Week 6: Chapter 22 Peds, Chapter 23 Geriatrics

Introduction to Pediatric Imaging

• Radiographers must develop multitasking skills when working with pediatric patients
• Multitasking skills include engaging the patient, gaining parent trust, utilizing immobilization techniques, and active communication

Waiting Room Environment

• A warm and inviting waiting room environment is beneficial for pediatric patients
• A waiting room should provide distractions for children to ease anxiety and boredom

Specific Pediatric Considerations

• Safety is paramount in pediatric radiography
• Communication with both the child and their parents is essential
• Respect for patient and parent rights and dignity is important
• Providing adequate care and service to the patient and family is a priority

Pediatric Safety

• Never leave a pediatric patient unattended
• Keep small items that could be swallowed out of reach

Pediatric Radiography Communications

• Introduce yourself, making eye contact with the patient and parents
• Explain the role of the radiography team
• Use language appropriate for the child's developmental level
• Explain the exam to the child and their parents
• Take a history as required, and discuss pertinent medical information at a level the family understands
• Avoid medical jargon and unfamiliar terms, explaining in lay terms if necessary
• Be mindful of conversations in front of the patient
• Ask if there are any questions or concerns before beginning the exam
• Use family teaching sheets when applicable, such as web-based outlines of hospital procedures

Respecting Patient/Parent Rights and Dignity

• Listen to the patient's and parent's questions and concerns
• If patients/parents speak English as a second language and have difficulty understanding, provide an interpreter
• Be mindful of cultural preferences and taboos
• Always knock before entering, and avoid entering during an exam

Adequate Care and Service for Pediatric Patients

• Create a child-friendly environment
• Use appropriately sized equipment
• Remember that parents know their child best, and seek their advice
• Utilize a child life specialist (CLS) for cooperation
• If not contraindicated, use a soft pad with a sheet on the exam table
• Place the patient on the exam table when ready to proceed

Age-Based Development in Pediatric Patients

• Premature infants have unique needs
• Neonates are 0 to 28 days old
• Infants are 28 days to 18 months old
• Toddlers are 18 months to 3 years old
• Preschoolers are 3 to 5 years old
• School-age children are 6 to 12 years old
• Adolescents are 12 to 18 years old

Premature Infants

• Elevate room temperature 10-15 minutes before arrival
• A nursing team usually accompanies the infant
• Explain the procedure and how the nursing team can help
• Leave in incubator/warmer until just before the procedure
• A radiolucent cushion can be used on the exam table
• Create a patient immobilization plan for the patient's condition with nursing input
• Have warming lights available, wash hands, apply gloves, and adhere to all isolation precautions

Neonates

• Maintain swaddling for security and comfort until the exam
• Decrease noise levels and dim bright lights
• Maintain a warm room, use warming lights unless contraindicated
• Speak soothingly and avoid sudden quick movements
• Communicate procedures to caregivers
• Involve caregivers in soothing and calming the infant
• Pacifiers, oral sucrose (check with nursing), blankets, and soft singing are helpful in soothing the newborn.

Infants

• Consult with caregivers to understand soothing techniques and what distresses the infant
• Separation and stranger anxiety occur at different ages
• Use a radiolucent table pad
• Avoid flexing the head forward, as it causes respiratory distress

Toddlers

• Potential obstacles include the inability to keep still, short attention spans, getting overwhelmed quickly, and being fearful
• Tips include allowing a toy or soothing object during the exam
• Distraction techniques are useful
• Offer sincere praise and positive statements

Preschoolers

• Potential obstacles include fear of the unknown or unfamiliar and separation anxiety versus need for independence
• To improve cooperation, establish rapport
• Provide time to familiarize the child with the environment and equipment
• Use directive statements and positive affirmation

School-Age Children

• Positive affirmations and reassurances are beneficial
• Satisfy natural curiosity with age-appropriate explanations
• Break down the exam into steps, explaining what to expect
• Avoid unfamiliar medical jargon to decrease confusion and improve coping
• Be very literal and avoid words that could be misconstrued
• Giving realistic choices provides a sense of control and entitlement, enhancing coping
• Provide coping and distraction techniques like deep breaths, blowing bubbles, listening to music, watching a movie, or playing on a tablet

Adolescents

• Respect their need for privacy by providing private changing rooms, knocking before entering, limiting personnel, and respecting gender preferences of caregivers if possible
• Communicate directly with the patient and be sensitive to potentially embarrassing questions
• Validate and reassure their emotional response to the exam
• Provide explanations and rationale for the procedure
• Use calming techniques, like deep breathing and listening to music

Patients with Special Needs

• Special needs can include physical disabilities, mental disabilities, and autism spectrum disorders
• Caregivers are knowledgeable about the patient's needs
• Consultation and preparation before the exam is useful

Radiation Protection for Pediatric Patients

• Pediatric effects from radiation differ from those in adults
• Shielding should be used
• Dose reduction techniques should be employed
• Communication of the risk and benefit of the exam should be discussed with parents
• Radiographers should not hold patients for exams unless absolutely necessary

Artifacts in Pediatric Imaging

• The dynamic range of digital radiography increases the number and type of artifacts seen
• The ratio of artifact size and body volume is greater in pediatric patients than in adults

Common Pediatric Positions and Projections

• Imaging studies include those of the abdomen, gastrointestinal system, genitourinary system, appendicular skeleton, chest, pelvis, hips, skeletal survey, skull, paranasal sinuses, soft tissue neck, and foreign body imaging

Selected Pediatric Conditions and Syndromes

• Cystic fibrosis affects multiple systems
• Developmental dysplasia of the hip requires specialized imaging
• Nonaccidental trauma is a critical consideration
• Osteogenesis imperfecta presents unique imaging challenges
• Pathological fractures can occur
• Both benign and malignant neoplasms are imaged
• Pneumonia is a common respiratory condition
• Progeria is a rare genetic condition
• Scoliosis assessment involves specific projections

Advances in Technology for Pediatric Imaging

• EOS system allows for low-dose, full-body imaging
• MRI provides detailed soft tissue imaging
• Ultrasound is useful for many pediatric applications
• CT scanning provides detailed anatomical information
• Interventional radiology offers minimally invasive procedures

Geriatrics

• Geriatrics is the branch of medicine focused on the aged population and their specific health problems
• Geriatric patients are generally defined as individuals older than age 65
• This population is continually increasing
• Because procedures on this population are increasing, it is important for radiographers to understand geriatrics for successful procedures and patient care

Gerontology

• Gerontology is a specialized field dedicated to the study of aging
• It includes illness prevention, illness management, health maintenance, and quality of life

Demographic and Social Effects of Aging

• Gender, race, ethnicity, and social class affects the quality of the aging experience
• Culture and values also affect how aging and the treatment of elderly individuals are perceived
• Economic status varies and influences health and well-being
• Single and minority elders have income at or below poverty level, which may impact their willingness to spend money on healthcare
• Elder abuse is a growing worldwide trend, and injuries are not always evidence of abuse

Forms of Elder Abuse

• Physical abuse involves inflicting physical pain or injury
• Sexual abuse involves nonconsensual sexual contact
• Neglect is the failure to provide food, shelter, health care, or protection
• Exploitation involves illegal taking, misuse, or concealment of funds, property, or assets of a senior
• Emotional abuse involves inflicting mental pain, anguish, or distress through verbal or nonverbal acts
• Abandonment is the desertion of a vulnerable elder by someone responsible for their care
• Self-neglect involves the failure to perform essential self-care tasks, threatening health or safety

Warning Signs of Elder Abuse

• Bruises, pressure marks, broken bones, abrasions, and burns may indicate physical abuse, neglect, or mistreatment
• Sudden withdrawal from normal activities, changes in alertness, and unusual depression may indicate emotional abuse
• Bruises around the breasts or genital area may point to sexual abuse
• Sudden changes in financial situations may indicate exploitation
• Bedsores, unattended medical needs, poor hygiene, and weight loss may suggest possible neglect
• Belittling, threats, and other controlling behavior by a caregiver could indicate verbal or emotional abuse
• Strained relationships and frequent arguments between caregiver and elderly person can be a sign of abuse

Ageism

• Ageism is stereotyping and discrimination against elderly persons, similar to racism and sexism
• Healthcare provider attitudes affect the quality of care for elderly patients
• Negative attitudes towards older patients exist among health professionals
• Quality of elderly care improves with appreciation, positive attitudes, and education about the elderly

Effects of Aging

• Aging has physical, cognitive, and psychosocial effects

Physical Effects of Aging

• Common health complaints of the elderly include weight gain, fatigue, loss of bone mass, joint stiffness, and loneliness
• Exercise is important for reducing the first four on that list
• Balance, coordination, strength, and reaction time all decrease with age
• Sight, hearing, taste, and smell can decline with age
• Help patients by providing one instruction at a time, limiting background noise, and speaking clearly and directly to the patient
• Not all elderly patients are hard of hearing, so voice volume must be adjusted

Cognitive Effects of Aging

• Cognitive decline is caused by disease, aging, and disuse
• Fears of cognitive loss, especially Alzheimer's disease, are common
• Dementia is a progressive cognitive impairment that interferes with daily function
• Alzheimer's disease is the most common form

Psychosocial Effects of Aging

• A positive attitude is key to healthy aging
• One in five persons older than age 65 may show signs of clinical depression
• Successful aging is linked to greater contact, health satisfaction, low vulnerable personality traits, and fewer stressful life events
• Factors like illness, medical emergencies, fixed income, few choices in personal living arrangements, and changing roles increase the risk of depression
• Recognize that each elderly person is unique and deserves respect

Top 10 Chronic Conditions of Patients 65+

• Arthritis
• Hypertension
• Hearing impairment
• Heart disease
• Cataracts
• Deformity or orthopedic impairment
• Chronic sinusitis
• Diabetes
• Visual impairment
• Varicose veins

Physiology of Aging

• Health depends on the degree to which organ systems work together

Aging of Organ Systems

• Integumentary, nervous, and sensory system disorders occur
• Musculoskeletal and cardiovascular system disorders are frequent
• GI system disorders and issues with immune system decline are common
• Disorders include respiratory and hematologic systems
• Also genitourinary and endocrine systems

Integumentary System Disorders

• The integumentary system is the first to show the apparent signs of aging
• Common skin diseases include herpes zoster, malignant tumors, and decubitus ulcers
• Skin membranes flatten and become vulnerable to abrasions and blisters
• Skin becomes wrinkled and thinner
• Gradual loss of function in sweat glands and skin receptors increase the risk of heat stroke
• A decrease in fat pad on feet increases foot conditions
• Graying, thinning, and loss of hair occur
• Exposure to sunlight has major effects on the skin
• Common skin tumors include basal cell carcinoma, malignant melanoma, and squamous cell carcinoma

Nervous System Disorders

• Nervous system disorders include one of the most common causes of disability
• It is affected by the degree of atherosclerosis
• Blood flow to the brain affects tissue damage, slowing motor and sensory tasks which lead to an increased risk of falls
• Cerebral infarcts lead to dementia

Sensory System Disorders

• Presbyopia is age-related farsightedness
• Cataracts are also common
• Distorted color perception can occur
• Decreased ability to adapt to light changes can occur
• Hearing impairment is common
• Presbycusis is gradual, progressive hearing loss of tone discrimination and is more common in men
• A decline in sensitivity to taste and smell can occur
• A decreased number of taste buds, decreased saliva, and dry mouth cause taste loss
• Hyposmia is loss of smell, and accounts for decreased appetite and irregular eating habits

Musculoskeletal System Disorders

• Musculoskeletal dysfunction is a major cause of disability
• Osteoporosis is a reduction in bone mass and density
• Osteoporosis is four times more common in women
• Osteoporosis increases the risk of fractures and kyphosis
• Degenerative joint disease or osteoarthritis also occur
• Chronic deterioration of joint cartilage develops and obesity is a key risk factor
• Osteoarthritis is the second most common cause of disability in the United States
• Symptoms of osteoarthritis include pain, swelling, and a decreased range of motion in the joint

Cardiovascular System Disorders

• Damage to this system affects the entire body because it supplies blood to every live tissue
• Cardiovascular disease is the most common cause of death worldwide
• Loss of arterial elasticity increases systolic blood pressure, increasing the risk for heart disease and stroke
• Postural hypotension is a fall in blood pressure when rising from supine to standing position
• Atherosclerosis is fatty plaques in arterial walls, which is the predominant change in blood vessels and increases the risk of aneurysm, increasing blood clot formation
• Complications include embolism, heart attack, and stroke
• Congestive heart failure is the inability of the heart to propel blood at sufficient rate and volume
• Preventive measures include blood pressure control, a healthful diet, exercise, and not smoking

Gastrointestinal System Disorders

• Malignancies include colorectal cancer, which is second to lung cancer as a cause of cancer-related mortality
• Early detection methods are very effective and increase survival rates
• Other disorders include peptic ulcer disease, bleeding, and pancreatitis Furthermore:
• Gallstone disease and Hepatitis can cause discomfot
• Dehydration and difficulty swallowing affect multiple patients
• Healthful lifestyle habits decrease risk of GI problems

Immune System Decline

• The immune system decline increases vulnerability to diabetes mellitus, pneumonia, and nosocomial infections
• There are three general categories of illnesses that preferentially afflict the elderly
  • Infections
  • Cancer
  • Autoimmune disease

Respiratory System Disorders

• Lungs lose elasticity, decreasing oxygen-carbon dioxide exchange
• Breathing muscles and the rib cage stiffen, increasing shortness of breath
• Diseases that increase in frequency with aging include emphysema, chronic bronchitis, and pneumonia
• Lung cancer is the most common cancer-related death in men and women

Hematologic System Disorders

• Anemia is of primary concern
• Symptoms of anemia include pale skin, shortness of breath, and fatigue
• Anemia can be caused by insufficient dietary intake
• Other causes are inflammation or destruction of the GI lining, leading to an inability to absorb vitamin B12

Genitourinary System Disorders

• Incontinence is commonly seen
• Changes in capacity and muscular control cause Incontinence
• Incontinence can lead to hygiene and social concerns
• The number of nephrons in kidneys decreases
• A normal dose of medicine can cause an overdose in the elderly
• Acute and chronic renal failure are common
• Benign prostatic hyperplasia (BPH) is frequent in men older than age 70 and causes enlargement of the prostate gland that obstructs urine flow
• Prostate cancer is the third most common cancer in males
• More than 80% of tumors are found after age 65

Endocrine System Disorders

• Diabetes mellitus is the most common age-related endocrine system disease
• Non-insulin-dependent type increases in frequency with age
• Regular exercise and weight loss can reduce risk and delay onset

Patient Care of Elderly: Quick Tips

• Take time to educate patient and family
• Education decreases the patient stress and anxiety and increase patient compliance and satisfaction
• Speak lower and closer to communicate
• Reduce background noise
• Communicate with warmth, empathy, and a positive attitude when treating patients with respect and dignity
• Provide rest time between projections and procedures to reduce vertigo and fear of falling
• Avoid using adhesive tape because it easily damages skin
• Use table pads and hand rails to make the patients more comfortable and compliant
• Provide blankets, sponges, and other positioning aides because they will increase comfort and reduce the risk of injury that is pressure-related
• Carefully check patient history prior to the administration of contrast
• Reduce adverse reactions such as dehydration induced kidney failure
• Assess for difficulty swallowing
• Administer drinking liquids in the upright position to reduce the risk of aspiration

Joint Commission Criteria for Geriatric Patients

• Age-specific competency for all health care professionals is required
• Including the following criteria to care for geriatric patients -Visual or hearing impairments -Digestive and esophageal problems -Grief concerns -Provisions of warmth
• Safety aids
• They also needed age-specific communication skills as well as knowledge of age-related changes and disease

Radiographer's Role

• It is imperative you adapt the procedures to accommodate the disability or disease of the patient
• You must have understanding of the physiology and pathology of aging
• You must have awareness of social, psychological, cognitive, and economic factors of aging

Radiographic Positioning for Geriatric Patients

• Chest: When doing chest radiographs, wrap the patient's arms for support
• Spine: Use a sponge to reduce movement and keep the patient straight
• Hip or/ and Pelvis: Do not rotate the limb until fracture is ruled out when doing radiographs of hip and pelvis
• As well as: -The patient should remain on the stretchier in the wheelchair as much as possible when doing any of the radiographs

Correct Exposure Factors:

     -Exposure times should be short to prevent movement of patient