# A nurse is preparing a client for a bronchoscopy procedure. Which assessment finding would be most important for the nurse to report to the healthcare provider before the procedure?

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## 문제

A nurse is preparing a client for a bronchoscopy procedure. Which assessment finding would be most important for the nurse to report to the healthcare provider before the procedure?

## 보기

1. Blood pressure reading of 150/88 mmHg
2. Platelet count of 75,000 per cubic millimeter **✔ 정답**
3. Heart rate of 102 beats per minute
4. Oxygen saturation of 94% on room air

**정답: 2**

## 해설

A platelet count of 55,000/mm³ indicates thrombocytopenia, increasing bleeding risk during bronchoscopy and requiring provider notification. Other findings like elevated BP, HR, or normal SpO₂ are not absolute contraindications.

## 심화 해설

Pre-procedural Safety Assessment for Bronchoscopy

Before a bronchoscopy, the nurse's priority is to identify any risk factors that could lead to life-threatening complications during or after the procedure. While all the listed findings require attention, one represents an absolute contraindication due to the risk of uncontrolled bleeding. The procedure involves passing a scope into the airways, and often includes a biopsy, which causes tissue trauma. The body's ability to form a clot is therefore critical.

The most critical finding to report is a platelet count of 75,000 per cubic millimeter. This represents significant thrombocytopenia. A normal platelet count is typically between 150,000 and 400,000 per cubic millimeter. A level below 100,000, and especially below 80,000, dramatically increases the risk of spontaneous and procedure-induced bleeding. During a bronchoscopy, even minor trauma from the scope or a biopsy can lead to a hemorrhage in the airways that is difficult to control and can quickly compromise the patient's airway and ventilation. The risk of bleeding is a primary concern in transbronchial procedures, as highlighted by the need for careful patient selection to minimize complications in lung biopsy techniques [1]. Reporting this before the procedure allows the provider to consider a platelet transfusion or cancel the procedure to prevent a catastrophic bleeding event.

The other findings, while not normal, are less immediately dangerous in the context of a contraindication. A blood pressure of 150/88 mmHg (Option 1) indicates Stage 1 hypertension. While it should be reported, it is not an absolute contraindication and can often be managed with pre-procedural medication. A heart rate of 102 beats per minute (Option 3) is mild sinus tachycardia, which could be due to anxiety, pain, or dehydration. It warrants investigation but does not pose the same immediate procedural threat as a bleeding diathesis. An oxygen saturation of 94% on room air (Option 4) is a mild hypoxemia that is expected in many patients with pulmonary disease requiring bronchoscopy. It is a key part of the assessment but is managed with supplemental oxygen during the procedure, not a reason to halt it. The foundational principle is that the risk of a fatal procedural complication, such as an airway hemorrhage, outweighs other concerns. A review of fatal adverse events related to procedural sedation and analgesia underscores that major complications, though rare, are often cardiorespiratory in nature, and a pre-existing bleeding risk is a direct setup for such a crisis .

References (research sources)

- [1]South African Thoracic Society consensus statement on transbronchial lung cryobiopsy for interstitial lung disease.GuidelineKoegelenberg CFN, Singh N, Esmail A, Hofmeyr R, Graham A, Allwood BW, Lalla U, Goussard P, Dheda K. (2025) · DOI: 10.7196/ajtccm.2025.v31i3.3748

## 임상 시나리오

Pre-Bronchoscopy Bleeding Risk AssessmentIdentifying the Critical Contraindication
A platelet count below 100,000/mm³ is a major red flag. A value of 75,000/mm³ represents severe thrombocytopenia and is often considered an absolute contraindication for transbronchial biopsy due to the risk of catastrophic airway hemorrhage.

The primary safety concern is uncontrolled bleeding. Even minor scope trauma or a biopsy can trigger hemorrhage that compromises the airway. Always verify coagulation studies (platelets, PT/INR, PTT) before the procedure.

CautionDo not proceed with biopsy if platelets are critically low without a corrective action plan. The provider may order a platelet transfusion immediately pre-procedure or cancel the bronchoscopy to prevent a life-threatening event.

## 핵심 개념

- **Thrombocytopenia** — A condition characterized by abnormally low levels of platelets (thrombocytes) in the blood, increasing the risk of bleeding.
- **Bronchoscopy** — An endoscopic procedure to visualize the airways, often involving tissue biopsy, which carries a risk of hemorrhage.
- **Platelet Count** — A lab test measuring the number of platelets per cubic millimeter of blood; normal range is typically 150,000 to 400,000.
- **Absolute Contraindication** — A condition or factor that makes a particular treatment or procedure completely inadvisable due to severe risk of harm.
- **Hemorrhage** — Escape of blood from a ruptured blood vessel, a primary risk during invasive procedures in patients with coagulopathies.

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