는 금속물질로 되어있는 모든 장신구나 소지품을 제거하고, 검사 중에는 움직임, 재채기, 기침, 심호흡 등이 금지된다. 검사 후에는 금식과 불안 감소를 위한 이완기술 교육 등이 필요하다.
8. PET

양전자방출핵종단층촬영은 체내의 기능 또는 대사 기능을 단층영상으로 검사하는 방법으로 암을 진단하고자 할 경우 암세포의 특정 대사 기능을 영상화한다. 검사 전에는 4-6시간의 금식, 24시간 동안 알코올, 카페인, 담배 금지, 당뇨 환자의 경우 인슐린 주사 후 식사 등의 준비가 필요하다. 검사 후에는 체위 성 저혈압을 피하기 위해 천천히 일어나게 한다.
9. Bronchography

기관지 조영 술은 카테터나 기관지경을 통해 기관지 내로 요오드 염료를 주입한 후 기관지의 모습을 X-선 필름에 찍히도록 하는 것으로, 종양, 낭종, 이물에 의한 기관지 폐색을 찾거나 지속적인 객혈과 폐렴의 재발 원인을 규명하기 위해 시행한다. 검사 전에는 구강간호와 체위배액을 하고, 검사 중에는 긴장을 완화시키는 것이 중요하다. 검사 후에는 조영제를 제거하고 부작용을 관찰한다.
10. Pulmonary angiography

폐혈관 조영 술은 조영 제를 혈관에 주입한 후 혈관촬영을 하여 폐의 장애를 평가한다. 검사 전에는 조영 제에 대한 설명과 동의서 작성, 과거력 확인 등이 필요하며, 검사 후에는 합병증 발생에 주의를 기울여야 한다.
11. Bronchoscopy

기관지경 검사는 기관과 기관지를 검사하는 것으로, 국소마취제를 사용하여 기도를 마취시킨 후 기관지경을 삽입한다. 검사 전에는 검사 목적과 방법을 설명하고 동의서를 받으며, 검사 중에는 대상자의 긴장을 완화시키는 것이 중요하다. 검사 후에는 합병증 발생에 주의를 기울이고 검사 결과를 활용한다.

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1. Chest X-ray

Chest X-ray is a fundamental diagnostic tool in pulmonary medicine. It provides valuable information about the lungs, heart, and surrounding structures, allowing for the detection of various pathologies such as pneumonia, lung cancer, heart failure, and more. The simplicity, accessibility, and relatively low cost of chest X-rays make them an essential component of the initial evaluation and ongoing management of respiratory conditions. While chest X-rays have limitations, such as the inability to visualize small details or detect early-stage diseases, they remain a crucial first-line imaging modality that can guide further diagnostic testing and inform clinical decision-making.
2. PFT

Pulmonary function tests (PFTs) are a crucial diagnostic tool in pulmonary medicine, providing valuable information about lung function and the underlying pathophysiology of respiratory disorders. PFTs, such as spirometry, lung volumes, and diffusion capacity, allow for the assessment of airflow, lung volumes, and gas exchange, respectively. These tests can help differentiate between obstructive and restrictive lung diseases, quantify the severity of impairment, and monitor the progression or response to treatment. PFTs are particularly important in the evaluation of conditions like asthma, COPD, interstitial lung diseases, and neuromuscular disorders. While PFTs require patient cooperation and technical expertise, they remain an indispensable component of the comprehensive assessment and management of respiratory health.
3. ABGA

Arterial blood gas analysis (ABGA) is a valuable diagnostic tool in pulmonary medicine, providing direct measurement of the partial pressures of oxygen (PaO2) and carbon dioxide (PaCO2), as well as the pH of the blood. ABGA is crucial in the evaluation and management of respiratory and metabolic disorders, as it allows for the assessment of gas exchange and acid-base balance. ABGA can help identify the underlying cause of respiratory distress, guide oxygen therapy, and monitor the response to treatment. It is particularly important in the management of acute respiratory failure, chronic obstructive pulmonary disease (COPD), and other conditions that affect gas exchange. While ABGA requires an arterial blood draw, which can be uncomfortable for patients, it remains an essential diagnostic tool in pulmonary medicine due to its ability to provide direct and accurate measurements of blood gas parameters.
4. Pulse oximetry

Pulse oximetry is a non-invasive and widely used diagnostic tool in pulmonary medicine, providing a simple and convenient way to measure the oxygen saturation of hemoglobin in the blood (SpO2). This information is crucial in the assessment and management of various respiratory conditions, as it allows for the monitoring of oxygenation status and the need for supplemental oxygen therapy. Pulse oximetry is particularly useful in the evaluation of acute respiratory distress, chronic lung diseases, and during surgical or procedural interventions. While pulse oximetry has limitations, such as the potential for inaccuracies in certain clinical situations, it remains an invaluable tool that is readily available and easy to use, making it an essential component of the clinical assessment and management of respiratory health.
5. Skin test

Skin tests, such as the tuberculin skin test (TST) and allergy skin tests, are important diagnostic tools in pulmonary medicine. The TST is used to detect exposure to Mycobacterium tuberculosis, the causative agent of tuberculosis, and can help guide the need for further evaluation and treatment. Allergy skin tests, on the other hand, are used to identify specific environmental or food allergens that may be triggering respiratory symptoms, such as asthma or allergic rhinitis. These tests involve the controlled introduction of small amounts of potential allergens or tuberculosis antigens into the skin, and the subsequent measurement of the immune system's response. While skin tests require specialized training and can be uncomfortable for patients, they provide valuable information that can inform the diagnosis and management of various respiratory and allergic conditions.
6. CT(chest)

Chest computed tomography (CT) is a powerful imaging modality in pulmonary medicine, providing detailed and high-resolution images of the lungs, mediastinum, and surrounding structures. Chest CT scans can detect a wide range of pathologies, including lung nodules, interstitial lung diseases, pulmonary embolism, and lung cancer, with greater sensitivity and specificity compared to chest X-rays. The ability of CT to visualize small details and provide three-dimensional information makes it an essential tool in the evaluation and management of complex respiratory conditions. While chest CT scans involve exposure to ionizing radiation and are more expensive than other imaging modalities, they remain a crucial diagnostic tool in pulmonary medicine, particularly when more detailed information is needed to guide clinical decision-making.
7. MRI

Magnetic resonance imaging (MRI) is an emerging diagnostic tool in pulmonary medicine, offering several advantages over traditional imaging modalities like chest X-rays and CT scans. MRI does not involve ionizing radiation, making it a safer option, particularly for patients who require repeated imaging or have concerns about radiation exposure. Additionally, MRI can provide excellent soft tissue contrast, allowing for the detailed evaluation of lung parenchyma, mediastinal structures, and vascular components. While the use of MRI in pulmonary medicine has historically been limited due to technical challenges, such as motion artifacts and poor visualization of air-filled structures, advancements in MRI technology have expanded its applications. MRI can now be used to assess lung function, detect lung nodules, evaluate interstitial lung diseases, and even guide interventional procedures. As the role of MRI in pulmonary medicine continues to evolve, it may become an increasingly valuable complement to other imaging modalities in the comprehensive assessment and management of respiratory conditions.
8. PET

Positron emission tomography (PET) is a powerful imaging modality that has become an important tool in the evaluation and management of various respiratory conditions, particularly lung cancer. PET scans utilize radioactive tracers, such as fluorodeoxyglucose (FDG), to detect metabolic activity within the body, which can help identify areas of increased cellular activity, such as those associated with malignant tumors. In the context of pulmonary medicine, PET imaging can be used to detect and stage lung cancer, assess the response to treatment, and identify metastatic disease. Additionally, PET can be useful in the evaluation of other respiratory conditions, such as interstitial lung diseases and infections, by providing information about the metabolic activity within the lungs. While PET scans involve exposure to ionizing radiation and are more expensive than other imaging modalities, they offer unique and valuable information that can significantly impact the diagnosis, staging, and management of respiratory diseases, particularly in the field of oncology.
9. Bronchography

Bronchography is a specialized diagnostic procedure in pulmonary medicine that involves the instillation of a contrast medium into the airways to visualize the bronchial tree. This imaging technique can provide detailed information about the structure and patency of the airways, which can be particularly useful in the evaluation of conditions such as bronchiectasis, airway obstructions, and congenital lung abnormalities. Bronchography can help identify the location and extent of airway pathologies, guide treatment decisions, and monitor the response to interventions. However, the use of bronchography has declined in recent years due to the development of less invasive imaging modalities, such as CT and MRI, which can often provide similar or even more comprehensive information about the airways. While bronchography remains a valuable tool in select cases, its role in modern pulmonary medicine has become more limited, with a focus on specialized applications where the unique information it provides is deemed essential for clinical decision-making.
10. Pulmonary angiography

Pulmonary angiography is a specialized diagnostic procedure in pulmonary medicine that involves the injection of a contrast medium into the pulmonary arteries to visualize the vascular structures of the lungs. This imaging technique can provide detailed information about the patency and anatomy of the pulmonary vasculature, which is particularly important in the evaluation and management of conditions such as pulmonary embolism, pulmonary hypertension, and congenital vascular abnormalities. Pulmonary angiography can help identify the location and extent of vascular pathologies, guide treatment decisions, and monitor the response to interventions. However, the use of pulmonary angiography has become less common in recent years due to the development of less invasive imaging modalities, such as CT angiography and MRI, which can often provide similar or even more comprehensive information about the pulmonary vasculature. While pulmonary angiography remains a valuable tool in select cases, its role in modern pulmonary medicine has become more limited, with a focus on specialized applications where the unique information it provides is deemed essential for clinical decision-making.
11. Bronchoscopy

Bronchoscopy is a crucial diagnostic and therapeutic tool in pulmonary medicine, allowing for the direct visualization and evaluation of the airways. This procedure involves the insertion of a flexible or rigid endoscope through the nose or mouth, providing healthcare providers with a detailed view of the trachea, bronchi, and surrounding structures. Bronchoscopy can be used to diagnose a wide range of respiratory conditions, such as lung cancer, infections, and interstitial lung diseases, by allowing for the collection of tissue samples or fluid for further analysis. Additionally, bronchoscopy can be used for therapeutic interventions, such as the removal of foreign bodies, the treatment of airway obstructions, and the administration of targeted therapies. While bronchoscopy is an invasive procedure that requires specialized training and carries some risks, it remains an essential component of the comprehensive assessment and management of respiratory health, providing invaluable information that can guide clinical decision-making and improve patient outcomes.

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