Ergonomics, Monitoring, and Medical Emergencies

ambulatory

able to walk, not confined to bed.

wheelchair

ambulatory INPATIENTS generally travel by _____

stretcher/bed

patients confined to bed must travel by _______

1. A broad base of support lends greater stability. Therefore, the radiographer should stand with their feet approximately 12 inches apart and one foot slightly forward.

2. Stability is achieved when the body’s center of gravity (center of the pelvis) is positioned over its base of support.

3. When carrying a heavy object, hold it close to the body.

4. Back should be kept straight; avoid twisting.

5. When lifting an object, bend the knees and use the leg and abdominal muscles to lift (rather than the back muscles).

6. Whenever possible, push or roll heavy objects (rather than lifting or pulling).

Rules of body mechanics:

At the elbow

Even the ambulatory outpatient might be somewhat unsteady, so a ready, supporting hand at the ______ can be very helpful.

1. Secure patient belongings

2. Ensure radiographic department is free of hazards to avoid unnecessary/painful movement.

3. ensure that all equipment are used properly and safely.

ex: x-ray tube must be moved away from the x-ray table, x-ray table lowered or a footstool is in place to assist the patient from the table

4. remove clothing and place clothing appropriately.

ex. clothing should be removed from the uninjured site first and placed on the injured site first.

It is the responsibility of healthcare personnel to ensure patient safety and comfort. This can be achieved in several ways:

pillows/sponge; under the knees

lumbar strain is relieved by a _____ placed under the ____

18-24 inches

The IV bag should be _____ above the level of the vein

reported to the supervisor and an incident report is completed.

Should an accident ever occur and a patient or health care practitioner be injured, no matter how small or insignificant the injury seems, it must be ______ and _______

risk management team, or similar group.

The _______ requires all such information for legal documentation and as a means of identifying and resolving potential hazards.

• ambulation

• wheelchair

• stretcher

Modes of patient transportation include:

an adequate supply of oxygen,

One of the human being’s most basic physiologic needs is ______

hypoxia

diminished oxygen supply

• an airway obstructed by aspirated material

• laryngeal edema as a result of anaphylaxis

• a pathologic process such as emphysema.

Hypoxia can result from:

atrial septal defect

a small hole (remnant of the fetal foramen ovale) in the interatrial septum

patent ductus arteriosus

persists and requires surgical closure

coarctation of the aorta

narrowing or constriction of the aorta.

ventricular septal defect

is a congenital heart condition characterized by a hole in the interventricular septum that allows oxygenated and unoxygenated blood to mix.

• perform the Heimlich maneuver

• summon the code team, or

• check the flow of oxygen already in place

The proper response to respiratory distress might be able to:

permanent damage or can die

Any tissues lacking in, or devoid of, an adequate supply can suffer _________

dysplasia

abnormal development of tissue

• anemia,

• pneumonia

• pulmonary edema

• shock

Oxygen supplementation maybe required in cases of severe:

• dyspnea

• cyanosis

• diaphoresis

• distention of the veins of the neck

• retraction of intercostal spaces

• dilated nostril

• distention of the veins of the neck

Symptoms of inadequate oxygen supply include:

1. call for help

2. assist the patient to a sitting or semi-Fowler position (recumbent position makes breathing more difficult)

3. have oxygen and emergency drugs available.

The patient experiencing symptoms of inadequate oxygen supply, the radiographer must do the following:

60-80 psi (pounds per square inch)

Oxygen is available through wall outlets at a pressure of ________, equipped with an easily adjustable flowmeter to regulate administration of oxygen.

humidified oxygen

It is important to administer ______ oxygen to avoid drying and irritation of the respiratory mucosa.

flow; indicate the amount of oxygen remaining in tank

Oxygen are available in tanks, with one valve to regulate ____, and another to _____

• COPD (chronic obstructive pulmonary disease)

• pneumonia

• severe asthma

• cystic fibrosis

• sleep apnea

conditions often requiring an oxygen therapy are:

graves disease

the most frequently occurring form of hyperthyroidism

• enlargement of the thyroid gland and exopthalmos

• thyroid OVERactivity

cretinism

hypOthyroidism can result what in a child?

myxedema

hypOthyroidism can result what in an adult?

Cushing syndrome

Adrenal OVERactivity produces what syndrome?

Addison disease

Adrenal UNDERactivity causes what disease?

low or high flow

Two types of amount of oxygen required by patient:

low-flow therapy

COPD patients require ______.

apnea

COPD patients who are on high-flow oxygen therapy can result in _____

1. Nasal cannula

2. oxygen masks

3. mechanical ventilators

Different oxygen devices available to deliver to patients:

Nasal cannula

An oxygen device that is most frequently used and used to supplement oxygen in room air.

• its short prongs extend approximately 1 cm into the nares.

• It is a low-flow small-percentage oxygen device.

1. Venturi mask

2. Simple face mask (low flow)

3. partial rebreathing mask (low flow) and nonrebreathing mask (low flow).

different types of oxygen masks

Venturi mask

An oxygen mask that mixes oxygen with room air and can deliver specific (usually, high flow) concentrations of oxygen

simple face mask (low flow)

An oxygen mask that is best suited for short-term oxygen therapy.

• with extended use, the plastic becomes warm and sticky.

• communication is difficult

• mask is easily displaced

• must be removed at mealtime

Partial rebreathing mask or nonrebreathing mask

An oxygen mask that deliver more precise concentration of oxygen to the patient.

Mechanical ventilator (high flow).

An oxygen device that are most frequently encountered in a hospital critical care unit and when a patient is unable to breathe on their own.

• patients have artificial airway in place

respiratory rate; and volume

the ventilator in mechanical ventilator controls the ______ and ______

suction device

the use of a ______ is required to maintain a patient’s airway by aspirating secretions, blood, or other fluids.

• the patient is unconscious

• secretions have high volume or viscosity

• coughing is ineffective

• the individual is unable to clear their airway

Suctioning may be indicated when:

a wall outlet or mobile apparatus

suction is available either from _____

disposable catheter

suction tubing must have ______ attached to its end for collection of airway secretions.

hypoxia and atelectasis

It is essential to use a correct diameter for the disposable catheter used in suction tubing because too large a diameter can result in airway occlusion, leading to _________ and ______ when suction is applied.

chest tube

Following a thoractomy or other thoracic surgery, a ______ may be put in place for the purpose of treating pneumothorax or hemothorax.

• it removes fluids or air from thoracic cavity.

below the level of the patient’s chest

the chest drainage system must be kept ______

1. suction control chamber

2. collection chamber

3. water seal chamber, which prevents atmospheric air from entering the chest cavity

The chest drainage system has three compartments:

pulmonary embolism

condition in which an occluded blood vessel stops blood flow to a portion of the lungs

pneumothorax

air in the pleural cavity

atelectasis

collapsed lung or part of a lung

hypoxia

a condition of low tissue oxygen

syncope

FAINTING, can be a result from shock

• a drop in blood pressure

• a decrease in heart rate

• NG tubes (DH tubes) used for feeding

• nasointestinal tube (NI)

• Nasoenteric tube (NE)

GI tubes can be one of the following:

NI/NE tubes

______ are used following digestive tract surgery

• may be single or double lumen and can sometimes be temporarily disconnected for radiographic exams.

clamped

single-lumen NG or NI/NE tube can be _____

never

double-lumen tube must ______ be clamped

• Cantor tubes

• Harris tubes

example of a single-lumen NE tubes are:

Miller-Abbott tube

example of a double-lumen NE tubes is:

Sengstaken-Blakemore tube

example of triple-lumen tube with a gastric balloon, an esophageal balloon, and a gastric suction port.

• usually used in the treatment of bleeding esophageal varices

• dialysis

• blood transfusion

• drug therapy (chemo, parenteral nutrition)

examples of continual access to the circulator system for long-term care:

• they are used also for lab draws and for monitoring CVP (central venous pressure).

• Port-A-Cath

• Hickman

• Raaf

• Peripherally inserted central catheter (PICC)

• salem-sump tube

CVP are also called CVCs (central venous catheters) or central lines. And examples of central lines include:

urinary catheterization

used postsurgically either to assist in the healing of tissues or assist an incontinent patient in the elimination of urine.

sterile

The procedure of urinary catheterization is _____ and that subsequent care is given to prevent UTI.

UTIs

account for the greatest number of nosocomial infections

• plastic

• rubber

• polyvinylchloride (PVC)

• silicone

Different types of urinary catheters

plastic and rubber catheters

what is used for short-term use of urinary catheter?

PVC or silicone catheters

what is used for long-term use of urinary catheter? (Up to 3 months).

below the level of the bladder,

the urine collection container must be kept ______

It will lead to infection

What could happen when there is a backflow of urine into the bladder?

away

Oxygen supports combustion, so it must be ______ from flame

• admitting diagnosis or recent nurses’ notes including information about the patient’s degree of ambulation

• any preparation for the x-ray procedure and how it was tolerated

• notes regarding lab tests

• possible need to save patient urine

What are some useful information of the patient’s chart:

by observing and listening

how to asses a patient’s condition?

• the severity of a traumatized patient’s injury

• the patient’s degree of motor control

• the need for support equipment or radiographic accessories.

To provide safe and effective care, the radiographer must be able to asses the following:

• can the patient move or be moved from the stretcher?

• can the anatomic part be imaged adequately and with less pain on the stretcher or in the wheelchair?

• Will the use of sponges/sandbags result in a more comfortable, safer, and better-imaged exams?

The radiographer should consider the following questions:

objective signs

patient’s appearance that can be seen and conditions that can be seen.

• color

• temperature

• moistness of patient’s skin

diaphoretic

patient has pale, cool skin

febrile

patient is usually exhibits hot, dry skin

anxiety

“Sweaty” palms may indicate ____

cyanotic/cyanosis

Turning blue on:

• lips

• mucous membranes

• nail beds

Need oxygen and require immediate medical attention

gross/general motor control

refers to basic body movement and locomotion such as walking or waving one’s arm

fine motor control

involves the coordination of bones, muscles. and nerves to produce smaller and more precise movements/tasks such as zipping. azipper, grasping, and writing w/ a pencil.

• brain

• spinal cord

• nerves

• muscles

• bony articulations

Parkinson’s disease

conditions of the brain such as _____ will impair fine motor control

Subjective signs

signs that are perceived by the patient–how they feel, level of their pain.

• body temperature

• pulse rate

• respiratory rate

• arterial blood pressure

Obtaining the vital signs involve the measurement of:

time of day and site of measurement

Body temperature varies with ____ and _____

• mouth

• rectum

• axilla

• bladder

• heart chamber

• external auditory canal

• temporal artery

Body temperature can be measured in various areas such as:

• general malaise

• increased pulse and respiratory rates

• flushed skin that is hot and dry to the touch

Symptoms of fever include:

98.6 Farenheit

Normal body temperature for an adult ORAL:

99.1 Farenheit - 99.6 Farenheit

Normal body temperature for an adult RECTAL:

97.6 farenheit - 98.1 farenheit

Normal body temperature for an adult AXILLARY:

97.9 farenheit - 100.4 farenheit (rectal)

Normal body temperature for an infant to children:

97.8 farenheit - 98.6 farenheit

Normal body temperature for an children aged (5-13 years):

lowest; highest

Body temperature is _______ in the early morning and _______ at night.

• radial (wrist)

• carotid (neck)

• temporal (front of the upper ear)

• femoral (inguinal region; groin)

• popliteal pulses (posterior knee)

The five most readily palpated pulse points are:

at the apex of the heart

where is the apical pulse?