Patient Care Exam 4

Mobile radiography is defined as

Radiographic procedures performed at the patients bedside

What are some different situations where bedside radiography might be preferable to imaging in the main department?

Patients in special care units

Orthopedic traction

patient in isolation

What is orthopedic traction?

Mechanical method that uses weights to provide constant pull on the part of the body for therapeutic reasons.

Appropriate procedure for gathering info before bedside x-ray.

Call nurse ask about cond.

Confirm order

greet patient and explain procedure

Check patient ID

Get room ready before bringing x-ray unit into room

postanesthesia care unit (PACU)

Recovery room located outside of surgery for ease of transfer and access by surgeion and anesthesia personnel

Three reasons why X-rays are ordered for patients in PACU?

1) Check line placement

2) Rule out pneumothorax or atelectasis

3) Check orthopedic hardware placement

abnormal condition characterized by the collapse of a lung or poriton of lung, preventing respiratory exchange of carbon dioxide and oxygen

atelectasis

Why would a mobile x-ray be order for an emerency/trauma patient?

To avoid intterupting care

Asses injuries of spine pelvis, chest without moving to patient or risk making injuries worse.

Special unit for care ob babies who are premature, low birth weight, or have a health issue

neonatal intensive care unit (NICU)

Why are mobile exams often performed while an infant is in an incubator?

The incubator keeps them warm, gives them oxygen and reduces exposure to airborne infection.

What is the radiographer required to wear when in the NICU?

Gowns and gloves

Neonate

newborn

Osseous

pertaining to bone

ICU

intensive care unit

CCU

coronary care unit

What is the ICU/CCU?

Special care units designed for patients in critical condition whose treatment and status require frequent if not constant monitoring.

What is the most common x-ray ordered in the ICU/CCU?

Chest x-ray

Four important factors noted before taking an x-ray in the ICU.

Location of patients lines, pumps, tubes, drainage receptors, monitors, and support equipment.

Talk to nurse in charge

Explain to patient (even if unresponsive)

Shield patient

Types of special beds in special care units

Alternating pressure mattresses

air mattresses

Rocking beds

various types of wave, flotation, nad bed mattresses

Precautions for moving or inflatable beds

Moving beds must be turned off

air beds must be inflated to maximum pressure.

IR must be placed __________ Warming/ cooling devices and reflective blankets

in front

an opening in the trachea where a tube is placed to provide an open airway. Sometimes hooked to a ventilator

tracheostomy

Surgical procedure that creates an opening into the trachea to provide a temporary or permanent artificial airway

traceotomy

Mechanical ventilators

Machines that provide beathing through a tube passed through the mouth or tracheostomy and into the trachea.

Make sure to time exposure to machines respiration

Three essential precautions to be taken with patients who have a tracheostomy?

1) Monitor closely

2) Never untie tapes holding tracheostomy tube in palce

3) Have suction equipment and supplies immediately available

NG tubes

Pass from nose to stomach

NE tubes

Pass from nose to duodenum

What are the used of NG/NE tubes?

Feeding

decompression

radiographic examination

What is a common type of NG tube?

Dobbhoff

has a smaller lumen and is more flexible than NG tubes used for decompression.

Decompression

Removal of gas and secretions by suction, prescribed to prevent vomiting in patients who have recently had surgery of have an intestinal obstruction.

What are two common types of NG tubes used for decompression?

Leven

Salem-Sump

Leven NG tube

Single lumen tube with several holes near its tip.

Salem-Sump NG tube

Radiopaque double lumen tube.

One lumen is used for remove gastric contents the other is and air vent.

Tube that is connected to a suction device is placed in the pleural cavity to remove fluid or air that has accumulated in the pleural space.

closed chest drainage

Precautions when working around closed chest drainage.

Do not disturb the drainage apparatus.

make sure it doesn't become dislodged

be certain the drainage unit remains below the patient chest.

Specialtiy catheters

Placed to help monitor and manage critical patients and patients requiring long-term care

If a catheter is placed in the Central vein what is it called?

CVC

If a catheter is inserted into a vein in the patients arm, at or superior to the antebubital fossa, and advanced until its tip lies in the superior vena cava what is it called?

PICC line.

The tip of a PICC or any Central venous catheter should be visualized in the:

Vena cava

When a Swan-Ganz catheter is in a wedged capillary position, it lies in:

The right of left pulmonary artery

An implanted device that electrically stimulates the heart to control its rate is called a:

Pacemaker

A Swanz-Ganz is what type of catheter?

Pulmonary artery flow-directed catheter that measure cardiac output.

If a patient has recently had a pacemaker put in what resctricions are placed on the patient for 24 hours after surgery to prevent dislodging it.

Do not abduct LEFT arm

Where are tips of Hickman, Groshong, and Raaf catheters supposed to end up?

Superior Vena Cava

Two types of units are generally used in mobile radiology

1. The mobile radiographic unit

2. The C-arm mobile intensifier ( fluoroscopic

unit )

tension type treatment used to correct a bone deformity

Orthopedic traction

Is a physicians consent required to change an order?

Yes

What units are considered special care units?

Intensive care

Coronary care

Neonatal intensive care

Post-anesthesia care

Trauma units in the emergency department (ED)

The beds in the ICU and CU are usually _________ _______ permitting operation of the C-arm through the bed

"Fluoro-capable" (radiolucent)

What is the PACU?

post anesthesia care unit

Designed and staffed to closely observe and care for patients after operative procedures that require anesthesia

Common complaint of patients in the PACU

being cold

This is because of the anesthesia, premedication and the cool atmosphere of the operating suite and PACU

altered state of consciousness

a type of consciousness other than normal waking consciousness

Confused, drowsy, or comatose

What kind of pediatric health problems might require radiographs

Pediatric respiratory distress syndrome (PRDS)

Newborn atelectasis (failure of the lungs to expand completely)

What are neonates at risk placed in?

An incubator under a radiant warmer or an enclosed incubator

Enclosed incubators

provide a closed environment with extra warmth, moisture and oxygen while reducing exposure to airborne infection

Should you open a closed incubator or handle a newborn unless a nurse of physician is present?

No

T or F: The neonate at risk must remain within the enclosed incubator for radiographs,

True

Why might some patients need to lie on an alcohol or water filled pad?

To raise or lower body temperature

What kind of surfaces are effective in reflecting body heat back toward the patients body?

Mylar warming blankets or pads (also known as aluminized, solar or space blankets)

ALARA

As Low As Reasonably Achievable

a mechanical method using weights to provide a constant pull on part of the body for therapeutic reasons

orthopedic traction

surgical operation of cutting into the trachea to provide a temporary or permanent artificial airway

tracheotomy

The opening through which a tube may be placed is called

A tracheostomy

Where are patients with a new tracheostomy monitored?

The ICU

Why are the tapes that hold the tracheostomy tube never untied?

Because a sudden cough can expel the tube, and the edges of the tracheostomy may close sufficiently to obstruct respiration

What are nasogastric (NG) or nasoenteric/nasoenteral (NE) tubes?

Tubes passed through the nose and down into the stomach or small intestine

Purposes of NG tubes

Feeding

Decompression or draining

Radiographic examination

Medication administration

Decompression is

the removal of gas and draining of secretions by suction

NE tubes can remove ——- and ——— occurring post-operative or as a result of a bowel obstruction

Gas and fluid

a method to remove fluid of air that has accumulated in the pleural space

Closed chest drainage

What does a closed chest drainage consist of?

a tube placed within the pleural cavity and connected to a suction device through a drainage receptacle

Tubes inserted through the anterior superior chest wall ........

remove air

Tubes placed through the posterior inferior chest wall......

drain fluid that collects at the base of the pleural space

Where must the chest drainage unit remain?

below the level of the patients chest to avoid reverse flow from the unit

A central line may be referred to as a

central venous catheter (CVC)

What is a PICC?

peripherally inserted central catheter

Pulmonary artery flow directed catheters

measure cardiac output, the pressures on the right side of the heart and indirectly the left heart and lung pressures

Pulmonary artery flow directed catheters diagnose

right and left ventricular failure and monitor the effects of specific medications, stress, and exercise on heart function

CVC facilitate

the administration of chemotherapy or another long term drug therapy, total Parenteral nutrition, dialysis, or blood transfusions

Central venous catheters (CVC) can be classified as:

Short or long term nontunneled external catheters

Long term tunneled external catheters

Long term implanted infusion ports

Where are short or long term nontunneled external catheters usually delivered and where do they go?

They're usually inserted at the bedside

They are placed through the skin and directly into a vein in the neck, shoulder, groin, or antecubital fossa

Where is the PICCA inserted?

Into a vein in the patients arm, at or superior to the antecubital fossa, and advanced until it's tip lies in the superior vena cava

Long term implanted infusion ports are used for

Patients who need intermittent infusion of medication or chemo. Blood transfusions, or the sampling of blood from the superior vena cava

The port, enclosed in plastic or metal, and an attached venous catheter are surgically implanted and sutured under the skin of the upper chest or arm

The artificial pacemaker is

an electromechanical device that regulates the heart rate by providing low levels of electrical stimulation to the heart muscle to replace the stimulation that is normally provided by nerve impulses

The pacemaker consists of

a battery powered energy source and a wire or catheter delivering electrical stimulation to the heart

Internal pacemakers are

surgically implanted inside the patients chest

External pacemakers

Are usually temporary, and the bulk of the instrument remains outside the chest in a "pocket" under the skin

Restriction placed on patients following the insertion of a pacemaker

Patient should avoid abducting or elevating the left arm for 24 hours after surgery to prevent dislodging the pacemaker and catheter

Which actions are essential before performing a bedside radiographic examination?

Check with the patients nurse to inquire about the patients condition

Confirm the order in the patients medical record

Greet the patients check the armband, and prepare the room

An example of a nasogastric tube used to feed the patient is a ______ tube

Dobbhoff

The tip of a PICC or any central venous catheter should be visualized in the:

superior vena cava

When a Swan-Ganz catheter is in a wedged capillary position, it lies in:

a branch of the pulmonary artery

Is a Swan-Ganz a central venous catheter?

No

A surgical opening into the trachea that provides a temporary or permanent artificial airway is called a

tracheostomy

What is the primary purpose of using contrast media in imaging?

To enhance the view of structures in the body during imaging procedures.

What time of day is contrast media usually scheduled

Morning

What should be scheduled first Iodine or Barium contrast

Iodine before barium

What are the local effects of contrast media administration?

Local effects can include symptoms such as pain, swelling, and redness at the injection site.

What are some examples of local effects from contrast media?

Extravastion, infiltration, Phlebitis, and Air Embolism

Extravastion

contrast escapes into the interstitial tissues at site of injection