A nurse is caring for a client after a bronchoscopy and biopsy. Which of the following signs if noted in the client should be reported immediately to the physician?
A. Blood-streaked sputum
B. Dry cough
C. Hematuria
D. Bronchospasm
Correct Answer: D. Bronchospasm
If a biopsy was performed during a bronchoscopy, blood-streaked sputum is expected for several hours. The client should be assessed for signs of complications, which would include cyanosis, dyspnea, stridor, bronchospasm, hemoptysis, hypotension, tachycardia, and arrhythmias. Cardiac arrhythmias may also occur especially in patients with pre-existing cardiac disease.
Option A: Frank blood indicates hemorrhage. In most cases, bleeding is usually self-limited. The pulmonologists should carefully ascertain for hemostasis, and in the event of severe bleeding prompt management should be immediately instituted.
Option B: A dry cough may be expected. In 1% to 3% of patients, pneumothorax may occur after transbronchial biopsies. Small pneumothoraces may be managed conservatively, while symptomatic and large pneumothorax will require chest tube insertion and hospitalization.
Option C: Hematuria is unrelated to this procedure. A tension pneumothorax results in hemodynamic instability and should be recognized even without imaging studies. Appropriate life-saving measures such as chest tube insertion should be undertaken immediately.
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