Patient Care Exam 2

Comprehensive vocabulary flashcards covering aseptic and nonaseptic techniques, critical thinking, emergency response, medication administration, and contrast media in radiologic technology.

Five Steps of Problem Solving **

1. Identify and clarify the problem;

2. Perform an objective analysis;

3. Develop realistic solutions;

4. Consider all viable solutions;

5. Select the best solution and implement it.

Critical Thinking Scenario: Pregnancy Inquiry

Ask the mother to step out of the room to ensure patient privacy and obtain an honest, accurate answer.

Critical Thinking Scenario: Unattended Portable in ER Corridor

Blank the monitor or log off the unit before leaving to safeguard protected health information.

Level 1 Trauma Center **

Provides comprehensive 24/7 care for all injury levels; fully staffed around the clock with surgeons, physicians, and imaging personnel.

Level 2 Trauma Center **

ED, radiology, nursing available 24 hours. CT, MRI, surgical radiology available on call.

Level 3 Trauma Center **

Community hospitals; Physicians & staff are on call for non-life-threatening care. Trauma patients w/ life threatening injuries are transferred to Level I and II.

Level 4 Trauma Center **

Small rural community hospital capable of stabilization before patient transfer.

“Golden Hour” in Trauma

The first hour after an accident or injury that has significant bearing on patient recovery and survival.

Disaster Response Triage **

The disaster response process of identifying victims, performing initial exams/evaluating vitals, and assigning care priorities.

Medical imaging professional’s Role in Emergencies **

Preserve life, avoid further harm to the patient, and obtain medical assistance as quickly as possible.

First Priority in Multiple Emergencies

Patients with the most unstable vital signs, especially when care is dependent on image results. In two equal urgent cases, the shorter exam time takes precedence.

Emergency response team also known as

Code Team. Usually one+ physician/s, nurses, a respiratory therapist, & an electrocardiographer.

Code Red **

Fire.

Code Blue **

Heart or respiration stopping (cardiac/respiratory arrest).

Code Orange **

Hazardous material spill or release.

Code Grey **

Combative person.

Code Silver **

Weapon or hostage situation.

Code Amber **

Infant or child abduction.

Emergency “Crash” Cart items:

Oxygen

Wall-mounted suction

AEDs (automatic external defibrillators; fully-automatic & semi-automatic)

Defibrillator (AED) **

Delivers an electric shock to the heart to correct an ineffective cardiac rhythm.

First Step in CPR

Check responsiveness (shake and shout).

CPR Compression Rate **

100-120 compressions per minute.

Four Levels of Consciousness (LOC) **

1. Alert and conscious

2. Drowsy, but responsive upon stimulus

3. Unconscious, but reactive to painful stimuli

4. Comatose.

Signs of a Deteriorating Head Injury **

Irritability

Lethargy

Slow pulse rate

Slow respiratory rate

Preferred Imaging Modality for Head Injuries

Computed Tomography (CT)

Coup Brain Injury

Primary impact. Injury occurring on the brain directly under the point of impact.

Contrecoup Brain Injury

Secondary impact. Injury occurring on the opposite side of the brain from where the impact occurred.

Spinal Injuries in Trauma **

All trauma patients are assumed to have spinal injury until it’s ruled out.

Patient will arrive on a backboard.

Use log-rolling to prevent further injury.

Cross-table lateral c-spine is first image obtained.

NEVER stand a patient up w/ cervical collars or suspected spinal injury.

First Radiographic Image for Spinal Trauma

Cross-table lateral C-spine, which must clearly demonstrate $C\text{-}7/T\text{-}1$.

3 Stages of Shock **

Compensatory stage

Progressive stage

Irreversible stage

Compensatory Stage of Shock **

Cold, clammy skin

Normal BP

Decreased urine output

Increased respiration

Hypoactive bowel sounds

Increased anxiety

Progressive Stage of Shock **

BP falls

Rapid & shallow respirations

Tachycardia

Severe pulmonary edema

Chest pain

Confused mental state

Irreversible Stage of Shock **

BP remains low

Renal & liver failure

Release of necrotic tissue toxins

Overwhelming lactic acidosis

Cardiogenic Shock

Cardiac failure or interference with heart function.

Anaphylactic Shock

Occurs from allergic reaction. May occur with contrast media administration. The most common type of shock encountered in medical imaging.

Septic Shock

Most severe form of sepsis caused by a widespread body infection causing organ failure.

Neurogenic Shock

Circulatory failure resulting from damage to the nervous system or spinal cord.

MILD Reactions to Contrast & Treatment **

Warmth

Flushing

Metallic taste

Coughing

Nausea

Treatment: None. Symptoms will resolve.

MODERATE Reactions to Contrast **

Erythema (redness of sin)

Urticaria (hives)

Bronchospasm

Treatment: Antihistamine (oral, IV, or IM) or Bronchodilator

SEVERE Reactions (Anaphylaxis) to Contrast **

Warmth

Tingling

Itching palms & soles

Dysphagia (difficulty swallowing saliva, food, liquids)

Respiratory arrest

Cardiac arrest

Seizure

Treatment: Maintain airway, call a code, Epinephrine via IV, other drugs as needed

Radiographer’s Response to Shock

Place patient supine to avoid a fall

Elevate feet to increase blood flow to the brain

Elevate head if dyspnea is noticed

Call for help/code

Be ready to perform CPR

Assist the code team if necessary

Chart the occurrence, treatment administered, patient’s response on incident report

Diabetes Mellitus: Type 1

Insulin-dependent; The pancreas does not produce enough insulin; More likely to lapse into diabetic coma.

Symptoms: extreme thirst, polyuria, fruity breath, excessive sweating.

Diabetes Mellitus: Type 2

Insulin-resistant. Related to obesity; Treated with hyperglycemic drugs.

Hypoglycemia **

Type 1 diabetics usually at risk. Excessive insulin. Low blood sugar. Can occur if patient takes normal dose of insulin and does not eat.

Hypoglycemia Symptoms **

Sudden weakness

Sweating

Tremors

Hunger

Loss of consciousness

Hypoglycemia Treatment **

Candy, sweet fruit juice, or oral glucose gel administered inside the patient's cheek.

Hyperglycemia

An abnormally high concentration of glucose in the blood caused by insufficient insulin secretion or ineffective glucose utilization.

Hyperglycemia Symptoms

Extreme thirst, frequent urination (polyuria), fruity-smelling breath, drowsiness, and progression toward diabetic coma.

Hyperglycemia Treatment

Medical administration of insulin, intravenous fluid hydration, and urgent clinical monitoring.

Universal Distress Signal for Choking

Clutching hands tightly to the throat.

Infant Choking Maneuver

Position infant face up over forearm and perform a two-finger abdominal thrust.

Epistaxis

Nosebleed; treated by leaning the patient forward, pinching the nostril against midline nasal cartilage.

Vertigo

Severe dizziness and spinning, sometimes nausea, caused by inner-ear disturbances or brain lesions.

Syncope

Fainting; a temporary state of shock from inadequate cerebral blood flow, treated by placing patient recumbent w/ feet elevated.

Compound (Open) Fracture

A fracture where the broken bone protrudes through the skin wound.

Pharmacology **

The science concerned with the origin, nature, effects, and uses of drugs.

Drug

Any chemical substance that produces a biologic response in a living system.

Physicians' Desk Reference (PDR) **

An annual publication detailing FDA-approved product information, accepted uses, side effects, contraindications, drug class, and dosages.

Available online & hardbound. If PDR is unavailable, consult a pharmacist.

Pharmacokinetics **

The study of how drugs absorb, distribute, metabolize,

& excrete the body. Affects the response of persons to drugs.

Pharmacodynamics **

The study of drug effects on normal physiological functions & receptor interactions.

Agonist **

A drug that produces such a specific action and promotes the desired result (it does what it needs to do).

Antagonist **

A drug that attaches itself to a receptor, preventing or blocking the agonist from acting.

Flumazenil (Romazicon) & Naloxone (Narcan) **

Example of an antagonist drug used to counteract the sedative effects of other drugs.

Antiarrhythmics **

A class of drugs used to treat chronic cardiac arrhythmias.

Analgesics **

Medications that relieve pain w/o causing loss of consciousness (ibuprofen, aspirin, narcotics).

Sedatives & Tranquilizers **

Drugs that exert a quieting effect, often inducing sleep; tranquilizers reduce anxiety better than sedatives.

Lorazepam (Ativan) & Diazepam (Valium) **

Examples of tranquilizers & sedatives used to reduce anxiety.

Lidocaine (Xylocaine)

A local anesthetic used to eliminate sensation in a specific area before a painful procedure.

Paralytic Agents

A skeletal muscle relaxant administered for endotracheal intubation or to combative patients.

Vasovagal Contrast Reaction Symptoms and Treatment

Symptoms: diaphoresis, hypotension, bradycardia; Treatment: place supine with feet elevated $20^\circ$, administer IV fluids and atropine.

Primary Goals of Aseptic Technique

To protect the patient from infection and prevent the spread of harmful pathogens.

What does Asepsis refer to in Medical Imaging?

The absence of pathogens

Procedures Requiring Aseptic Technique

Biopsies, angiographic procedures, line placement, arthrography

Identify two procedures that require aseptic techniques in medical imaging.

Catheter insertion & Myelogram

Fomites

Inanimate objects that carry and spread infectious pathogens.

Surgical Asepsis

Protection against infection before, during, and after surgery by using sterile techniques to eliminate all microorganisms.

Medical Asepsis

The state of being free from disease-causing microorganisms, focused on reducing spread through facility practices like handwashing.

Dropping Sterile Contents Technique

Hold the item and gently drop it onto the sterile field from about $6\text{ inches}$ above at a slight angle.

Purpose of Cleansing Enema

Defecation to clear the bowel before a procedure.

Fluoroscopy Procedures Not Requiring Sterile Technique

Barium enema and esophagram.

Factors that influence drug action **

Age

Health status

Time of day

Emotional state

Other drugs in the body

Genetic variations

Disease state of the body

Synergistic Effect **

when drugs taken together have an additive effect which exceeds the desired outcome

The Radiographer’s Role with Medications **

Know your scope of practice related to medication administration

Know common medications

Use PDR to look up side effects

Check patient chart for allergy history

Ask patient about allergies & check armband for allergies before administering meds

Golden Rules of Drug administration

Right drug

Right amount

Right patient

Right time

Right route

3 classes of drug administration Routes **

- Enteral (gastrointestinal):

Oral

Sublingual

Buccal

Rectal

- Parenteral (bloodstream):

Intradermal

Intramuscular

Subcutaneous

Intravenous

- Topical:

Transdermal

Nasogastric (NG) Tube **

Used as enteral (gastrointestinal) route. Also an alternative to oral administration. It is more reliable & easily controlled.

Topical Routes: Sublingual & Buccal **

Absorption through mucosal tissues into the bloodstream. This bypasses the GI tract.

Parenteral Administration **

Rapid action bc they are absorbed directly into the bloodstream. All forms require a needle, syringe, & different kinds of containers. Needle diameters are expressed in gauges.

Height of IV bag or bottle above the vein **

18-20 inches to ensure proper flow and gravity assistance.

Ampules & Vials **

Ampules are for single-use application. Vials may be used more than once.

Negative Contrast Agents **

RADIOLUCENT. Air & gas appear black/dark on radiographs due to increased density. Used in arthrography and in myelography.

Positive Contrast Agents **

RADIOPAQUE. White or light appearance on radiographs due to decreased density. Used in CT.

Water soluble iodine Contrast Agents **

Used to demonstrate soft tissue structures which are difficult to distinguish. Enhance the ability to see blood vessels and organs on xray and CT.

Ionic Contrast Media Agents **

Less expensive but associated w/ more adverse reactions than nonionic contrast agents. Approx 4-12% of patients experience hypersensitivity reactions within minutes or hours.

Nonionic Contrast Agents **

LESS likely to cause patient reaction. Lower osmolality, more soluble in blood plasma. Warmed to increase viscosity. Represent a new class of intravascular iodinated xray contrast agents.

Persistence **

The length of time the contrast remains in the body following a procedure.

Contrast Reactions **

Generally occur within the first minute of injection and can be unpredictable.