Healthcare Examination Procedures Quiz

Hypoglycemia

• Hypoglycemia occurs when the blood sugar or glucose level drops.
• It's also known as low blood sugar or low blood glucose.
• This is common in people with diabetes, especially Type 1.
• TYPE 1 DIABETES occurs when the body doesn't produce insulin.
• TYPE 2 DIABETES occurs when the body can't use insulin properly.

Seizures

• Seizures are caused by various diseases, trauma, genetics, structural abnormalities, or tumors in the brain.
• Seizures can last for several minutes.
• During a seizure, remove objects that could harm the patient and loosen tight clothing.
• Do not put your hand in the patient's mouth.
• Turn the patient's head to the side.
• Gently restrain the patient to prevent injury.
• PETIT MAL seizures are characterized by a brief loss of consciousness (10-30 seconds), and eye or muscle fluttering.
• GRAND MAL seizures are characterized by a loss of consciousness, falling, and generalized muscle spasms.

Anesthesia

• General anesthesia makes a patient unconscious and unaware of sensations.
• Regional anesthesia numbs a body area to prevent pain during surgery.
• Anesthesiologist or RNA injects local anesthesia near the nerves that provide sensation to the area undergoing surgery.
• Two common types are spinal and epidural anesthesia, and nerve blocks are another type.
• Sedation (sometimes called "monitored anesthesia care") causes the patient to feel drowsy and relaxed, and they can respond to questions.
• Deep sedation uses Propofol and places the patient in a state of sleep and they can breathe without assistance.
• Local anesthesia numbs a small area, offering pain relief for procedures such as dental work.

Terminology with Anesthesia

• Anesthesia is the loss of sensation with/without loss of consciousness in all or part of the body.
• Analgesia is the absence of pain.
• Amnesia is the loss of memory.
• Paralysis is a loss of muscle function.
• Sedation is decreased consciousness.
• Unconsciousness is loss of consciousness.

Assessment of Changing Patient Conditions

• Visual observation of the patient.
• Changes in skin color (cyanotic or pale).
• Patient verbalizations of discomfort or dizziness.
• Cyanosis of lips or nail beds.
• Patient is cool and diaphoretic (sweating) to the touch.
• Vital signs monitoring equipment used including ECG, blood pressure monitor, and pulse oximeter.

Shock

• Shock is a critical medical emergency.
• This occurs due to insufficient blood (oxygen) flow to vital organs.
• Symptoms and signs of shock include low blood pressure, rapid pulse, rapid breathing, lack of body temperature control, flushed skin, clammy skin, gray or bluish tinge to lips/fingernails, nausea or vomiting, enlarged pupils, weakness, dizziness, fainting, or changes in mental status or behavior (anxiety or agitation).
• Three types of shock include Hypovolemic, Cardiogenic, and Distributive.
• Distributive shock has three subtypes: Neurogenic, Septic, and Anaphylactic.

Radiographer's response to shock

• Stop the procedure immediately.
• Place the patient in a Trendelenburg position or elevate their legs above their heart.
• Obtain immediate help or activate a code.
• Determine the patient's blood pressure.
• Administer oxygen.
• Accurately document the time and any actions taken.

Crash Cart

• Contains procedural supplies, oral airway supplies, venipuncture supplies, emergency medications, intravenous fluids, and pediatric intubation supplies.

Crash Cart Items

• Backboard, stethoscope, blood pressure cuff, ambu bag, laryngoscope, flashlight, batteries, extension cord, oxygen flow meter, tourniquet, airways, and more.
• Includes endotracheal tubes, nasopharyngeal tubes, suction catheters, Levine tubing, Jelco cannulas, tracheal tubes, cut-down trays, suction bottles, hemostats, scissors, sterile gloves, various sizes of syringes, needles, and a checklist.

Crash Cart - Common Medications

• A list of common medications, with their corresponding clinical indications.

GI System or Urinary System - Patient Preparation

• Low-fiber or clear liquid diet.
• NPO (nothing by mouth) for 8-12 hours.
• Cathartics and enemas to cleanse the GI system.
• Patients should be asked to explain the procedure.
• Remove clothing covering the area of interest.
• Remove all radiopaque objects from the area of interest.

History and Patient Care Preceding Injection of Iodinated Contrast Media

• Determining history of allergies or previous hypersensitivity to contrast media.
• Reviewing patient's medical problems and medications.
• Determining the presence of possible contraindications to the contrast medium being used.
• Verifying pertinent laboratory values, including blood urea nitrogen (BUN), creatinine, and glomerular filtration rate (GFR).
• Verifying appropriate dosage related to patient weight and age.
• Locating all emergency equipment.
• Obtaining informed consent.
• Carefully observing the patient (skin colour, voice pitch, and presence of apprehension or anxiety)

Contrast Media - Negative

• Creates a higher density on the image.
• Air is the most commonly used negative contrast agent.
• Others include carbon dioxide and nitrogen.
• Chest x-rays are a common x-ray using a negative contrast.
• Organs become radiolucent.
• Produces optimal density on the images.
• Air can be used with positive contrasts for a double-contrast study.

Contrast Media - Positive

• Positive contrast agents include barium or iodinated contrast.
• Barium sulfate has an atomic number of 56 and iodine has an atomic number of 53.
• Provides a lower density of the final image.
• Increases contrast between different structures.

Barium Sulfate (BASO4)

• Inert salt, colloidal suspension
• Used orally and rectally for upper GI series and esophagograms
• Most palatable when mixed with cold water
• Barium enema bags are mixed with approximately 100°F water (body temperature).

Iodine

• Iodine has an atomic number of 53.
• Water-soluble contrast
• Introduced orally, urinary, IV, rectally.
• Used in perforations, pre/post-surgery.
• Non-ionic compounds containing 3 iodine atoms (opacifying agents)
• Will not form into separate ions, therefore less chance of reaction.

Contrast Media - lonic vs Non-ionic

• Contraindications to use of iodinated contrast media include previous sensitivity to contrast agents, known sensitivity to iodine, asthma, hay fever, and shellfish allergies.
• Both ionic and nonionic contrast agents are iodinated; however, the amounts can differ.

Important points about IV Iodinated contrast

• Age and weight affect the amount administered.
• Previous urinary system surgeries affect the amount administered.
• Diabetes status
• Hydration status
• Kidney function should be considered based on blood work.
• Previous contrast studies and allergies should be considered.

Most Common Drugs Administered for Reaction to Iodine

• Benadryl (diphenhydramine hydrochloride, antihistamine)
• Epinephrine (adrenalin, vasoconstrictor and bronchodilator)
• Prednisone (steroid, given prophylactically).

Osmolality

• Measurement of dissolved particles per unit of water in serum.
• Higher osmolarity = more water in the blood system (hypertonic).
• Lower osmolarity = less water in the system (hypotonic).
• Isotonic is a normal range (275-295 mOsm/kg).

Viscosity

• Increased viscosity is thicker and more difficult to inject, causing more heat due to friction.
• Viscosity increases as room temperature decreases.

Toxicity

• Greater osmolality, especially with ionic contrasts.

Miscibility

• Contrast agents should be ready-to-mix with blood.

Contraindications for Barium in GI tract

• Do not use barium if perforation is suspected.
• Use water-soluble iodinated contrast media (e.g., gastrografin or gastroview) for GI tract procedures.

Aftercare Instructions for Barium Studies

• Barium can become thickened (inspissation) due to water absorption, leading to constipating symptoms.
• Encourage the patient to drink plenty of fluids.
• Adhere to the doctor’s protocol.

Scheduling of Multiple Exams

• Prioritise sonography, endoscopy, and CT procedures without contrast.
• Next, schedule antegrade urinary tract exams (e.g., IVU) because of quick excretion.
• Schedule imaging of the biliary system (e.g., gallbladder studies) after urinary tract exams.
• Barium Sulfate studies should be scheduled last.
• Consider scheduling UGI and small bowel follow-through based on the individual's condition and other scheduled procedures.
• Consider the specific ordering of examinations based on whether there is any need to be aware of a period of time that can adequately be used to allow a person to recover before being exposed to another part of a procedure.

Patient Preparation

• Low-residue diet/low-fiber or clear liquid diet
• NPO (nothing by mouth) for 8 to 12 hours
• Use cathartics and enemas to cleanse the GI tract, if needed.

Standard Precautions

• Blood, body fluids, secretions, excretions, and mucous membranes should be considered potential sources of infection.
• Wear gloves when touching a body fluid or exposure is likely.
• Use protective gowns and aprons when necessary.
• Masks and eye protection for splashes or splashes of body substance.
• Discard contaminated articles in labeled biohazard containers.

Standard PPE

• The right PPE equipment for the body area exposed to the potential hazard.
• PPE items listed include eye protection (safety glasses, goggles), ear protection (earplugs, muffs), face protection (shield), hand protection (gloves), foot protection (shoe coverings), torso/body protection (fluid-resistant gowns, splash suits), and respiratory protection (N95 respirator, surgical mask).

Transient Microbes

• Exist on skin surfaces
• These are considered temporary.

Resident Microbes

• Consist of bacteria which live deep within the skin.

The Microbial World

• The world of infectious agents is broken down into four main parts.
• Bacteria, Viruses, Fungi, Protozoan Parasites.

Cycle of Infection

• All factors are involved in the spread of disease including an Infectious Agent, Susceptible Host, Portal of Entry, Mode of Transportation, Reservoir, Portal of Exit.

Mode of Transmission

• Exogenous- Transmission outside of the body.
• Endogenous- Transmission inside of the body.
• Vehicle- The pathogen is transported by a medium (e.g., blood, saliva, food, water, contaminated equipment).
• Fomite- A non-living object carrying an infection.
• Vector - A living organism transmitting a disease (e.g., flies, mosquitoes).

Isolation Techniques

• Three sets of guidelines for isolation techniques, Contact, Droplet, Airborne.
• Airborne transmission droplets remain in the air for a long time, potentially travelling to another person.

Patients with Neutropenia

• Neutropenia is decreased white blood cell count.
• Usually due to treatments like chemotherapy or an immune system suppression.
• Radiographers should follow strict protocols to prevent further infection in neutropenic patients.
• These guidelines may include wearing PPEs and rigorous handwashing.
• Some hospitals may use Reverse Isolation or Protective Isolation protocols for patients with compromised immune systems.

Droplet Precautions

• Droplets expelled through coughing, sneezing, or talking can infect others.
• Droplets typically travel within 3 feet.
• Patients and healthcare workers should wear a surgical mask.

Contact Precautions

• Used in conjunction with standard precautions for infections spread through close contact.
• Includes infections spread through body fluids, including respiratory tract, eyes, nose, mouth sores, conjunctiva.
• Maintain the private room, clean equipment, and use "clean versus dirty" techniques.

Handwashing

• Cleaning hands thoroughly is a crucial component in infection control.
• Routine handwashing removes dirt and transient microorganisms.
• Hand antisepsis uses antimicrobial soap to destroy soil.
• Hand rub/degerming and surgical hand scrubs use antimicrobial solutions to kill microorganisms in a limited area or more comprehensively.

Medical Asepsis (Disinfection)

• Reduction in the number of harmful pathogens but doesn't eliminate them all.
• Soap and water, alcohol-based hand sanitizers, chemical disinfectants.

Surgical Asepsis (Sterilization)

• Kills all microorganisms, including spores, through various methods.
• Chemical, dry heat, boiling, autoclaving, and gas sterilization.

Handling and Disposal of Hazardous Waste

• Familiarisation with material safety data sheets (MSDS).
• Proper handling and disposal of potentially infectious or hazardous waste.
• Use of appropriate containers and labels, following CDC guidelines for standard precautions.

Equipment - Ventilator

• Forcing oxygen into the patient’s airway until they can breathe on their own or for long-term mechanical ventilation.

Equipment - Endotracheal tube

• Used for oxygen or anesthesia administration
• Proper placement ensures adequate air exchange

Equipment - Tracheostomy

• An artificial airway placed in the trachea to help oxygen reach the lungs

Equipment - Chest Tube

• Removes air or fluid from the pleural space, resolving pneumothorax or hemothorax.

Equipment - Thoracentesis

• Procedure to remove extra fluid from the pleural cavity.

Equipment - Nasogastric (NG) tubes

• Used for feeding, suction, and medication delivery for patients unable to swallow. Insertion verification through fluoroscopy or X-ray.

Equipment - Levin and Salem Sump Tubes

• Short-term feeding, suction, or decompression

Equipment - Placement of NG tubes - X-ray

• The use of an X-ray to ensure correct placement.

Equipment - Tube Feeding (Enteral Nutrition)

• Various tubes including Nasogastric (NG), Nasoduodenal (ND), and Nasojejunal (NJ) to feed patients unable to swallow.
• Gastrostomy (G-tube), Jejunostomy (J-tube), or Gastrostomy-Jejunostomy (GJ-tube) tubes are permanent placements for long-term feeding.

Equipment - Percutaneous Endoscopic Gastrostomy (PEG)

• Method to provide long-term access to the stomach for nutrition.
• The location is typically under the skin for easy access

Equipment - Urinary Catheters(Foley/Suprapubic)

• Allows for continuous drainage of urine.
• Placed in the bladder and connected to a drainage bag to maintain patency in the urethra.

Equipment - Foley Catheter

• A catheter that is placed through the urethra into the bladder for urine drainage.
• Usually temporary and uses a balloon for retention.

Equipment - Straight-Type Catheter

• Usually used one time and discarded.
• Intermittent catheterisation is needed for patients with paralysis or nerve problems that hinder bladder function.

Equipment - Suprapubic Catheter

• Placement of a catheter through an incision in the abdomen and introduced into the bladder for long-term urine drainage.
• Used in situations where a person cannot use a regular Foley catheter.

Equipment - Central Venous Line Catheters (CVC): Hickman, Cook, Groshong, Broviac, Portacath, PICC, and Vascath

• Used for long-term access for chemotherapy, dialysis, intravenous medications, and total parenteral nutrition (TPN).
• Have specialized features for long-term use.
• Important considerations to ensure appropriate placement for these catheters

Equipment - Total Parenteral Nutrition (TPN)

• Method to provide nutrients intravenously when patients cannot ingest food orally.

Equipment - Access Sites for CVC

• Placement site options and considerations for various central lines.

Tunneled Central Venous Catheters (CVC)

• Placement process, imaging confirmation for proper placement, and long-term use.

Tunneled Femoral Vein Catherization

• Femoral central vein catheter as a long-term use.

Subclavian Central Venous Line Groshong

• Tunneled central venous catheter using a three-way valve that opens outward in infusion and inward in blood aspiration to reduce the risk of clotting or blood reflux.

Non-Tunneled Central Venous Catheters (CVCs)

• Used for short-term access, particularly for emergency situations, requiring the placement via insertion in multiple areas in the body to access the superior vena cava.

Non-Tunneled Femoral Central Venous Catheters (CVC)

• Used when there is scar tissue or other reasons the usual placement sites are not suitable.

PICC Line

• Peripherally inserted central catheter, a long-term central venous access.

Ports

• Implanted central venous access port;
• Usually placed under the skin close to the large veins to avoid risk of infection.
• Accessible through a needle for fluids, medications, blood.
• Ports are generally useful for long-term care.

Swan-Ganz Catheter

• Catheterization for diagnostic information about the heart for critically ill patients

Greenfield Filter

• A filter placed in the inferior vena cava to trap blood clots before they can travel to the lungs.