Chapter 46,44,45,53,54 Para Test PDF

[[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-1**Radiologic Studies ========================== Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-1...

[[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-1**Radiologic Studies ========================== Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-1aSafety** --------------- **Figure 46--1** **Figure 46--2** **Quick Tips** ### **Practical Application** **Patient Education** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-1bX-Rays and Radiation Therapy** ------------------------------------- **Figure 46--3** **Figure 46--4** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-1cPreparing Patients for X-Rays** -------------------------------------- **Quick Tips** ### **Practical Application** **Figure 46--5** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-2**Radiologic Procedures ============================= Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-2aGallbladder Imaging** ---------------------------- **Figure 46--6** **Patient Education** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-2bUpper GI Series---Barium Swallow** ----------------------------------------- **Patient Education** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-2cLower GI Series---Barium Enema** --------------------------------------- **Table 46--1** ### **Preparation for Barium Enema (Prep may vary per facility)** -- -- -- -- **Figure 46--7** **Quick Tips** ### **Practical Application** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-2dIntravenous Pyelogram** ------------------------------ **Table 46--2** ### **Preparation for Intravenous Pyelogram (IVP) (Prep may vary per facility)** -- -- -- -- **Patient Education** **Patient Education** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-2eKub** ------------ **Figure 46--8** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-2fMammography** -------------------- **Figure 46--9** **Table 46--3** ### **Instructions for Mammography Preparation (Prep may vary per facility)** -- -- -- -- **Patient Education** - Schedule the mammography during the first week following the patient's menstrual cycle because the breasts must be compressed firmly during the procedure to obtain a satisfactory image for diagnostic purposes, and during this time, the patient would experience less discomfort. - Advise patients to omit caffeine from their diets for 7 to 10 days prior to this examination to reduce the possible effects of swelling and soreness that caffeine often produces. - After the procedure, some areas of the breasts might become temporarily discolored. However, it does not damage the breast tissue and should not be alarming. - At the advice of the provider, a mild analgesic may be taken to relieve any discomfort or aching the patient might experience. **Quick Tips** ### **Practical Application** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-2gCT Scans** ----------------- **Figure 46--10** **Figure 46--11** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-2hNuclear Medicine** ------------------------- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-2iSonographic Studies** ---------------------------- **Patient Education** ### **Preparation for Ultrasound Procedure (Prep may vary per facility)** -- -- -- -- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-3**Magnetic Resonance Imaging (MRI) ======================================== **Figure 46--12** **Figure 46--13** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-4**Positron Emission Tomography (PET) Scan =============================================== **Figure 46--14A** **Figure 46--14B** **Table 46--5** ### **Preparation for Pet Scan** -- -- -- -- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-1**Quality Control and Quality Assurance for Diagnostic Testing ==================================================================== 1. Date. 2. Patient's name. 3. Test performed. 4. Results of the test. 5. Your initials. 6. Any kit, reagent strip, or [**reagent**](javascript://) lot numbers and expiration dates. 7. Quality control results. Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-2**Hematology Testing ========================== - The red blood cells are filled with hemoglobin, making their primary function delivering oxygen to the cells and picking up carbon dioxide to be exhaled. - The chief function of the white blood cells is to protect the body against invaders such as bacteria and viruses. The granulocytes engulf bacteria and debris, as do the monocytes. The lymphocytes produce antibodies against specific antigens, usually viruses. - The platelets, with other clotting factors, stop bleeding when an injury occurs. - Total red blood cell count. - Total white blood cell count. - Total platelet count. - Hemoglobin. - Hematocrit. - Total granulocyte count. - Total lymphocyte and monocyte count. - Percentage of granulocytes. - Percentage of lymphocytes and monocytes. - Red blood cell indices. **Quick Tips** ### **Practical Application** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-2aHemoglobin** ------------------- **Figure 44--1A** **Figure 44--1B** **Procedure 44--1** ### **Determine Hemoglobin Using a Hemoglobinometer** ----------------------------- -- -- Charting Example Laboratory Log Book Example ----------------------------- -- -- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-2bHematocrit** ------------------- **Figure 44--2** **Figure 44--3** **Figure 44--4** **Procedure 44--2** ### **Determine Hematocrit (HCT) Using a Microhematocrit Centrifuge** +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | Charting Example | | | +-----------------------+-----------------------+-----------------------+ **Figure 44--5** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-2cComplete Blood Count** ----------------------------- - The normal total red blood cell count for an adult male is 4.5 to 6.0 million per millimeter. A decrease in the total number of red blood cells constitutes a type of anemia. - The normal total red blood cell count for an adult female is 4.0 to 5.5 million per millimeter. A decrease in the total number of red blood cells constitutes a type of anemia. - The normal total platelet count for males and females is 150,000 to 400,000 per millimeter. - The normal total white blood cell count for males and females is 4,500 to 11,000 per millimeter. When the WBC count is elevated, it indicates a disease process of some type, whether it is an infection or a precursor to leukemia. When the WBC is decreased, the patient could be immunocompromised due to HIV or AIDS infection or current cancer therapy in the form of chemotherapy or radiation treatments. When the WBC count is decreased, the patient is more prone to opportunistic infections because immunity is compromised. - The granulocyte ratio should be larger than the lymphocyte/monocyte ratio. The normal percentage range for granulocytes is 50 to 70 percent with the lymphocyte/monocyte percentage generally in the 20 to 40 percent range. Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-2dThe WBC Differential** ----------------------------- **Figure 44--6** **Table 44--1** ### **Categories of White Blood Cells and Their Functions** -- -- -- -- -- -- **Quick Tips** ### **Practical Application** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-2eErythrocyte Sedimentation Rate** --------------------------------------- - Acute infections. - Acute inflammatory processes. - Chronic infections. - Rheumatoid arthritis or autoimmune disorders. - Temporal arteritis and polymyalgia rheumatica. - Monitoring inflammatory and malignant diseases. **Figure 44--7** **Procedure 44--3** ### **Perform an Erythrocyte Sedimentation Rate (ESR)** ------------------ -- -- Charting Example ------------------ -- -- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-3**Glucose Testing ======================= **Figure 44--8** **Procedure 44--4** ### **Screen Blood Sugar (glucose) Level** +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | Charting Example | | | +-----------------------+-----------------------+-----------------------+ | Laboratory Log Book | | | | Example | | | +-----------------------+-----------------------+-----------------------+ Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-3aGlucose Tolerance Test** ------------------------------- **Figure 44--9** **Quick Tips** ### **Practical Application** **Quick Tips** ### **Practical Application** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-3bHemoglobin A1 C** ------------------------ **Figure 44--10** **Procedure 44--5** ### **Perform Hemoglobin A1C (Glycosylated Hemoglobin) Screening** -- -- -- -- -- -- Charting Example **Patient Education** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-4**Cholesterol Testing =========================== **Procedure 44--6** ### **Perform a Cholesterol Screening** +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | Charting Example | | | +-----------------------+-----------------------+-----------------------+ Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-5**Immunology ================== Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-5aMononucleosis Testing** ------------------------------ **Procedure 44--7** ### **Perform a Screening for Infectious Mononucleosis** --------------------- -- -- Charting Example Quality Control Log --------------------- -- -- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-5bAllergy Testing** ------------------------ - *Skin prick test*. The allergen (the substance to which the patient is suspected to be allergic) is applied directly to the patient's skin and scratched or pricked into the epidermis. The areas of application are observed for reaction from antibodies, usually as a reddening of the area with itching. - *Intradermal injections.* This test is more sensitive than the skin prick test. A small amount of the allergen is injected between the epidermis and dermis with an observation of the area for a reaction. Usually, reactions occur immediately, although patients can be instructed to return 24 to 72 hours later for delayed responses to the allergen. - *Skin patch test*. An allergen-soaked pad is placed on the surface of the skin for 24 to 72 hours to observe for a reaction. **Figure 44--11** ### **Scratch Test and Skin Prick Test** **Figure 44--12A** **Figure 44--12B** **Figure 44--12C** ### **Intradermal Test** **Figure 44--13** **Figure 44--14** **Patient Education** 1. Urge patients to follow the allergy serum desensitizing schedule closely to help build up immunity to the substance to which they are allergic. 2. Advise them to avoid what they are allergic to if at all possible. 3. Instruct patients to read all labels carefully (household products, clothing, consumable products, etc.) to identify possible allergens. 4. Urge them to develop and practice good health habits such as following a sensible, well-balanced diet; proper rest; and exercise. They should also be encouraged to wash their hands frequently with soap and warm water for 20 seconds (approximately the length of time it takes to sing the Happy Birthday song at a traditional pace) and teach their families to do so. 5. Advise them to take only prescribed medication and to avoid OTC medications unless advised by the provider. 6. If patients have a known severe reaction to a particular substance, remind them to carry their EpiPen kit with them at all times. ### **Patch Test** ### **Rast Testing** ### **Nasal Smear** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-5cTesting for HIV** ------------------------ Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-6**PKU Testing =================== **Figure 44--15A** **Figure 44--15B** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-7**Testing Outside the Pol =============================== **Figure 44--16** **Table 44--2** ### **Normal Values of Commonly Performed Laboratory Tests and Their Indications** -- -- -- -- -- -- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **45-1**Electrocardiography =========================== Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **45-1aElectrical Impulses of the Heart** ----------------------------------------- **Figure 45--1** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **45-1bReasons for Performing an Ecg** -------------------------------------- **Figure 45--2** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **45-1cElectrocardiograph Equipment and Supplies** -------------------------------------------------- ### **Electrocardiograph Machines** **Figure 45--3A--C** (A), (B) Courtesy of Spacelabs Medical, Inc. **Figure 45--4** Courtesy of Spacelabs Medical, Inc. Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **45-1dElectrocardiograph Paper** --------------------------------- **Quick Tips** ### **Practical Application** **Figure 45--5A--B** ### **Electrocardiograph Leads** **Figure 45--6** Courtesy of Spacelabs Medical, Inc. **Figure 45--7** **Figure 45--8** **Table 45--1** ### **Anatomical Positioning of the Chest or Precordial Leads** -- -- -- -- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **45-1ePerforming the ECG** --------------------------- ### **Preparing the Patient** ### **Standardization** **Figure 45--9** **Figure 45--10** **Procedure 45--1** ### **Perform Electrocardiography** +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | **Figure 45--11A--D** | | | | | | | | \(A) A male patient | | | | with electrodes | | | | placed properly for | | | | a standard 12-lead | | | | ECG. (B) Lead wires | | | | attached to the | | | | patient's legs. (C) | | | | A female patient | | | | with electrodes | | | | placed properly for | | | | a standard 12-lead | | | | ECG. (D) When | | | | placing electrodes | | | | for a standard | | | | 12-lead ECG on a | | | | female with a | | | | larger breast, | | | | elevate the breast | | | | using the back of | | | | the hand. | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ Charting Example **Patient Education** 1. Remind them to eat a low-fat, low-cholesterol diet and keep their salt and sodium intake at a minimum. 2. Advise them to get proper rest, perform provider-approved exercise, and keep their weight at an acceptable level. 3. Instruct cardiac patients to take their prescribed medication regularly and immediately to report to the provider any problems they might experience. Remind them not to take OTC medications without the permission of the provider. 4. Remind them to keep their scheduled appointments and make a list of questions for the provider to review with them at that time. 5. Urge them not to use tobacco and to avoid alcoholic beverages. 6. Advise them to practice stress-reducing behaviors. ### **Artifacts** **Figure 45--12A--D** Courtesy Quinton Cardiology, Inc. ### **Cardiac Arrhythmias** **Figure 45--13A--B** - *Pacemaker arrhythmias:* Pacemaker spikes or pacer spikes show up as vertical signals that represent the electrical activity of the pacemaker. Usually these spikes are more visible in unipolar than in bipolar pacing. Interpreting paced rhythms may not always be simple, and the biggest obstacle to interpreting pace rhythms is identifying the paced beats. Modern pacemakers provide low-voltage spikes on the ECG that may go unnoticed. Once pacemaker activity is identified, the next step is to determine if the activity is a normal or abnormal function ([[Figure 45--14A]](javascript://)). **Figure 45--14A** - *Premature atrial contractions (PACs):* Can be seen in healthy individuals and people who smoke or use stimulants such as caffeine. Can indicate a serious cardiac problem. On the ECG, they are indicated by a cardiac cycle that occurs before the next cycle is due, with the P waves shaped differently than on a normal ECG ([[Figure 45--14B]](javascript://)). **Figure 45--14B** - *Paroxysmal atrial tachycardia (PAT):* Can be seen in both healthy individuals and in those with cardiac disease. It is an episode during which the heart rate ranges from 160 to 250 BPM and lasts momentarily. Patients often describe it as a flutter in the heart ([[Figure 45--14C]](javascript://)). **Figure 45--14C** - *Atrial fibrillation (A-Fib):* Although relatively rare in healthy individuals, it still can be seen in both healthy individuals and those with cardiac disease. It causes rapid multiple electrical signals that fire from areas in the atria other than the SA node. The heart rate can range from 400 to 500 BPM. Some causes are myocardial infarction, hypertension, mitral valve diseases, heart failure, thyroid disorders, pulmonary emboli, and excessive alcohol consumption. On the ECG, it looks like small, irregular complexes that are hard to interpret because the P waves can't be identified ([[Figure 45--14D]](javascript://)). **Figure 45--14D** - *Premature ventricular contractions (PVCs):* Can be seen in healthy individuals who use tobacco and other stimulants as well as in patients with hypertension, coronary artery disease, and lung disease. Other causes include myocardial infarction, electrolyte imbalances, lack of oxygen, and certain medications. They are indicated on the ECG by a beat that occurs early in the cycle and is followed by a pause before the next cycle occurs ([[Figure 45--14E]](javascript://)). **Figure 45--14E** - *Ventricular tachycardia:* This is seen in patients with cardiac disease. It often occurs when a patient is having a myocardial infarction. This is a life-threatening condition. On the ECG, it is identified by three or more PVCs occurring at a rate of 150 to 250 BPM. There are no P waves, and the QRS complexes are imprecise ([[Figure 45--14F]](javascript://)). **Figure 45--14F** - *Ventricular fibrillation (V-Fib):* This is seen in patients with cardiac disease or those who are experiencing a myocardial infarction. The ventricles appear to tremor, and there is no cardiac output. Some providers refer to this jagged rhythm as a sawtooth rhythm. This is a life-threatening condition that appears on the ECG as an erratic, jagged rhythm ([[Figure 45--14G]](javascript://)). **Figure 45--14G** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **45-2**Holter Monitor ====================== **Figure 45--15** **Procedure 45--2** ### **Holter Monitoring** +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | **Figure 45--16** | | | | | | | | Correct placement of | | | | the Holter monitor on | | | | a patient. | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | Charting Example | | | +-----------------------+-----------------------+-----------------------+ Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **45-3**Stress Tests ==================== - Reaches a target heart rate. - Develops chest pain or a change in blood pressure that is concerning. - Seems not to be getting enough oxygen to the heart muscle, as indicated by changes on the ECG. - Is too tired or has other symptoms, such as leg pain, that keep them from continuing. **Figure 45--17** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **45-4**Echocardiography ======================== Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **45-5**Other Cardiovascular Equipment ====================================== **Figure 45--18** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **53-1**Emergencies in the Medical Office ========================================= - A patient receives a medication or injection and has a severe reaction. - Someone is injured just outside the office and comes in for immediate treatment. - A patient brings in a very ill or injured family member. Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **53-1aOffice Policy Manual and Documentation** ----------------------------------------------- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **53-1bEmergency Supplies and Equipment** ----------------------------------------- **Figure 53--1A** **Figure 53--1B** - Gloves - Alcohol wipes - Stethoscope - Blood pressure cuff - Penlight - Aromatic spirits of [**ammonia**](javascript://) - Oxygen tank with flow meter and wrench for opening the tank - Tubing, nasal cannula, and pediatric and adult masks - Ambu bag - Resuscitation masks in a variety of sizes - Airways of differing sizes (nasal and oral) - Bandage material (sterile dressings) - Adhesive tape - Bandage scissors - Disposable syringes - Tourniquets - IV supplies: tubing and needles (butterflies and angiocaths) and fluids, including D5W, NS, D10W, and lactated Ringer's - Medications for emergency use **Table 53--1** ### **Medications Commonly Stocked on Crash Cart** +-----------------------------------+-----------------------------------+ | - Activated charcoal | - Lidocaine | +-----------------------------------+-----------------------------------+ | - Atropine | - Local anesthetics | +-----------------------------------+-----------------------------------+ | - Diphenhydramine | - Nitroglycerine | +-----------------------------------+-----------------------------------+ | - Epinephrine | - Phenobarbital and diazepam | +-----------------------------------+-----------------------------------+ | - Furosemide | - Sodium bicarbonate | +-----------------------------------+-----------------------------------+ | - Instant glucose | - Solu-Cortef | +-----------------------------------+-----------------------------------+ | - Insulin | - Verapamil | +-----------------------------------+-----------------------------------+ Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **53-2**Recognizing and Responding to an Emergency ================================================== - Cardiac arrest - Respiratory arrest or great difficulty breathing - Uncontrolled severe bleeding - Head injury - Poisoning - Open chest or abdominal wound - Shock - Significant burns **Figure 53--2** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **53-2aActivating EMS** ----------------------- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **53-2bTelephone Screening in an Emergency** -------------------------------------------- - The victim's name - The caller's name and phone number in case the connection is lost - When did the problem start? - Is the victim conscious and breathing; does the victim have a pulse? - The nature of the situation - The location of the victim **Quick Tips** ### **Practical Application** - Reassure the caller that EMS is on the way. - Give appropriate specific instructions in relation to the situation, such as: - Try to stay calm and support the caller until EMS arrives and you are assured the victim is being cared for. - Document in the patient's medical record or EHR all the information obtained and discussed. Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **53-2cDocumenting Emergencies** -------------------------------- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **53-3**Common Emergencies in the Medical Office ================================================ - [**Chronic**](javascript://)---long, drawn out, not acute. Some diseases have a slow chronic phase but can quickly change into an acute episode. - [**Subtle**](javascript://)---hidden, not apparent, treacherous. Often, disease conditions have a slow, hidden beginning and then quickly develop symptoms. - [**Urgent**](javascript://)---a situation requiring intervention as soon as can be arranged. This term may be applied to the need for care when experiencing a blocked ureter by a kidney stone. - [**Sudden**](javascript://)---occurring quickly and without warning. Onset of headaches or allergies can be sudden. - [**Acute**](javascript://)---having a rapid onset, severe symptoms, and short course. Heart attacks are an example of acute illnesses. - [**Severe**](javascript://)---extensive, advanced. When injuries are severe, it usually implies multiple sites and requires considerable medical attention. The term is also applied to an illness that requires aggressive action and is potentially irreversible. - [**Life threatening**](javascript://)---can cause death. Extensive trauma and massive circulatory or respiratory involvement that might be beyond medical intervention are deemed life threatening. Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **53-3aHyperglycemia and Hypoglycemia** --------------------------------------- **Table 53--2** ### **Causes, Symptoms, and First Aid of Diabetic Ketoacidosis and Insulin Shock** -- -- -- -- -- -- **Procedure 53--1** ### **Perform First Aid Procedures for Diabetic Coma or Insulin Shock** -- -- -- -- -- -- Charting Example Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **53-3bFainting** ----------------- **Figure 53--3** **Procedure 53--2** ### **Perform First Aid Procedures for Syncope (Fainting Episode)** -- -- -- -- -- -- Charting Example Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **53-3cHeart Attack** --------------------- - Shortness of breath - Burning sensation in the chest (often dismissed as heartburn) - Nausea and vomiting and other flulike symptoms - Unexplained fatigue or weakness - Pain in the jaw, neck, shoulder, back, or ear - Overwhelming sense of doom **Figure 53--4A** **Figure 53--4B** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **53-3dHeat Exposure** ---------------------- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **53-3eCold Exposure** ---------------------- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **53-3fHemorrhage** ------------------- **Figure 53--5** **Figure 53--6** **Procedure 53--3** ### **Perform First Aid Procedures for Bleeding** -- -- -- -- -- -- Charting Example Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **53-3gPoisoning** ------------------ Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **53-3hSeizures (Convulsions)** ------------------------------- **Procedure 53--4** ### **Perform First Aid Procedures for Seizures** -- -- -- -- -- -- Charting Example Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **53-3iAccidental, Allergic, and Drug-Induced Distress** -------------------------------------------------------- - A patient suffering from severe edema of the vocal cords as a result of an allergic reaction to food or stings of bees or wasps must be hospitalized as quickly as possible. - The victim of a drowning must receive rescue breathing immediately. This can be given before the patient is taken from the water if there is help to support the patient while resuscitation is given. A person surviving drowning needs to be hospitalized for follow-up observation. - Poisoning by toxic gases, such as carbon monoxide, or suffocation can also require immediate rescue breathing. - A person having an asthma attack might have great difficulty breathing. The provider must determine the treatment needed, but you can be helpful by attempting to calm the patient. Emotional upset often starts an asthma attack. - Some medications can cause a slowing or [**cessation**](javascript://) of breathing. - Electric shock can cause respiratory paralysis. The victim must be moved away from the source of the electricity by indirect means (never touch the victim) and then be given rescue breathing and CPR if necessary. Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **53-3jShock** -------------- **Procedure 53--5** ### **Perform First Aid Procedures for Shock** -- -- -- -- -- -- Charting Example Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **53-3kStroke** --------------- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **53-3lObstructed Airway** -------------------------- **Figure 53--7** **Quick Tips** ### **Practical Application** **Figure 53--8A** **Figure 53--8B** **Figure 53--9** **Quick Tips** ### **Practical Application** **Procedure 53--6** ### **Perform an Abdominal Thrust on an Adult Victim with an Obstructed Airway** -- -- -- -- -- -- Charting Example ### **Special Considerations for Infants** 1. Place the baby facedown on your forearm, which is extended on your thigh ([[Figure 53--10]](javascript://)). You might also kneel or sit with the infant on your lap to do this. 2. The head should be lower than the body and supported by your hand. 3. With the heel of your other hand, deliver five backslaps, forcefully, in the middle of the back between the infant's shoulder blades. 4. If this is unsuccessful, turn the infant face up; support the head and neck. Keep the head lower than the trunk. 5. Place two fingers on the midsternal area just below the nipple line. 6. Give five quick downward chest thrusts; deliver chest thrusts at a rate of about one per second ([[Figure 53--11]](javascript://)). 7. Continue with five back blows and five chest thrusts until the object is dislodged or the infant becomes unconscious. 8. If unsuccessful, call out for help to notify EMS. 9. If no help arrives, give the infant CPR for one minute and then call 911 yourself. 10. Continue CPR until assistance arrives. **Figure 53--10** **Figure 53--11** - Even if the procedure is successful and infant seems fine, check with the provider for further instructions. - If you can *see* the object, try to remove it with your finger. - *Do not* try to grasp the object and pull it out if the infant is conscious. - *Do not* perform the procedure on an infant who stops breathing for other reasons, such as asthma, swelling in the throat, head injury, or an infectious process. Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **53-4**CPR and AED Procedures ============================== - AHA: [[www.heart.org]](http://www.heart.org/) - American Red Cross: [[www.redcross.org]](http://www.redcross.org/) - Health & Safety Institute: [[www.hsi.org]](http://www.hsi.org/) - National Safety Council: [[www.nsc.org]](http://www.nsc.org/) **Figure 53--12** **Procedure 53--7** ### **Produce Up-to-Date Documentation of Provider/Professional-Level CPR** -- -- -- -- -- -- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **53-4aResponding to Cardiac Arrest** ------------------------------------- 1. Recognition of early warning signs 2. Activation of the EMS system 3. Basic CPR 4. Early defibrillation with AED 5. Intubation 6. Intravenous administration of medications Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **53-4bPrinciples of CPR** -------------------------- - Begin chest compressions to restore blood [**circulation**](javascript://). Brain damage or death can occur if blood circulation stops. - Clear the [**airway**](javascript://). - Initiate rescue [**breathing**](javascript://) to provide oxygen to the victim's lungs. A variety of devices are available, from the simple CPR mouth barriers and pocket masks to CPR ventilating masks and Ambu bag and masks. **Table 53--3** ### **Summary of Key BLS Components for Adults, Children, and Infants** -- -- -- -- -- -- -- -- **Quick Tips** ### **Practical Application** ### **CPR for Children and Infants** - When assessing the infant's consciousness, flick the bottom of the foot. - Using a resuscitation mouthpiece, cover the infant's mouth and nose. - Observe the infant's chest for evidence of effective breaths. - Use the brachial artery in the arm to check for a return of the pulse ([[Figure 53--13]](javascript://)). **Figure 53--13** ### **CPR Safety** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **53-4cAED Procedure** ---------------------- - Analyze the heart rhythm of a person in fibrillation or arrest. - Recognize a shockable rhythm. - Advise the operator through lights, text, and voice prompts if shock is indicated. - With built-in diagnostic capability, permit lifesaving intervention without the operator needing to evaluate the situation or interpret an ECG. - Turn on the power. - Attach the electrode pads of the AED to the victim's chest (must be against dry bare skin and might require cutting or shaving of hair; usually, a disposable razor is with the equipment). Adult pads may be used on victims over eight years old. - Analyze the heart rhythm. Some machines respond automatically; others require a button to be pushed. Stop CPR. It is critical for no one to touch the victim while the rhythm is being analyzed. - Charge the AED if so advised by the AED message; some charge automatically. - Advise everyone to stay clear, and then push the shock button if the AED so indicates. Some AED systems have been designed to deliver both adult and child shock doses. You must follow the AED instructions to select the lower (child) shock doses for children ages one to eight. - If the victim responds, leave the electrodes in place in case of rearrest. If no response, repeat the analysis and shock sequence. - Continue efforts until emergency medical services arrive. - For children one to eight years of age, be sure to change the child key or switch and use the child pads. If this is not available, you may use the adult pads and dose. - For infants under the age of one, there is not enough evidence to recommend for or against the use of an AED. - The victim must not be in water; drag the victim from the area before using. - If the victim has an implanted pacemaker or defibrillator, place the electrode at least one inch to the side. - Remove and wipe dry any area covered with a transdermal patch that interferes with electrode placement. Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **53-4dDocumenting CPR and AED Procedures** ------------------------------------------- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **53-5**Emergency Preparedness and Evacuation ============================================= - Hearing-impaired patients in the waiting room. - Sight-impaired patient with an escort in an exam room. - Personnel working in the laboratory. - Wheelchair-bound patient in an exam room. **Figure 53--14** **Table 53--4** ### **Emergency Evacuation Planning** -- -- -- -- **Quick Tips** ### **Practical Application** **Procedure 53--8** ### **Develop Safety Plans for Emergency Preparedness** -- -- -- -- -- -- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **53-5aEmergency Phone Numbers** -------------------------------- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **54-1**Accidents and Injuries ============================== Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **54-1aForeign Bodies** ----------------------- **Figure 54--1** **Quick Tips** ### **Practical Application** **Figure 54--2** **Figure 54--3** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **54-1bStrains and Sprains** ---------------------------- **Figure 54--4** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **54-1cDislocations** --------------------- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **54-1dFractures** ------------------ **Figure 54--5** **Table 54--1** ### **Types of Fractures** -- -- -- -- **Procedure 54--1** ### **Perform First Aid Procedures for Fractures** -- -- -- -- -- -- Charting Example Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **54-2**Bites and Stings ======================== Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **54-2aAnimal Bites** --------------------- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **54-2bHuman Bites** -------------------- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **54-2cStings** --------------- **Figure 54--6** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **54-3**Burns ============= Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **54-3aTypes of Burns** ----------------------- - [***Thermal***](javascript://)---Caused by residential fires; automobile accidents; playing with matches; accidents with gasoline, space heaters, or firecrackers; scalding water from the stove or tub; and coming in contact with curling irons, stoves, or clothing irons. Some childhood burns, such as from cigarettes, can be traced to deliberate abuse. Sunburn occurs from overexposure to the sun. - ***Chemical***---From contact with, ingestion, inhalation, or injection of acids or alkalines. - [***Electrical***](javascript://)---Occur after contact with faulty electrical wiring, a child chewing on an electrical cord, or from downed high-voltage power lines. Although rare, an electrical burn can also come from a lightning strike. Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **54-3bClassification of Burns** -------------------------------- **Figure 54--7A** **Figure 54--7B** **Figure 54--8** **Figure 54--9A** **Figure 54--9B** **Figure 54--9C** - A *minor* burn has less than 2 percent of BSA at the third-degree level and burns on less than 15 percent for adults and 10 percent for children at the second-degree level. - A *moderate* burn is when third-degree burns cover 2 to 10 percent of BSA; second-degree burns cover from 15 to 25 percent on adults or over 10 percent on children. - A *major* burn is when a third-degree burn covers more than 10 percent of BSA or second-degree burns cover more than 25 percent in adults or 20 percent in children; burns of the hands, feet, or genitalia are also major burns; burns that are complicated by fractures, affect poor-risk patients, or are electrical are also major burns. Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **54-3cTreatment of Burns** --------------------------- **Quick Tips** ### **Practical Application** ### **Treating Electrical and Chemical Burns** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **54-4**Wounds ============== **Figure 54--10** **Figure 54--11** **Figure 54--12** **Figure 54--13** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **54-4aCleaning Wounds** ------------------------ **Procedure 54--2** ### **Perform Wound Care** -- -- -- -- -- -- **Figure 54--14** Apply sterile gauze and bandage into place. Charting Example Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **54-4bBandaging Wounds** ------------------------- ### **Tube Gauze Bandage** **Figure 54--15A** **Figure 54--15B** **Figure 54--15C** **Procedure 54--3** ### **Apply a Tube Gauze Bandage** +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | a. cutting the | | | | excess bandage | | | | from the finger | | | | and wrapping the | | | | end of the | | | | bandage | | | | diagonally across | | | | the back of the | | | | hand to the | | | | wrist. | | | | | | | | b. circling the | | | | wrist once or | | | | twice. | | | | | | | | c. tying off or | | | | taping it at the | | | | wrist or taping | | | | it in place. | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ Charting Example ### **Spiral Bandage** **Procedure 54--4** ### **Apply a Spiral Bandage** -- -- -- -- -- -- **Figure 54--16A--G** Application of a spiral bandage. Charting Example Courtesy of Harris CareTracker PM and EMR. ### **Figure-Eight Bandage** **Figure 54--17** **Procedure 54--5** ### **Apply a Figure-Eight Bandage** -- -- -- -- -- -- Charting Example ### **Cravat Bandage** **Figure 54--18** **Procedure 54--6** ### **Apply a Cravat Bandage to Forehead, Ear, or Eyes** -- -- -- -- -- -- **Figure 54--19** Applying a cravat bandage to the head. Charting Example Courtesy of Harris CareTracker PM and EMR. Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **54-5**Applying Heat and Cold Treatments ========================================= **Figure 54--20** Change font size [**[help]**](javascript://) ### **MOST DIFFICULT / COMPLEX QUESTIONS** 1. **What is a dosimeter, and what are the differences between OSL and TLD types?** a. **Answer:** A **dosimeter** is a device used to measure radiation exposure. The **OSL dosimeter (Optically Stimulated Luminescence)** measures radiation exposure by emitting light when optically stimulated, and is sensitive to very low doses. The **TLD dosimeter (Thermoluminescent Dosimeter)** uses special crystals that emit light when heated after being exposed to radiation, providing a more accurate measurement, but at a higher cost. 2. **Why is radiation particularly dangerous during the first trimester of pregnancy, and what safety protocols should be followed?** b. **Answer:** During the first trimester, the fetus is in a critical stage of development, and radiation exposure can cause developmental defects or malformations. Pregnant women must inform their providers, and radiological procedures should be avoided unless absolutely necessary, with protective measures like lead shielding used to minimize exposure. 3. **Compare the preparation requirements for a barium swallow (Upper GI series) and a barium enema (Lower GI series).** c. **Answer:** The **barium swallow (Upper GI series)** requires the patient to fast from midnight before the test and consume a light meal before the procedure. The patient ingests a barium mixture during the exam. In contrast, the **barium enema (Lower GI series)** requires a liquid diet the day before, along with laxatives and possibly an enema to clear the intestines before the procedure. ### **MODERATE DIFFICULTY POINTS** 4. **What is the difference between a CT Scan and an MRI?** a. **Answer:** A **CT scan** uses radiation to create cross-sectional images of the body, useful for examining bones and dense tissues. An **MRI** uses a magnetic field and radio waves to create detailed images of soft tissues without radiation, making it ideal for evaluating the brain, muscles, and joints. 5. **What are the preparation instructions for a PET scan?** b. **Answer:** The patient must follow a low-carbohydrate diet for 24 hours before the exam, avoid eating for 4-6 hours prior, and refrain from consuming sugary liquids. They should also report any allergies to contrast dyes or medications they are taking. 6. **Explain the process and importance of a Complete Blood Count (CBC) and what values are reviewed.** c. **Answer:** The **CBC** measures various blood components, including red blood cells, white blood cells, and platelets, and is critical for diagnosing anemia, infections, and coagulation issues. The **normal red blood cell count** for males is 4.5-6 million/mm³ and for females, 4-5.5 million/mm³. The **normal white blood cell count** is 4,500-11,000/mm³. ### **EASIER POINTS / SIMPLE QUESTIONS** 7. **What is a KUB, and what does it assess?** a. **Answer:** **KUB (Kidneys, Ureters, Bladder)** is an abdominal X-ray used to diagnose urinary system disorders and locate foreign objects in the digestive tract. 8. **Why should deodorants be avoided before a mammogram?** b. **Answer:** Deodorants can contain metallic particles or substances that interfere with mammogram images, making it harder to detect issues in the breast tissue. 9. **How is a capillary blood sample obtained for a glucose test?** c. **Answer:** A sterile lancet is used to make a small puncture in the skin, typically on the fingertip, and a drop of blood is placed on a glucose test strip to measure blood sugar levels. 10. **What is the ideal cholesterol range in blood?** - **Answer:** The ideal total cholesterol level is between **180-200 mg/dL**. A level above 200 mg/dL may indicate hyperlipidemia, which increases the risk of heart disease. ### **STUDY TIPS:** - **Practice procedures**: Make sure you understand and can explain the steps for tests like **microhematocrit**, **glucose testing**, and others. - **Memorize normal ranges** for values like **hemoglobin**, **red blood cells**, **white blood cells**, and **cholesterol**, as these are often asked directly in exams. - **Compare and contrast**: Be prepared to explain the differences between similar tests or imaging methods (e.g., **CT vs. MRI**, **high vs. low contrast** in radiology studies).