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ptcare final
Patient Care Final
| Question | Answer |
|---|---|
| What must Level 1 trauma care hospitals be able to do at all times? | 24 hour staffing. Able to provide radiography, fluoroscopy, CT, and MRI. Must have access to nuclear med, angiography, sonography. |
| What must Level 2 trauma care have access to? | ER doctors, nurses and radiology staff on duty 24 hours. Access to angiography, CT and MRI |
| What must Level 3 trauma centers have access to? | ED physicians on call. Trauma patients are transferred to level 1 and level 2 centers. |
| What is the golden hour? | most patients with life threatening injuries have a greater chance of recovery if stabilized within 1 hour of the trauma. |
| The big 3 in radiography | C spine, CXR, and AP Pelvis |
| What is a disaster? | emergency of huge magnitude that creates an unforeseen, serious or immediate threat to public health. |
| Code silver | weapon or hostage |
| code amber/pink | infant/child abduction |
| code grey | combative person |
| code red | fire |
| code blue | heart or respiration stopping |
| code clear | situation is resolved |
| What does a code team consist of? | 1 or more physicians, several nurses, respiratory therapist and electrocardiographer |
| What does a crash cart contain? | airways, ventilation equipment, emergency meds, blood pressure cuff, stethoscope, defibrillator, protective apparel, sterile/nonsterile gloves, IV solutions and tubing. |
| What is a nasal cannula used for? | longer term O2 administration |
| what is the rate of o2 and concentration in nasal cannula? | 6 mL/min. (3L in acute situations) 24-45% concentration |
| What is a simple oxygen mask used for? | short term O2 and humidity admin. |
| What is the delivery rate of o2 and concentration in simple oxygen mask? | 1-10mL/min. 40-60% |
| What is the concentration of o2 in a non-rebreathing mask? | O2 levels at 100%. It contains a valve to prevent exhaled air from being breathed again. |
| What is the rate of O2 in a partial rebreathing mask? | 40-70% |
| What is the rate of a high flow oxygen mask? | 24-60% (Venturi) |
| What is an oxygen tent used? | when a higher rate of humidity and O2 is needed than what is available, and it typically used in the pediatric department. |
| Placement of any tube? | intubation |
| artificial opening into the trachea to provide o2/ventilation? | tracheostomy |
| mechanical repspirator device which administers a controlled respiratory rate, volume and oxygen concentration | ventilator |
| what measures o2 concentration in the blood? | pulse oximeter |
| When should an RT provide suction for a patient? | nauseated patient, bleeding from nose or mouth, anyone unable to swallow secretions. |
| How do you place a patient if they begin to aspirate? | lateral recumbent. |
| What are the symptoms of choking/airway obstruction? and the RT response? | agitation, face redness, grabbing at throat. Abdominal thrust (adults) alternating back blows/chest thrusts (infants) |
| what are the symptoms of reactive airway disease/asthma? and the RT response? | wheezing, shortness of breath, undetermined cause. We keep the patient calm, call for assistance and administer o2. Severe acute episodes can be treated with epinepherine ordered by doctor |
| What causes an interruption of blood flow and pressure on the right ventricle? | pulmonary embolism |
| What are the symptoms of a PE and the RT response? | dyspnea, tachycardia, chest pain. Be aware of the risk factors: hx of surgery, smoking, immobilization, pregnancy, COPD, heart failure and give o2. |
| What are the symptoms of a heart attack and RT response? | pain, diaphoresis, irregular heartbeat, pallor, nausea and SOB. RT minimizes pt. exertion, stay with patient, call a doctor, assist patient into comfortable position. Give 2-4L/min of O2 |
| Occurs when the coronary arteries are unable to supply the heart with sufficient oxygen | angina pectoris |
| what are the symptoms of angina pectoris? | vague ache, intense crushing, substernal. RT response is have patient rest or take sublingual nitroglycerin. If pain isn't relieved call doctor. |
| What are the symptoms and RT response of cardiac arrest? | no pulse/respiration. RT shake and shout patient, check carotid pulse, observe respiration, call a code and do CPR. |
| What are head injuries and levels of consciousness based on which scale? | Galsgow Coma Scale |
| Contrecoup injury | severe blow tot he head causing the brain to move from side to side within the cranium and causes injury to opposite side of the blow. |
| flail chest | multiple rib fractures causing a loss in structural integrity of the chest wall and atelectasis. Symptoms are difficulty breathing and chest pain. |
| cardiac tamponade is? | bruising of the heart an hemorrhage into the pericardium caused by a blunt blow to the chest. |
| wound dehiscence | occurs when the area of the suture comes apart and underlying tissue/organs protrudes through the opening. RT response is to put patient in recumbent position and call doctor |
| difference between 1st, 2nd and 3rd degree burns | 1-redness/warmth/tenderness 2- blisters 3- white/charred |
| RT response to burns | use reverse/protective precautions. Make sure pt. has taken meds prior to exam. |
| What is hypovolemic shock? | large volume of blood loss. |
| what is septic shock? | occurs after a large infection increases the permeability of blood vessels causing blood pressure to drop sharply |
| neurogenic shock? | occurs with head/spinal trauma. pooling of blood in peripheral blood vessels that occurs after an injury to the nervous system. |
| cardiogenic shock? | results from heart failure or interference with heart function |
| anaphylactic shock? | occurs when a person is exposed to a substance to which they are highly allergic causing sharp, drop in BP, respiratory edema. |
| psychologic shock? | mental trauma/ ptsd |
| what are the symptoms of shock? | pallor, increased HR and respirations, restlessness, confusion, cool clammy skin (except for neurogenic or septic) drop in BP, decreased urination. |
| caused by problems related to the kidneys or pituitary gland causing the secretion of glucose in the urine | diabetes insipidus |
| the symptoms of diabetes insipidus and RT role? | polyuria, excessive thirst. RT fluid replacement |
| Diabetes Mellitus | inability to metabolize glucose. Type 1 thin patients under 25. Type 2 obese patients over 40 |
| symptoms and rt response of diabetes mellitus | fatigue, thirst, weight loss, blurred vision, frequent urination. RT fluid replacement |
| Hyperglycemia | high blood sugar that often occurs in the diabetic patient who has not taken their insulin |
| symptoms and rt response for hyperglycemia? | increase thirst, frequent urination, dry mouth, N/V, SOB, sweet smelling breath. RT alerts doctor, gives fluids and insulin |
| hypoglycemia | low blood sugar often in diabetic patient who has taken insulin but no good |
| hypoglycemia symptoms and RT response | weakness, tremors, sweating, LOC. RT alert doctor, give them sugar, glucagon. |
| RT response for a stroke/CVA? | assist the patient in fowler's position, stay with patient, notify doctor. Monitor vital signs |
| rt response for seizure? | notify dr. keep patient safe by preventing a fall, remove dangerous objects, pad the area and don't leave the patient. |
| postural (orthostatic) hypotension rt response? | patient sit up slowly and remain close to provide support. |
| what are the 3 types of contrast medium? | barium sulfate, water-soluble iodine compounds, gases. |
| Scheduling/Sequence of xray procedures using contrast. | 1. xray exams not requiring contrast 2. xray exams with contrast-urinary tract 3. exams with contrast biliary system 4. CT studies 5. lower GI studies 6. Upper GI studies |
| What order of scheduling patients? | Fasting patients first. 1. emergency/diabetic 2. pediatric/geriatric |
| Prep for GI tract exams | low residue diet, increased liquid intake, clear liquid diet, fasting 8-12 hours prior npo. |
| Types of cathartics | liquid (magnesium citrate) tablet (dulcolox) kits |
| types of cleansing enemas | tap water, soapsuds in water, fleet's enema, normal saline. |
| types of iodinated contrast for GI tract exams | gastorgraffin/hypaque oral. This is used when barium administration may be contraindicated |
| When is barium contraindicated? | perforated ulcer/appendix, bowel injury (trauma), pre/post op GI surgery, high risk of barium impaction. |
| what does glucagon do? | slows peristalsis, reduces cramping. |
| What is a nasogastric tube used for? | feeding and decompression (removal of gas& secretions through suction) |
| Types of NG tubes and their uses | Dobbhoff- feeding-most common Salem-Sump - decompression Levin- decompression |
| types of NE tubes and their uses | feeding/decompression Miller-Abbott - double lumen Cantor- feeding Harris- feeding |
| Types of pulmonary artery flow-directed catheter and its uses | Swan-Ganz - cardiac output, pressure in the right side of the heart. Used to diagnose ventricular failure, effects of meds,stress and exercise on heart. Oxygen left in the blood after it has circulated through the body |
| This is placed through the subclavian, internal/external jugular, or fermoral veins and they are advanced to the right atriu,. | Pulmonary Artery flow catheter (Swan-Ganz) |
| What are Central Venous Catheters (Central Lines) used for administration for? | chemo, total nutrition, dialysis, blood transfusions. Can also be used for blood draws and to monitor venous pressure. |
| What are the types of Central lines? | PICC (peripherally inserted central catheter) CVC (central venous catheter) |
| What are long-term external/tunneled central lines? | Hickman- feeding/nutrition Groshong- med admin/blood draw Raaf-dialysis |
| Long term implanted infusion ports (Venous Access Ports) are used for what? | intermittent infusion, chemo, blood transfusions, medication, blood sampling from the SVC |
| Types of venous ports? | port-a-cath and mediport |
| Where do almost all central lines go up to? | Superior Vena Cava |
| What should you avoid positioning for a patient with a pacemaker? | abduction of the arm on the side of the pacemaker for 24 hours after placement |
| What is surgical clothing/attire an RT will wear? | non-sterile shirt & pants, mask over nose and mouth, hair cover, shoe cover, shoes w/ closed heels and toes. |
| who are the sterile members of the surgical team? | surgeon, surgeon's assistant, non-PA, scrub person (nurse or surgical tech) |
| who are the non sterile members of the surgical team? | anesthesiologist, circulating nurse, xray, orthopedic, neurologic, biomedical (lab) |
| RT's responsibility in OR | be aware of sterile fields and don't contaminate. |
| what is the sterile corridor? | the area between the patient drape and the instrument table. |
| What does RACE stand for in a fire? | rescue, alarm, contain, extinguish |
| ergonomics | the study of the human body in relation to the working environment |
| Types of fire extinguishers | solid combustibles, flammable liquids or gasses, elecrrical equip. or wiring, multipurpose |
| center of gravity? | mid-pelvis.Point around which the weight of the body is balanced |
| line of gravity? | imaginary vertical line passing through the center of gravity |
| what is a bacteria? | small, single cell organisms that grow independently. Ex. TB, strept, lyme, E. Coli |
| what is a virus? | among the smallest known disease causing organisms. Needs a host. |
| What is fungi? | single-celled yeasts |
| what is a prion? | smallest, have no RNA or DNA. Causes irreversible neurological damage |
| what is a protozoa? | complex, single celled animals that exist as free living organisms. Motile. |
| what most a host provide for a pathogen to survive? | moisture, nutrients, and suitable temperature. |
| what is direct contact? | the organisms are placed in direct contact. |
| What are the 3 types of indirect contact? | fomite, vector, vehicle |
| what is a fomite? | an object that has been in contact with pathogenic organisms. Any inanimate object |
| what is a vector? | arthropods that carry infectious organisms. (mosquitos,ticks, fleas) |
| what is a vehicle? | any medium that transports microorganisms. ex. food, water, blood, drugs. |
| what are examples of droplet contact? | flu, meningitis, pertussis, streptococcal pneumonia, diptheria |
| what are examples of airborne contact? | TB, rubeola, varicella |
| active artificial immunity? | vaccination |
| active natural immunity? | person is exposed to harmful antigen |
| passive artificial immunity? | antibodies from one individual is injected into another individual. |
| passive natural immunity? | passage of antibodies from mother to child |
| what are the standard precautions? | blood, all body fluids, secretions, excretions, nonintact skin |
| what is disinfection? | destruction of pathogens by using chemicals |
| what are airborne precautions? | wear N95 respirator- filters out 95% protects against: TB, rubeola, varicella, mumps, SARS, measles |
| what are droplet precautions? | mask, eye wear, gloves protects against: flu, diptheria, pneumonia |
| what are contact precautions? | gloves, gown, mask. Prevents against: multidrug resistant wound infections, MRSA, VRE, ecoli, C diff |
| What are combo airborne/contact precautions? | gloves, gown, mask protects against: SARS, varicella |
| what is diaphoresis? | patient has cool, clammy skin |
| what is a fever? | patient has hot, dry skin |
| Name the 4 levels of consciousness: | 1. alert & conscious 2. drowsy, but responsive 3. unconscious but reactive to painful stimuli 4. comatose |
| what is orthopnea? | inability to breathe when recumbent |
| what temperature is a fever? hypothermia? | 100.4 + and 94 degrees |
| why is a rectal thermometer contraindicated? | may stimulate the vagus nerve |
| normal body temperature range? | 96.8 - 99.8 degrees |
| when is body temperature highest? | in the evening |
| what is a pulse? | advancing pressure wave in an artery caused by the expulsion of blood when the left ventricle of the heart contracts |
| normal pulse? | 60-100 beats per minute |
| normal adult respiration? | 12-20 breaths per minute |
| what does systolic pressure measure? | the pumping action of the heart muscle when the arteries contract |
| what does diastolic pressure measure? | pressure on arterial walls when heart is relaxed |
| normal systolic and normal diastolic? | 95-119 and 60-79 |
| hypertension? | 140 systolic 90 diastolic |
| hypotension? | 90 systolic 50 diastolic |
| normal creatinine level | .6 - 1.3 mg/dL |
| normal BUN level | 7/18 mg/dL |
| what does pulse ox monitor? | pulse and blood oxygen levels. 95-100% |
| pharmokinetics measures which factors? | people's age, size, gender, how drugs are absorbed, reach their site of action, metabolized, exits the body |
| therpeutic effect is? | the action of drugs on specific cells that results in anticipated outcomes |
| toxicity from medication can occur because? | age, inadequate excretion, impaired metabolism, overdose, drug sensitivty |
| common side effects for contrast? | metallic taste in the mouth and warmth in the body |
| antiallergy medications: | benadryl, epinepherine |
| common anticonvulsants? | dilantin, ativan, tagretol |
| common antiarrythmics? | lidocaine, pacerone |
| common analgesics? | aspirin, ib profen, acetaminophen |
| common sedative/tranquilizers? | diazepam, phenobarbitol, midazolam (versed) |
| common antagonists? | counteract a specific drug. Naloxone (opioid overdose) Flumazenil (valium overdose) |
| common local anesthetics? | lidocaine |
| common paralytic agent? | succinylcholine chloride |
| hypoglycemic agent common? | glucotrol |
| common antihypertensives? | beta blockers (propranolol/inderal) Angio tensin- ACE inhibitors and captopril |
| What are the six rights of medication administration? | right dose, right medication, right patient, right time, right route, right documentation |
| how is IV administered? | 15-45 degrees. |
| how is intradermal administered? | under layer of skin 15 degrees angled. |
| how is subcutaneous done? | under the skin 45 degrees |
| intramuscular done? | inside muscle. injected 90 degrees. |
| what are the veins not to use? | arm on side of mastectomy, edematous areas, hematomas, arm with transfusion, scarred arms, arms with canunulas/fistulas, arm above an IV |
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