Basic Patient Care in Radiography PDF

Metal items such as necklaces, rings, and watches are not to be warn for Objectives certain radiologic examinations 1. list three safety measures that must be A large envelope can...

Metal items such as necklaces, rings, and watches are not to be warn for Objectives certain radiologic examinations 1. list three safety measures that must be A large envelope can be given to the taken when transferring a patient from a patient to keep such valuables. hospital war to the radiography The envelope can be kept in the department an returning him to the patient’s purse or pocket, or a secure ward. place in the department. 2. List three situations in the radiography A written record of the items should be department that might result in damage kept. to the patient’s skin, and explain how to The RT must not value patient’s prevent them. belongings. An item that may seen 3. Demonstrate the correct method of insignificant to the RT may be the moving a patient who is wearing a patient’s most treasured belonging. plaster cast. 4. List four signs of circulatory impairment 2. Correct Body postures in moving & that the RT must recognize in a patient transferring patients who is wearing a plaster cast.  The rules of correct body mechanics 5. Demonstrate the correct manner of should be followed when moving & assisting a patient with a bedpan or lifting patients to avoid injury to oneself urinal. and to the patient.  Safe body mechanics require good 1. Dressing / undressing the patient for posture. Radiography  The body should be in alignment with all  When a patient comes to the radiology parts in balance. Good posture permits department from outside the hospital, the musculoskeletal system to work at he is frequently required to remove all maximal efficiency with a minimal or some items of clothing before a amount of strain on joints, tendons, radiographic examination can be ligaments, and muscles. It also helps performed. other body systems to work efficiently.  The RT is usually be the person who receives the patient an informs him Rules for correct upright posture which items of clothing are to be  The chest is held up and slightly forward removed. with the waist extended - (This helps  The patient’s discomfort or the lungs to expand properly and fill to embarrassment can be lessened if the capacity. RT will approach this situation in a  The head is held erect with the chin held courteous an professional manner. in. -(This puts the spine in proper  The patient should be taken to the alignment) specific place (dressing/changing  Stand with the feet parallel and at right room/cubicle) where he is expected to angles to the lower legs. Feet 4 - 8 disrobe. inches apart. Boy weight equally  The RT should show how to close the distributed on both feet. door or raw the curtain of the dressing  Keep the knees slightly bent. - They act room/cubicle. as a ‘shock absorber ‘ for the body.  He should clearly explain how the  keep the buttocks in and the abdomen patient is to where the examination up and in. – This prevents strain on the gown and where to go afterwards. back and abdominal muscles. (some gowns open at the back)  The patient should be supplied with Correct procedures to follow when moving and hangers for his clothing. lifting patients.  The patient should be informed where  Keep the heaviest part close to your to leave his clothing. body.  Purses, jewelry, and other valuables  When the object is too heavy get should be treated with special care. assistance.  The force of friction opposes movement. Care of valuables Take action to reduce friction. Dressing rooms are not safe places to o Friction can be reduced by leave the valuables. reducing the surface area to be RT should consider the patient’s moved, or employing some of concerns and explain what must be the patients own strength to done with them. assist with the movement.  o Keep the patients arms across  Are his motions restricted any way? - the chest to reduce surface area. mobility of the patient. o Pulling rather than pushing  Will he become fatigued and be unable reduces the friction. to complete the transfer without o A pull sheet placed under the assistance? – strength and endurance patient will also work to reduce  Can he sit or stand for as long a period the friction. as is required? – ability to maintain balance Do s and Don’ts  Is he responsive and alert? – ability to understand  Does he fear or resent the move? – acceptance of the move. Important rules regarding moving or transferring patients 1. Give only the assistance that the patient needs for comfort and safety. 2. Always transfer across a shorter distance 3. Lock all wheels on gurneys (beds), trolleys, and wheelchairs. 4. It is better to move a patient towards his strong side while somebody assists at his weak side. 5. Patient should wear shoes for standing transfers, but slippery bedroom slippers should not be worn. 6. Inform the patient about the plan of the move, and encourage his help. Moving & transferring patients 7. Give simple short commands, and help  Before trying to transfer or move a him to carry them out. patient the RT must assess the patient’s ability to aid in the process. Methods of patient transfer o By gurney (special patient bed) Assessing the patients mobility o By trolley  Identify any abnormalities in the o By wheelchair patient’s body alignment. o By walking (ambulation)  If there are any abnormalities, 1. Moving a patient from trolley to x-ray table determine the reasons for the problem. or vice versa (reverse)  It may be resulted from, i. Using a pull sheet o poor posture ii. Three carrier lift o trauma o muscle damage or dysfunction of i. Using a pull sheet the nervous system 1. Obtain a heavy sheet (Bed sheet folded) o malnutrition 2. Get the assistance from another person o fatigue 3. Turn the patient onto one side and o emotional disturbances. move him to the distal side of the trolley.  Support the affected limbs or body parts 4. Place the sheet on the trolley and roll with pillows, support blocks, or one half of it as close to the patient as sandbags possible.  Assess the mobility of the patient and 5. Turn the patient across the sheet roll the limitations of joint motions. and straighten the sheet on the distal  Assess the patient’s ability to walk(his side. gait) 6. Return the patient to supine position.  Note the conditions of respiratory, 7. Cross the patient’s arms across the chest cardiovascular disease, endocrine 8. Three or four people may be required to disease etc. complete the move; one should support the head, two on either side, one may Final judgement support the legs.  How well or how poorly is the patient 9. In unison all of them raise the patient functioning? – general condition of the with the sheet and transfer from the patient. trolley to the table or vice versa Placing the sheet  Step 1 Step 2 Step 3 Moving the patient Log roll (to turn an injured patient to a lateral  Care must be taken if the two surfaces position) are not at the same level, to avoid injury 1. Place a pillow and support block at the to the patient. The friction can be side to which the patient is going to be minimized by using sliding boards turned. 2. Place a pillow between knees to support the legs when turned to side. 3. Two people will stand on either side of the bed, one at the head 4. The sheet is brought up over the patient and grasped by two persons at leg end 5. One at the head support the head and neck without allowing the neck to bend Cart Transfer or head to rotate. A. Place cart near and parallel to the x-ray 6. Other two must support the body table, and lock wheels 7. In unison, the team rolls the patient to B. Do not attempt patient transfer from the desire side as if he were a log cart to x-ray table without assistance keeping his head, neck and torso C. One person supports the neck and immobile during the move. shoulders at the head of the cart; the 8. the head should rest in lateral position second person lifts the pelvis and knees; on the support block and pillow if available, other individuals support patient at both sides Log roll method to turn a patient witout D. Transfer sheet or draw sheet should be bending his neck and spine used under patient; a slide board should be used when available E. On signal, all persons involved in transfer move patient in one fluid motion to the x-ray table ii. Three carrier lift method 1. Keep the trolley perpendicular to the table 2. Moving a patient from x-ray table to the 2. Slide the patient to the inner side of the wheelchair trolley 1. First it is necessary to turn the patient from 3. Three persons go to the side close to the supine position to a sitting position , to do that patient  Stand in front of the table 4. One stands to support the head and  Keep one arm under the patient’s neck, one at the buttocks and the other shoulders and the other across his knees at the legs and ankles  Instruct the patient to push himself up 5. Cross the patient’s arms across the chest with the support of his upper arm if 6. All three lifters place their arms under possible, when he is asked to do so. the patient- the region of the body Then on the count of three, move the which they are going to lift patient or help him to move to a sitting position 7. At the signal, the movers roll the patient at the edge of the table with the knees flexed. off the table and on to theirs chests. 2. Keep the wheel chair parallel to the table and 8. All three pivot and placed the patient on lock the wheels to the surface to which he is being 3. Then stand in front of the patient transferred. 4. Place the patient’s arms across your shoulders 5. Put your knees around the patients knees C. Explain the transfer procedure to the 6. Help the patient stand and pivot, and thus patient to gain cooperation and alleviate lower onto the wheel chair. (bending your fear knees and keeping your back straight) D. The radiographer must always use proper body mechanics for patient Transfer from X-Ray Table to Wheelchair transfer A. Check to see that brakes of wheelchair 1. Keep knees slightly bent have been applied 2. Keep back straight B. Assist patient to a sitting position 3. Use legs, not back, to perform all lifting C. Allow patient to sit up for a short time Transfer from Wheelchair to X-Ray Table to regain sense of balance A. Wheelchair is parallel to table D. Ambulatory patient B. Brakes are applied with step stool 1. Assist to a standing position and pivot nearby 2. Have patient reach back with both C. Using face-to-face method, assist the hands and grab arms of wheelchair patient to a standing position 3. Assist patient to sit in the wheelchair D. Have patient place one hand on step E. Nonambulatory patients stool handle, place the other hand on 1. Stand facing the patient your shoulder, and step up onto the 2. Reach around patient and place your stool hands on each scapula E. Patient pivots with back against the 3. Lift patient upward to a standing table into a sitting position on the edge position with your knees bent of the table 4. Pivot so that the back of the patient’s F. Place one arm around patient’s shoulder leg is touching the edge of the and the other arm under the knees wheelchair; ensure the wheels on the G. Assist patient to a supine position wheelchair are locked 5. Ease patient down to a sitting position From wheel chair to table with your knees bent 6. Position foot and leg rests into place 7. Cover patient’s lap with a sheet 1 2 3 Moving a patient 3. Care of severely ill patients from Wheel chair to on trolleys and wheel chairs at table. the radiology/radiotherapy  Get help from department. another  The patient must be covered with a person sheet as much as possible.  Put one of  A confused, disoriented or unconscious your shoulder patient or child must never be left alone, under the on a radiographic table or trolley. armpit (one person on either side of the  Patient who is unstable in suiting patient) position should not be left alone on a  Put the other arm around the pathent’s wheelchair back  Take special care when changing dress  Raise together of patients with Intravenous canulas &  Turn around to turn your back to the drips table and keep the patient sitting on the  Pay attention to patients with various table drainage tubes (urinary catheters, IC tubes, Colostomy tubes etc.) Patient Transfer A. Check identification bracelet to ensure Patient Comfort that correct patient is being transferred A. Taking into account the patient’s B. Ask patient to state his or her name to physical condition, carefully position double-check identity; ask date of birth pillows or radiolucent sponges so that as a backup  they do not interfere with the Semi-Fowler’s position examination  Head is raised B. Evaluate patient’s condition from a 15-to 1. Ability to breathe 30 degree 2. Presence of nausea angle. 3. Allow patient to remain partially upright  Arms must be when possible supported to 4. Special care must be given to older prevent pull patients, who may have decubitus ulcers on shoulders. or particularly sensitive or thin skin  Feet must be supported to prevent planter flexion or foot drop. Keep the pt well covered and secured  This position helps reduce respiratory distress. Sims’ position  Patient lies on left or right side. Lowe arm forward an flexed. 4. Protective positions of patients – if required  Upper arm to be kept for a long time extended behind the body.  Top knee bent sharply and the bottom Supine position knee slightly bent.  Patient flat on the back. Pillow may be placed Trendelenburg position - under the  The table or be is inclined with the patient’s head to tilt it head forward.  is lower than the rest of the body.  Feet should be supported to 4. Skin Care prevent  Skin breakdown can occur in a brief planter flexion. period of time (1-2 hours) and result in a decubitus ulcer. Protective side-lying (Semi-prone) position  Mechanical factors that may result in  Patient lies skin breakdown are: on either side o Immobility with a pillow o Pressure for support o Shearing force under the o Friction head and neck. Causes of decubitus ulcers  The upper 1. Immobilizing a patient in one position arm and the for an extended period of time creates leg supported pressure on the skin bearing the on pillows patient’s weight. This results and restricts capillary blood flow and tissue Protective prone position necrosis.  Patient Lies on 2. Moving a patient to or from one surface face down. A to another without adequately small pillow protecting the skin may damage to supports the external skin or the underlying tissues, head. resulting tissue necrosis.  Patient should 3. The movement of the patient back & be moved down forth on a rough or uneven surface such so that the feet as wrinkled bed sheet can cause friction drop over the edge , or a pillow may be and skin breakdown. placed under the ankles. 4. Allowing a patient to lie on a damp Fowler’s position sheet can also lead to skin damage.  Patient semi-sits with his head raise 5. Urine or fecal matter allowed to remain from 45-60 degree angle on the skin acts as irritant an is damaging to the skin. The areas most susceptible to decubitus ulcers o Scapulae o Sacrum o Trochantors o Knees o Heels  (The chance of occurance of Decubitus ulcers can be minimized by changing the position of the patient every two hours). 5. Care of patients with wet casts (green cast)  A fresh (wet) cast still contains water and can accidentally be compressed.  The compression on a cast may produce pressure on the patient’s skin which will result in formation of a decubitus ulcers under the cast.  A cast that becomes too tight may cause circulatory impairment or compression of a nurve How to take take care not to apply pressure on the cast?  Slide the hands with open fingers and flattened under the cast  Avoid grasping it with fingers.  Support the cast at the joints when moving it  Move the casted extremity as a whole unit.