A client has just returned to a nursing unit following bronchoscopy. A nurse would implement which of the following nursing interventions for this client?
A. Encouraging additional fluids for the next 24 hours
B. Ensuring the return of the gag reflex before offering foods or fluids
C. Administering atropine intravenously
D. Administering small doses of midazolam (Versed).
Correct Answer: B. Ensuring the return of the gag reflex before offering foods or fluids
After bronchoscopy, the nurse keeps the client on NPO status until the gag reflex returns because the preoperative sedation and the local anesthesia impair swallowing and the protective laryngeal reflexes for a number of hours. Although bronchoscopy can be done without sedation, most procedures are done under moderate conscious sedation with the use of various sedatives based on the clinician’s preference (e.g., benzodiazepines, opioids, dexmedetomidine).
Option A: Additional fluids are unnecessary because no contrast dye is used that would need to be flushed from the system. Regardless of the sedation or anesthesia used the physicians should be aware of the potential side effects and how to manage patients receiving these medications.
Option C: Atropine would be administered before the procedure, not after. Atropine premedication is widely used for fiberoptic bronchoscopy and may help by drying secretions, producing bronchodilation, or preventing vasovagal reactions.
Option D: The administration of additional midazolam in small doses, until the target sedation level is achieved, is a safe procedure that is associated with significantly less discomfort and pain during bronchoscopy and a greater consent to re?examination when compared with the administration of a fixed dose of midazolam.
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