Patient Care Capstone

ARRT Code of Ethics

guidelines to medical imaging professionals on ethical behavior

Body mechanics and stability

Hold close to body

• Keep back straight- avoiding twisting

• Bend knees- use leg and abdominal muscles not your

back

• Push or roll- do not pull

• Broad base of support

• Feet 12” apart with one foot slightly forward

• Center of gravity (pelvis) over base of support

Diversity Cultural groups include

• Religious

• Age

• Racial

• Socioeconomic

• Geographical

• Gender

• Handicapped

• Generational

• Gender

• Sexual preference

Steps of grief/loss

Denial

Anger

Bargaining

Depression

Acceptance

Tort

violation of civil law- results in injury to another person, property, reputation

Intentional misconduct includes

Assault, battery, False imprisonment, invasion of privacy, libel, slander, fraud

assault

threat to cause harm- conduct by radiographer that causes fear in patient

Battery

unlawful touching without consent- harm from contact

•Palpating patient without telling patient

•Imaging against patient’s will

•Wrong patient wrong body part

False imprisonment

unjustified restraint

• Restraints need to be ordered by MD

•Care when using positioning aids

•Care if other is holding patient

libel

written defamation of character or loss of reputation

writing in chart- -patient was drunk

slander

orally spreading false information that results in loss of reputation

fraud

manipulation of electronic data that is ethically wrong or legally questionable

•Using wrong processing algorithm

•Altering exposure indicator

•Cropping/masking anatomy

Unintentional misconduct

negligence

no intent to harm- malpractice (professional

negligence)
1. Neglect or omission of reasonable care
2. Reasonably prudent doctrine
3. Gross negligence
4. Contributory negligence

Reasonably prudent doctrine

person with similar education and experience would perform under similar circumstances

gross negligence

reckless regard for life

contributory negligence

injured person is a contributing party to the injury

malpractice

Must show breach of care
•Breach must cause harm or damage
•Did your action cause the harm or damage

Respondeat superior

let the master answer
• Employer responsible for employees actions

Res ipsa loquitur

thing speaks for itself

• Leaving something in patient after surgery

medical ethics

Duty to the patient,
autonomy, justice, beneficence, justice, nonmaleficence

Autonomy

able to think, decide, and act on own free will

• Patient’s make decisions for themselves

• We can help by providing full information

justice

Ethics should be based on what is consistent and fair

•Patients in similar condition should have same access to care

beneficence

Doing the “most good”

•Doing what is best for the patient

•Consider pain, mental suffering, risks, quality of life

•May not coincide with our clinical judgement

• Elderly broken hip

nonmaleficence

Do no harm-prevent harm

•Most treatments involve some degree of risk or adverse reactions

ethonocentrism

Belief one’s personal experience and perception of the world is superior to to the experiences and perceptions of others

•One’s own culture is superior to others

veracity

Truthfulness

•Healthcare workers shouldn’t lie to patients

•Ex/Small bowel series- convincing them to have exam and tell them it will be fast

fidelity

Faithfulness and loyalty

Charting

electronic or written

•Date and time

•Patients condition entering, during, and after

•Procedure performed

•Contrast- amount and reactions

•Never erase an error- must be crossed out and initialed

Radiographic image must include

Legal documents- MUST include

•Patient identification

•Anatomical markings- R/L

•Use lead markers

•Date

•institution

•Marking added to images electronically may not be legally admissible

Implied consent

unconscious-based on assumption that patient would approve

verbal consent

Verbal vs written

• All exams need verbal consent

•Right to information

•Right to ask questions

•Right to refuse

•CXR- verbal

valid (informed) written consent

Mentally competent

• Voluntary

• Pt adequately informed

• Legal age- 18 unless

• Minor may consent- married, parent of a patient that is also a child, emergency

• Explain procedure and risks

• Explanation in lay terms

when can minor written consent

married, parent of a patient that is also a child, emergency

Healthcare Proxy/Durable Power of Attorney-

designated surrogate- designated by patient in case they are incapacitated

Advanced Health Care Directive or living will

has patient’s own decisions on care- DNR- and can also name someone to make those decisions

Prioritizing patients for exams

1- emergency patients
2- fasting patients
3- pediatric or geriatric that are NPO
4- diabetics who put off meds till after exam

scheduling of exams

1- not requiring contrast

2- thyroid- iodine uptake exams

3- urinary tract

4- biliary tract

5- lower GI

6- upper GI

Cycle of infection

spread of disease

• Infectious organism pathogen

• Reservoir of infection- thrive and grow

• Portal of exit

• Mode of transportation- direct/indirect

• Portal of entry- inhalation, breaks in skin, GI,

mucous membranes of eyes, nose, and mouth,

respiratory tract and urinary tract

• Susceptible host

Mode of transportation

direct/indirect

Portal of entry

inhalation, breaks in skin, GI,

mucous membranes of eyes, nose, and mouth,

respiratory tract and urinary tract

direct contact

Infected person touches host

indirect contact

Fomite-object
• Vector- animal/insect
• Vehicle- blood, food, water
• Droplet- spraying on host
coughing/sneezing
• Airborne- droplets/dust remain air for extended periods of time

Standard Precautions

Always wear gloves, gowns, masks if any chance of contact with body substances

most effective method to prevent the spread of infection

Handwashing

Medical Asepsis

Microorganisms have been eliminated as much as

possible- reducing

•Water, friction, soap, antiseptic- on tissue

•germicides and some chemicals for disinfection on

surfaces- inanimate objects

•Proper hand hygiene- best way to prevent spread of

microorganisms

• Alcohol based sanitizer- 15 seconds

• Soap and water- 30-60 seconds- dry after

Alcohol based sanitizer length

15 seconds

Soap and water

30-60 seconds- dry after

Surgical asepsis

Complete removal of all organisms and spores from equipment and the environment

•Sterilization- equipment and instruments

• Dry heat-

• Gas sterilization

• Autoclaving
• radiation

Dry heat

Dry heat- oven greater than 329 degrees-

long periods of tim

gas sterilization

ethylene oxide exposed to a mixture of gases

autoclaving

steam/moist heat under pressure- most effective method

radiation

to sterilize disposable equipment- x-rays, gamma rays,
electron beams

BOILING IS

disinfection, no effect on spores
More effective boil for 20 min then cool and boil again- repeat 3 times

Respiration amt

12-16 breaths/min= normal

pulse and vessels

superficial arteries- radial (conscious)- most

common, carotid artery (unconscious), temporal,

femoral, popliteal

apical pulse

Apex of heart most accurate but need to use stethoscope

pulse numbers

Tachy-over 100 beats/min

Brady- under 60 beats/min

Blood pressure average

110-140/60-90

high diastolic

Greater than 90= increasing level of hypertension

low diastolic

Under 50= indication of shock

blood pressure

Varies due to age, sex, fatigue, physical

stress, disease, trauma

o2 sat number

Measured by pulse oximeter, 95-100%

hypoxic number

lack of oxygen in the blood

• Blood oxygen saturation 90 or below considered hypoxic

Symptoms of shock

Restlessness/ apprehension

• Accelerated pulse

• Pale skin

• Weakness

• Alteration in ability to think

• Cool, clammy skin

• Systolic less than 30

Parenteral

anything other than through GI- tract

•Subcutaneous- 45 degrees

•Intravenous-15-30 degrees

•Intramuscular- 90 degrees

•Intradermal- 10-15 degrees

Intraarterial 30-45 degrees

•Intrathecal- varies on anatomy 10-15

subcutaneous injection angle

45

Intravenous injection angle

15-30

intramuscular injection angle

90

intrathecal injection angle

10-15

Extravasation first

remove needle

extravasation stuff

Pain, swelling, and redness

•First remove needle

• Apply pressure until bleeding stops

• Cold compress to relieve pain Elevate part

• Warm compress at site to lessen absorption

and spread of contrast or other medications

Phlebitis

Inflammation of veins

air embolism

If air goes into vein

• More serious if air goes into artery

Central venous catheters
-placed where, advanced til where

Catheters placed in large veins (jugular/subclavian/femoral)

•Deliver frequent medication (drugs-chemo) or nutrition, blood transfusions, dialysis and to monitor cardiac pressure

•Vary in size, shape, lumen, and intended use

•Advanced till tip rests in superior vena cava near the right atrium

Ports

Port-A-Cath- implanted access port

PICC
-inserted where

peripherally inserted central catheter- inserted in basilic or subclavian

Externally tunneled types

Hickman/Broviac/Groshong/RAAF

Swan Ganz runs where

through femoral or jugular
advanced into pulmonary artery

NG/NE tube

• Levin- single lumen

• Salem-sump- double lumen

• Dobhoff

• Miller Abbott

• Cantor

levin lumen

single lumen

salem sump lumen

double lumen

Tracheostomy
-inserted where

• Surgical opening of the trachea to provide and secure an open airway

• Upper airway obstruction- above larynx

• Inserted between the 2nd and 3rd tracheal ring

Osmolarity

concentration of solution-

high causes increase of risk to patient- ionic has higher osmolarity

Viscosity

thickness- warm up to reduce viscosity

Miscibility

able to be mixed

Single most commonly used contrast in radiology

Air

vial

larger container that holds a number of doses of medication

ampule

small container that usually holds a single dose of medication

Petite mal

Non-convulsive

• May not be apparent to us

Grand mal
aka

Tonic-clonic

• Major motor seizure

• Help pt to floor

• Remove hazardous objects in area

Orthostatic hypotension

Sudden decrease in blood pressure from moving from laying to upright position

• Faint or light headed

fire first thing

First thing you do is evacuate area

RACE

• Rescue

• Alarm

• Contain

• Extinguish

PASS

• Pull

• Aim

• Squeeze

• Sweep

Drug administration 6 rights

• Right patient

• Right drug

• Right amount

• Right route

• Right time

• Right documentation

dyspnea is what kind of contras reaction

mild to moderate

what jurisdiction covers administration of contrast

state

Barium is an

inert organic salt substance

inert substance, aqueous compounds cause

dehydration

golves need to be worn with what types of isolation

droplet and contact