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RAD 110 Lesson 4

Questioning techniques Open-ended questions, facilitation, silence, reflection/reiteration, clarification or probing, summarization
OPEN-ENDED QUESTIONS This encourages patients to share information about their condition and give their explanation to why they’re having a specific imaging study.
FACILIATION When patients provide you with information, we must nod or say “yes” in order to encourage our patients to continue with their story.
SILENCE This gives patients time to think and organize thoughts without interruptions.
REFLECTION OR REITERATION Gives technologists an opportunity to reiterate what the patient said and lets the patient know we are listening. This allows us to accurately record information on our patients.
CLARIFICATION OR PROBING Ask for specifics. For example, a patient is complaining of abdomen pain. Have the patient point to the specific area. (right inguinal region) Use terminology that is understandable to patients!
SUMMARIZATION After they are finished providing information, summarize their history to make sure everything is recorded accurately.
Elements of a history Begin your history by asking a general question about the nature of the problem. Certain exams require particular information. Ask appropriate history questions for various exams.
detailed history Onset, duration, specific location, quality of pain, aggravation factors, what alliviates
Onset What happened? How did it start? Is this a chronic issue?
Duration How long has this been bothering you? When did this happen?
Specific Location Where does it hurt? Point to the area with the most pain.
Quality of Pain What does your pain feel like, sharp, dull, throbbing? Is it mild or severe pain?
What aggravates When is your problem worsened? Do you have more problems during a particular time of day, after meals, etc.?
What alleviates What helps the pain? What has helped in the past?
patient’s physical status are they able to stand? Do they require oxygen? Allergies.Observe your patient before, during, and after procedure. Skin color; pale, cyanotic, etc? Skin temperature, diaphoretic? Hot or red skin? Patient’s level of consciousness mental state.
Four levels of consciousness Alert and conscious, Drowsy but responsive, Unconscious but reactive to painful stimuli, Comatose
breathing An increase in depth and rate of respiration is usually the first sign of respiratory distress. Identify those patients with emphysema (prevents patients from exhaling effectively and limits their inhalation of fresh air)
Patient assessment / temperature Provides important information about the patient’s basic metabolic state. Body temperatures are lowest in the morning and highest in the evening.
Fever (pyrexia or hyperthermia) is a sign of increased body metabolism and typically a response to an infectious process. In adults, fever is usually 100.4°F orally or 101.4°F rectally.
Oral temperature Alert, cooperative patients. Not useful when patient is on oxygen, recently had something to drink, or is breathing through mouth.
Rectal temperature Accurate/fast; contraindicated on patients w/cardiac conditions due to vagus nerve stimulation, and tenth cranial nerve which has connections to the SNS. May produce a vasovagal response: slows heart rate, lowers blood pressure and may cause fainting.
Axillary temperature Less accurate and more timely; less invasive
Tympanic temperature Preferred for children younger than 6 years of age; measure temp at the tympanic membrane in the ear. Probe is placed in the external ear canal.
Temporal temperature Preferred for children younger than 6 years; measures temp above temporal artery in the forehead region. Research indicates this method is more accurate than tympanic.
Pulse RATE A pulse is the advancing pressure wave in an artery caused by the expulsion of blood when the left ventricle contracts. This is an easy and effective way to measure heart rate and is measured in beats per minute (bpm).
APICAL PULSE a measurement taken by listening to the heartbeat through a stethescope and is placed over the apex of the heart and is normally found in the fifth anterior intercostal space at the left midclavicular line.
Respirations The normal adult range is 12-20 breaths per minute.
Bradypnea slow breathing with fewer than 12 breaths per minute
Tachypnea rapid breathing in excess of 20 breaths per minute. Pleurisy (inflammation of the pleura causing adhesions between lungs and chest wall) may cause rapid, shallow breathing also.
blood pressure A normal systolic pressure will measure between 95 and 119 mm Hg. A normal diastolic pressure will measure between 60 and 79 mm Hg.
Hypertension Abnormally high blood pressure; 140/90; contributes to CVAs and congestive heart disease
Hypotension Abnormally low blood pressure; 90/50; can result is life-threatening condition called shock.
CBC Complete blood count;12 different values may be performed. All CBCs include a RBC count, hemoglobin concentration (HgB), Hematocrit (Hct), RBC indices, WBC count, WBC differential count, and platelet count.
Hemoglobin is the pigment in RBCs that carry oxygen from the lungs to the tissues and is vital to sustain life.
Carbon Dioxide is produced when oxygen is utilized and is transported by RBCs back to the lungs to be exhaled.
WBC counts are done to determine if infection or inflammation is present. It also monitors treatment for cancer.
Blood Clotting Assessments- Important for diagnostic imaging studies. Blood clotting is necessary so patients will not hemorrhage from invasive procedures. However, when clotting occurs too readily, clots may form within vessels causing tissue necrosis (failure of blood supply).
Thrombus A blood clot formed on the wall of a vessel
Embolus When a thrombus detaches from the vessel wall and become a free floating clot in the body. When clots become lodged in vessels, this can cause strokes, MIs (myocardial infarctions), and PE (pulmonary embolism).
Platelets responsible for forming blood clots! Platelet function analysis tests and coagulation tests may be performed known as prothrombin time (PT) and partial thromboplastin time (PTT). These tests determine stroke and hemorrhage.
INR-International Normalized Ratio Established standardized reporting system for PTs and is reported in a numeric ratio between 2.0 and 3.0! This is used for patients taking oral anticoagulant medications. An increased INR may be a contraindication for contrast media.
Blood chemistry tests Glucose, Cholesterol, BUN, Creatinine, Serum Bilirubin
Glucose Form of sugar; referred to as the blood sugar test (Plasma glucose) measured to diagnose and manage diabetes. Hyperglycemia is an abnormally high glucose level and hypoglycemia is abnormally low glucose level.
Cholesterol Major risk factor for heart disease. The total serum cholesterol test is a measurement of the sum total of cholesterol incorporated in lipoproteins (family of cholesterol containing substances).
HDL High-density lipoprotein- Good cholesterol- greater than 60mg
LDL Low-density lipoprotein-Bad cholesterol-elevated levels of 160 mg+ for normal adults and 100mg + for diabetics
BUN (Serum urea nitrogen or blood urea nitrogen)- a byproduct of protein metabolism. Nonprotein nitrogenous waste products excreted by the kidneys. High BUN levels indicate impaired renal function (greater than 20 mg)
Creatinine Metabolite associated with skeletal muscle mass. Nonprotein nitrogenous waste products excreted by the kidneys. An elevated creatinine level (greater than 1.5 mg) is a more specific indication of impaired kidney function than the BUN.
Serum Bilirubin Blood chemistry assessment the measures waste products from the breakdown of hemoglobin.
Pulse Oximeter Placed on a finger, toe, or earlobe and continuously monitors the pulse rate and blood oxygen levels. Normal values range from 95% to 100%. Anything less than 95% may indicate that tissues are not receiving enough oxygen.
Arterial catheters Introduction of a special arterial catheter into a large artery to provide continuous measurement of heart rate and blood pressure. This is applied under sterile conditions.
Electrocardiograph Monitors measures the electrical activity of the heart and displays information graphically in the form of waves. The graph is a ECG (electrocardiogram).
Created by: dwschema