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PT care ch8-14
PT care
| Question | Answer |
|---|---|
| define trauma | injury-physical damage by violence,accident,or fracture.traumatic-physical wound to the body |
| what are the precautions used for trauma | standard precautions, gloves,mask,apron or gown if pt is hemorrhaging or nauseated,vomitting |
| Can the radiographer adapt positioning and technical considerations to the pt? | YES |
| two things to assess and observe if pt is transferred to imaging dept. | 1)observe for symptoms of shock 2)assess neurological status and level of consciousness before and every 5-10min of exam |
| who is the emergency team | ER DR, attending DR,resident/medical student, surgeon, ER nurses, rad tech,res ther,phlebotimist,anesthesiologist,admitting clerk and house supervisor |
| when can dressing,splints,sandbags,collars or other supportive devices be removed? | with physician approval |
| TorF__pt on stretcher or backboard can be moved to a table for an exam | false, not w/o pt DR order to do so |
| on a c-spine lateral the collar, or pt's neck,can be removed at what point | a physician interprets radiograph and CLEARS pt of injury |
| impaled objects or injured areas require_______ when moving them | support |
| the log roll requires assistance why? | it must be done in one synchronized move to be safe and painless |
| can pneumatic antishock garments be removed? | NO |
| Things the radiographer prepares to assist w/ are... | o^2,suction equip,emesis basin |
| three things a radiographer must do to minimize repeats on a trauma pt | work quickly,work accurately,work efficiently |
| things not to displace during exam | IV's,tubes lines,catheters |
| three cardinal principles | time,distance,shielding |
| assess and develop plan for exam,determine mobility,predetermine equip,two images 90deg. from eachother,include anatomy of interestpromote cooperative enviroment, are considered | basic rules for trauma |
| what are battle signs____________________ what are coon's eyes__________________ | fx at base of posterior skullblood from skull_____ fx in soft tissue around eyes |
| what is frequently used method for head injury | CT |
| if pt has head injury you have to assume there is ________ injury | C-spine injury |
| name two types of head injury and their description | open-brain vulnerable to damage and infection----closed or blunt-swelling of brain tissue,pressure and brain damage |
| closed head injury manifestations | varying LOC,loss of reflexs,changes in vital signs,headache, dizziness,giddiness,gait abnormalaties,unequal pupil dilation,seizures,vomiting,hemiparesis |
| some open head injury manifestations | abraisons,contusions,lacerations,break or penetration in skull or meninges,varying LOC,subconjuctival hemorrhage,hearing loss,facial nerve play, periorbital ecchymosis,basa fracture |
| radiographers response for head injury | head and neck immobilized,head elevated 15-30deg,body temp normal,pulse and respirations,observe clear airway,observe for changes in LOC or hypoxia,apply sterile dressing for profuse bleeding, call emergency help |
| facial injury manifestations | distortion of facial symmetry,inability to move jaw,edema,flatness of cheek, double vision,blindness,nosebleed,hemorrhage,paresthesia,halo sign,changes in LOC |
| TorF---pt must not have nasal suction preformed for facial injury | TRUE |
| most spinal cord injuries require a crosstable lateral and _________ projection demonstrating what for complete transection | "swimmers"-flacid paralysis,loss of all muscles below injury,respitaory distress,bradycardia,loss of body temp, unable to perspire,absence of skin, organ sensation below site, unstable low BP,incontinience,priapism, |
| how does partial transection differ from complete transection | asymmetrical flacid paralysis, asymmetrical loss of reflexes below level of injury, some feeling of pain temp pressure touch, stable BP,perspire unilaterally,some skin organ sensation |
| radiographers response to spinal cord injury | monitor vitals,keep warm,maintain open airway only using jaw downward movement not chin lift,move synchronized log roll method,observe for signs of shock,if pt is unconscious assume spinal injury |
| things to look for in cross table lateral and swimmers | soft tissue swelling,alignment injury,possible fx,sublaxtion,endotracheal tube position,fx of facial bones or skull,sphenoid air fluid levels |
| sphenoid air fluid levels indicate | basal skull fx |
| what is sublaxtion | incomplete or partial dislocation |
| portables are usually ordered to see what | pathology of bony thorax,lung field,cardiac silhoutte,soft tissue,line placement(increase in density) trach tube,catheters,PICC,pacemakers,chest tubes |
| imaging condiderations for trauma and portable radiographs | observe pt from beginning to end,knowledge creativity and adaption, preform exam w/speed and pt comfort,radiation protection,follow rules and guidelines |
| what is an open fx | visible wound that extends between fx and skin surface,overt bleeding |
| TorF a closed fx is obvious | false, it may be, it may show deformity and swelling,hemmorrage within tissue,reddness,loss of movement,loss of pulse,numbness of tingling,involountary spasms |
| what is the leading cause of death after MVA | internal injury after fx of pelvic bones |
| should a possible fx pelvis be kept in mind for a pt w/multiple traumatic injuries | of course |
| large number of trauma deaths are pneumothorax and hemothorax, how are they caused and what are they | blunt or penetrating trauma to the thorax. pneumothorax-air or gas in pleural space that collapses lung. hemothorax-blood in pleural space, and one more for good measure-pus-pyothorax |
| some clinical manifestations for a fx are | pain and swelling, functional loss and deformity of the limb, grating sound or feel,discoloration of surrounding tissue caused by hemorrhage within the tissue(closed fx) overt bleeding(open fx) |
| radiographers response for fx | keep affected area immobilized,movement must be directed by MD,inform pt before movement,use sterile gloves if cin contact w/wound,support joint and limb above and below fx,move as single unit with two people one at either end |
| what are some examples of abdomenal trauma | blunt or penetrating trauma,appendicitis,bleeding ulcers, |
| clinical manifestations of abdominal trauma/acute distress | abrasions,lacerations,entry&exit wounds,contutionsrigid abdomen,abdomonal pain,nausea and vomiting,extreme thirst,symptoms of hypovolemic shock |
| radiographers response for abdomen trauma/acute distress | dont remove antishock garments, gloves for open wounds, sterile gloves if in direct contact,if unable to stand alternative method transport w/basin and tissues, NPO, observe for shock symptoms |
| who are the pediatric patients | neonates NICU, pediatrics PICU, infants, toddlers pre-schoolers school aged children adolescents, |
| true or false each group requires the same care | FALSE special care and knowledge for each group and cases vary |
| pediatrics is infancy to what age | 15 |
| when caring for children 5-things must be done | educate parents and child if possible, assess needs an dlevel of independence, privacy, safe surroundings(dont leave alone) |
| ways to establish rapport w/child | talk to from comfortable distance, keep explanations simple and brief, come to their level to speak face to face |
| TorF 6mos-3yrs the child has separation anxiety | TRUE |
| Is a birth to 6mos child fearful of strangers | NO |
| at what age is a child more verbal and independent | 3-6yrs |
| How does a child 6-12yrs respond | interested, understand cause and effect |
| at what age does a child have heightened awareness of their body | 12-19yrs. image,privacy |
| what is the NICU | care for high risk new born infants, immature immune systems more susceptible to infection |
| what is protocol for entering NICU | surgical scrub or 2-min scrub for medical asepsis, cleaning portable,IR, shields, and markers, standard precautions/barrier precautions |
| who helps position infant in NICU | nurse |
| you shoud provide lead apron for nursing assistant | YES |
| why provide shielding for the NICU | receive many images,much exposure to radiation, radiosensitivity of rapid and changing cell growth |
| Some standard principles for projections in the NICU | ALARA(time distance shielding), collimation, short exposure time,high MA to reduce exposure, if you have an dinfection or cough or cut on your hand let some one else go to the NICU |
| some ways to approach adoledcents or older children | non-judgemental attitude, therapeutic communication, identify and educate pt, privacy, simple terms allow questions,allow parent if pt wishes and policy allows, allow choices if possible |
| immobilizations should be used | only when necessary |
| If pt is immobilized a parent doesn't have to be notified or given reason for it | FALSE |
| IT is your ethical and legal obligation to report these three types of child abuse | physical abuse or neglect, emotional abuse, sexual abuse |
| what are some child abuse indicators | child says harmed, knowledge of unusual injury to child, parent unable to explain |
| what are some behavior indicators of child abuse | excessively compliant,fearful,passive, agressive or physically violent child or caretaker attempts to hide injuries, detailed or age-inappropriate comments of sexual behavior |
| who medicates pt | MD,nurses |
| radiographers administer _________ w/assessment of questionare and consent form | contrast media if pt is awake, responsive and any allergy out of way |
| can the pt be released right after contrast exam | no, risk of complications assessed before,child must be awake prior to discharge |
| questions to ask for assessment of administering medication | any allergies to food or meds, response to medication, what meds given at home, supervision after discharge, any unusual circumstances MD should know about, is parent educated in action,purpose,side effects of drugs administered |
| should all persons be assessed by chronological age or individual basis | individual basis |
| things a tech should pay attention to | normal changes of aging and affects of disease, polypharmacy can affect pt response level, depression is common |
| some symptoms for dementia/alzheimer disease which is not part of normal aging process | disorientation confusion paranoia hallucinations |
| pt w/dementia will be able to understand and remember directions and can be left unattended | FALSE |
| risk of falling form x-ray table is great 2-things to prevent it from happening | care to prevent falls, assist in positioning and getting on and off the table |
| skin is more_______ and pt less responsive to ______ | fragile, painful stimuli |
| momentary blindness is caused by rapid changes in lighting, it affects pediatric or geriatric pts | geriatric |
| you can assume a geriatric pt has hearing loss and you can yell | dont assume, but be sure pt is able to hear directions |
| symptoms of pulmonary system | breathless fatigue cough refleex less effective more prone to aspirate, drink contrast upright, chronic pulmonary disease cannot lie flat more than brief period due to dyspnea use 2nd full inspiration to ensure lung expansion |
| neurologically geriatric pt fully responsive to pain stimuli and process information quickly | FALSE |
| what are the special considerations for cardiovascular geriatric pts | hypothermia cold caused by decreased circulation, avoid chilling. postural hypotension feeling dizzy by rapid positioning changes |
| name some special conditions for geriatric pts for GI system/hepatic/GU | exams scheduled early,UGI pt must drink slowly to avoid choking, BE-problem holding barium,aging liver potential drug reactions bed pan & urinal close-limited capacity, handle dentures carefully |
| can pt have weight on surgical site | no |
| should chart be checked for weight bearing and mobility | YES |
| how is geriatric pt checked to determine rate of healing | radiographs requested several days post-op |
| manifestations after hip replacement | dislocation of prosthesis abduction &adduction must be prevented-keep in extention. hips not flexed more than 90deg. weight bearing restriction for varying legths of time |
| manifestations of knee replacement | continuous passive motion device weight bearing restricted knee cannot be hyperflexed pt should not kneel |
| what type of tube is inserted through the nasopharynx into the stomach | nasogastric tube |
| what is a nasogastric tube used for | keep stomach free of gastric contents,diagnostic exam,administor feeding&meds, treat intestinal obstruction,control bleeding,during disease process pre or post-op to assist with healing |
| what is a nasoenteric tube (NG) | inserted through nasopharynx into duodenum or jejunum by way of peristalis |
| what tube is used for decompression,diagnosis,treatment, feeding tubes to obtain nourishment for longer period of time | Nasoenteric Tube (NE) |
| name some nasogastric tubes | levin,sump, sengstaken-blakemore(S-B) |
| two most common NG tubes found in radiology and description | levin-single lumen, Sump-double lumen must never be clamp and second lumen remains outside |
| what NG is a triple lumen and is seen more in the ICU and can be done portabley | S-B NG |
| name a NE tube and where it enters body | cantor,single lumen, enters small intestine |
| how is progress and placement of tube observed | under fluroscopy and radiographs |
| does radiographer place tube or assist | assist |
| what type of tube is taped in place | NG tubes, not NE because peristaltic action keeps tube in position |
| things to remember about NG tubes | don't put pressure on them, pt NPO unless physician order |
| what tube can a radiographer remove with physician order | NG tube |
| what tube can only be removed by MD or RN | NE tube |
| what should a radiographer do to reduce risk of aspiration on pt w/ NE and NG tubes | pt in sem-fowlers position during and 30min after administration of any agent in tube |
| when should placement of a tube be verified, and how | before administering medication,food,water or contrast- radiograph or test aspirated fluid for acidity |
| if a pt w/tube is on a continuous or intermittent suction device it can be discontinued and the pt can be transferred to imaging dept. | NO, suction devices can be discontinued w/DR orders, must know length of time suction can be delayed |
| how do you know the amount of pressure for suction, | check order |
| what is the maximum amount of suction for an adult | 25mm Hg |
| is a single or double lumen tube okay to clamp for transport purpose | only single can be clamped, double can have syringe inserted into "blue pigtail" w/barrel pointed upward and pinned to pt gown |
| what is gastronomy | surgical opening into stomach |
| what is the placement for gastronomy tube | through surgical opening of stomach a tube is placed inside stomach to abdominal wall |
| radiographer should watch these things for a G-tube | prevent infection,dislodgement,sensitive to pt feelings, tube is clamped after feeding |
| what is a gastronomy tube used for | feeding on temp or perm basis |
| how do you know a pt has just gotten a gastronomy tube | dressing will be in place, older may not have |
| what is central venous catheter | long term med administration,blood transfusions,hypersmolar solutions,total parenteral nutrition,measure Central Venous Pressure |
| placement for CV catheter | brachiocephalic vein at junction of superior vena cava or within superior vena cava,line is seen medial to anterior border of the 1st rib |
| how are CV catheters confirmed for correct placement | portable chest or c-arm fluro during actual insertion |
| what is the difference between partial and total parenteral nutrition | PPN-placed in lg peripheral vein,TPN-least common, lg vein in central venous system,controlled by IV pump,hypersmotic solutions would damage peripheral veins |
| CV catheter uses and names | tunneled to exit the anterior chest, inserted into subclavian or internal jugular vein then into SVC or r.atrium, names-hickman,broviac,groshong |
| what is PICC | peripherally inserted central catheter |
| where is PICC placed | pt arm and advanced until its tip lies in central vein |
| implanted ports are needed for | pt who need frequent IV meds or transfusions |
| where is the implanted port felt and placed | not visible can be felt, implanted into subcutaneous tissue in the chest |
| needle and catheter insertion on an implanted port | catheter-from port into subclavian or internal jugular vein, huber needle-inserted to access central vein through the port |
| CVC have more than one lumen and several access ports at the ________ site. They come in single, double and multiple lumens for______ and ___________ care | exit, short and longterm care |
| things radiographer should be aware of for CVC | prevent infection,need DR orders to change dressing, prevent dislodging |
| Is it in the radiographers scope of practice to do suctioning | NO, but need to determine if suctioning is needed and use sterile technique, maintain equip in dept |
| signs suctioning is needed | profuse vomiting in pt that can't change position,audible rattling or gurgling sound from throat,signs or respitory distress |
| what to do if suspected suctioning needed | conscious person in semi-fowlers, unconscious in lateral side lying pos. assist to clear airway, pt w/spinal cord injury w/vomiting log-roll with face directed downward while keeping head and neck immobile |
| opening created surgically to relieve respitory distress or improve respitory function. can be permanent or temp. | tracheostomy |
| what helps seal and protect air leaks and aspiration of gastric contents for a tracheostomy | adults have cuff |
| things to be aware of while caring for pt w/tracheostomy | pt fearful,unable to speak, afraid of choking,semi-fowlers most comfortable position,explaining full procedure can alleviate anxiety, required suctioning requires RN present |
| mechanical ventilation is used for | pt who cannot breath, respiration is inadequate to O2 blood levels, gas exchange blood disorders, disease that affects mechanics of breathing |
| pulmonary emboli and severe respitory disease are _______________ | gas exchange disorders that may require mechanical ventilation |
| extrapulmonary disorders such as CVA and Guillain-Barre syndrome are______________ | diseases that affect mechanics of breathing and may require mechanical ventilation |
| what type of ventilators are more common, purpose and requirement | positive pressure ventilators, inflate lungs by exerting positive pressure on the lungs stopping inspiration when a preset pressure is attained, to use they require an artificial airway(endotracheal or tracheostomy) |
| things radiographer should be aware of with a patient on ventilator | notify nurse and have them stand by, move pt safely w/help if needed,don't put pressure on any tubings, don't disconnect power to any equip., use medical asepsis tech,watch for pt to breath because they cannot "hold" breath |
| purpose and insertion of endotracheal tubes | inserted through mouth into trachea,cuff is inflated,hence open airway established. The tube prevents aspiration of foreign objects into bronchus |
| correct placement of endotracheal tube | 5-7cm above carina (tracheal bifurcation), 20% of tubes require repositioning after initial insertion |
| chest images are taken on pt with endotracheal tube with the initial insertion and | on a daily basis to ensure tube has not shifted,handle pt with care so to prevent this |
| what happens if endotracheal tube is inserted is inserted to far and enters the R. bronchi | collapse left lung |
| if the tube is not positioned far enough down into trachea, too high, | may cause air to enter stomach, pt regurgitates gastric contents leading to aspiration pneumonia |
| what is placed for a pt that has pressure in pleural cavity is normally lower thatn atmospheric pressure because of disease or injury | chest tube |
| a total or partial collapse of the lung , absence of gas from part or whole lung is | atelectasis |
| what is a surgical opening into chest cavity | thoracotomy |
| pneumothorax,atelactasis,hemothorax require placement of ______________ into the pleural cavity | one or more chest tubes |
| chest tube is attached to ________ to remove any air or fluid from the pleural cavity to reestablish correct intrapleural pressure and allow lungs to expand normally | water-sealed drainage unit |
| things a radiographer must know about the water-sealed drainage unit | could have 1,2 or 3 chambers,don't clamp, keep straight w/o tension or kinking, keep at chest level, water sealed chambers must remain below pt chest,know when to notify nurse |
| when should a nurse be notified about a drainage unit | if water sealed chamber is continuously bubbling, or pt has rapi,shallow breathing,cyanosis, or complaint of pressure on chest |
| Tissue drains are placed where | at or near wound when lg amounts of drainage are expected to prevent infection and fistulas |
| what is a fistula | abnormal passage from a hollow organ to the body surface, or from one organ to another |
| common tissue drains | hemovac,jackson-pratt, penrose |
| what is penrose drain | soft rubber tube that drains into surgical dressing |
| what is jackson-pratt and hemovac and which one is most common | hemovac most common, drains maintain constant,low,negative pressure by means of small bulb, drainage goes from tubing into bulb |
| placement for T-tube | common bile duct |
| placement for Cecostomy tube | in cecum |
| placement for cystostomy | in kidney |
| patient care for tissue drains/tubes | identify type of tube during assessment, plan care to prevent tension, consider infection control----(use STERILE aseptic technique) |
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