Lesson 20 — Pulmonary Assisting

Half B · HLT420B·Kinn's Ch 26·General Patient Care (18.7%)

Source

All procedural steps, PURPOSE rationales, and topic content below are verbatim from MedCerts HLT420B Storyline modules. Quiz items have been normalized to multiple-choice format with verbatim source rationales. Reference textbook: Niedzwiecki & Pepper, Kinn's The Clinical Medical Assistant, 15th ed., Chapter 26. No outside material added.

Learning Objectives — NHA-aligned
Module L20-01 · Procedural skill

Peak Flow Meter

Goal: To instruct the patient in the proper method of performing a peak flow meter test.

Equipment
  • Patient's health record
  • Peak flow meter
  • Disposable mouthpiece
  • Biohazardous waste container
  1. Sanitize your hands.
    Purpose

    To ensure infection control

  2. Place the mouthpiece on the peak flow meter and slide the marker to the bottom of the scale.
    Purpose

    The indicator must be at the bottom of the scale for proper measurement of expiratory effort.

  3. Introduce yourself and confirm the patient's identity by name and date of birth.
  4. Explain the purpose of the test.
    Purpose

    To help reassure the patient.

  5. Explain the actual maneuver of forced expiration.
    Purpose

    The patient must understand the maneuver so that he or she can cooperate fully; this produces the best test results.

  6. Make sure the patient is comfortable and in a proper position, either sitting upright or standing (standing is preferred).
    Purpose

    Proper positioning ensures maximum lung expansion and accurate test results.

  7. Loosen any tight clothing, such as a necktie, bra, or belt.
    Purpose

    Tight clothing may restrict breathing capacity.

  8. Hold the meter upright, taking care not to block the opening with the fingers.
    Purpose

    To prevent obstruction of forced exhalation.

  9. Instruct the patient to inhale as deeply as possible, to place the mouthpiece into the mouth beyond the teeth, and to form a tight seal with the lips.
  10. Caution the patient not to put the tongue in the mouthpiece when exhaling.
    Purpose

    To prevent any leakage of air around the mouthpiece and any obstruction of airflow.

  11. Instruct the patient to exhale as fast and as forcefully as possible into the peak flow meter.
  12. The forced exhalation will move the marker up the scale and stop at the point of the peak expiratory flow. Record this number and return the marker to the bottom of the scale.
  13. Repeat the procedure two more times, sliding the indicator to the bottom of the scale before each reading, and record each result.
  14. Encourage the patient to inhale as deeply as possible and to exhale as fast and as forcefully as possible with each effort.
  15. Place the test results in the patient's record for the provider to review, noting the time and date of the highest reading.
  16. Clean and disinfect the equipment, discarding waste in a biohazardous waste container, and give the patient the meter for continued use at home with instructions to follow the manufacturer's cleaning recommendations.
  17. If peak flow readings trigger bronchospasms or severe coughing in patients experiencing an asthma attack, instruct the patient to rest and try again.
  18. If the patient is unable to perform three readings because of bronchospasms and/or coughing, follow the provider's guidelines for managing this situation.
  19. Sanitize your hands.
    Purpose

    To ensure infection control.

  20. Record the testing information in the patient's health record.
    Purpose

    Procedures that are not recorded are considered not done.

Module L20-02 · Procedural skill

Spirometry

Goal: To perform volume capacity testing.

Equipment
  • Patient's health record
  • Scale with height measuring device
  • Sphygmomanometer and stethoscope
  • Spirometer with recording paper in place
  • External spirometric tubing
  • Disposable mouthpiece
  • Nasal clip if needed
  • Biohazardous waste container
  1. Sanitize your hands and assemble the spirometer.
    Purpose

    To ensure infection control.

  2. Introduce yourself and confirm the patient's identity by name and date of birth. Determine whether the patient needed any special preparation (e.g., no smoking, not taking bronchodilators) and if so, whether it was done.
    Purpose

    If special procedures were not followed, the test may have to be rescheduled.

  3. Explain the purpose of the test.
    Purpose

    To help reassure the patient.

  4. Measure and record the patient's vital signs, height, and weight.
  5. Explain the actual maneuver.
    Purpose

    The patient must understand the maneuver so that he or she can cooperate fully; this produces the best test results.

  6. Make sure the patient is comfortable and either is standing or is sitting (preferred) with the legs uncrossed and the feet on the floor.
    Purpose

    Proper positioning ensures maximum lung expansion and accurate test results. The test may cause dizziness, so sitting is preferred. If the patient stands, a chair must be next to the person.

  7. Loosen any tight clothing, such as a necktie, bra, or belt.
    Purpose

    Tight clothing may restrict breathing capacity

  8. Show the patient the proper chin and neck position: the chin should be slightly elevated and the neck slightly extended. Practice the maneuver with the patient before beginning the test.
    Purpose

    To relieve apprehension and enhance understanding.

  9. Place a soft nose clip on the patient's nose if this is part of the facility's procedure.
    Purpose

    To prevent air from escaping through the nose during exhalation.

  10. Instruct the patient to place the mouthpiece in the mouth and to seal the lips around it when exhaling.
  11. Tell the patient to inhale according to instructions; take as deep a breath as possible and blow air out hard and long.
  12. Use active, forceful coaching during exhalation. Patient must exhale completely to get accurate test results.
    Purpose

    Coaching improves performance. The patient should continue to exhale even after he or she thinks the process is complete.

  13. Provide the patient with feedback after he or she completes the maneuver.
    Purpose

    Encouragement and explanations of mistakes in the maneuver can help improve the patient's compliance.

  14. Carefully observe the patient for indications of vertigo or dyspnea or any other signs of difficulty. If complications occur, stop the test and inform the provider.
  15. Continue testing until three acceptable maneuvers have been performed.
  16. Clean and disinfect the equipment. Discard waste, including the disposable mouthpiece and tubing, in a biohazardous waste container.
  17. Sanitize your hands.
    Purpose

    To ensure infection control.

  18. Record the procedure in the patient's EHR and/or place the spirometer printout in the records for the provider to review.
    Purpose

    Procedures that are not recorded are considered not done.

Module L20-03 · Procedural skill

Pulse Oximetry

Goal: To assess the adequacy of oxygen levels (or oxygen saturation) in the blood using a pulse oximeter.

Equipment
  • Patient's health record
  • Pulse oximeter monitor and appropriate sized probe
  1. Assemble the equipment.
  2. Confirm the patient's identity by name and date of birth and explain the procedure.
    Purpose

    An informed patient is more cooperative.

  3. Sanitize your hands.
    Purpose

    Standard Precautions must be followed to prevent spread of disease.

  4. Turn on the monitor and attach the probe to the finger (preferred) or ear lobe so it is flush with the skin.
    Purpose

    To measure the pulse and oxygen saturation level.

  5. The light-emitting diode (LED) should be placed on top of the nail.
  6. If the patient is wearing nail polish or has artificial nails, these may have to be removed to get a strong pulse signal.
    Purpose

    To measure the pulse and oxygen saturation level.

  7. Record the oxygen saturation percentage and pulse in patient's health record. Include date, time, and if the patient is receiving supplemental oxygen record the amount in liters.
    Purpose

    Procedures that are not recorded are considered not done.

  8. Sanitize the patient probe and the external portion of the monitor with an aseptic cleaner.
    Purpose

    To follow Standard Precautions.

  9. Sanitize your hands.
    Purpose

    To ensure infection control.

Module L20-04 · Procedural skill

Sputum for Culture

Goal: To collect a sputum sample, following Standard Precautions.

Equipment
  • Patient's health record
  • Sterile laboratory specimen cup, accurately labeled
  • Biohazard laboratory specimen bag with laboratory requisition
  • Disposable examination gloves
  • Face shield with goggles
  • Impervious gown
  • Biohazardous waste container
  • Cup of water
  • Ginger ale or juice
  1. Assemble the equipment and label the specimen cup.
  2. Identify the patient by name and date of birth and explain the procedure.
    Purpose

    An informed patient is more cooperative.

  3. Sanitize your hands and put on gloves, a face shield with goggles, and an impervious gown.
    Purpose

    Standard Precautions must be followed when potentially infectious materials are collected.

  4. Have the patient rinse his or her mouth with water.
    Purpose

    Any food particles in the mouth will contaminate the specimen.

  5. Carefully remove the specimen cup lid, taking care not to touch the inside of the lid or the inside of the container, and place it upside down on a side table.
    Purpose

    To maintain the sterile environment of the specimen cup.

  6. Instruct the patient to take three deep breaths and then cough deeply to bring up secretions from the lower respiratory tract.
    Purpose

    The organisms for culture must be from the lung fields in the lower respiratory tract.

  7. Tell the patient to spit directly into the specimen container and to avoid getting any sputum on the exterior of the container.
    Purpose

    Sputum on the exterior of the container is considered hazardous.

  8. Do not touch the inside of the container during the procedure.
    Purpose

    Prevent contamination of the inside of the container.

  9. Place the lid securely on the container, taking care not to touch the inside of the lid, and then place the container in the plastic specimen bag.
    Purpose

    To maintain the sterility of the container and to minimize the chance of spreading the potentially infectious organisms.

  10. Offer the patient a glass of juice or ginger ale.
    Purpose

    The patient may have a bad taste in the mouth after the test, and this may cause nausea.

  11. If another sputum test is ordered for the next morning, instruct the patient when to come to the office or explain how to perform the procedure at home. Remind the person to follow the same instructions for preparation.
  12. Stress the importance of maintaining the sterility of the container and of collecting the specimen first thing in the morning.
  13. Sanitize the work area and properly dispose of all supplies.
    Purpose

    To follow Standard Precautions.

  14. Sanitize your hands.
    Purpose

    To ensure infection control.

  15. Process the specimen immediately to ensure optimum test results or refrigerate the specimen until it is sent to the laboratory for analysis.
    Purpose

    Microorganisms may propagate or die, which can result in a false-positive or false-negative result.

  16. Record the procedure in the patient's health record.
    Purpose

    Procedures that are not recorded are considered not done.

Practice quiz · verbatim from MedCerts

Knowledge-check items

Click an answer to lock it in — you'll see the rationale below. Reset any time to re-attempt. Items originally formatted as true/false, fill-in-blank, or drag-and-drop have been normalized to multiple choice; the source format is noted in the eyebrow.

L20-01 · Peak Flow Meter

Q1 · L20-01
When teaching a patient to use a peak flow meter, where should the marker be placed on the meter's scale for proper measurement of expiratory effort?
Rationale
"The indicator must be at the bottom of the scale for proper measurement of expiratory effort."

The marker must be reset to the bottom before each reading to provide an accurate baseline for measuring the patient's peak expiratory flow.

Source: L20-01 Knowledge Check
Q2 · L20-01
How many total times is the peak flow meter procedure conducted with the patient?
Rationale
"Repeat the procedure two more times, sliding the indicator to the bottom of the scale before each reading, and record each result."

The procedure is performed three times total to ensure consistent and reliable measurements of the patient's peak expiratory flow.

Source: L20-01 Knowledge Check
Q3 · L20-01
When conducting the peak flow meter procedure with the patient, what should be done if a patient begins severe coughing during the procedure?
Rationale
"If this occurs, instruct the patient to rest and try again."

Bronchospasms or severe coughing can occur as a result of peak flow readings in asthmatic patients; allowing rest before retry helps the patient recover and attempt the maneuver again.

Source: L20-01 Knowledge Check
Q4 · L20-01
Which is the preferred patient position for conducting a peak flow meter procedure?
Rationale
"Make sure the patient is comfortable and in a proper position, either sitting upright or standing (standing is preferred)."

Standing is the preferred position because it allows maximum lung expansion and provides the most accurate test results.

Source: L20-01 Knowledge Check

L20-02 · Spirometry

Q1 · L20-02 · normalized from tf
If the patient did not complete the required special preparation prior to the spirometry testing, what may need to occur?
Rationale
"If special procedures were not followed, the test may have to be rescheduled."

Proper preparation (such as avoiding smoking or bronchodilators) is essential for valid spirometry results, and failure to complete these requirements necessitates rescheduling.

Source: L20-02 Knowledge Check
Q2 · L20-02 · normalized from tf
How many acceptable maneuvers should be completed during spirometry testing?
Rationale
"Continue testing until three acceptable maneuvers have been performed."

Three consistent, acceptable maneuvers are required to ensure reliable and reproducible spirometry results.

Source: L20-02 Knowledge Check
Q3 · L20-02 · normalized from tf
During spirometry testing, should the patient receive coaching and feedback during the procedure?
Rationale
"Use active, forceful coaching during exhalation. Patient must exhale completely to get accurate test results." And "Provide the patient with feedback after he or she completes the maneuver."

Active coaching improves patient performance and test quality, and feedback helps encourage compliance and corrects technique errors.

Source: L20-02 Knowledge Check
Q4 · L20-02 · normalized from tf
When performing spirometry, can a soft nose clip be placed on the patient's nose to prevent air from escaping through the nose during exhalation?
Rationale
"Place a soft nose clip on the patient's nose if this is part of the facility's procedure. PURPOSE: To prevent air from escaping through the nose during exhalation."

A soft nose clip may be used per facility protocol to ensure all exhaled air is measured by the spirometer.

Source: L20-02 Knowledge Check
Q5 · L20-02 · normalized from tf
During spirometry testing, the patient's chin should be slightly elevated and the neck slightly extended to achieve proper positioning.
Rationale
"Show the patient the proper chin and neck position: the chin should be slightly elevated and the neck slightly extended."

Proper head and neck alignment helps maximize lung expansion and improves the quality of spirometry measurements.

Source: L20-02 Knowledge Check

L20-03 · Pulse Oximetry

Q1 · L20-03 · normalized from fitb
When confirming the patient's identity by name and date of birth during pulse oximetry, you are doing so to:
Rationale
"Confirm the patient's identity by name and date of birth and explain the procedure. PURPOSE: An informed patient is more cooperative."

Confirming identity is a critical safety step that ensures the procedure is performed on the correct patient.

Source: L20-03 Knowledge Check
Q2 · L20-03 · normalized from fitb
What is the preferred site to place the pulse oximetry probe?
Rationale
"Turn on the monitor and attach the probe to the finger (preferred) or ear lobe so it is flush with the skin."

The finger is the preferred site because it typically provides the strongest pulse signal for accurate oxygen saturation and heart rate measurements.

Source: L20-03 Knowledge Check
Q3 · L20-03 · normalized from fitb
If the patient is wearing nail polish or has artificial nails during pulse oximetry, what may need to occur?
Rationale
"If the patient is wearing nail polish or has artificial nails, these may have to be removed to get a strong pulse signal."

Nail polish and artificial nails can interfere with the light-emitting diode (LED) signal transmission, compromising the accuracy of pulse oximetry measurements.

Source: L20-03 Knowledge Check

L20-04 · Sputum for Culture

Q1 · L20-04 · normalized from dragdrop
Which procedural step should be performed when the patient rinses the mouth with water before sputum collection?
Rationale
"Have the patient rinse his or her mouth with water. PURPOSE: Any food particles in the mouth will contaminate the specimen."

Rinsing removes food debris that could introduce contaminant organisms into the sputum sample, compromising culture results.

Source: L20-04 Knowledge Check
Q2 · L20-04 · normalized from dragdrop
What is the purpose of instructing the patient to take three deep breaths and cough deeply during sputum collection?
Rationale
"Instruct the patient to take three deep breaths and then cough deeply to bring up secretions from the lower respiratory tract. PURPOSE: The organisms for culture must be from the lung fields in the lower respiratory tract."

Deep breathing and forceful coughing mobilize secretions from the lower respiratory tract, ensuring that the culture sample contains organisms from the actual site of infection rather than contaminating saliva.

Source: L20-04 Knowledge Check
Q3 · L20-04 · normalized from dragdrop
Why is it important to avoid getting sputum on the exterior of the specimen container during collection?
Rationale
"Tell the patient to spit directly into the specimen container and to avoid getting any sputum on the exterior of the container. Sputum on the exterior of the container is considered hazardous."

Sputum on the exterior poses a biohazard risk to laboratory personnel handling the specimen and violates Standard Precautions.

Source: L20-04 Knowledge Check
Q4 · L20-04 · normalized from dragdrop
Why is offering the patient juice or ginger ale important after sputum collection?
Rationale
"Offer the patient a glass of juice or ginger ale. PURPOSE: The patient may have a bad taste in the mouth after the test, and this may cause nausea."

Providing a beverage helps remove the unpleasant taste left after sputum collection and reduces the risk of nausea, improving patient comfort and satisfaction.

Source: L20-04 Knowledge Check
Q5 · L20-04 · normalized from dragdrop
Why must a sputum specimen be processed immediately or refrigerated until laboratory analysis?
Rationale
"Process the specimen immediately to ensure optimum test results or refrigerate the specimen until it is sent to the laboratory for analysis. PURPOSE: Microorganisms may propagate or die, which can result in a false-positive or false-negative result."

Delayed processing allows bacterial overgrowth or die-off, either of which produces inaccurate culture results and compromises diagnostic value.

Source: L20-04 Knowledge Check