Patient Care and Management PDF

PATIENT CARE AND MANAGEMENT Patient Care Center of Gravity -care is collaborative and coordinated and goes -hypothethical point around which the force of beyond physical well-being to also include...

PATIENT CARE AND MANAGEMENT Patient Care Center of Gravity -care is collaborative and coordinated and goes -hypothethical point around which the force of beyond physical well-being to also include gravity appears to act emotional, social, and financial aspects of a patient’s -point at which combined mass of the body appears situation to be concentrated -patients are autonomous with decision making about their own care and treatment Center of Body Weight -point where body weight is balanced Body Mechanics -located in the midportion of the pelvis or lower -ways to move abdomen depending on body build -how we hold our bodies in every physical activity -any object you hold adds to the weight on the base such as sitting, standing, lifting, carrying, bending, of support affecting the location of your center of and sleeping gravity Poor body mechanics = cause of back problems Body is most stable when the center of gravity is Muscle Strain nearest to the center of the base of support. -common among healthcare workers -common injury Center of Gravity -specifically located at sacrum 2 Most Sensitive Muscles Anterior Body Mechanics -biceps brachii Reasons: -rectus abdominis 1. Muscles work best when used correctly. 2. Makes lifting, pulling, and pushing easier. 3. Prevents unnecessary fatigue and strain; Posterior saves energy. 4. Prevents injury to self or others. -erector spinae -hamstring group (biceps femoris, semitendinosus, semimembranosus) 8 Rules for Body Mechanics: 1. Maintain a broad base of support (feet 8 to 10 inches apart), one foot is slightly forward, BALANCE weight is balanced on both feet and pointing Base of Support toes in the direction of movement. 2. Bend at the hips and knees not waist, keep -portion of body in contact with the floor or other back straight. horizontal surface (feet) 3. Use the strongest muscles (shoulders, upper arms, hips, thighs) not back muscles ̶ they are weak. Broad Base of Support -provides stability for body position and movement CHESTER ALAN M. DE ASIS, RRT TOP 1 RTLE DECEMBER 2023  PATIENT CARE AND MANAGEMENT 4. Use your body weight to help push or pull -the lower arm is positioned behind the (pushing is better). When possible, push, client and the upper arm is flexed at the slide, or pull rather than lift. shoulder and the elbow 5. Carry heavy object close to your body. 6. Avoid twisting the body. 5. Fowler’s Position 7. Avoid bending for extended periods. -semi-sitting position and may have knees 8. Get help if the person or object is too heavy either bent or straight for you to lift. -best for patients with dyspnea (shortness of breath) PATIENT COMFORT AND SAFETY 6. Trendelenburg Position -pay attention to the patient’s body language, -lain supine on a 15 to 30 degree incline tonality, and posture with the feet elevated above the head -if they appear stressed or uncomfortable, take a 7. Lithotomy Position moment and ask them how they are feeling -common position for surgical procedures and medical examinations involving the pelvis and lower abdomen, as well as a Rule of Thumb common position for childbirth -called as heuristics in cognitive psychology -also used for hysterosalpingogram and retrograde pyelography -used in more automatic mental processes and are described as mental shortcuts that lessen mental strain Preparing for Safe Patient Transfer 1. Check with nursing service and obtain chart. Radiolucent Pad 2. Check patient identification. -it must be used for the comfort of the patient when -verification from patient performing radiographic examinations more than -wrist band 10 minutes -case number -date of birth 3. Make a plan and prepare the room. Different Body Positions 4. Get transport equipment and make sure it works. 1. Supine -lying on one’s back -sleep position Patient Chart – Wrist Band – Radiology Room – Stretcher (Gurney or Litter) 2. Prone -lying face down 5. Enlist patient’s help and cooperation. 3. Lateral Tell what you are doing as you proceed. -lateral decubitus 6. Obtain additional help when necessary. -lateral recumbent Check to make certain your assistants -side lying understand their role in the transfer. -nursing assistant 4. Sims Position -orderly -semi-prone -halfway between the lateral and the prone position CHESTER ALAN M. DE ASIS, RRT TOP 1 RTLE DECEMBER 2023  PATIENT CARE AND MANAGEMENT To build a strong rapport with the patient, establish 10. If they start to fall, don’t try to stop the fall, harmonious relationship by communicating with but rather, bend your knees and slowly them (greeting). lower them to the chair, bed, floor, or other safe surface. Call for help, if necessary. Transfer by Sliding Board Helping Patients to Dress and Undress -board acts as a bridge to allow individuals to move from one seated surface to another such as moving 1. If the patients need help, these are the from a wheelchair to a bed things that must be considered: -with cast -contraindicated for patients with fractures or -with brace dislocation -with too weakened body 2. Radiologic technologists could offer Using Sheet for Transfer assistance and stay near the dressing room -place the sheet on the table with the fold against in order to provide help when needed. the patient’s back 3. Radiologic technologists may consider -take the top half of the sheet and roll it against the cutting off the clothing but only in patient emergency cases. In cutting clothing off, the -after the patient is rolled to the opposite side, the radiologic technologists should gain rolled half of the sheet is straightened out approval of the client or member of the family and do so in writing to protect the radiologic technologists. Wheelchair Transfer 4. Always keep in mind the patient’s privacy 1. Wheelchair as close as possible to where you when assisting in dressing and undressing are moving the person. the patient. 2. Transfer on the stronger side of the person’s body. 3. Lock the wheelchair and keep it locked while INFECTION CONTROL person is moving into it. 4. Have the foot pedals and/or leg rests moved Microorganism out of the way. -from the Greek word mikros meaning small, and 5. Use the gait belt to prevent injury to the organismos meaning organism person. 6. Protect your back, bend your knees during -also called microbe the transfer and maintain a natural curve on -an organism that is microscopic your back. 7. Once the person is in the wheelchair, if -affects the skin, lungs, brain, blood, and other parts you’re moving upward – for example, up a of the body curb or stairs – pull the wheelchair backwards. 1. Bacteria 8. Have the person seated with their legs at a -minute one-celled organisms without a right angle (90 degrees) at both the knees typical nucleus and hips. -contain both DNA and RNA 9. Have the person seated with their feet flat Classification According to Shape: on the floor, unless they have been directed  Spherical (cocci) otherwise.  Oblong (bacilli)  Spiral (spirilla) – spiroschetes CHESTER ALAN M. DE ASIS, RRT TOP 1 RTLE DECEMBER 2023  PATIENT CARE AND MANAGEMENT Classification According to Divisional Groups: Infection  Diplococci (groups of two) -invasion by and multiplication of pathogenic  Streptococci (chains) microorganisms in a bodily part or tissue, which  Staphyloccocus (grape-like bunches) may produce subsequent tissue injury and progress to overt disease through a variety of cellular or toxic mechanisms 2. Fungi -invasion of a body tissue by microorganisms and -are eukaryotic organisms that may include their proliferation in that area yeasts, moulds, and mushroom -exists in two forms: yeasts and molds -reproduce by budding or spore formation Chain of Infections -require moisture and darkness to cause diseases in humans 1. Infectious Agent -infects the skin and scalp of humans and are -pathogen brings disease to its host difficult to cure because they produce spores that remain under the outer skin and -it is another name for a pathogen as they cause reproduce even when environmental infections conditions are favorable -as with any organism, pathogens prioritize survival and reproduction 3. Protozoa -polyphyletic group of single-celled -examples include the microbes such as bacteria, eukaryotes, either free-living or parasitic fungi, protozoa, and viruses that feed on organic matter such as other -can be removed through medical asepsis microorganisms -complex one-celled microorganisms -often parasitic and are able to move from 2. Reservoir one place by pseudopod formation, by the action of flagella or by cilia -a host that harbors the pathogens and serves as -flagella are whip-like projections while cilia a source of the infective agent that it transmits to are hair-like projections on the exterior a potential host surface of the cell wall -it is an area where the pathogens are capable of multiplying 4. Viruses -a submicroscopic infections agent that -example is the Mycobacterium in the lungs, replicated only inside the living cells of an causing pulmonary tuberculosis organism -infect all life forms, from animals to plants to microorganisms including bacteria and 3. Portal of Exit archaea -refers to any route that the pathogen can leave -minute microorganisms that cannot be the reservoir visualized under an ordinary microscope -smallest microorganisms known to produce -this depends entirely on the characteristics of diseases in man the reservoir -the genetic material of a virus is either DNA -in humans, the main portals exit include the or RNA but never both alimentary tract through vomiting, diarrhea, and -viruses must invade a host cell in order to saliva survive and reproduce CHESTER ALAN M. DE ASIS, RRT TOP 1 RTLE DECEMBER 2023  PATIENT CARE AND MANAGEMENT 4. Mode of Transmission 3. Third Phase (Actual Disease Process) -it refers to how an infectious agent, also called a -when the signs and symptoms of the disease pathogen, can be transferred from one person, reach their fullest extent or produce only vague, object, or animal to another subclinical symptoms -it can be airborne, droplet, direct or indirect contact 4. Fourth Phase (Convalescence) -during this phase, the symptoms begin to 5. Portal of Entry diminish and eventually disappear -refers to the manner in which a pathogen enters a susceptible host Nosocomial Infection -the portal of entry must provide access to tissue -also called as hospital-acquired infections in which the pathogen can multiply or a toxin can -any infection that first occurs during a patient’s -it is possible for the pathogen to not enter the stay at a health-care facility, regardless of whether body or host by having a strong immune system it is detected during the stay or after 6. Susceptible Host Asepsis -the final link in the chain of infection is a -a condition in which no living disease-causing susceptible host microorganisms are present -susceptibility of a host depends on genetic or -asepsis covers all those procedures designed to constitutional factors, specific immunity, and reduce the risk of bacterial, fungal or viral nonspecific factors that affect an individual’s contamination, using sterile instruments, sterile ability to resist infection or to limit pathogenicity draping and the gloved ‘no touch’ technique -persons particularly susceptible to infection are those who are poorly nourished or are fatigued Donning -those at greater risk are persons with chronic diseases such as diabetes mellitus or cancer -proper wearing of protective apparel -immune-suppressed persons are at great risk of acquiring infections Doffing -proper removal of protective apparel Stages of Infection 1. First Stage (Latent Period) Medical Asepsis -this is the stage wherein the pathogenic -also called as clean technique microorganisms enters the body and lies dormant -includes all practices intended to confine specific microorganisms to a specific area, limiting the -at this point the disease become communicable number, growth, and transmission of microorganisms 2. Second Stage (Incubation Period) -an example of this is handwashing (from hand to wrist) -during this stage, the microbes reproduce and disease process begins CHESTER ALAN M. DE ASIS, RRT TOP 1 RTLE DECEMBER 2023  PATIENT CARE AND MANAGEMENT -removes 80% of pathogens, the other 20% is  Rectal – most accurate but removed through disinfectants such as alcohol and contraindicated for patients who have hand sanitizer cardiac problems Normal Range of Body Temperature Surgical Asepsis Body Site Type of Normal Range Mean (°C) -also called as sterile technique Thermometer (°C) Axilla Mercury, 34.7 – 37.3 36.4 -includes all practices that destroy all electronic Sublingual Mercury, 35.5 – 37.5 36.6 microorganisms and spores electronic Rectal Mercury, 36.6 – 37.9 37.0 -uses autoclaving machine electronic Ear Infrared 35.7 – 37.5 36.6 -an example of handwashing (from hand to elbow) Factors Affecting Body Temperature VITAL SIGNS 1. Age -these are group of the four to six most crucial -one of the most elementary factors that medical signs that indicate the status of the body’s influence normal body temperature is age vital functions 2. Sex -these measurements are taken to help assess the general physical health a person, give clues to -a woman’s body temperature is higher during possible diseases, and show progress toward ovulation and pregnancy and lower at the start of recovery the menstrual cycle -allow the patients to rest for 5 to 10 minutes upon 3. Diurnal Variation arrival for them to have an accurate vital sign -it is usually at its lowest early in the morning and measurement slowly climbs up after a person wakes up, reaching its peak late in the afternoon 1. Body Temperature 4. Physical Exertion -a measure of how well your body can make and -during strenuous physical activity, your muscles get rid of heat generate a tremendous amount of heat, which results in an increase in your body temperature -the body is very good at keeping its temperature within a safe range, even when temperatures 5. Stress outside the body change a lot -this increase in temperature is an adaptive -when you are too hot, the blood vessels in your response of the body to deal with perceived skin widen to carry the excess heat to your skin’s threats surface 6. Meals -this reflects an increase in your metabolic rate, Types of Thermometer to facilitate digestion  Infrared 7. Smoking  Temporal -smoking cigarettes has also been known to  Tympanic/Ear cause spikes in body temperature  Electronic  Digital CHESTER ALAN M. DE ASIS, RRT TOP 1 RTLE DECEMBER 2023  PATIENT CARE AND MANAGEMENT 2. Pulse / Cardiac Rate 2. Radial Pulse -it is the number of times each minute that your -a pulse of the radial artery (felt in the wrist) type heart beats, which is normally between 60 - 100 of; heart rate, pulse, pulse rate or the rate at times per minute for adults which the heart beats -your pulse is a way you can feel each time your heart beats 3. Brachial Pulse -it is palpated on the anterior aspect of the Deoxygenated Blood elbow by gently pressing the artery against the underlying bone with the middle and index -dull red fingers -this brachial artery pulse is commonly used to Oxygenated Blood measure blood pressure with a stethoscope and sphygmomanometer -scarlet red 4. Carotid Artery Age Span Heart Rate (bpm) Less than 1 month 120-160 -these are a pair of blood vessels 1 to 12 months 80-140 -there’s one on each side of the neck 12 months to 2 years 80-130 2 to 6 years 75-120 -the carotid arteries deliver blood to the brain 6 to 12 years 75-110 and head More than 12 years 60-100 Average heart rates by age Age in years Average maximum Target heart rate Carotid artery disease occur when fatty deposits, heart rate (bpm) range (bpm) called plaques, clog the blood vessels that deliver 40 180 90 to 153 blood to the brain and head (carotid arteries). 45 175 88 to 149 50 170 85 to 145 55 165 83 to 140 60 160 80 to 136 5. Femoral Artery 65 155 78 to 132 70 150 75 to 128 -it is the main blood vessel supplying blood to your lower body Different Pulse Site -it starts in your upper thigh, near your groin and runs down to the back of your knee 1. Apical Pulse -the function of the femoral artery and its -a pulse point on your chest that gives the most branches is to supply the lower body with blood accurate reading of your heart rate -it’s also called the point of maximal impulse (PMI) and the apex beat 6. Popliteal Artery -a deeply placed continuation of the femoral artery opening in the distal portion of the Rheumatic Heart Disease adductor magnus muscle -with 1 or 2 valvular defect -it courses through the popliteal fossa and ends -can be assessed through auscultation when there is at the lower border of the popliteus muscle, a murmuring sound CHESTER ALAN M. DE ASIS, RRT TOP 1 RTLE DECEMBER 2023  PATIENT CARE AND MANAGEMENT where it branches into the anterior and posterior 4. Body size tibial arteries -short stature also includes a faster heart rate, which increases cardiac minute work and shorten diastole 7. Temporal Artery -stiffening lowers the aortic diastolic pressure -it sends blood to your scalp and face and, coupled with a shortened diastole, could -it starts below your ear and runs vertically adversely influence myocardial supply between your cheekbone and your ear 5. Medication -Azithromycin (Zithromax) is an antibiotic that 8. Dorsalis Pedalis Pulse may speed up your heart -it is an artery of the upper surface of the foot -other antibiotics, such as levofloxacin, that is a direct continuation of the anterior tibial amoxicillin, and ciprofloxacin, can change your artery heart rate too -the dorsalis pedis artery runs along the line 6. Stress between the first and second toe, and its pulse -your body releases adrenaline, a hormone that point is felt in the mid-foot temporarily causes your breathing and heart rate to speed up and your blood pressure to rise 9. Posterior Tibial Pulse -it can be readily palpated halfway between the Pulse Oximeter posterior border of the medial malleolus and -the pulse oximeter or Pulse Ox, is an electronic the achilles tendon device that measures the saturation of oxygen carried in your red blood cells Factors Affecting Pulse / Cardiac Rate -can be attached to your fingers, forehead, nose, foot, ears or toes 1. Sex -women tend to have a smaller cardiovascular system than men, resulting in lower stroke Oxygen Saturation Level volume -for most people, a normal pulse oximeter reading -this means they must rely more heavily on heart for your oxygen saturation level is between 95% and rate to get blood pumping to their muscles, and 100% they tend to have a higher heart rate than the -if you have a lung disease such as COPD or male counterparts pneumonia, your normal oxygen saturation level 2. Environment may be lower -heart rate tends to increase during exercise as Observation Oxygen Pulse rate Temperature saturation (bpm) (°C) the ambient temperature goes up (SpO2) Normal readings 96% or 40-100 36.5 to 37.5 -we also have higher heart rates during exercise more as we move to higher altitudes Acceptable to 95% 101-109 38 continue home 3. Age monitoring Seek advice from 93% to 94% 110-130 38.1 to 39 your general -as you get older, your heart can’t beat as fast physician during physical activity or times of stress as it did Need urgent 92% or less 131 or 39 or more when you were younger medical advice more CHESTER ALAN M. DE ASIS, RRT TOP 1 RTLE DECEMBER 2023  PATIENT CARE AND MANAGEMENT 3. Respiratory Conditions -conditions that can increase a person’s respiration rate include chronic obstructive pulmonary disease:  Asthma  Pneumonia  Emphysema  Carbon monoxide poisoning 4. Heart Problems 3. Respiratory Rate -if the heart does not pump properly to get -it is the rate at which breathing occurs oxygen to the organs, the body may react by breathing faster -it is set and controlled by the respiratory center of the brain (medulla oblongata) -a person’s respiratory rate is usually measured in 4. Blood Pressure breaths per minute -it is the pressure of blood pushing against the walls Age Respiration Rate of your arteries Less than 1 year 30-40 1 to 2 years 25-35 -arteries carry blood from your heart to other parts 2 to 5 years 25-30 of your body 5 to 12 years 20-25 More than 12 years 12-20 -your blood pressure normally rises and falls throughout the day Normal Respiration Rates Newborns 44 respirations per minute Infants 20-40 respirations per minute Systolic Pressure Children (1 to 7 years) 18-30 respirations per minute Adults 12-20 respirations per minute -the first number, called systolic blood pressure, measures the pressure in your arteries when your heart beats Factors Affecting Respiratory Rate -contraction phase 1. Anxiety Diastolic Pressure -people may breathe faster when they are afraid or anxious -the second number, called diastolic blood pressure, measures the pressure in your arteries when your -fast breathing, or hyperventilation, is a heart rest between beats common symptoms of panic attacks -relaxation phase or resting phase -the fast breathing will usually pass once the anxiety goes away 2. Fever -as body temperature increases with a fever, respiratory rate can also increase -the increase is the body’s way of trying to get rid of the heat -we put a damp towel on the forehead because the hypothalamus regulates the body’s heat CHESTER ALAN M. DE ASIS, RRT TOP 1 RTLE DECEMBER 2023  PATIENT CARE AND MANAGEMENT Factors Affecting Blood Pressure 2. Oxygen therapy is a key treatment in respiratory care. The purpose is to increase oxygen saturation 1. Cardiac Output in tissues where the saturation levels are too low -any factor that causes cardiac output to due to illness or injury. increase, by elevating heart rate or stroke 3. Breathing prescribed oxygen increases the volume or both, will elevate blood pressure and amount of oxygen in the blood, reduces the extra promote blood flow work of the heart, and decreases shortness of 2. Stress breath. -although anxiety and stress are not factors in chronic hypertension, they can affect your blood Uses of Oxygen Therapy pressure during the measurement itself Some of the conditions oxygen therapy is used to -when you are under stress, your body releases treat include: cortisol - a stress hormone 1. Documented hypoxemia 3. Smoking 2. Severe respiratory distress -tobacco products (cigarettes, tobacco, cigars, etc,.) contain nicotine, which could increase -examples include acute asthma or pneumonia heart rate and blood pressure 3. Severe trauma -cigarette smoking, for example, can lead to an -vehicular accident immediate increase in blood pressure of 5 to 10 mmHg 4. Chronic obstructive pulmonary disease (COPD), including chronic bronchitis, emphysema and 4. Alcohol / Caffeine chronic asthma -consumption of alcohol and caffeine (coffee, 5. Pulmonary hypertension black or green tea, energy drinks) can increase your blood pressure levels, and studies show that 6. Cor pulmonale this effect can last from 30 minutes up to several hours Hyperbaric Oxygen Therapy -is used to treat the following conditions: Oxygen Therapy 1. Gas gangrene -administration of oxygen as a medical intervention, which can be for a variety of purposes 2. Decompression sickness in both chronic and acute patient care 3. Air embolism 4. Smoke inhalation Oxygen is essential for cell metabolism; and in turn, 5. Carbon monoxide poisoning tissue oxygenation is essential for all normal physiological functions. 6. Cerebral hypoxic event Purpose of Oxygen Therapy Oxygen Delivery System 1. The body is constantly taking in oxygen and -oxygen is delivered to the respiratory tract under releasing carbon dioxide. If this process is pressure by artificial means inadequate, oxygen levels in the blood decrease, -oxygen is humidified to prevent excessive drying of and the patient may need supplemental oxygen. mucous membranes usually done by passing CHESTER ALAN M. DE ASIS, RRT TOP 1 RTLE DECEMBER 2023  PATIENT CARE AND MANAGEMENT through distilled water because it is only slightly 4. Masks or face shields and eye protection should soluble in water. be used at any time that there is a chance, splashes or droplet of blood may touch the eyes or face. 5. Gowns and impermeable aprons must be worn Adverse Reaction Related to Oxygen Therapy when clothing is likely to become soiled by Administration splashes of blood or body fluids. A physician should be notified and emergency 6. Great care must be taken to avoid needle sticks services may be required if the following symptoms or cuts from scalpel blades or other sharp develop: instruments that are used for penetrating the skin. 1. Frequent headaches 7. Hypodermic needles should not be recapped, 2. Anxiety bent, broken or separated from syringe. They must be placed immediately after use in a puncture- 3. Cyanotic (blue) lips or fingernails resistant container meant for this purpose. 4. Drowsiness 8. Puncture-resistant containers for this used 5. Confusion equipment must be readily available throughout the hospital. 6. Restlessness 9. Items that are to be reused must be placed in a 7. Slow, shallow, difficult or irregular breathing designated puncture-resistant container for transport to area designated for re-cleaning. UNIVERSAL PRECAUTIONS & ISOLATION 10. Mouthpieces and resuscitation bags must be TECHNIQUES kept in all diagnostic imaging examination and treatment rooms. Universal Blood and Body Fluid Precaution -all healthcare workers are now obliged to follow universal blood and body fluid infection control Isolation Technique guidelines without exemption -whatever category of isolation technique, the RT -this includes wearing gloves, gowns, goggles, should always adhere to the four basic principles in methods of disposal for syringes without recapping, dealing with communicable diseases. immunization against hepatitis B, and follow-up 1. Hands are washed before and after each care for employees inadvertently exposed to blood preparation and caring for the client. and body fluid borne pathogens 2. All items used for patient care are sterilized, disinfected or disposed of to prevent spread of The universal blood and body fluid precaution infection. follows: 3. Items removed from isolation rooms are bagged 1. Gloves should be worn for touching blood, body and labelled as contaminated before being sent for fluids, mucous membranes or non-intact skin of disinfection. any patient. 4. All hypodermic needles must be placed in 2. Gloves should be worn for handling items or labelled, puncture-resistant receptacles used only touching surfaces soiled with blood or body fluids. for this purpose. 3. Gloves should be changed and hands washed after each patient contact. CHESTER ALAN M. DE ASIS, RRT TOP 1 RTLE DECEMBER 2023  PATIENT CARE AND MANAGEMENT Restraints Always remember that a patient in restraints for a long period of time, he must understand that -radiologic technologists must not use restraining restraints must be removed at least every 2 hours devices without an order from a physician and and put through range-of-motion. Always must comply with the policy of the institution in remember to reapply before removing another applying restraints restraint. -always remember that restraints are used to protect the patient's safety and that their use is the only way to obtain satisfactory results from the What to Remember with Restraints procedure or examination to be performed 1. Documentation is very important. 2. Type of restraint used, time applied and Reasons for the Application of Restraints removed, reason for its application and assessment of the patient at each stage is relevant in the 1. To control movement of an extremity when an documentation. intravenous infusion or diagnostic catheters is in place. 2. To remind the patient who is sedated and having Restraining the Pediatric Patients difficulty remembering to remain in a particular What to remember when dealing with pediatric position. patients: 3. To prevent the patient who is unconscious, 1. Explanations to the children should be brief, delirious, cognitively impaired, or confused from simple, and to the point. falling from an examination table or a gurney; from removing a tube or dressing that may be life 2. Speak to the child face to face at an eye level. sustaining; or injuring himself by the impact with 3. Use a soft tone of voice and speak in terms that diagnostic imaging equipment. are simple and familiar when explaining the procedure. Rules for the Application of Restraints 4. Always remember to protect the child from falling. 1. The patient must be allowed as much mobility as is safely possible. 2. The areas of the body where restraints are Restraining the Anxious Child applied must be padded to prevent injury to the skin 1. Restraints should be used only when no other beneath the restraint. means are safe or logical and should be of quality 3. Normal anatomic position must be maintained. that should not cause harm on the patient. 4. Knots that will not become tighter with 2. If physical restraint is to be used by an assistant, movement must be used. the radiologic technologist must instruct the assistant to not be forceful. 5. The restraint must be easy to remove. 6. Neither circulation nor respiration must be impaired by the restraint. Types of Restraints 7. If leg restraints are necessary, wrist restraints  Sheet restraints must also be applied to prevent the patient either  Commercial restraints unfastening the restraint in attempt to leave the examination table. CHESTER ALAN M. DE ASIS, RRT TOP 1 RTLE DECEMBER 2023  PATIENT CARE AND MANAGEMENT Restraining an Older Child Patient Major Classes of Shock 1. When caring for an older child, the radiologic 1. Hypovolemic Shock technologists should be direct and honest in his -caused by losing about 1/5 or more of the normal explanation of what will occur during the procedure. amount of blood in your body 2. Use simple terms and allow the patient to ask -blood loss can be due to: questions and express his fears and apprehensions.  Bleeding from cuts -example: amputation Restraining the Geriatric Patients  Bleeding from other injuries  Internal bleeding such as in gastrointestinal -also called as elderly or gerontological patients, tract they are known to be demanding, sensitive, and irritable The amount of circulating blood in your body may drop when you lose too many other body fluids, Symptoms of Dementia: which can happen with:  Disorientation  Burns  Confusion  Diarrhea  Gross memory deficits  Excessive perspiration  Hallucinations  Vomiting  Depression Symptoms: 1. Radiologic technologists must always remember that the following symptoms are signs of disease 1. Anxiety or agitation process. 2. Cool, clammy skin 2. Radiologic technologists must always remember 3. Confusion that elderly patients exhibiting those signs are not able to retain to directions given to them. 4. Decreased or no urine output 3. Speak to the elderly in a low soft tone voice. 5. General weakness 6. Pale skin color or pallor MEDICAL EMERGENCIES IN THE DIAGNOSTIC 7. Rapid breathing IMAGING 8. Sweating, moist skin Shock 9. Unconsciousness -a life-threatening condition that occurs when the body is not getting enough blood flow Syncope – fainting or transient loss of consciousness -this can damage multiple organs -shock requires immediate medical treatment and can get worse very rapidly Radiologic Technologist Actions: 1. Stop diagnostic imaging, place patient in flat, supine position with legs elevated slightly (unless Common symptom: patient has head injury). Low diastolic pressure 2. Take vital sign every 5 minutes. Low blood pressure CHESTER ALAN M. DE ASIS, RRT TOP 1 RTLE DECEMBER 2023  PATIENT CARE AND MANAGEMENT 3. Notify the physician in charge of the patient and Symptoms: call for an emergency assistance. 1. Chest pain or pressure 4. Make certain that the patient is able to breathe 2. Profuse sweating, moist skin without obstruction. 3. Rapid breathing  Airways  Breathing 4. Rapid pulse  Circulation 5. Restlessness, agitation, confusion 5. If there are blood or body fluids, don gloves and 6. Shortness of breath wipe off secretions. 7. Skin that feels cool to the touch 6. Do not leave the patient unattended. 8. Pale skin color or blotchy (mottled) skin 9. Weak (thready) pulse 2. Septic Shock 10. Decreased mental status -a serious condition that occurs when an overwhelming infection leads to life-threatening -loss of ability to concentrate low blood pressure -loss of alertness 11. Coma (loss of consciousness) Symptoms: 1. Cool, pale extremities Radiologic Technologist Actions: 2. High or very low temperature, chills 1. Summons emergency assistance and place 3. Lightheadedness emergency cart nearby. 4. Low blood pressure, especially when standing 2. Notify the doctor in charge of the patient. 5. Low or absent urine 3. Place the patient in a semi-fowlers' position or a position comfortable for the patient. 4. Keep the patient warm and quite. Radiologic Technologist Actions: 5. Take vital signs every 5 minutes. 1. Stop the procedure and notify the physician in charge of the patient. 6. Do not give patient anything to eat or drink. 2. Place the patient in flat, supine position and keep 7. Be prepared to begin cardiopulmonary him quite. If the patient's skin is warm cover him resuscitation and assist in oxygenation, IV fluids, and with a blanket. medical administration. 3. Take the vital signs every 5 minutes 4. Prepare to assist with the administration of Patients for CPR: oxygen, intravenous fluids, and medication. Non-responsive Pulseless 3. Cardiogenic Shock Breathless -is a state in which the heart has been damaged so much that it is unable to supply blood to the organs of the body. What to do when performing CPR: Prepare ECG machine and epinephrine CHESTER ALAN M. DE ASIS, RRT TOP 1 RTLE DECEMBER 2023  PATIENT CARE AND MANAGEMENT 4. Neurogenic Shock Radiologic Technologist Actions: -occurs when concussion, spinal cord injury, psychic 1. Keep emergency cart readily available. trauma or spinal anesthesia causes abnormal 2. Know the patient's medical history, especially the dilatation of the peripheral blood vessels. things he is allergic to when using iodinated contrast media. Symptoms: 1. Hypotension Diabetes Mellitus 2. Bradycardia -chronic disease involving disorder of carbohydrate, protein and fat metabolism 3. Warm, dry skin and subnormal body temperature -the normal blood sugar level is 80 to 115 mg/dL 4. Visible signs of poor tissue perfusion Types of Diabetes: Radiologic Technologist Actions: 1. Type I - insulin dependent diabetes mellitus 1. Notify the physician in charge of the patient. (IDDM) 2. Keep patient flat, and monitor vital signs every 5 2. Type II - noninsulin dependent diabetes mellitus minutes. (NIDDM) 3. Do not move the patient in case of suspected 3. Gestational diabetes spinal cord injury. -risk factor for preeclampsia (abnormally high 4. Prepare to assist in oxygenation, IV fluid, and blood pressure) medical administration. Symptoms of Type 1 and Type 2 Diabetes 5. Anaphylactic Shock 1. Extreme thirst (polydipsia) -often classified with neurogenic shock because of the physiologic similarities 2. Frequent urination (polyuria) -a result of an exaggerated hypersensitivity 3. Extreme hunger (polyphagia) reaction 4. Unexplained weight loss -the common causes are drugs, iodinated contrast 5. Fatigue agents, chemotherapeutic agents, anesthetics, certain foods and insect venoms 6. Blurred vision 7. Slow-healing sores Symptoms: 8. Frequent infections, such as gum or skin infections and vaginal or bladder infections 1. Tightness in the chest 2. Itchiness in the site of medication 3. Nasal congestion; sneezing and coughing 4. Nausea, vomiting and diarrhea usually accompanied by reaction to food CHESTER ALAN M. DE ASIS, RRT TOP 1 RTLE DECEMBER 2023