CH. 7 PATIENT POPULATIONS

Who are the pediatrics population?

• neonates, infants, toddlers, preschoolers, and school-age children

Why are neonates kept in the hospital after birth?

respiratory problems, infections, or complications from hemolytic jaundice, pre-maturity or birth defects

What are pediatric common hospital visits?

asthma, infectious diseased, sports injury or drug poising (ED), foreign body (FB)

How do children respond in a positive manner?

to honesty and friendliness

establish rapport- have them touch the equipment

have x-ray room prepared, less time for patient in the room

allow parent/caregiver to help; give clear instructions

methods of pediatrics

• speak at child’s eye level

• give clear instructions; specific body parts; use interpreter

• only one person (tech) speaks to child and parent for instruction

• use soft tone in voice - quietly

• remain clam and move efficiently, allow toy to stay with child

• keep child warm

• caregivers are covered with lead; responsible for child staying on table

basic points for care with teens

• establish a rapport

• verify x-ray exam

• verify patient identification

• explain x-ray exam

• educate the patient

• maintain the patients concern for privacy

• provide aftercare directions

What does the method of child transfer depend on?

child’s size and the nature of the illness or injury

code pink

possible infant abduction

code purple

toddler

infant and child transport

• parent, guardian or caregiver stays with minor when transporting to x-ray department

• two patient identification: arm band and parents

• check with RN and check patients chart each time

• return patient with side rails up and lowered to ground with emergency call button visible

infant and child immobilization

• first attempt to complete x-ray exam by instruction and explanation

• use of proper radiation protection, may double as immobilization

• use immobilization if first attempt is not successful

  • immobilize patient for safety during exam; reassure parents

What are methods of child immobilization?

• towels, body wrapped in sheets, held by parents, pig-o-stat, sedation given by RN/ED MD discretion only

• distraction is key during exam process

Why is radiation protection a priority for infants and children?

because of the radio sensitivity of their rapid and changing cell growth

gonadal shielding

• ALARA

• triangular shield reduces exposure to patient

• female= point down

• male= point up

Image Gently campaign

raise awareness of the need to improve patient safety outcomes in pediatric imaging with an emphasis on CT scanning initially

• goal: to ensure that every technologist selects and uses the appropriate exposures when performing imaging and interventional procedures in children as safely as possible to reduce radiation dose

child abuse

any act of omission or commission that impairs a child’s physical or emotional development

child physical abuse

purposely injected by another person

child neglect

failure to provide adequate food, shelter, affection, supervision, education or medical care

child emotional abuse

injury to self esteem, emotional well being with isolation, ignoring, berating, rejection

child sexual abuse

any inappropriate sexual activity to child, exploitation

child medical abuse

false info for treatment harms the child

main cause of death in persons 65+

heart disease, cancer, and strokes

geriatric patients (65+)

• lifestyl, culture, hereditary, and the body are all factors which play a part in age

• elderly are more commonly met with chronic issues than acute

chronic

diabetic, COPD, CHF, obesity, hypertension

acute

stroke, trauma, fall, cancer

depression

threat of becoming a burden to their family

dementia

confused, disorientation, memory loss, paranoid ideas

alzheimer’s disease

not part of normal aging process, increase in population

elderly skin changes

tears, bruising, wrinkles, coldness; vulnerable to infections

elderly sensory changes

• presbyopia= mild loss of visual acuity

• lens of the eye thickens, making the pupils of eye appear cmaller

• changes to the eyes include cataracts and glaucoma

• light-sensing threshold is affected, and adaptation from light to dark and color perception diminishes

• tear production is either reduced or increased

• skin of eyelid loosens and muscle tone decreases

• sensory, neural, and conductive changes occur in the ear

• yearling loss is common

• sense of taste and smell decrease

elderly pulmonary changes

• lung capacity finishes because of stiffening of the chest wall, among other changes

• cough reflex becomes less effective

• normal respiratory defense mechanisms lose effectiveness

• chronic obstructive pulmonary disease (COPD) or emphysema is seen more often in elderly patients because of the years of abuse to the lungs from smoking or environmental conditions

• lung cancer is more common in people aged over 65 years and in former smokers, causes more deaths than other cancer in this age group

elderly cardiovascular changes

• structural changes occur in the heart as aging progresses

• coronary arteries calcify and lose elasticity

• heart continues to pump the same amount of blood, but there is a decline in coronary blood flow

• the aorta and its branches dilate and elongate, the heart valve thickens

• barorecepotrs become less sensitive in arteries

• 85% have cardiovascular disease

• hypertension is common and can lead to other processes such as chronic heart failure (CHF) or stroke

elderly gastrointestinal changes

• gastric secretion, absorption, and motility decrease

• dryness of mouth and swallowing reflex becomes less effective

• abdominal muscles weaken

• teeth present are decayed or gums diseased, many have full dentures or partial plates

• esophageal motility declines

• tone of the internal anal sphincter decreases

• common conditions for the geriatric patient include diverticulitis and pancreatitis

• gastrointestinal (GI) malignancies are the second highest cause of cancer mortality and include cancers of the pancreas, stomach, and colon

elderly genitourinary changes

• muscle tone and bladder capacity decrease

• pubic hair becomes sparse

• vaginal atrophy occurs

• involuntary bladder contractions increase

• prostate gland enlarges, and the tone of the bladder neck increased

• size of penis and tests is decreased because of sclerosis of blood vessels

• urinary incontinence is a common problem

elderly musculoskeletal changes

osteoporosis

• muscle mass decreased

• muscle strength decreased

• ligaments are less elastic

• shortening spinal column

• kyphosis

• posture and gait change

elderly neurological changes

• cva

• stroke

• brain weight changes

• ability to store information changes

• sensorimotor function decrease in proprioception creates problems with spatial relations

fall risk

• elderly changes give risks to falls

• normal aging- mobility/flexibility

• keep obstacles out of their way

• stay close for assistance

• assist with wheelchair if needed

How many seniors experience elder abuse?

1 of every 20 seniors

What does APS stand for?

Adult Protective Services

elder physical abuse

use of physical force that may result in bodily injury, physical pain, or impairment

elder sexual abuse

nonconsensual sexual contact of any kind with an elderly person

elder emotional/psychological abuse

inflicting of anguish, pain, or distress through verbal or nonverbal acts

elder isolation or caregivers neglect or self-neglect

refusal or failure to fulfill any part of a persons obligations or duties to an elder or self

elder financial abuse

occurs when anyone takes or keeps an elder’s property with the intent to defraud

What are the three subcategories of elder abuse?

domestic, institutional, self-neglect/self-abuse

domestic elder abuse

pattern of violence by someone who has a special relationship with the elder, such as a spouse, child, sibling, or caregiver

institutional elder abuse

occurs in residential facilities, such as assigned living or board and care; the perpetrators are usually the paid caregivers, staff, and professionals

elder self-neglect

does not involve the perpetrator, but rather the neglect is because of the elder refusing to accept care. can lead to illness, injury, or death

disabilities

• impairments, limitations, and restrictions

• caused by trauma, disease, or condition interfering with body process

• determines ability to participate

What are the disabilities classifications in radiology?

mobility limitations, sensory limitations, neurological disorders, adapt to patients needs in x-ray

agitated and ETOH patients

• psychosis

  • elderly - UTI causes neuro changes, sepsis, confusion, low blood sugar

  • combative, aggressive, spitting, restrained

• etoh or intoxicated patients

  • 5150 - code grey

  • always ask for assistance

ethnicity and cultural awareness in x-ray

• give patients their space and listen when they speak to you

• use interpreter documentation

• factors may affect the ability to do the exam:

  • culture: customs and values of patient

  • sociological: economic background, education, status

  • psychological: will patient self-identify affect plan of care, self concept

  • physiologic and biological- anatomical or racial aspects to affect care

Confusion and other symptoms of dementia are to be expected in an elderly patient, since they are part of the normal aging process. T/F

false

Which of the following statements is not considered part of the definition of cultural competence

it requires a set of measurable skills and goals

The World Health Organization disease classification that encompasses an individual's limited ability to learn and function is known as:

intellectual disability

Eighty percent of deaths in persons aged over 65 years are due to:

cancer, heart disease, and strokes

Social determinants of health might include 1) education level, 2)income level, or 3) physical environment

1,2,3

Which of the following is true regarding individuals who have a learning disability?

People with learning disabilities usually have IQs in the normal range

On average, people who reach 65 years can expect to live nearly blank more years

15

Reports from the Agency for Healthcare Research and Quality have shown which of the following?

Worsened access to care for minorities

Children who have ADHD are typically treated with which type of medication?

stimulants

The leading cause of vision loss in the elderly is:

muscular degeneration

Which of the following is NOT a culturally appropriate service in the health field

Obtaining appropriate religious paraphernalia for the patient during procedure

Which of the following statements is true regarding aging and CVD

The heart continues to pump the same amount of blood as it ages

When communicating with children who have mental health disorders, health care workers should 1) address the parents instead of the children, 2) address children directly, or 3) involve parents only as appropriate to assist with assessing childs communication needs

2 and 3

To confirm understanding of information such as informed consent discussions, health care workers should:

Ask the patient to teach back what was discussed regarding the consent

Fall risk in the elderly is increased by all of the following except

poor nutrition

About one half of infants are hospitalized if they get which of the following?

pertussis

Seniors living with family or in long term care facilities are less at risk for elder abuse and neglect

false

Which of the following are signs of autism? 1) avoiding eye contact, 2) Disinterest in pretend games, 3) problems with language

1 and 2