CPE- PATIENT CARE

Microorganisms

• grow in/ on host organism & cause disease (Infections)

Varicella (chicken pox) is what 2 isolation precautions?

1. Airborne

2. Contact

Bacteria

• microscopic, single-celled organisms

  • May reside in host in a group or a cluster (colony)

Classification of bacteria through morphology (size or shape):

1. Cocci/ spheres

2. Bacilli/ rods

3. Spirals

Virus

• cannot live outside a living cell

• Depends on host cell to provide missing factors

Fungi/fungus

• size much larger than bacteria

• Some are medically important

Dimorphic

Medically important fungi (yeast or mold)

Protozoa

• larger than bacteria

• Classified by their motility

• Live on or in other organisms at expense of host

• Can ingest food particles, some are equipped with digestive systems

6 cycle chain of infection

1. Susceptible host

2. Pathogen

3. Reservoir

4. Portal of exit

5. Mode of transmission

6. Portal of entry

Microorganisms tend to like:

• warm temperatures

• Moisture

• Darkness

Vector

Usually an arthropod

• takes blood from 1 host & carries it to the other

  • Ex:

    • Tick/ insects

Fomite

Inanimate object that has been in contact with/ an infectious organism

• Ex:

  • Food, water, radiographic equipment

Reservoir

Site where an infectious organism can remain alive & from which transmission can occur

Nosocomial Infection

• specific to receiving infection at a hospital

Iatrogenic

• infection that is a result of intervention w/ a physician

HIV vs AIDS

Human immunodeficiency virus

Acquired immunodeficiency syndrome

HIV leads to aids if untreated

Sequence for donning PPE

1. Gown

2. Mask/respirator

3. Googles/face shield

4. Gloves

Sequence for doffing PPE

1. Gloves

2. Goggles/face shield

3. Gown

4. Mask

Airborne examples

• TB

• Chickenpox (varicella)

• Measles (rubeola)

**N95 needed

Droplet examples

• rubella

• Mumps

• Flu

• Adenovirus

  • Must wear surgical mask within 3 ft

Medical Asepsis

• reduction in numbers of infectious agents, decreasing probability of infection

  • Not necessarily a reduction to zero

Surgical asepsis

• used to prevent contamination of microbes before, during, & after surgery using sterile technique

  • Complete removal of microorganisms & spores

Sterilization

• complete destruction or elimination of all living microorganisms by dry heat, moist heat, gas or chemicals

  • ABSOLUTE KILLING OF ALL LIFE FORMS

4 types of physical sterilization

1. Heat

2. Gas

3. Chemicals

4. radiation/ UV

Sterile vs nonsterile tape

Sterile= black lines

Nonsterile= white lines

Endotracheal tube placement

• distal tip 1-2 inches (3-5cm) above tracheal bifurcation (carina)

Hemothorax & pleural effusion insertion

• 5th-6th intercostal space

  • Can go through 4th/8th space if needed

Pneumothorax insertion

• 2nd & 3rd intercostal space at midclavicular line

Central line placement

**most common is subclavian vein, internal jugular, or femoral

1. Superior vena cava

2. 2-3 cm above right atrial junction

3. SCV is large & can withstand large infusions of IV fluid

**confirmation= chest-X-ray

PICC line

• catheter inserted into peripheral vein & guided to a central vein

Port A cath placement

Distal tip of Cather into superior vena cava

What is the most common site for a central venous line?

Subclavian vein

Location considered proper placement of distal tip of Endotracheal tube

• 1-2 inches above carina

This pathogen requires an aerobic environment to live

• fungi

This pathogen is classified by its motility and some even have their own digestive systems

Protozoa

A sterile gown is considered sterile from:

The waist up

The most common misplacement of the Endotracheal tube is the ___

Right main bronchus

judiciary has to do with

a system of courts

legislative has to do with

congress

executive has to do with

presidency

types of criminal law

• felony (murder, robbery, rape)

• misdeamnor

what is tort law

• patients claim that he/she has been wronged or has sustained injury

• violation of a duty imposed by general law on all persons involved in a transaction or situation

• paintiff (patient) vs. defendant (person or organizaiton)

assault definition

• any willful attempt or threat to inflict injury on the person of another, when coupled with the apparent present ability to do so, and give the victim reason to fear or expect immediate bodily harm

battery definition is

• any unlawful touching of another that is without justification or excuse

libel

written defamation

ARRT

• standards of ethics

  • code of ethics

  • rules of ethics

    • promote the protection, safety, and comfort of patients

“requirements” for newborn abandonment

• infants up to 28 days of age

• does not apply to victims of child abuse

Res ipsa loquitur means

“the thing speaks for itself”

respondeat superior

• “the master speaks for the servant”

  • physician, supervisor, or health care faciltity may be liable in certain cases for the wrongful acts of employees or subordinates

advance directives is a

• written, legal instructions regarding your preferences for medical care if you are unable to make decisions for yourself

• guide choices for doctors and caregivers if you’re terminally ill, seriously injured, in a coma, in the late stages of demetia or near the end of life

living will

• a written, legal document that spells out medical treatments you would and would not want to be used to keep you alive, as well as your preferences for other medical decisions, such as pain management or organ donation

health care proxy

• type of advance directive in which you name a person to make decisions for oyu when you are unable to do so

implied (simple) consent

• person’s agreement to allow something to happen which is not expressly given but rather inferred from a person’s action or inactions

• non-verbal behavior indicates can mean agreement/disagreement

• many radiology proceduures fall under this category

• RT has responsibility to explain and teach thoroughly PRIOR to the procedure

implied consent- minors

• consent is given through signing of “consent for treatment” when entering the healthcare environment (include inpatient, outpatient, ED patient)

  • best practice is to still have a discussion with the parent/guardian and obtain their consent

being informed includes:

• purpose of proposed treatment

• what patien tcan expect to feel or experience

• intended benefit of proposed treatment

• possible risks or negative outcomes

• advantages and disadvantages of possible alternative treatments (including no treatment)

parental permission

required for all minors (under 18)

anti-kickback statute

prohibits asking for or receiving anything of value in exchange for referrals of federal healthcare program business

ethics in patient referrals act (EPRA) or “stark law”

limits physician referrals when a physician has a financial relationship with the hosptal or health system

Glasgow coma scale:

• assesses neurological functions using 3 areas of functioning

  • Eyes open response

  • Verbal response

  • Motor response

Types of shocks

1. Hypovolemic

2. Distributive

   • anaphylactic

   • Neurogenic

   • Septic

3. Cardiogenic

Hypovolemic shock

• caused by loss of blood or tissue fluid

  • Typically due to excessive diarrhea, vomiting, sweating, or excessive bleeding

  • Heart is unable to pump enough blood to the body

Distributive shock

• results from excessive vasodilation & the impaired distribution of blood flow

  • Septic

  • Anaphylactic

  • Neurogenic

Septic shock

• type of distributive shock from a bacterial infection

• An infection in the body causes extremely low BP & organ failure due to sepsis

• Most severe type of shock

What is the most severe type of shock?

Septic

Anaphylactic shock

• distributive shock

  • AKA vasogenic shock

• Most often caused by an allergy to food, insect bites, certain meds, or iodinated contrast in radiology

• Mild to severe

Mild reactions of anaphylactic shock

• itching

• Urticaria (hives)

• Nausea, vomiting

Neurogenic shock

• Type of distributive shock from a

  • Can occur after a spinal cord injury

  • Body has trouble regulating BP, HR, & temp due to nervous system damage

  • Keeps O2 from reaching organs

Cardiogenic shock

• heart can’t supply enough oxygen-rich blood to the body to meet its needs

• Can cause organ failure

  • Most often:

    • MI or heart failure

Normal glucose level

70-110 mg/dL

Hyperosmolar coma

• life threatening complication of diabetes

• Occurs when blood glucose levels (sugar) are too high

  • Doesn’t have enough insulin to convert glucose to energy for a long period leading to severe dehydration

Ketoacidosis (DKA)

• occurs when the body doesn’t have insulin or not enough insulin

• The liver breaks down body fat for energy

  • Releasing “ketones”

• Occurs slowly but can be fatal

Stridor

• abnormal breathing sound that resembles wheezing/ creaking or whistling sound

Cardiac tamponade

• blood/fluids build up around the heart, compressing it & preventing it from pumping blood

CPR

• CAB

  1. Circulation (compressions)

  2. Airway

  3. breathing

Patient needs oxygen to the brain within __ minutes

4

Ventricular tachycardia

• a heart arrhythmia a rapid heartbeat that originates in the heart’s lower chambers (use an AED)

  • Result= hearts inability to pump blood

Minor emergencies:

• nausea & vomiting

• Epistaxis

• Vertigo & syncope

• Seizures

• Wounds

Syncope

• self-correcting, temporary state of shock & the result of lack of blood flow to the brain

  • Assist pt into a recumbent position w/ feet elevated

  • Loosen tight clothing

  • Moist cloth

Crepitis

• “grating” feeling/sound when limb is moved

What immobilizer is this?

Traction

Professional liability

person who administers the drug is expected to know:

1. Safe doage

2. Safe route of administration

3. Limitations of the drug

Classifications of Pharmacology

1. Nomenclature

2. Chemical group (action)

3. Method of legal purchase

4. Mechanism & site of action

5. Primary effect

Nomenclature brand name

Tylenol

Chemical group (action or function)

• grouped into families that have similar chemical actions

  • Relieve Pain—> analgesics

  • Treat High BP—> antihypertensives

  • Fight inflammation—> anti-inflammatories

Mechanism & site of action (MOA)

• term used to describe how a drug or other substance produces an effect in the body

  • Provides info a/b the safety of the drug

Primary effect

• desired therapeutic effect of the drug

Therapeutic index/ range

• measures safety of a drug

  • The relation between dosage at which the intended effect of a drug is obtained & the amt that produces an unwanted effect

Analgesics

• relieve pain w/o causing loss of consciousness

What are the 2 groups of analgesics ?

1. Opioid (narcotic)

2. Nonopioid (non-narcotic)

Benzodiazepines

• used often as a pre-operative drug for procedures (anxiety), relieves muscle spasm, & seizures

  • Diazapam (Valium)

  • Lorazepam (Ativan)

  • Alprazolam (Xanax)

  • Midazolam (Versed)

Oral anticoagulants

• warfarin (Coumadin)

Are generics lowercase or uppercase?

Lowercase

Antiseptic

• kill microorganisms on your skin

  • Ex:

    • Chlorhexidine

    • Antibacterial dye

    • Peroxide & permanganate

    • Halogenated phenol derivative

NSAIDS

Nonsteroidal Anti-inflammatory analgesic drugs

• Ibuprofen (Advil, Motrin)

• Acetaminophen (Tylenol)

Bronchodilators examples

• Albuterol

• Tiotropium

Pharmacokinetics

• study of how a drug is absorbed into the body, circulates within the body, is changed by the body, & leaves the body

  • Absorption

  • Distribution

  • Metabolism

  • Excretion (half-life)

Metabolism of drug

• alternates chemicals in the body, done by the liver, how things interact w/ the body

Excretion of drug

• kidneys excrete the drug out

  • Half life (100, then all the way to zero)

    • When the drug will be out of the system

  • Too slow= can reach toxic levels

  • Too fast= don’t get full effect

What is thought to be the 1st step of the Pharmacokinetics process?

Disintegration

Pharmacodynamics

• study of the method or mechanism of drug action on living tissues or the response of tissues to chemical agents at various sites in the body

• Drugs can alter physiological effects in the body