CT boards patient care

Ct technologist plays a vital role in ensuring that the order is for a particular procedure is

Clinically indicated and justified

CT examinations of the trunk (chest, abdomen, pelvis) should be scheduled ____ an imaging procedure that requires higher density oral contrast (barium) or only after sufficient time to allow for bowel clearance

before

During contrast studies the patient should be instructed to

empty the bladder the start of the examination to reduce the possibility of discomfort or interruption

Before contrast agent administration discuss potential physical effects such as

the warm sensation and metallic taste so that the patient is not surprised and upset during data acquisition.

The patient is required to provide ____ before the start of any invasive procedure

Informed consent

Patient consent may be deemed informed only when the procedure, including its risk benefits and alternative is

clearly explained in a language.The patient fully comprehends

Occurs when a patient is in need of immediate medical services but is unconscious or is physically unable to consent to treatment. In this case, services are rendered with the assumption that the patient would consent if able

Implied consent

A patient who is awake alert and responsive is considered to exhibit a

Normal level of consciousness

The patient appears drowsy , but can be aroused

Lethargic state

Is in a more depressed to level of consciousness and may not be easily aroused from a state of confusion

Obtunded

Describe the state of near unresponsiveness Describe the state of near unresponsiveness semi comatose.(semi comatose)

Stupor

the patient is completely unresponsive to stimuli

Coma

A sudden drop in blood pressure when moving to the standing position the accompanying feelings of dizziness and blurred vision may interfere with the patient's ability to support their own weight

Orthostatic hypotension

Temperature pulse blood pressure. Respiration

Vital signs

Normal body temperature is

97.7 F - 99.5 F (36.5 C - 37.5 C)

Pulse rates for adults

60 - 100 bpm

Pulse rates for children

70 -120 bpm

Systolic blood pressure

Indicates the pressure within arteries during cardiac contraction and should be less than 120 mm Hg

Diastolic pressure

is measured during relaxation of the heart and should be less than 80 mm Hg

Normal respiration of an adult is

12 - 20 breaths per minute

Normal respiration rate of a child

20 - 30 breathe per minute

An electronic device used to measure pulse and respiratory status placed on a patients finger toe or earlobe. Measures blood oxygen levels which are normally between ninety five percent and a hundred percentMeasures split oxygen levels, which are normally between 95% and a 100%.

Pulse oxymeter

Refers to the series of blood flow related events that occur from the beginning of one heartbeat to that of the next. Frequency determines the patient's heart rate

Cardiac cycle

A graphic representation of the electrical activity of the heart.It is used particularly during cardiac t procedures to evaluate the heart rhythm and cycle

Electrocardiogram (ECG)

If not contraindicated ,_____ may be administered just before the cardiac CT images at higher heart rates. This capability may prelude the need for pharmaceutical intervention as clinically indicated

Sublingual nitroglycerine

Refers to a condition whereby the patient suffers from low concentration of oxygen from the blood.

Hypoxemia

Describes insufficient oxygenation of tissue at the cellular level

Hypoxia

Loss of muscular coordination

Ataxia

Hypoxia can lead to

Headache, nausea, dizziness, and more serious complications such as ataxia, tachycardia, and pulmonary vasculature. When left untreated can lead to cyanosis, low blood pressure and death.

Localized hypoxia can result in tissue effects such as

pain, cyanosis, and eventually gangrene

death of body tissue due to a lack of blood flow or a serious bacterial infection. commonly affects the arms and legs, including the toes and fingers. It can also occur in the muscles and in organs inside the body, such as the gallbladder.

conditions that can damage the blood vessels and affect blood flow, such as diabetes or hardened arteries (atherosclerosis), increases the risk

Treatments may include antibiotics, oxygen therapy, and surgery to restore blood flow and remove dead tissue.

gangrene

Oxygen is considered to be a drug and

Is typically administered under the ordered of a physician

A two-pronged tube inserted into the nose for delivery of oxygen. Used to deliver 1-5 LPM of oxygen

Nasal cannula

Covers the patient's nose and mouth to deliver oxygen flow rates of 6 lpm or higher

Oxygen mask

Includes an attached reservoir that fills with oxygen and provides a higher percentage of delivery. Includes a valve one-way valve that prevents the patient from exhaling into the reservoir

Nonrebreathing mask

Patient's with an insufficient airway or the inability to maintain adequate oxygenation may require incubation with an endotracheal tube and mechanical ventilation

Ventilator

A chest tube maybe placed to drain fluid from the intrapleural space of the ill or injured ct patient

Thoracostomy

Normal BUN value

7-25 mg/dL

Bun stands for…

Blood urea nitrogen

Normal creatine levels

0.5 - 1.5 mg/dL.

Normal bun/creatinine ratio

6:1 to 22:1

GFR

Stands for glomerular filtration rate and is a more accurate measure of renal function. It is calculated by using the patient's measured serum creatinine level and takes it into account the patient's age, sex and race.

An eGFR measurement greater than 90 - 120 mL/ min indicates…..

Normal kidney function

The normal range for PT approximately is

12 to 15 sec

the measure of blood coagulation.

Prothrombin (PT)

An additional lab value used to detect abnormalities and blood clotting.

Partial thrombolastin time (PTT)

PTT normal range for clotting time is generally…

25 - 35 sec

Normal Platelet count is…..

Is used to assess the patient's clotting ability

140,000 - 440,000 per mm3 or μL of blood

Testing is utilized for the diagnosis of deep vein thrombosis and pulmonary embolism. although non specific the presence of elevated amounts in the bloodstream may indicate recently degraded blood clots

D - Dimer

Use to screen for damage to the patient's liver and consist of a panel of blood test that measure the levels of various enzymes and proteins and circulating blood

will include alanine transaminase (ALT), aspartate transaminase (AST), Alkaline phosphate (ALP), Bilirubin, Albumin, total protein (TP), Gamma-glutamyl transferase (GGT), L-Lactate dehydrogenase (LD).

Liver function test LFT

This drug is used to prevent the formation of blood clots and veins and arteries and may reduce the incidence of heart attack and stroke. Patients undergoing therapy or any other anticoagulant are prone to excessive bleeding caused by trauma, including IV access for contrast agent administration

Warfarin

What is the proprietary name for warfarin?

Coumadin

Patient without a history of AKI

do not need to discontinue metformin before or after the contrast enhanced CT procedure. reassessing the patient’s renal function following the procedure is also unnecessary.

A drug used to treat type 2 diabetes. Patients with acute kidney injury (AKI) or with severe chronic kidney disease may be instructed not to take this medication before the administration of iodinated contrast media and for up to 2 days after contrast enhanced CT examination

Metformin

G1 Kidney damage with normal function GFR: greater than 90

G2 Mild loss of kidney function GFR: 89-60

G3a Mild to moderate loss of kidney function GFR: 59-44

G3b Moderate-to-severe loss of kidney function GFR: 44-30

G4 Severe loss of kidney function GFR: 29-15

G5 Kidney failure GFR: less than 15

Stages if chronic kidney disease

What is the brand name for metformin?

Glucophage

Anxiolytic medications are prescribed to….

reduce patient anxiety

What class are these medications?

Benzodiazepines, diazepram (valium), alprazolam (xanax), clonazepam (klonopin), and lorazepam (antivan)

Anxiolytic drugs

Paroxetine (paxil), serialized (zoloft), fluoxetine (prozac), and escitalopram (lexapro)

SSRIs

Belong to a class of substances known as radioaque contrast media such as iodine and barium.

Positive contrast

What are negative contrast agents?

Air, gases, and water

Describes the agents propensity to cause fluid from the extravascular space to move into the intravascular space.

Osmolality

Iodine’s high atomic number causes it to

attenuate a large portion of the primary beam. Introducing iodine into tissue changes the subject contrast of the enhanced anatomic area.

The American Hospital Association drafted A Patient’s Bill of Rights in 1973. Included among the 12 "rights" are the patient’s right to…

considerate and respectful care

the right to refuse treatment.

Release of the patient’s diagnostic examination results is not an inherent right and is at the discretion of the physician(s) involved.

compares a patient’s PT with a control sample for a more accurate result

The international normalized ratio (INR)

The normal range for INR is

0.8 to 1.2

Patient prep before a contrast-enhanced CT examination

The patient should have nothing by mouth (NPO) for several hours prior. This practice reduces the incidence of nausea, vomiting, and possible aspiration of contrast material.

After approximately 2 hours, the percentage of iodinated contrast material in blood plasma is reduced to

half of the administered volume.

Normal range of GFR for women

60 ± 10 mL/min/m²

Normal range of GFR for men

70 ± 14 mL/min/m²

An ____ is one that a patient acquires through interaction with a physician.

iatrogenic infection

Medical tape is potentially damaging to skin and

should not be utilized for immobilization.

The patient "breath-hold" is an ___ method of reducing motion, particularly during CT examinations of the trunk.

effective

Normal ___ times are laboratory-specific and range between approximately 11 and 15 seconds. This test is used to evaluate the coagulation ability of a patient scheduled to undergo an invasive CT procedure.

prothrombin (PT)

The maximum dose of intravenous iodinated contrast agent should not exceed ___ during pediatric CT examinations. Contrast loads in excess of this limit have been reported to cause acute osmolar poisoning in children.

3 mg/kg of body weight

5 stages of infection

incubation, prodromal, active, convalescence

Examples of mild adverse reactions to iodinated contrast material are…

nausea, mild urticaria, and a warm flushed sensation.

is a moderate reaction.

Dyspnea, or difficulty breathing

What type of reaction is a sudden drop in blood pressure when moving to the standing position. The accompanying feelings of dizziness, faintness and blurred vision may interfere with the patient’s ability to support their own weight.

orthostatic hypotension

sudden overreaction of the body's autonomic nervous system to a trigger, such as pain or emotional stress, that causes a temporary drop in heart rate and blood pressure. This leads to reduced blood flow to the brain, which can cause fainting. Common symptoms before fainting include light-headedness, sweating, nausea, and paleness, with blood flow usually restoring quickly once the person lies down.

vasovagal syncope

The categories of isolation technique are

drainage-secretion precautions

enteric precautions

acid-fast bacillus isolation

respiratory isolation

contact isolation

strict isolation.

something that is full of, contains, or is composed of pus, often signifying an infection

Purulent

Volute

Emesis

It is within the scope of practice for CT technologists to administer other medications in addition to iodinated contrast media upon the order of a licensed independent practitioner. Examples include the

oral or IV administration of beta-blockers to lower the patient’s heart during a cardiac CT procedure and medications used to treat adverse contrast reactions.

___ reaction to iodinated intravenous contrast must be recognized early so that proper initial treatment is provided. A combination of bradycardia (heart rate below 50 beats per minute) and hypotension (systolic pressure below 80 mm Hg)

vagal reaction

refers to the contraction of heart muscle. It can be divided between atrial systole and ventricular systole.

systole

Administration of an ___ drug is the usual treatment for the development of urticaria (hives) following the injection of iodinated contrast media.

antihistamine

Medical term for hives

urticaria

The term vasovagal pertains to systemic hypotension often leading to

cerebral ischemia

Transient ischemic attack

Ionic contrast materials are salts that separate into

independent charged particles when placed in aqueous solutions.

A faint or lightheaded feeling is commonly referred to as

syncope.

The partial thromboplastin time indicates the

coagulation time of a patient’s blood

is caused by an insufficient volume of circulating blood. The common signs and symptoms are pallor (absence of color in the skin), hypotension, tachycardia, and oliguria (decreased urine production).

Hypovolemic shock

Checking the information located on the wrist band is the most

accurate method of verifying patient identification.

is used with patients at risk of infection because of immunosuppression or some other form of debilitative disease. This type of precaution technique was previously referred to as "protective" or "reverse" isolation.

Strict isolation

However, when possible, all protocols should have patients refrain from eating for some time prior to the scheduled examination because

avoiding eating before a CT scan of the abdomen and pelvis reduces nausea and vomiting from contrast medium injections, decreases patient discomfort from bladder filling during the study, and ensures gastric emptying for more accurate diagnoses. An empty stomach also makes it easier for the patient to consume the necessary oral contrast agent.

___ hours is the recommended period to pump and discard breast milk before resuming normal breastfeeding. Because the plasma half-life of iodinated contrast material is approximately 2 hours, the level in breast milk after 24 hours is essentially negligible.

12 to 24

objects that have been contaminated by an infectious organism or microbe.

Fomites