Module B - Week 1_2 Review PDF

**[Handwashing ]** - Hand hygiene is one of the most important measures for preventing the spread of bacteria in healthcare settings. - Hospital-acquired *(nosocomial)* infections are most frequently spread from one patient to another *at the hands of healthcare workers.* -...

**[Handwashing ]** - Hand hygiene is one of the most important measures for preventing the spread of bacteria in healthcare settings. - Hospital-acquired *(nosocomial)* infections are most frequently spread from one patient to another *at the hands of healthcare workers.* - In 34 studies of handwashing, workers washed their hands only 40% of the time. - Methicillin-Resistant S. Aureus (MRSA) & Vancomycin-Resistant Enterococci (VRE) - Resistant bacteria -- carried by patients in their underarms, groins & hand/wrists - Alcohol-based hand rubs are more effective than regular soap and hand washing - Use when your hands are not visibly soiled or contaminated with blood/body fluids - You should use soap and water when: your hands are visibly soiled, visibly contaminated with blood/body fluids, before you eat, after using the bathroom **[Body Mechanics Safety & Pt. Transfer (Chapter 7)]** Duties and Responsibilities of the Radiographer - Safe transfers (from bed to stretcher, stretcher to table, and wheelchair to table) - Patient Assistance with bed pans or urinals, going to the restroom, changing into a gown - Radiation protection - Taking care of yourself to reduce injuries and maintain a professional manner. Patient belongings: direct the pt to the correct dressing area, give dressing instructions to pt, lockers for clothing and personal items such as jewelry, wallets, purses etc. Body Mechanics - **Ergonomics** -- study of the human body in relation to the working environment. - **The most common injuries are to the musculoskeletal**: Back, neck, wrist (U/S), & Shoulders. These can be reduced with proper lifting assistance and equipment Principals of proper body alignment, movement, and balance. 1. Base of support -- portion of the body in contact with the floor 2. Center of gravity 0- the point around which body weight is balanced (hip/pelvis level) 3. Line of gravity -- imaginary vertical line passing through the center of gravity **[Patient Transfer (Chapter 8)]** Wheeled transport for ALL inpatients - Wheelchair -- for those who can stand & sit in safety & comfort - Stretcher -- for those who cannot stand or have not stood/walked since an accident (esp. spinal injuries), surgery, stroke, or heart attack - Bed transfers **Before you move a patient:** Always introduce yourself, identify pt by using 2 identifiers (ID Bracelet and verbal response to name and DOB/ compare to X-ray req), explain to the pt what you need to accomplish & how you intend to do that, **assess** pt and determine has much assistance the pt will need. **Assessment Consideration:** -general condition -- range of motion & weight bearing ability -- strength & endurance -- balance -- ability to understand -- patient acceptance of the move -- medication history (hx) **Orthostatic Hypotension** -- mild reduction of O2 supply to the brain from rapid change to body position. Causes light-headedness or fainting. Wheelchair Transfers - **Assess patient ability** -- strong/weak side - **Chair position relative to the table** -- 45-degree or parallel - **Lower table or have footstool ready** - **Lock wheels** - **Move the footrests of the wheelchair** - **Give verbal directions to the patient** Stretcher-to-table moves 1. Lock stretch in position next to the table 2. Determine the amount of asst pt. needs 3. Be sure draw sheet in place or "smooth mover" available 4. Log roll pt. onto transfer device 5. Pts. Arms crossed over chest 6. One person directs, at the count of three ( usually at pts head) 7. Move pt. in 2 stages. Pt Transfers - **Never move a patient without enough assistance to prevent injury to yourself and the patient.** - **Never move a patient without assessing the patient's ability to assist.** - **When returning a patient back to his/her room**: - Stop at nurse's station, return chart, and inform RN or staff that pt. has returned. - Return patient to the room, help the pt. into bed, make them comfortable, and place bed closest to the floor, with side rails up. - Give pt the call button in case pt. needs assistance. - Always return the patient/ pts. Room back to the original position that you found them to ensure maximum comfort. Why Immobilize? 1. Patient safety 2. Reduce repeat exposures due to motion 3. Increase positioning accuracy - The need for immobilization is reduced by good communication between tech and pt. - Always ask permission of the patient before applying any restraints, if immobilization is in the best interest of the pt. Immobilization tools - Sponges (radiolucent / infection control) - Sandbags - Velcro straps/tape - Backboards - "Brat" boards - Pigg-O-Stat - Sheets Urinals & Bedpans - Don't ignore pts. Requests & expect them to wait to use the bathroom. I - Determining the amount of assistance needed: if they can use the restroom, help them and stay near the door. Show the emergency call button./ 2 types of bedpans -- standard & fracture, urinals. **Ambulatory -- Pt can walk** **Palpation -- When touching pts. 1-2 Fingers only** **Geriatric / Pediatric / Neonate -- 65 and up; related to infants, children & adolescents \>21yrs old / a newborn infant \>28 days old** **Immobilization -- limiting movement** **Restraint -- using a manual hold to restrict movement** **Rapport / Empathy -- creating a good relationship & communication w/ the pt; the ability to understand and share the feelings of another** **[Professional Attitudes & Communication (Chapter 6)]** Maslow Hierarchy of Needs (bottom to top): - Physiological Needs: air, water, food, shelter, sleep, clothing, reproduction - Safety Needs: personal security, employment, resources, health, property - Love and Belonging: friendship, intimacy, family, sense of connection - Esteem: respect, self-esteem, status, recognition, strength, freedom - Self-Actualization: desire to become the most that one can be Skills a radiographer needs: Critical Thinking, Problem Solving, Therapeutic Communication, the ability to provide pt. education. **Verbal communication**: includes the written and spoken words **Non-verbal communication:** body language/posture, facial expression, eye contact, touch, & personal appearance. Communication in healthcare, effective communication is key to a successful & pleasant experience Avoid Miscommunication: - Speaker: - face the person to whom you are speaking - Select words appropriate for the listener - Avoid ambiguous statements - Speak clearly -- enunciate - Control your non-verbal signals - Listener: - Give full attention to speaker - Listen to words used & observe non-verbal behavior to get real message - Use questions to clarify speakers intended meaning - Paraphrase message to confirm Cultural Diversity Our society consists of many groups in addition to ethnic groups, each w/ unique characteristics, such as: gender, racial, generational, geographic, sexual pref, religion, socioeconomic, family structure, or non-racial physical characteristics (deaf, blind, obese, disabled etc). - As healthcare professionals, we are bound by our code of ethics **[to treat all people equally]** without discrimination regardless of sex, race, religion, or disease. Language Barriers - Certified Interpreter Vs. Family members - Pt. may not reveal certain info to a friend/relative, family members may not have good language skills, family members freq chance messages - **Speak to the patient, not the interpreter** - Telephone translation -- conference call - Non-verbal communication -- gestures, facial expression, eye contact, touch - Beware of words having different meanings in other countries - Validate all communication Barriers **Impaired Vision** -- Determine which form of assistance is acceptable and appropriate for the individual **Hearing Loss or Deafness (HOH)** - Keep hearing aids on as long as possible, can the pt lip read?, sign language? **[Aphasia]** --language disorder caused by damage in a specific area of the brain that controls language expression and comprehension. Impaired mental function - Assess ability to understand and follow directions - Use simple & direct instructions Altered states of consciousness - Don't assume they will remember instructions - Do not assume non-responsive patients *cannot* hear or remember! Touch - Should never be forced on someone as it may be considered an invasion of personal space by some cultures. - Advise the patient of what you need to do - Keep touching/**palpation** to a professional level -- use only what is needed to provide good health care - Palpation =1-2 fingers only Communication w Pts. Families - Preferably family members should stay out of exam room for **radiation safety, and allows staff to proceed w/o interruptions from concern family members who may not understand what is happening.** - If a family member is needed in exam room: only one person should be allowed, clarify the person's role, refer inquiries to the physician in charge, and respond to aggressive demands with reassurance rather than anger. - \*Always provide updates to pt. and/or family to let them know why they are waiting, especially when there are unforeseen delays Communication Under Stress - Lower voice & speak slowly & clearly when a situation is emotional - Be nonjudgemental in both verbal & nonverbal communication. Do not allow an upset individual's inappropriate actions/speech to goad you into a similar response - When you are uncertain whether the listener has understood, request confirmation. Questioning Skills - Ask open-ended questions - Facilitation ( encourage elaboration) - Use silence to give pt. time to remember - Use probing, focused questions - Use repetition or reword to clarify - summarize Use common layman's terms when conversing w/ pts. **[BUT]** use correct medical terminology when writing history. Patient Education - A patient who comes to the imaging department has a right to expect that he or she will be instructed as to the exam. - **A detailed description of the procedure.** - **A description of the purpose of the exam.** - **Approximate amount of time.** - **An explanation of any unusual equipment.** - **Follow up care/results after procedure is complete.** - **If the patient questions the exam, do not begin until the problem is resolved.** Obtaining the Clinical History - Keep in mind that the HX we receive on the x-ray request is often incorrect, some procedure require a more in-depth HX than others and the history must always be obtained prior to the start of a procedure Elements of a complete history: 1. Chief Complaint 2. Localization --where? 3. Chronology -- how long? 4. Quality -- severity? 5. Onset -- when did it start? 6. Aggravating or alleviating factors 7. Cause of symptoms? Objective / Subjective Data - ***Objective* -** perceptible to the senses, things that can be seen, heard, & felt - More concrete -- examples: lab reports, vital signs, degree of swelling, lump in the breast, - ***Subjective* --** pertain to or are perceived by the affected individual only. Info relayed to you by patient or spouse. - Harder to define -- example: the severity of pain a patient is experiencing. **[Pediatric Radiography ]** The Pediactric Pt. - Age: Infancy to 15yrs - Establish rapport with the parent and child (communication skills) - Establish eye-level contact (talk w/ your pt. unless they are too young, in infancy, then talk in layman's terms to the parent) Children and their Age Specifics - Infants (Birth -12 months) - Toddlers (1yr -- 3yrs) - Preschooler (3-5yrs) - School-age (6-12yrs) High Risk -- Newborn Infants! - NICU - Hand Hygiene -- be extra fastidious! - Appropriate clothing attire including gloves, cleanliness of portable - Consult w/ infant's nurse prior to exam and NEVER image an infant w/o assistance (Provide lead shielding for the nurse and self), shield the infant. Infants - Have an increased risk for hypothermia -- should be imaged in isolette or in the warmer usually w/ portable. - Always cover the IR w/ a warm blanket prior to placing under the baby. Pts. W/ Special Needs - Children over 8yrs like to be independent -- ask them how they need to be lifted or moved to the table - Mental Disabilities -- may react to verbal stimuli. Loud or abrupt phrases may agitate them Immobilization and the Anxious Child - Immobilizers are used when a child is not able to stay in place long enough for a successful image and should only be used when no other means are safe or logical - Images should be of high quality - May require the help of the parents or other techs: If parents are needed, include 1 parent, preferably DAD. No chance of pregnancy (NCP) - When dealing w/ an agitated pt., remain calm and try to escort parent out of the site of the pediatric pt. The Approach - Bend down & talk with the child on their terms. Introduce yourself. Be sure the room is prepared ahead of time. Suggest the child can help you w/ some pictures. Praise the child w/ each completed task. Offer choices when applicable (rather stand or sit). Use child-friendly distractions such as stickers, etc! SMILE! The Adolescent or Older Child - Use effective communication, Identify the pt, explain the procedure, educate the pt, maintain the pts concern for privacy, provide after care directions Radiation Protection - Rad protection is a priority for infants/children because of the radiosenstivity of their rapid & changing cell growth. - ALARA should always take place Child Abuse - Child abuse is any act of omission or commission that endangers or impairs a child's physical or emotional health and development. - Child abuse includes the following: Physical abuse and neglect, Emotional abuse, & Sexual abuse Behavior Indicators are: Child is excessively passive, compliant or fearful, excessively aggressive or physically violent, child/caretaker attempts to hide injuries or child make detailed & age-inappropriate comments regarding sexual behavior. Indicators of Physical Abuse: - History: The child states the injury was caused by abuse, knowledge that the injury is unusual for a specific age group, parent is unable to explain the cause of the injury - Mandatory Reporting for suspected abuse: Look for patterns of skeletal injury - Posterior rib fx - Corner fx - "bucket handle" fx's of limbs It will be the **radiographer's ethical and legal obligation to report suspected child abuse** to the person at the institution who makes the inquiries and the required reports in such cases. Babygram Protocol per clinical agency (baby x-ray including chest and entire abdomen) - [Pros] - Ordered for line placement or trauma occurrences. - [Cons] - Distortion from improper centering - Excessive scatter - Under or over-exposure due to variations in part thickness. Radiographic Studies specific to children - [Skeletal Survey] (Look for old fractures or specific types of fractures that are indicative of child abuse). R/O abuse, not Mets (CA). - [Bone Age] -- PA hand including wrist of the least dominant hand. - [Scoliosis Study] -- imaging of the spine to R/O scoliosis - [Limb lengths] -- pt. non-thriving, measures leg lengths - [Hips, clavicles, skulls] -- birthing defects - [Foreign Bodies] -- imaging of area of interest, **soft tissue neck images**, if pt. swallowed an artifact. **[Geriatric Radiography ]** Patient of 65yrs or older -- Age 65 is the age that has been designated at which a person is eligible for Medicare benefits, social security benefits, and retirement. - Elderly pts. Are burdened w/ chronic illness rather than acute - 80% of deaths in persons over the age of 65 are caused by heart disease, cancer, and strokes - Long-term care is caused by hypertension, arthritis, diabetes, pulmonary disease, visual and hearing impairment. Depression - Depression is a common and debilitating emotional problem of the aged person. Can be due to: - Burden of the family - The fear of losing one's good health - Giving up independent lifestyle - Chronic illness - Symptoms of depression in the elderly person are often confused with "dementia" Alzheimer Disease - Persons w/ Alzheimer disease present w/ symptoms of dementia - Recent studies indicate that of people over 65, 50% suffer from Alzheimer disease at various stages -When an exampination of the geriatric pt. is complete, you must assist the pt. w/ returning to the dressing room, caretaker, or waiting room. -The elderly pt must not be left alone in the radiographic imaging room bc they may become confused & may be in danger of falling from the table. Changes Associated w Aging - Older adults may have nonspecific symptoms such as: Dizziness, Falls for no apparent reason, infections w/o level and Urinary Incontinence As a radiographer, you must be able to differentiate what is normal from pathological Communication 1. You must ascertain that the pt is able to hear your directions and **speak loudly enough** for the patient to understand. **DO NOT SHOUT.** 2. Be especially careful to **clearly state instructions and check for understanding** (Allow pt to keep in hearing aids if applicable to diagnostic procedure) 3. Address the pt. appropriately (Mr. or Mrs) Integumentary System - The skin of geriatric is fragile and thus more easily traumatized - **If a tear to the skin occurs, report it to your Clinical Preceptor before the patient leaves the department, and an incident report must be completed.** Pulmonary System - Normal changes of Aging -- Lung capacity diminishes, the cough reflex becomes less effective, the normal respiratory defense mechanism lose effectiveness - Pts w/chronic pulm disease cannot be expected to lie flat for more than brief periods of time as this position increases dyspnea. - During chest exam, ask pt to hold their breath on the second full inhalation to ensure full lung expansion - During upper gastrointestinal exam, position the pt. in an upright position to prevent aspiration Cultural Considerations and Ageing -- one must take culture differences when imaging pts, some elderly pts. are accepting of treatment offers while others require a detailed explanation from family. Elder Abuse - It is estimated 1 out of 20 senior experience elder abuse - Elder abuse is: The neglect, mistreatment or exploitation of anyone age 65 or older (or any disabled dependent adult). - There are 3 categories of elder abuse: 1.Domestic elder abuse 2\. Institutional elder abuse 3\. Self-neglect or Self-abuse Avoid Elder Abuse or Neglect During Imaging procedures - Avoid -- avoid pinching pts skin - Utilize -- when immobilizing elderly pts, utilize the standards of care for immobilizing the geriatric pt - Assist -- assist the geriatric pt when they ask for help - Protect -- protect modesty. **Treat EVERY pt as if they are your loved ones** **[Death and Dying Advanced Directives]** 5 Stages of Grief: 1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance **Remember DABDA** \*These stages apply to other situations such as loss of job, home, spouse, etc Advance Directives - AKA "living will" or "durable power of attorney for health care" -- **legally recognized document** which can you plan ahead for important health care decisions. Designed to prepare a directive which clearly reflects your medical treatment preferences. - Makes sure your wishes are clearly understood by others and relieves burdens of decision-making from your loved ones and prevents disagreements among those who may care for you. Statistics on Death/Dying - 80% of deaths occur in hospitals - Deaths are frequently unnecessarily prolonged, painful, expensive, and emotionally burdensome to both pt and families. - Aggressive medical invention leaves \~2 Million Americans confined in nursing homes - 1.4 million kept alive on feeding tubes and 30,000 kept alive in a comatose & per veg state. Cost Burdens - 20% cases a family member had to quit work - 31% lost all or most of their savings (96% had insurance!) - 20% loss of major income source - 70 -- 95% indicated they would rather refuse aggressive medical treatment than have their lives prolonged medically - "Quality of Life" Advance Directives - Document must be signed and dated by two witnesses who are NOT blood relatives or beneficiaries of property. - Copies given to: Primary physician, health care proxy, Attorney?, US Living Will Registry? - Update regularly -- recommended every 5yrs. Indicate new date on form. Witness needed for changes. Remember to notify others of change.