17-20 book objectives

what are the 4 categories of basic infectious agents along with their unique characteristics?

bacteria - prokaryotic, ubiquitous, single-celled organisms

viruses - only replicates withing living host-cells

fungi - eukaryotic protists, absence of chlorophyll, presence of rigid cell wall

protozoan parasites - unicellular, submicroscopic to macroscopic, free-living, commensalistic, mutualistic, or parasitic

what are the steps involved in the establishment of an infectious disease?

1. encounter

2. entry

3. spread

4. multiplication

5. damage

6. outcome

what are the 4 factors involved in the spread of disease and the chain of infection?

host

infectious microorganism

mode of transmission

reservoir

what are various sources of healthcare-associated infection?

medical personnel - skin to skin contact or indirect contact through ingestion/inhalation

patient flora - healthy microorganisms that can become compromised

contaminated healthcare environment - not sterilized; contamination through bloodstream, urinary, and endotracheal catheters

blood-borne pathogens - disease causing microorganisms transmitted through blood

invasive procedures - surgeries or insertion of medical devices, not sterilized, can cause infection

what are the constituents of microbial control within the host?

constitutive defenses - mechanical, chemical, or cellular defense (ex: mucous membrane, tears, urine, phagocytes)

normal microbial flora - microbial community of a healthy person, colonization of pathogens, secrete toxins for protection

chemotherapy - antimicrobial drug; targets specific proteins, nucleic acids, and bacterial cell wall; inhibit growth, but don’t kill (ex: tetracyclines/penicillin)

immunization - induce active immunity (ex: vaccines)

what is the difference between medical and surgical asepsis?

medical asepsis - number of infectious agents reduces → decreases the probability of infection (does not necessarily reduce it to zero)

surgical asepsis - procedure to prevent contamination of microbes and endospores (before, during, and after surgery using sterile technique)

what are the chemical and physical methods of asepsis?

chemical - disinfectants (antiseptic, bacteriostatic, bactericidal) (include chlorine and iodine)

physical - moist heat, pasteurization, freezing, UV light, barriers (gloves, gowns, masks, eyewear, face shields)

what is the medically aseptic handwashing technique?

1. go to sink, don’t touch clothes, use foot/knee levers, adjust water temp/force

2. wet hands thoroughly, keep hands lower than elbows

3. apply soap, use foot/knee levers

4. firm, vigorous, rotary motion; rub wrist, fingertips, palms, back of hands, between fingers, under nails

5. rinse, allow water to run over hands

6. repeat to cleanse elbow → fingertips

7. turn off water, use foot/knee levers (or paper towel if unavailable)

8. dry area from elbow → fingertips, leave area

what are the basic premises of standard precautions?

handwashing

gloving

personal protective equipment

needle recapping

biohazard spill

airborne precautions

droplet precautions

contact precautions

how do transmission-based precautions and appropriate clinical situations relate?

because they directly dictate the specific isolation protocols (airborne precautions, droplet precautions, contact precautions)

what is the contact precautions technique?

1. determine # of cassettes needed for exam and place each into a protective bag (plastic or isolation)

2. move portable to isolation room

3. locate isolation supplies

4. remove ornamentation (ex: watches, rings, earrings, etc.)

5. put on lead apron

6. proper handwashing

7. put on clean gown

8. put on mask securely

9. put on gloves (new and clean)

10. have assistant put on gown, gloves, and cap (for sterilization)

11. enter isolated area, AIDET

12. position patient and cassette

13. assistant manipulate machine and exposure

14. remove cassette from behind patient

15. untie gown (waist)

16. untie gown (neck), remove gown and discard

17. remove gloves (pull inside out) and discard

18. remove cap and mask

19. proper handwashing

20. assistant follow, clean portable

21. proper handwashing

how does the use of a sterile drape establish a sterile field?

because it is considered free of viable microorganisms

what are the steps in a surgical scrub?

1. have scrub brushes, antiseptic soap, and nail cleansers nearby

2. remove jewelry

3. wash hands, wrists, and forearms with antiseptic soap

4. clean subungual areas with nail file

5. scrub sides, between, back, and front of fingers/hands for 3 mins

6. scrub wrist and forearm (hands higher than elbow), wash 3 inches above elbow for 1 min

7. repeat process for other hand/wrist/forearm

8. dry hands in same motion

what are the procedures for gowning and gloving?

self-gowning

self-gloving (closed/open technique, removal)

gowning another person

gloving another person

what are the basic principles of sterile technique?

opening a sterile package

opening the first flap

opening the side flaps

pulling the last flap by grasping the corner

what is the procedure for changing a dressing?

1. proper handwashing; patient consent and privacy; remove adhesive tape around dressing; baby oil may be used o loosen the tape, but minimal amounts to avoid contamination to the wound

2. remove dressing with forceps/gloved hands; place dressing in a plastic bag

3. reapply new dressing; wash hands, sterile towel (sterile field), sterile dressings (placed on sterile towel)

4. cut tape to correct lengths; tape is not sterile, do not place it near sterile field

5. put on gloves, apply dressing; then remove gloves and place tape over dressing; wash hands. cover patient, discard waste properly

what are the proper techniques for safe removal of potentially hazardous waste materials?

thick, leak proof plastic bags (discarded gloves, gowns, tubing, etc.)

labeled containers for needles or sharp hazardous waste

what is the proper care for a patient with a tracheostomy?

communication (if possible; yes/no, hand signals/sign language, written)

explain procedures

do not touch tracheostomy unless sterile technique

suction tracheostomy (emergencies)

check position of tube for imaging purposes

what is the proper care for a patient with chest tubes?

caution when handling tubes; moving near/around patient, or on bed/wheelchair (can be pulled/dislodged)

careful positioning to prevent compromising tubes

report drainage or color change in fluid

what is the proper care for a patient with a urinary catheter?

keep catheter bag low to prevent reflux

do not let bag drag on the floor

empty bag and record output

sterile techniques

what is the difference between intravenous and intraarterial lines?

intravenous - veins; inserted to give medications and intravenous fluids and measure central venous pressure (swan-ganz, intracath, hickman, broviac, and arrow-howes triple lumen)

intraarterial - radial and femoral artery lines; drawing blood and measuring blood pressure

how is fluoroscopy used for guidance in the insertion of pacemakers?

dynamic imaging that can assist the radiographer in placing the guidewire correctly, watching which direction it needs to go

what are the common sterile techniques that are used during surgery using the C-arm?

draping the c-arm and image intensifier with a snap cover

hip pinning or femur rodding

drape site with additional sterile cloth

describe the insertion, care, and removal of nasogastric tubes.

1. identify patient and explain procedure; verify consent

2. place the patient in fowler’s position and support head and shoulders with pillows; place emesis basin close to patient; measure distance from nose to stomach; levin tubes show markings where to insert and stop

3. lubricate tube at its distal end with water soluble lubricating jelly before insertion; instruct patient to begin drinking water; insert tube smoothly; encourage patient to continue swallowing naturally

4. cut 2 pieces of tape (2 in) and place over tube for security

be cautious so tube isn’t moved/pulled, verify placement, offer patient gum or small ice chips to alleviate dryness

1. identify patient and explain procedure; verify consent

2. proper hand washing; disconnect suction equipment

3. remove tape from tube/skin

4. put on gloves; instruct patient to take deep breath in and gently withdraw tube; wrap tube in paper towel and place in disposal bag; stop the procedure if there is resistance and seek assistance

how would you assist a patient with the use of a male urinal?

patient in fowler’s position/supine/lying left or right side

hand aseptic urinal to patient and provide privacy

when done, put on gloves remove and empty urinal; record output if needed

if patient needs assistance:

1. put on gloves, raise the cover sheet for visibility but do not compromise patient privacy

2. spread patient's legs, place the urinal between them, place penis into the urinal, ensure it does not slip out, hold the urinal in place by the handle until the patient finishes., remove the urinal, empty it, remove the gloves, wash hands

how would you assist a patient with the use of a bedpan?

1. remove bedpan cover, place it at the end of the table; have a chair nearby on which to place the pan

2. if the patient is able to move, place one hand under the lower back, place pan under hips and position properly, ensure patient is covered with a sheet

3. patient's head should be elevated approximately 60 degrees

4. do not leave patient alone for long, but be sure to indicate how assistance may be summoned

5. offer tissues/ washcloths for cleaning when patient is done, put on gloves, patient lie back, place one hand under the lumbar area, instruct the patient to raise hips

6. remove pan, cover it, and empty it, discard plastic bedpans, rinse metallic ones with cold water and return to where used equipment is placed, offer patient a wet paper towel/washcloth to wash hands/paper towel to dry them, remove gloves and wash hands

assisted:

1. both persons put on nonsterile gloves

2. assistant should stand at the opposite side of the table

3. assist patient to lateral position

4. place pan against patient's hips, turn patient back to supine position, holding the pan in proper position, ensure hips are aligned on pan, place pillows under the patient's shoulders and head, stay nearby for assistance

5. when patient is finished, put on gloves and reverse the procedure to remove pan, assistant should hold the pan level, avoid spilling the contents, other person assists the patient to lateral position for the removal of pan

what are the common types of enemas?

liquid enemas (water, saline, hypertonic solutions, soaps)

barium enema (single/double contrast)

what is the preparation, procedural, and postprocedural need of a patient regarding a barium enema?

indicate identification: blood in stool, abdominal pain, bowel habits, etc.

1. describe insertion and enema procedure to patient

2. allow patient time to ask questions before starting, mix barium sulfate solutions well, suspend the bag and let some of the barium flow through the tubing to the tip to remove any air

3. ask patient to lie in sims position

4. wear gloves and coat the enema tip well with water-soluble lubricant

5. tell the patient you are going to insert the tip and it may feel a bit cool, advise patient to relax and take slow deep breaths, lift the right buttock with the heel of your hand to expose the anus, when the patient exhales, insert rectal tube gently into the anal orifice and direct the tube anteriorly 1 to 1½ inches, DO NOT force the enema tip

6. tape the tube in place to prevent slipping, if a retention balloon is being utilized on this tip, do not inflate the balloon unless directed by the radiologist

7. ensure the stopcock is closed on the tubing so that no barium flows into the patient

8. the patient may lie on their back while waiting for the radiologist.

9. ensure that the enema bag is not more than 24 inches above the table

10. notify the radiologist that everything is ready for the exam

11. radiologist will inflate the rectal balloon, if necessary observing with fluoroscopy to ensure placement proximal to the internal sphincter

postprocedural

check stool and assess for dehydration and mental status, patient increase fluid and fiber intake, check for symptoms: weakness or fainting, abdominal pain, constipation, or rectal bleeding, not passing flatus, polyuria, nocturia, or abdominal distention

what is the difference between the single-contrast and double-contrast barium enemas?

single - allows rapid flow, allows good adhesion to the mucosa for even coating, provides adequate radiographic density in a thin layer, lacks foam or artifacts

double - adds air/carbon dioxide for 2 contrasts, traps barium in transverse colon for imaging purposes

what is the procedure for the colostomy barium enema?

1. radiologic and imaging science professional typically lubricates the tip of the cone and hands it to the patient for insertion or if unable, the radiologist performs the task

2. wear gloves, a much smaller amount of barium solution is needed

3. intravenous smooth-muscle relaxant is necessary to prevent peristalsis (continually empties the colon), do not over distend the colon if air insufflation is used

4. on completion of the procedure, the drainage bag can be attached to the cone and the barium drained

5. when drainage is complete, the ambulatory patient can be escorted to the toilet with the drainage bag still in place to be cleaned; the ostomy pouch is then replaced

what are the needs of a colostomy patient undergoing a barium enema?

allow the patient as much self control as possible, and provide sensitivity, technical competency, and plain speaking

what are the objectives of first aid?

recognize emergency situations and need for assistance, maintain a calm and confident presence, and take appropriate action

what are the general priorities for working with patients in acute situations?

1. ensure an open airway

2. control bleeding

3. take measures to prevent or treat shock

4. attend to wounds or fractures

5. provide emotional support

6. continually reevaluate and follow up appropriately

what is the purpose of an emergency crash cart and its contents?

contains equipment and drugs typically required in emergency situations; reduces the time required to respond to a medical crisis

what are the 4 levels of consciousness?

1. alert and conscious

2. drowsy, but responsive

3. unconscious, but reactive to painful stimuli

4. comatose and unresponsive to virtually all stimuli

what are the signs and symptoms of various medical emergencies?

• shock: restlessness, anxiety, tachycardia, decreased blood pressure, cold/clammy skin, pallor, and diaphoresis

• hypoglycemia: excessive hunger, nervousness, irritability, cold/clammy skin, diaphoresis, tremors, confusion, and potential loss of consciousness

• hyperglycemia: excessive thirst (polydipsia), excessive urination (polyuria), dry mouth, rapid and deep breathing, sweet/fruity breath odor, and gradual onset of confusion or coma

• syncope: dizziness, lightheadedness, pallor, diaphoresis, nausea, dimming vision, and eventual loss of posture/consciousness.

• cerebrovascular accident (CVA / stroke): slurred speech or inability to speak (dysphasia/aphasia), severe headache, muscle weakness or paralysis (usually unilateral/on one side), facial drooping, and sudden loss of balance

• seizure: involuntary muscular contractions (clonic/tonic movements), loss of consciousness, stare/blank expression (absence seizure), salivation, and post-seizure confusion/fatigue (postictal state).

• epistaxis: nosebleed

• vertigo: dizziness, “room spinning”

what are methods of avoiding factors that contribute to shock?

• maintain normal body temperature: keep the patient comfortably warm using blankets (hypothermia can shock)

• reduce pain, stress, and anxiety: provide calm reassurance, clear explanations of procedures, and gentle handling

• avoid sudden postural changes: transfer and position patients smoothly to prevent orthostatic hypotension

• monitor vital signs: observe changes in pulse, blood pressure, respiration, and skin color

• prompt fluid/contrast reaction management: report early allergic or anaphylactic signs (itching, urticaria/hives, throat tightness) during contrast administration before neurogenic or anaphylactic shock develops

what factors contribute to the development of hypoglycemia?

• prolonged fasting: patients required to fast for imaging examinations (upper GI series, abdominal ultrasound, CT scans) may not receive necessary carbohydrate intake

• administering insulin without food intake: a patient takes their usual dose of insulin or oral hypoglycemic medication as scheduled, but fails to eat breakfast due to imaging preparation requirements

• excessive depletion of body glucose: increased physical exertion or prolonged waiting times while fasting can deplete available glucose stores rapidly

what is the appropriate procedure for handling patients with various medical emergencies?

1. stop the radiologic procedure immediately

2. call for help/activate emergency response system: initiate a "code blue" or call the rapid response team according to facility protocol

3. primary assessment: assess the patient's level of consciousness and check the primary vital functions

4. position the patient appropriately:

   1. shock/syncope: place in a recumbent position with feet elevated (Trendelenburg position if appropriate and not contraindicated)

   2. epistaxis: sit upright and lean slightly forward (compressing nasal alae).

   3. emesis/vomiting: turn to a lateral recumbent (side-lying) position to prevent aspiration

   4. seizure: move nearby hard objects to prevent injury; do not insert anything into the patient's mouth or forcibly restrain them

5. prepare emergency equipment: retrieve the crash cart, emergency oxygen, and suction equipment

6. stay with the patient: provide continuous observation and psychological support until the emergency team arrives, then provide a concise report

what is the correct procedure for administration of cardiopulmonary resuscitation?

1. check responsiveness & breathing:

   1. tap shoulders and ask, "Are you okay?"

   2. check for breathing and a carotid pulse simultaneously for 5 to 10 seconds.

   3. if unresponsive with no pulse/breathing, call for help (Code Blue) and get an Automated External Defibrillator (AED).

2. C – Circulation (Chest Compressions):

   1. position patient supine on a hard, flat surface (e.g., cardiac board)

   2. place heel of hand on the lower half of the sternum

   3. compress: Depth of at least 2 inches (5 cm) for adults at a rate of 100 to 120 compressions per minute.

   4. allow complete chest recoil after each compression.

3. A – airway:

   1. pen the airway using the Head-Tilt/Chin-Lift maneuver (or Jaw-Thrust if spinal injury is suspected).

4. B - breathing:

   1. give 2 rescue breaths (1 second per breath) using a barrier mask or bag-valve-mask (BVM), observing for visible chest rise.

   2. maintain a 30 compressions to 2 breaths (30:2) ratio for single and two-rescuer adult CPR.

5. defibrillation (AED):

   1. turn on the AED as soon as available, attach pads, pause compressions for rhythm analysis, and deliver a shock if advised, immediately resuming compressions afterward.