SAFETY IN RADIOGRAPHIC IMAGING

CHAPTER 3

CARE OF BELONGINGS

PATIENTS SHOULD BE TAKEN TO A DRESSING ROOM TO CHANGE.

EXPLAIN BEFORE THE PATIENT UNDRESSES WHAT YOU WANT THEM TO REMOVE.

DRESSING ROOMS ARE NOT SAFE PLACES TO KEEP CLOTHES AND PERSONNEL ITEMS, THE PATIENT CAN TAKE THESE THINGS WITH THEM.

ITEMS MUST BE LABELED AND PUT IN A SAFE PLACE.

PATIENTS ITEMS MUST ALWAYS BE TREATED AND HANDLED WITH CARE.

BODY MECHANICS

MOVING AND LIFTING IS THE LEADING CAUSE OF INJURY TO HEALTH CARE WORKERS!!!!GRAVITY IS THE FORCE THAT PULLS OBJECTS TOWARD THE CENTER OF THE EARTH!

THE CENTER OF GRAVITY IS THE POINT AT WHICH THE MASS OF ANY BODY IS CENTERED.

BODY MECHANICS

SAFE BODY MECHANICS REQUIRES GOOD POSTURE. THIS MEANS THE BODY IS IN ALIGNMENT, WITH ALL THE PARTS IN BALANCE.

GOOD BODY POSTURE ALSO AIDS OTHER BODY SYSTEMS TO WORK EFFICIENTLY.

RULES FOR UPRIGHT POSTURE

HOLD CHEST UP AND SLIGHTLY FORWARD WITH THE WAIST EXTENDED.

HOLD HEAD ERECT WITH CHIN HELD IN.STAND WITH FEET PARALLEL AND AT

RIGHT ANGLES TO THE LOWER LEGS.KEEP KNEES SLIGHTLY BENT.KEEP THE BUTTOCKS IN AND THE

ABDOMEN UP AND IN.

MECHANICS

YOU MUST DETERMINE THE CENTER OF GRAVITY AND MAKE A PLAN.

KEEP THE HEAVIEST PART CLOSEST TO THE BODY.

PULLING THAN PUSHING REDUCES FRICTION.

KEEP YOUR LINE OF BALANCE CLOSEST TO THE CENTER OF THE LOAD.

GUIDELINES TO LIFTING

WHEN PICKING UP BEND THE KNEES AND LOWER THE BODY.

PULL HEAVY ITEMS OR PATIENTS RATHER THAN PUSH THEM.

BALANCE THE WEIGHT ON BOTH FEET WHEN ASSISTING A PATIENT. STAND CLOSE TO THE PATIENT, FLEX YOUR GLUTEAL MUSCLES, AND BEND YOUR KNEES TO SUPPORT THE LOAD.

ALWAYS PROTECT YOUR SPINE.MAKE CERTAIN THE FLOOR IS CLEAR OF

OBJECTS.

ALERT

NEVER MOVE A PATIENT WITHOUT ENOUGH ASSISTANCE TO PREVENT INJURY TO YOURSELF AND THE PATIENT!!!!!

MOVING AND TRANSFERRING A PATIENT

1. ESTABLISH THE CORRECT IDENTITY OF THE PATIENT.

2. REQUEST ANY INFORMATION FROM THE NURSE ON PHYSICAL DEMANDS OF THE PROCEDURE.

3. REQUEST INFORMATION CONCERNING THE AMBULATION AND MOBILITY OF THE PATIENT.

4. MOVE THE PATIENT TO THE X-RAY DEPARTMENT KEEPING IN MIND WHAT YOU WERE TOLD.

COMPLETED PROCEDURE

1. STOP AT THE NURSES STATION AND RETURN THE CHART AND INFORM THE UNIT PERSONNEL THAT THE PATIENT IS BACK.

2. RETURN PATIENT TO THEIR ROOM.

(SIDE RAILS, CALL BUTTON ETC..)

ASSESSING MOBILITY

CRITICAL THINKING MUST BE APPLIED!!PLAN YOUR MOVE USING INTERVIEW AND

ASSESSMENT SKILLS!1. DEVIATIONS FROM CORRECT ALIGNMENT.2. IMMOBILITY OR LIMITATIONS IN RANGE OF

MOTION.3. ABILITY TO WALK.4. CARDIO, RESPIRATORY AND

MUSCULOSKELETAL PROBLEMS.5. GENERAL CONDITION.

ASSESSING MOBILITY

6- PATIENTS STRENGTH AND ENDURANCE.

7- BALANCE.

8- ABILITY TO UNDERSTAND.

9- ACCEPTANCE OF MOVE.

11- PATIENTS MEDICATION HISTORY.

ALERT!!!!!!!!!!!!!!

A PATIENT MUST NEVER BE MOVED WITHOUT ADEQUATE ASSISTANCE!

GET HELP AND DO NOT BE AFRAID TO ASK FOR ASSISTANCE !

WHEN YOU HURT YOUR BACK WHO WILL PAY YOUR BILLS?

RULES OF MOVING A PATIENT

1. GIVE ONLY THE ASSISTANCE THAT THE PATIENT NEEDS FOR COMFORT AND SAFETY.

2. LOCK ALL WHEELS ON WHEELCHAIR AND GURNEYS (STRETCHERS).

3. IT IS BETTER TO MOVE A PATIENT TOWARD THEIR STRONGER SIDE WHILE ASSISTING ON THE WEAKER SIDE.

4. THE PATIENT SHOULD WEAR SHOES FOR STANDING TRANSFERRS.

5. INFORM THE PATIENT OF THE PLAN.6. GIVE THE PATIENT SHORT SIMPLE COMMANDS

AND HELP THEM AS THEY ARE MOVING.

METHODS OF MOVING PATIENTS

GURNEY

AMBULATION

WHEELCHAIR

GURNEY

THE PATIENTS HEAD, SPINE AND EXTREMITIES MUST BE WELL

SUPPORTED.

METHODS OF MOVING PATIENTS

SHEET TRANSFER.SLIDING BOARD TRANSFER

PLEASE READ THESE SECTIONS CAREFULLY AND LOOK AT THE PICTURES IN YOUR BOOK!

LOG ROLL

TURNING A PATIENT WITHOUT FLEXING THEIR NECK OR BACK.

FIVE PEOPLE ARE NEEDED.TWO PERSONS STAND ON EACH SIDE

OF THE PATIENT AND ONE PERSON SUPPORTS THE HEAD BY PLACING THEIR HANDS ON THE SIDES OF THE PATIENTS FACE.

WHEELCHAIR MOVES

ALWAYS HELP A PATIENT TO AND FROM A WHEELCHAIR.

WHEN MOVING A PATIENT FROM A BED TO WHEELCHAIR ALWAYS PUT ON NON SKID SLIPPERS AND PROVIDE ASSISTANCE.

WATCH THE FOOTREST ON THE WHEELCHAIRS.

LOCKS MUST BE ON AND CHECKED.

VIDEO

GAIT BELT

BELT MADE OF A STURDY MATERIAL

ITS PURPOSE IS TO STABILIZE A PATIENT DURING AMBULATION.

IMMOBILIZERS

IMMOBILIZERS MUST BE ORDERED BY THE DOCTOR IN CHARGE!

IMMOBILIZERS SHOULD ONLY BE USED AS A LAST ATTEMPT.

THERAPEUTIC COMMUNICATION SHOULD BE TRIED BEFORE IMMOBILIZING.

LESS RESTRICTIVE IMMOBILIZERS

VELCRO

SANDBAGS

TAPE

SPONGES

REASONS FOR IMMOBILIZATION

1. TO CONTROL MOVEMENT OF AN EXTREMITY WHEN AN IV INFUSION OR CATHETER IS IN PLACE.

2. TO REMIND A SEDATED PATIENT WHO CAN NOT REMEMBER A POSITION.

3. UNCONSCIOUS, DELIRIOUS, COGNITIVELY IMPAIRED OR CONFUSED PATIENT.

CARING OF AN IMMOBILIZED PATIENT

EXPLAIN WHY YOU ARE IMMOBILIZING TO YOUR PATIENT AND ALSO TO WHOEVER THEY ARE WITH.

NEVER LEAVE A PATIENT UNATTENDED WITH IMMOBILIZERS.

EXPLAIN IT IS ONLY TEMPORARY.ALL RADIOGRAPHERS MUST DOCUMENT

APPLICATION OF IMMOBILIZERS ON THE CHART.

REMAIN CALM AND REASSURING TO YOUR PATIENT.

RULES FOR APPLICATION OF IMMOBILIZATION

1. THE PATIENT MUST BE ALLOWED AS MUCH MOBILITY AS POSSIBLE.

2. APPLIED IMMOBILIZATION SHOULD BE PADDED.3. ANATOMICAL POSITION.4. PROPER KNOTS SHOULD BE USED.5. NEITHER CIRCULATION OR RESPIRATION

SHOULD BE IMPAIRED.6. IF LEG IMMOBILZERS ARE NEEDED YOU MUST

ALSO APPLY THEM TO THE WRIST.7. MUST BE ABLE TO REMOVE IMMOBILERS

QUICKLY.

FACTS OF IMMOBILIZERS

MUST BE REMOVED EVERY TWO HOURS.

APPLIED TO A FRAME OF A GURNEY, BED OR TABLE NOT A MOVABLE PART.

THE JOINT SHOULD BE PLACED ON A NORMAL RANGE OF MOTION.

DOCUMENT REMOVAL, WHEN APPLIED AND REASON FOR.

POSITIONING FOR EXAMS

SUPINE/DORSAL RECUMBENTLATERALPRONEHIGH FOWLERSSEMI-FOWLERSSIMSTRENDELENBERG

ASSISTING THE PATIENT TO DRESS AND UNDRESS

INITIAL ASSESSMENTDOES THE PATIENT HAVE A CAST?IS THE PATIENT YOUNG?IS THE PATIENT CONTRACTED?POOR EYESIGHT?

TRAUMA UNDRESSING

CUTTING AWAY THE GARMENT MAY HAVE TO BE DONE ON TRAUMA PATIENTS. CUT ALONG THE SEAMS IF NEEDED AND WITH THE PATIENTS CONSENT.

DO NOT THROW AWAY CLOTHING-PUT IN A SAFE PLACE OR A BAG.

RULES TO UNDRESSING A PATIENT

1. A YOUNG PATIENT NEEDS A PARENT OR GUARDIAN TO HELP THEM UNDRESS.

2. IF A PATIENT HAS A DISABILITY OF THE LOWER EXTREMITIES THE CLOTHING SHOULD BE REMOVED FROM THE TOP PART OF THE BODY FIRST!!!!

3. PUT A GOWN OVER THE PATIENT FIRST AND INSTRUCT THEM TO REMOVE THEIR PANTS. IF THEY CAN NOT YOU CAN REACH UNDER THE GOWN AND PULL DOWN THEIR PANTS OVER THEIR HIPS.

4. HAVE THE PATIENT SIT.

REMOVING A DRESS

1. PLACE A SHEET OVER THE PATIENT AND HELP THEM TO REMOVE BRA AND SLIP.

2. PUT ON THE GOWN AND REMOVE THE SHEET.

STEPS TO RE-DRESS A PATIENT

1. SLIDE THE PANTS OR SKIRT OVER THE FEET UP TO THE HIPS.

2. HAVE THE PATIENT STAND AND PULL OVER THE HIPS.

3. PUT SHIRT ON WHILE THE PATIENT HAS A GOWN OVER THEM.

4. REMOVE THE GOWN.

THE DISABLED PATIENT

1. COVER THE PATIENT AND HAVE A GOWN READY.

2. REMOVE THE CLOTHING FROM THE LESS AFFECTED SIDE FIRST.

3. NEXT PLACE THE GOWN ON THE UNAFFECTED SIDE.

4. REMOVE SHIRT AND PANTS AS PREVIOUSLY LEARNED.

5. FOLD THE CLOTHES AND MAKE SURE THEY PLACED IN A BAG AND LABELED.

RULES TO UNDRESSING A PATIENT

1. A YOUNG PATIENT NEEDS A PARENT OR GUARDIAN TO HELP THEM UNDRESS.

2. IF A PATIENT HAS A DISABILITY OF THE LOWER EXTREMITIES THE CLOTHING SHOULD BE REMOVED FROM THE TOP PART OF THE BODY FIRST!!!!

3. PUT A GOWN OVER THE PATIENT FIRST AND INSTRUCT THEM TO REMOVE THEIR PANTS. IF THEY CAN NOT YOU CAN REACH UNDER THE GOWN AND PULL DOWN THEIR PANTS OVER THEIR HIPS.

4. HAVE THE PATIENT SIT.

WHEN A PATIENTS GOWN IS WET OR SOILED IT IS YOUR JOB TO CHANGE IT.

WHEN CHANGING A GOWN OF A PARALYZED OR INJURED PATIENT REMOVE THE GOWN FROM THE UNAFFECTED SIDE FIRST! THEN PLACE THE CLEAN GOWN FIRST ON THE AFFECTED SIDE AND THEN ON THE UNAFFECTED SIDE!

PATIENT WITH AN IV

1. IF THE GOWN MUST BE CHANGED SLIP THE CLOTHING OFF THE UNAFFECTED SIDE.

2. CAREFULLY SLIDE THE SLEEVE OF THE UNAFFECTED SIDE OVER THE IV TUBING AND THEN OVER THE CONTAINER.

3. SUPPORT THE ARM FIRMLY.4. WHEN REPLACING THE GOWN, FIRST

PLACE THE SLEEVE ON THE AFFECTED SIDE.

SKIN CARE

THE BREAKDOWN OF SKIN CAN HAPPEN FAST ( 1 TO 2 HOURS).

A DECUBITUS ULCER CAN RESULT.FACTORS FOR SKIN BREAKDOWN ARE

IMMOBILITY, PRESSURE AND FORCE.BE CAREFUL WHEN MOVING PATIENTS

ESPECIALLY IF THEY ARE IMMOBILIZED.DAMP SHEETS OR SOILED GOWNS CAN

ADD TO THE BREAKDOWN OF SKIN.

BREAKDOWN OF SKIN

EARLY SIGNS ARE BLANCHING AND COLDENESS OVER PRESSURE AREAS.THIS IS CALLED ISCHEMIA.

PERSONS PRONE TO SKIN BREAKDOWN ARE THE ELDERLY, MALNOURISHED AND THE CHRONICALLY ILL.

DECUBITUS ULCERS

BE CAREFUL OF HARD X-RAY TABLES!!!!AREAS OF THE BODY THAT ARE SUSCEPTIBLE ARE

THE SCAPULAE, SACRUM, TROCHANTERS, KNEES AND HEELS.

KEEP PRESSURE OFF THE HIPS AND HEELS.A PATIENT THAT IS PRONE TO ULCERS SHOULD BE

MOVED EVERY TWO HOURS.X-RAY TABLE MOVE EVERY 30 MINUTES.SPECIAL PRECAUTIONS SHOULD BE TAKEN TO

PROTECT THE FEET AND LOWER LEGS WHEN THERE IS A POSITION CHANGE.

CAST CARE AND TRACTION

CASTS CAN BE MADE OF PLASTER, FIBERGLASS, PLASTIC OR CAST-TAPE MATERIAL.

COMPRESSION OF A CAST CAN PRODUCE PRESSURE TH THE EXTREMITY.

RULES FOR MOVING A CAST1. SLIDE YOUR OPENED, FLATTENED HAND UNDER

THE CAST.2. A CAST MUST BE SUPPORTED AT THE JOINTS

WHEN MOVED.3. A CASTED EXTREMITY MUST BE MOVED AS A

UNIT WITH FLAT HAND SUPPORT.

CAST CARE AND TRACTION

1. CAST MUST BE WELL SUPPORTED.

2. A RECENT CAST SHOULD BE ELEVATED.

3. ASSESSMENT OF CIRCULATION OR NERVE COMPRESSION SHOULD BE DONE EVERY 15 MINUTES WHEN IN THE X-RAY DEPT.

SIGNS OF IMPAIRED CIRCULATION

COLDNESSPAINBURNING OR TINGLINGSWELLINGSKIN COLOR CHANGESINABILITY TO MOVE FINGERS /TOESDECREASE OR ABSENCE OF PULSE.

TRACTION

WHEN WORKING WITH A PATIENT IN TRACTION YOU MUST NEVER EVER, EVER REMOVE THE TRACTION DEVICE.

BEDPAN AND URINALS

1. HELP THE PATIENT TO THE BATHROOM AND ALL BATHROOMS SHOULD HAVE A WORKING CALL BUTTON.

2. AFTER THE PATIENT IS DONE HELP THEM BACK TO THE ROOM.

3. CHECK THE BATHROOM .

4. WASH YOUR HANDS.

BEDPAN

THERE ARE TWO TYPES OF BEDPANS1. STANDARD2. FRACTURE PAN

ASSISTING A PATIENT1. WASH YOUR HANDS AND GET TISSUES AND THE BEDPAN2. PLACE ONE HAND UNDER THE LOWER BACK AND ASK THE

PATIENT TO RAISE THEIR HIPS.3. PLACE THE PAN UNDER THE PATIENTS HIPS AND COVER

THE PATIENT.4. REMOVE YOUR GLOVES AND WASH YOUR HANDS.5. WHEN THE PATIENT IS DONE PUT ON GLOVES AND HELP

THE PATIENT OFF THE BEDPAN. 6. REMOVE THE BEDPAN AND COVER AND DISPOSE.7. OFFER THE PATIENT PAPER TOWELS.8. REMOVE YOUR GLOVES.

WIPE THE PERINEAL AREA FROM FRONT TO BACK TO PREVENT A POSSIBLE URINARY TRACT INFECTION!!!!!!!!!!!!!!!!!!!!!!!!!!!!

MALE URINAL

MADE OF PLASTIC OR METAL.IF A PATIENT CAN NOT HELP

THEMSELVES………1. PUT ON CLEAN GLOVES.2. PLACE THE URINAL BETWEEN THE

PATIENTS LEGS.3. PLACE THE PENIS IN THE URINAL AND

HOLD THE URINAL IN PLACE UNTIL THE PATIENT STOPS VOIDING.

4. REMOVE AND WASH YOUR HANDS.

DEPARTMENTAL SAFETY

PREVENTION OF PATIENT AND PERSONNEL INJURY IS THE RESPONSIBILITY OF ALL HEALTH CARE WORKERS.

IT IS YOUR RESPONSIBILITY TO PRACTICE SAFETY IN ALL ASPECTS OF YOUR WORK!!!!!!

FIRE SAFETY

1. TELEPHONE NUMBER TO REPORT A FIRE.2. FIRE DRILL AND EVACUATION PLAN3. LOCATION OF FIRE ALARMS4. LOCATION OF FIRE EXTINGUISHERS CARBON DIOXIDE EXTINGUISHER- GREASE OR ELECTRICAL FIRE SIDA AND ACID WATER- PAPER AND WOOD FIRE DRY MECHANICAL EXTIGUISHER- RUBBISH OR WOOD FIRE ANTIFREEZE OR WATER- RUBBISH, WOOD, GREASE OR

ANESTHETIC FIRE1. A FIRE MUST BE REPORTED BEFORE AN ATTEMPT IS MADE TO

PUT IT OUT.2. FIRE HOSES MUST BE KEPT CLEAR AT ALL TIMES3. HALLWAYS FREE OF EQUIPMENT4. WARNING SIGNS POSTED5. INSPECTION ON A REGULAR BASIS

IF A FIRE OCCURS

1. PERSONS IN DANGER SHOULD BE MOVED.

2. WINDOWS AND DOORS CLOSED.

3. OXYGEN TURNED OFF.

4. EVACUATION PROCEDURES ARE FOLLOWED.

PREVENTION OF ELECTRIC EQUIPMENT ACCIDENTS

1. USE GROUNDED PLUGS2. NO WET FEET OR HANDS3. DO NOT PULL ON THE ELECTRICAL CORD4. CORDS SHOULD BE UNFRAYED AND UNKINKED5. SOUND WORKING ORDER6. TEST EQUIPMENT7. REPORT ANY SHOCKS8. WATCH EXTENSION CORDS9. DO NOT USE ANY ELECTRICAL EQUIPMENT IF

YOU DON’T UNDERSTAND HOW TO USE IT

PREVENTION OF FALLS

PATIENT FALLS ARE THE MOST COMMON ACCIDENTS IN THE HOSPITAL!!!!!PATIENTS WHO ARE ELDERLY, MEDICATED, HAVE NEUROLOGICAL DISORDERS, HEAD TRAUMA OR CONFUSED ARE MORE LIKELY TO FALL.

1. LEARN THE CONDITION OF YOUR PATIENT.2. KEEP FLOORS CLEAR OF OBJECTS.3. ALWAYS KEEP SIDE RAILS UP.4. LOCK WHEELCHAIRS.5. NO OBSTRUCTED PASSAGEWAYS.

POISONING AND HAZARDOUS WASTE

1. LABEL ANY TOXIC CHEMICAL.2. STORE IN A SAFE PLACE.3. POSTED EMERGENCY INSTRUCTIONS IN CASE

OF POISONING.4. CHEMICALS TO REMAIN IN THEIR OWN

CONTAINERS.5. DISPOSED ACCORDING TO FEDERAL MADATES

AND POLICY.6. RESTRICTIONS OF DISPOSAL MUST BE POSTED.7. CONTRAST AND OTHER DRUGS MUST BE KEPT

IN A SAFE PLACE. HAZARDOUS MATERIALS MAY BE LABELED WITH A COLOR CODE.

ACCIDENTAL SPILL OF A HAZARDOUS SUBSTANCE FIRST AID GUIDELINES!!!

EYE CONTACT- FLUSH EYES FOR 15 MINUTES AND CONSULT A DOCTOR

SKIN CONTACT- REMOVE AFFECTED CLOTHING AND WASH WITH SOAP AND WATER.

INHALATION- REMOVE FROM EXPOSURE, BEGIN CPR AND CALL THE EMERGENCY NUMBER.

INGESTION- DO NOT INDUCE VOMITING, CALL THE EMERGENCY NUMBER.

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