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RAD271-Patient Care
Medical Emergencies/Pharmacology
| Question | Answer |
|---|---|
| What is PHARMACOLOGY? | The science concerned with drugs and their sources, appearance, chemistry, actions and uses |
| Describe Patient History particularly regarding pharmacology. | -Using observation and listening skills to assess patient's condition; -Asking about patient prep NPO -History of intolerance to contrast? -check chart for lab values/DX that contraindicate procedure? |
| How are medications administered? | 1. ORAL - (PO - per Os) by mouth; PARENTERAL 2. topical (surface) 3. subcutaneous (beneath skin) 4. intradermal (within skin) 5. intramuscular (within muscle) 6. intravenous (within vein) 7. intrathecal (within spinal canal) |
| Describe IV equipment. | Needles; Syringes; Fluids (saline, D5W (5% dextrose); IV catheters; heparin locks; IV poles; infusion sets |
| What is gauge/bore in needles? | Gauge identifies the size/bore of the needle lumen; LARGE GAUGE = smaller bore (more passes through die); SMALLER GAUGE = larger bore diameter |
| What is the HUB of a needle? | The part of the needle that attaches to syringe or IV tube |
| What type of needle is used for an infusion injection? | IV catheter is most common; butterfly can be used |
| What type of needle is used for injecting contrast? | butterfly is most common; IV catheter can be used |
| Describe HEPARIN LOCK. | -a venous catheter established for a period of time to make a vein available for medications that have to be administered at frequent intervals -(to prevent sclerotic, scarred veins) |
| At what level should the IV container be hung? | 18-24" above the vein - this affects how quickly the fluid will flow (too high = too fast, too low = too slow and can cause backflow of blood into tubing) |
| What is venipuncture? | surgical puncture of a vein especially for the withdrawal of blood or for intravenous medication |
| Describe the venous anatomy. | Most common vein for contrast admin - ANTECUBITAL VEIN (in bend of arm); BASILIC VEIN (dorsal surface of hand) is used as backup ; CEPHALIC VEIN (lateral aspect of arm) |
| What angle is used to insert a needle into vein? INTRAVENOUS SUBCUTANEOUS INTRAMUSCULAR | INTRAVENOUS - 15° ; blood flows back into tubing when needle is correctly positioned; SUBCUTANEOUS - 45°; INTRAMUSCULAR - 90° |
| What is the purpose of CONTRAST MEDIA? | artificially increase subject contrast in body tissues in areas where there is little natural subject contrast. (IE abdominal viscera) |
| What are the types of contrast media commonly used? | POSITIVE MEDIA - Barium sulfate - Iodinated NEGATIVE MEDIA - Air - Other gases (CO2) |
| What is negative contrast media? | Radiolucent material commonly used WITH positive contrast to coat the soft tissue structures under study and fill the space to permit visualization of entire tissue COMMONLY used in BARIUM ENEMAS and UGI exams |
| What is positive contrast media? | Radiopaque high atomic number material that absorbs photons, increasing image contrast; IODINATED agents (water and oil based) and BARIUM SULFATE (suspension). Barium is the least toxic contrast |
| What order are contrast studies scheduled in? Why must they be scheduled in specific order? Saia p71 | IVU > contrast enema > UGI > SBS ; to prevent residual contrast from obscuring anatomy under study; perform exams first with contrast that is quickly excreted |
| Describe patient prep for UGI/SB series. | NPO 8 hrs (or after midnight) |
| Describe patient prep for BE. | large bowel must be very clean; requires low residue diet 2-3days prior, clear liquids day prior with admin of cathartics/cleansing enemas |
| Describe patient prep for IVU. | NPO past midnight; (some facilities require large bowel be cleansed of gas and fecal material) |
| What is AFTERCARE? | patient care post procedure - because Barium floculates, patient must drink plenty of fluids to prevent barium impaction in large bowel (also eat plenty of fiber, take milk of magnesia and expect changes in bowel color) |
| What are the qualities of IODINATED CONTRAST that contribute to discomfort, side effects and reactions? | 1. viscosity - difficult to inject thick liquids and produce heat/irritation; 2. toxicity - higher with ionic agents; 3. miscibility - mixibility with blood; 4. osmolality - low osmolality has fewer particles, less likely cause allergic reaction |
| What is it called when study is performed on patient with NG tubes? | ENTEROCLYSIS - contrast is administered via NG tube |
| what specific diagnosis contraindicates use of BARIUM? | SUSPECTED BOWEL PERFORATION |
| What is INSPISSATION? | absorption of fluid from material in large bowel; thickened in consistency; broadly : made or having become thick, heavy, or intense |
| Describe types of IODINATED contrast | 1. WATER based are either IONIC or NONIONIC, IONIC has higher OSMOLALITY (more particles); NONIONIC are more expensive 2. OIL based are not water soluble, rarely used now, not readily absorbed by body, remain for lengthy periods of time in tissue |
| What patient prep is required for diabetic patients prior to a contrast study? | WITHHOLD morning insulin; take insulin immediately post procedure; DIABETICS must be PRIORITY patient in schedule |
| What is EXTRAVASATION? | leakage of medication or contrast from vein rupture or inadvertent introduction to tissue outside vein |
| What is INFILTRATION? | diffusion of medication or contrast further into adjacent tissues (more than EXTRAVASATION) |
| What is procedure if extravasation occurs? | remove needle and apply pressure with hot/cold compress to prevent formation of hematoma; elevate limb |
| What is the difference between SIDE effect and TOXIC effect? | Side effects are effects produced by a drug that are mild, common, unintended and nontoxic TOXIC effects (adverse effects) are effects produced by a drug that are severe or life threatening; require ANTIDOTE |
| What is an ALLERGY? | an abnormal, acquired immune response to a substance that would not normally trigger a reaction; normally requires an initial exposure (sensitization); subsequent exposures result in INFLAMMATORY response |
| What is ANAPHYLAXIS? | life threatening allergic reaction that can result from food, insect venom, meds, anesthetics, latex resulting from ingestion, injection or absorption of sensitizing agent |
| Name mild reactions to contrast. B p541/Torres p307/Saia p39-41 | - anxiety - lightheadedness - syncope - flushed appearance or pallor - shaking - nausea, vomiting - metallic taste - nasal congestion; - mild urticaria |
| Name severe reactions to contrast. | - respiratory failure; - shock; - death |
| Name side effects of contrast. | metallic taste; warm, flushed sensation during injection; |
| What are the three classifications of reactions to contrast media? | Prophylactic - (FLUSHING, HIVES, NAUSEA); Cardiovascular - (HYPOTENSION, TACHYCARDIA, CARDIAC ARREST); Psychogenic - (may be caused by patient ANXIETY) |
| Define OVERDOSE | Too much of a drug for the body to handle: may occur in infants or adults who have renal, cardiac, or hepatic failure |
| Define ANAPHYLACTIC REACTIONS | Flushing, hives, nausea |
| Define CARDIOVASCULAR REACTIONS | Hypotension, tachycardia, cardiac arrest |
| Define PSYCHOGENIC FACTORS | May be caused by patient anxiety or suggested by possible reactions described during informed consent process. |
| What are complications that may arise at injection site? | Extravasation causing local irritation; Phlebitis in vein |
Created by:
Larobbins
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