1. 1. Tori Hafen and John Harmon Patient Care
2. 2. Student Learning Objectives
3. 3. Patient Assistance and Transfer Back Injuries are the leading cause of missed work days among health care workers Health care workers are 4.5 times more likely to sustain back injuries than any other profession 12% of healthcare workers leave the profession due to back injuries
4. 4. The problem of lifting patients Is compounded by the increasing Weight of patients due to the obesity Epidemic in the United States and The rise in Geriatric patients who require Assistance. In the imaging department we are Often faced with the challenge of Difficult patient transfers. Employing proper lifting techniques prevents back injuries!
5. 5. Proper body mechanics and lifting techniques are the key to avoiding injuries
6. 6. Patient Transfer Consult the chart or ask the nurse or about any specific limitations of the patient. Anterior hip replacement no abduction, adduction or rotation but can sit up at a 90 angle Posterior No adduction, rotation or crossing of legs. Must NOT flex more than 90 Do not raise the left arm after pacemaker implantation follow department protocols. Verify patient identification. Gather the necessary equipment (for example, a mechanical lift or wheelchair) and making sure that the equipment is in good working condition. Enlist the patients help and cooperation when possible. Ask for help if necessary
7. 7. Transferring Devices Transfer Belt Transfer Boards Draw Sheet Hospital Bed Mattress Hydraulic Lifts Hovermat?
8. 8. Often, patients will have some type of medical equipment, i.e.: Infusion catheters and pumps Oxygen: cannula, mask or tracheal intubation. Nasogastric or nasoenteric Urinary catheters Chest tubes ETC Always check a patients O2 tank setting before switching to room Oxygen.
9. 9. Always communicate with your patient even if they seem unresponsive!
10. 10. Patient Monitoring Temperature Heart rate Blood pressure Respiration Even patients who seem healthy and strong can experience sudden changes in their condition without warning.
11. 11. Blood Pressure Systolic Pressure/Diastolic Pressure Place cuff over brachial artery Position bell of Stethoscope in antecubital space Inflate to 160-180mm/hg Slowly release pressure Systolic pressure at first sounds of pulse Diastolic pressure when pulse no longer audible Average adult BP 120/80 Korotkoff Sounds
12. 12. Pulse and Respiration Measuring Pulse Radial Pulse Apical Pulse Carotid Pulse Femoral Pulse Popliteal Pulse Pedal Pulse Quantity Volume Regularity Normal-60 to 100 BPM Tachycardia- over 100 BPM Bradycardia-under 60 BPM Measuring Respiration Respiratory Rate: the number of breaths (inhalation and exhalation) per minute 12 to 20 pm Respiratory Rhythm Depth of Respiration Quality of breathing Listen for abnormal sounds Dyspnea
13. 13. Superior Venacava Inferior Venacava Ascending Aorta Aortic Arch Brachiocephalic Artery Left Common Carotid Artery Left Subclavian Artery Right Pulmonary Veins Right Atrium Tricuspid Valve Right Ventricle Left Pulmonary Artery Right Pulmonary Artery Left Pulmonary Veins Left Atrium Chordae Tendinaea Mitral Valve Left Ventricle Pulmonary Valve Descending Aorta
14. 14. Signs of Patient Distress Eyeball your patient! Observe, compare, evaluate Is patient alert, focused? Does patient make eye contact, are they responsive? p211 Watch for signs of distress Skin color, temperature Breathing Coherent speech Level of consciousness
15. 15. Levels of Consciousness Alert and conscious Drowsy but responsive Unconscious but responsive to painful stimuli Comatose !In trauma situations, be aware of injuries both known and unknown! P212,311
16. 16. Glascow Coma Scale
17. 17. Medical Emergencies Physical Injury or Trauma Cardiac or Respiratory Arrest Allergic reactions Other Medial Disorders
18. 18. Imaging in the Emergency Department Obtain as much patient information as possible. Introduce yourself to patient and briefly explain what you need to image. Access situation: What images are ordered and how will you acquire them? Seek assistance moving and positioning patient when necessary. Provide appropriate shielding.
19. 19. Trauma Patients Radiographers should be cautious to avoid further injury when handling patients with fractures, wounds or burns Be alert for changes in the patient's condition that may indicate shock or increased intracranial pressure Cervical spine precautions must be observed until the possibility of cervical spinal fracture has been ruled out
20. 20. Emergency Situations in the Imaging Suite Call For Help! Allergic Reactions: Benadryl Epinephrine Cardiac or Respiratory Arrest: Administer CPR Shock: Lie patient down, elevate feet Keep warm Turn patient on side if nauseous
21. 21. Emergency Situations in the Imaging Suite cont. Seizures: Do not leave patient Lie patient on back or side Place pillow or something soft under head Do not attempt to restrain patient Keep patient safe Diabetic Reactions: Hydration is important Patient may respond to a piece of candy or fruit juice Some types of diabetic reactions require immediate treatment with medication Dizziness or Syncope: Sit patient down Give oxygen if needed
22. 22. Documentation Documentation is your friend Sign of a professional Be objective Document Incidents Document any drugs, contrast administered Document Patient History include prior procedures and current medications Document abnormal patient behavior Document patient condition, difficulties
23. 23. It is vital to obtain a thorough patient history during the radiographic examination! Symptoms Duration of symptoms Possible causes of symptoms Recent procedures Related Illness or injuries Level and type of pain 208-211
24. 24. Consent
25. 25. A patient must receive a full explanation of the procedure and its risks and benefits before the procedure begins. A patient must be competent to sign consent form Only parent or legal guardians can sign for minors Consent forms must be completed before signing Only the physician named on the form can perform the procedure Any condition stated on the form must be met The consent can be revoked by the patient at any time Informed consent must include
26. 26. Pharmacology Six Rights of Medication Administration: 1. Right dose 2. Right medication 3. Right patient 4. Right time 5. Right route 6. With right documentation
27. 27. A Valid Prescription Must Contain
28. 28. Before the Administration of Any Medication Check Physician's orders Obtain a list of current patient medications Check for contraindications Be aware of exam sequencing and scheduling and plan accordingly.
29. 29. Routes of Administration Enteral: Oral, Rectal, Nasogastric tube Inhalation Topical Sublingual and Buccal Parenteral Injections
30. 30. Venipuncture
31. 31. Intravenous Injections
32. 32. Intrathecal route of drug administration is well established in anesthesia and pain management. A variety of therapeutic substances can be delivered by the intrathecal route. Intrathecal Administration
33. 33. Do medical hand washing. Open a sterile set or tray by unfolding the topmost part of the covering wrapper away from you. Open the second layer of the wrapper to the sides of the set or try. Open the final layer of the wrapper toward you. The wrapper can now become the sterile field immediately surrounding the sterile set or tray.
34. 34. Syringe Never Re-Cap Needles! Dispose used needles in Sharps container.
35. 35. Ampules single doses Vials small glass bottle with sealed rubber cap Pre-filled Syringes
36. 36. Check and recheck label Check expiration date Never inject a solution you havent drawn up!! Calculate correct dose Swab top of vial with alcohol Assemble syringe and needle Remove cap from needle and draw back air into syringe Inject air into vial Invert vial & withdraw solution into syringe Remove air bubbles
37. 37. Contraindications to Contrast Exams Barium: be aware of issues concerning possibility of perforated bowel. Allergies to Iodine can lead to anaphylactic shock Patient must have labs done prior to Iodine exam BUN-6 to 20mg/dl Creatinine-0.6 to 1.5mg/dl GFR->60 Ask about medications and medical history Diabetics should not take Metformin 24 hours prior to, and 48 hours following exam.
38. 38. Soft tissue has a low absorption ratio Absorption is dependent on: - atomic number - atomic density - electron density - part thickness - K shell binding energy Absorption occurs through photoelectric effect
39. 39. Contrast is a substance that when introduced into the body allows for visualization of structures that would otherwise be difficult to see
40. 40. Types of Contrast Agents
41. 41. Atomic number of 56 Barium sulphate, compound K shell binding energy of about 37 kEv Inert colloidal suspension Comes in powder form or concentrated liquid suspensions Administered orally, rectally or through a stoma or NG tube Thin, thick or paste
42. 42. Contrast can be barium, barium with air or iodine Prep is NPO and a cathartic Patient may be given glucagon to reduce spasms Sims position used to insert enema tip
43. 43. Hygroscopic can cause constipation/impaction/bowel obstruction Aspiration Hypervolemia from fluid overload due to enlarged colon Perforation of colon/rectum Allergic reaction to latex tip Barium peritonitis
44. 44. Atomic number of 53 Can be administered enteral orally or rectally, intravenously (parenteral), orally, rectally, through a catheter , directly into a structure or intrathecally K shell binding energy approximately 33 kEv Should not go over 70 kVp when imaging Mainly aqueous Ionic and Nonionic (aqueous) Ethiodized Oils
45. 45. Possible Complications and Reactions to Medications Infiltration/Extravasation Hematoma Phlebitis Thrombophlebitis Infection Septicemia Pulmonary Embolism Air Embolism Catheter Embolism Speed Shock
46. 46. All iodine exams must be completed first Ultrasound and CT exams must be performed prior to barium studies Any thyroid studies must be done prior to iodine administration UGI performed prior to BE!
47. 47. Post Examination Instructions: Drink plenty of fluids Eat normally Rest Refrain from taking Metformin medication for 48 hours following examination Now go home
48. 48. The End