RADR 1309: Exam 5

auscultation

listening to the internal sounds of the body, usually using a stethoscope, such as heart, lungs, and the gastrointestinal system

barium

high atomic number for optimum contrast. bulky, fine white powder, without odor or taste, and free from grittiness; used as a contrast medium in radiography of the digestive tract. bag is usually suspended at a greater distance (up to 30 inches) above the table

nonaseptic technique

requires special procedures for nonsterile procedures; typically involves tubes and lines into the digestive tract; body wastes, enemas and enemas for contrast examination

Nasogastric Tubes

plastic/rubber tubes inserted through the nasopharynx into the stomach; used for administration of medications and gastric decompression/ removal of flatus and fluids from the stomach after intestinal obstruction/major trauma

by air injection and listening over the abdomen for a whooshing sound

how is nasogastric (NG) tube placement verified

Use a piston-like syringe

How can leakage from a double-lumen tube be prevented?

flatus

gas or air evacuated through the anus

levin tube

Most common nasogastric tube

urinal

made of plastic or metal and is shaped so that it can be used by a patient who is supine,lying on his right/left side/fowler's position (mostly for males)

urinal

typically used for ambulatory male patients

bedpan

vessel for receiving the urinary and fecal discharges of a patient unable to leave their bed; standard; 2 inches high

sterilized between uses

Bedpans should be:

Fracture Bedpan

has a unique wedge-shaped design. allows patient to elevate the hips only slightly for placement. convenient handle for placement and removal. shallower and for limited mobility

colitis

inflammation of the lining of the colon

enema

liquid injection or to be injected into the rectum

enemas

used for bowel cleansing and to promote defecation. typically given to outpatients and can be self-administered

cleansing enemas

this technique is a liquid treatment most commonly used to relieve severe constipation

tap water (hypotonic), hypertonic (fleet enema), saline (safest-used on infants), oil retention, soapsuds solution

5 types of enemas

barium enema

administered in an examination used to diagnose pathologic conditions of the colon or lower gastrointestinal tract.

barium enema catheter

May have a plain tip or an inflatable cuff attached to it

Dehydration

what can cause a postural drop in blood pressure after a barium enema

rapid flow, good mucosal adhesion, thick layering

3 desirable characteristics of a barium suspension

double contrast barium enema

-Used for polyps

-History of colorectal cancer

-Rectal bleeding

-Anything where the colon mucosa needs to be visualized

-Barium = Positive agent (white) (radiopaque)

-Air = Negative agent (black) (radiolucent)

better for outlining the bowel

prone position

What position does the patient lie in during the double-contrast enema exam

single contrast enema

Uses a larger volume of barium. Excess barium is drained back into the bag, the tip is removed, and the patient is sent to the toilet to evacuate as much of the barium as possible. Post-evacuation images taken.

Gastrografin

What contrast should be used if there is any risk of perforation in the GI tract

colostomy

the surgical creation of an opening between the colon and the surface of the body; also used to refer to the opening, or stoma, that is created. Typically called a "loopogram," Pt will have a dressing over the stoma

colonoscopy

endoscopic exam of the large bowel and the distal part of the small bowel with a charge -coupled device camera or a fiberoptic camera on a flexible tube passed through the anus. Biopsies can be performed during the procedure. excellent method to identify small polyps or masses.

defecation

evacuation of fecal material from the intestines

virtual colonoscopy

is performed on a multi-slice computed tomography scanner that takes up to 600 two-dimensional/three-dimensional images of the colon in approximately 30 seconds. (performed in CT and takes approximately 5 minutes)

hypertonic solution

used when a patient cannot tolerate large amounts of fluid

1000 mL

How much fluid should an adult patient be able to tolerate from a cleansing enema?

emesis basin

kidney-shaped vessel for the collection of vomitus

enterostomal therapist

health professional (usually a nurse) with special training and certification in the care of ostomies and related concerns

fowler position

position in which head is raised 18/20 inches above the flat position; the knees are also raised

hydration

The term used to indicate that a liquid substance contains water

loopogram

The radiographic evaluation of the small and large bowel that has been connected to the skin surface as a substitute for the urinary bladder with an ostomy

low-residue diet

A diet that gives the least possible fecal residue, such as gelatin, sucrose, dextrose, broth, and rice

lumen

Cavity or channel within a tube or tubular organ (plural, lumina)

ostomate

one who has undergone enterostomy or ureterostomy

perineum

region between the thighs, bound in the male by the scrotum and anus and in the female by the vulva and anus

purgation

catharsis; relief of fecal matter affected by a cathartic

sigmoidoscopy

procedure used to see inside the signmoid colon and rectum with a flexible tube that has a camera on the end (sigmoidoscope) and is placed through the anus

Sims' position

position in which the patient lies on the left side with the right knee and thigh flexed and the left arm parallel along the back

stoma

opening established in the abdominal wall by colostomy, ileostomy, and so forth

virtual colonoscopy

performed on a multi-slice computed tomography scanner that takes up to 600 two-dimensional and three dimensional images of the colon in approximately 30 seconds

viscosity

physical property of liquids that determines the internal resistance to shear forces

stool

what does the proximal stoma deliver with a double-barrel colostomy

mucus

what does the distal stoma produce with a double-barrel colostomy

patient shoud be told to use deep breaths and the enema should be stopped

what should be done if cramping occurs during a barium enema

nasogastric (NG) tube

purpose is medication administration, gastric decompression, and short-term feeding

cantor, keofeed, miller-abbott, sengstaken-blakemore

4 common types of NG tube besides Levin

use of topical anesthetics and patient education

how can patient discomfort during NG tube placement be eased

high fowler's position with head and shoulders supported

patient position for NG tube insertion

ETT tube

Nasogastric (NG) tube

aura

subjective sensation or motor phenomenon that precedes and marks the onset of a paroxysmal attack, such as epileptic attack

medical emergency

sudden change in medical status requiring immediate action

automatic external defibrillator (AED)

device used for application of external electrical shock to restore normal cardiac rhythm and rate

cardiac arrest

sudden stoppage of cardiac output and effective circulation

cardiopulmonary resuscitation (CPR)

artificial substitution of heart and lung action as indicated for cardiac arrest or apparent sudden death resulting from electric shock, drowning, respiratory arrest, and other causes

cerebrovascular accident (stroke or brain attack)

condition with sudden onset caused by acute vascular lesions of the brain; often followed by permanent neurologic damage

claustrophobia

An extreme fear of enclosed or tight spaces

emergency priorities

Ensure open airway

Control bleeding

Take measures to prevent or treat shock

Attend to wounds or fractures

Provide emotional support

Continually reevaluate and follow up appropriately

emergency

unexpected or sudden occasion; an urgent or pressing need

providing an open airway

In working with a patient, what would be the first priority for attention?

lethargy, slow pulse rate, slowing respiratory rate

3 signs/symptoms of a deteriorating head injury

Airway, Breathing, Circulation

ABC's of CPR

epitaxis

nosebleed; hemorrhage from the nose

erythema

Redness of the skin, typically caused by irritation or injury

FAST scan

Acronym for Focused Assessment with Sonography for Trauma; a bedside sonography exam used to assess trauma patients for internal bleeding

emergency cart (crash cart), oxygen, wall-mounted suction, AED (automatic external defibrillator)

emergency equipment

anaphylactic shock

vasogenic; severe allergic reaction (food, insect stings, medications)

effect: immune overreaction - widespread vasodilation and airway constriction, decrease blood pressure and oxygen delivery

signs: low blood pressure, rapid heart rate, swelling (especially of the face, lips, or throat), difficulty breathing/wheezing, hives, rash, or itching.

intial stage, compensatory stage, progressive stage, irreversible (refractory) stage

4 stages of shock

inital stage

tissues are under perfused, decreased CO, increased anaerobic metabolism, lactic acid is building

compensatory stage

reversible. SNS is activated by low CO, attempting to compensate for the decrease tissue perfusion

progessive stage

failing compensatory mechanisms: profound vasoconstriction from the SNS; ISCHEMIA Lactic acid production is high; metabolic acidosis

Irreversible stage

cellular necrosis and multiple organ dysfunction syndrome may occur; death is imminent

assess patient's level of consciousness, clinical symptoms may not manifest right away, hematoma, brain swelling, CT is preferred modality

head injuries

alert and conscious, drowsy, unconscious, comatose

4 levels of consciousness

hemorrhage

escape of blood from the vessels; bleeding

hypoglycemia

abnormally diminished concentration of glucose in the blood

lethargy

abnormal drowsiness or stupor; a condition of indifference

nausea

unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting

shock

A failure of the circulatory system to support vital body functions

neurogenic, hypovolemic, cardiogenic, and vasogenic

4 classes of shock

anaphylactic shock

most common type of shock encountered in medical imaging

pallor

paleness; absence of skin coloration

shock

condition of profound hemodynamic and metabolic disturbance characterized by failure of the circulatory system to maintain adequate perfusion of vital organs

spinal cord or nervous system injury

what causes neurogenic shock

key signs are low blood pressure, slow heart rate, warm (dry skin)

hypovolemic shock

caused by major fluid/blood loss (bleeding, burns, dehydration)

low blood pressure, rapid heart rate, cool (clammy) skin

3 key signs of hypovolemic shock

heart failure (often a heart attack)

what causes cardiogenic shock

low blood pressure, weak pulse, cold extremities, chest pain

4 key signs of cadriogenic shock

caused by low blood pressure, warm skin (early), rapid heart rate, confusion or altered mental state

anaphylactic shock

caused by severe reaction (food, stings, meds)

anaphylactic shock

key signs and symptoms include low blood pressure, rapid heart rate, swelling (face, lips, throat), difficulty breathing/wheezing, hives, rash, and itching.

widespread vessel dilation (sepsis/anaphylaxis)

what causes vasogenic (distributive) shock

syncope

temporary suspension of consciousness as a result of generalized cerebral ischemia; faint or swoon; treatment is aimed at increasing blood flow to the head; assist pt into recumbent postion