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PT care ch8-14

PT care

Question	Answer
define trauma	injury-physical damage by violence,accident,or fracture.traumatic-physical wound to the body
what are the precautions used for trauma	standard precautions, gloves,mask,apron or gown if pt is hemorrhaging or nauseated,vomitting
Can the radiographer adapt positioning and technical considerations to the pt?	YES
two things to assess and observe if pt is transferred to imaging dept.	1)observe for symptoms of shock 2)assess neurological status and level of consciousness before and every 5-10min of exam
who is the emergency team	ER DR, attending DR,resident/medical student, surgeon, ER nurses, rad tech,res ther,phlebotimist,anesthesiologist,admitting clerk and house supervisor
when can dressing,splints,sandbags,collars or other supportive devices be removed?	with physician approval
TorF__pt on stretcher or backboard can be moved to a table for an exam	false, not w/o pt DR order to do so
on a c-spine lateral the collar, or pt's neck,can be removed at what point	a physician interprets radiograph and CLEARS pt of injury
impaled objects or injured areas require_______ when moving them	support
the log roll requires assistance why?	it must be done in one synchronized move to be safe and painless
can pneumatic antishock garments be removed?	NO
Things the radiographer prepares to assist w/ are...	o^2,suction equip,emesis basin
three things a radiographer must do to minimize repeats on a trauma pt	work quickly,work accurately,work efficiently
things not to displace during exam	IV's,tubes lines,catheters
three cardinal principles	time,distance,shielding
assess and develop plan for exam,determine mobility,predetermine equip,two images 90deg. from eachother,include anatomy of interestpromote cooperative enviroment, are considered	basic rules for trauma
what are battle signs____________________ what are coon's eyes__________________	fx at base of posterior skullblood from skull_____ fx in soft tissue around eyes
what is frequently used method for head injury	CT
if pt has head injury you have to assume there is ________ injury	C-spine injury
name two types of head injury and their description	open-brain vulnerable to damage and infection----closed or blunt-swelling of brain tissue,pressure and brain damage
closed head injury manifestations	varying LOC,loss of reflexs,changes in vital signs,headache, dizziness,giddiness,gait abnormalaties,unequal pupil dilation,seizures,vomiting,hemiparesis
some open head injury manifestations	abraisons,contusions,lacerations,break or penetration in skull or meninges,varying LOC,subconjuctival hemorrhage,hearing loss,facial nerve play, periorbital ecchymosis,basa fracture
radiographers response for head injury	head and neck immobilized,head elevated 15-30deg,body temp normal,pulse and respirations,observe clear airway,observe for changes in LOC or hypoxia,apply sterile dressing for profuse bleeding, call emergency help
facial injury manifestations	distortion of facial symmetry,inability to move jaw,edema,flatness of cheek, double vision,blindness,nosebleed,hemorrhage,paresthesia,halo sign,changes in LOC
TorF---pt must not have nasal suction preformed for facial injury	TRUE
most spinal cord injuries require a crosstable lateral and _________ projection demonstrating what for complete transection	"swimmers"-flacid paralysis,loss of all muscles below injury,respitaory distress,bradycardia,loss of body temp, unable to perspire,absence of skin, organ sensation below site, unstable low BP,incontinience,priapism,
how does partial transection differ from complete transection	asymmetrical flacid paralysis, asymmetrical loss of reflexes below level of injury, some feeling of pain temp pressure touch, stable BP,perspire unilaterally,some skin organ sensation
radiographers response to spinal cord injury	monitor vitals,keep warm,maintain open airway only using jaw downward movement not chin lift,move synchronized log roll method,observe for signs of shock,if pt is unconscious assume spinal injury
things to look for in cross table lateral and swimmers	soft tissue swelling,alignment injury,possible fx,sublaxtion,endotracheal tube position,fx of facial bones or skull,sphenoid air fluid levels
sphenoid air fluid levels indicate	basal skull fx
what is sublaxtion	incomplete or partial dislocation
portables are usually ordered to see what	pathology of bony thorax,lung field,cardiac silhoutte,soft tissue,line placement(increase in density) trach tube,catheters,PICC,pacemakers,chest tubes
imaging condiderations for trauma and portable radiographs	observe pt from beginning to end,knowledge creativity and adaption, preform exam w/speed and pt comfort,radiation protection,follow rules and guidelines
what is an open fx	visible wound that extends between fx and skin surface,overt bleeding
TorF a closed fx is obvious	false, it may be, it may show deformity and swelling,hemmorrage within tissue,reddness,loss of movement,loss of pulse,numbness of tingling,involountary spasms
what is the leading cause of death after MVA	internal injury after fx of pelvic bones
should a possible fx pelvis be kept in mind for a pt w/multiple traumatic injuries	of course
large number of trauma deaths are pneumothorax and hemothorax, how are they caused and what are they	blunt or penetrating trauma to the thorax. pneumothorax-air or gas in pleural space that collapses lung. hemothorax-blood in pleural space, and one more for good measure-pus-pyothorax
some clinical manifestations for a fx are	pain and swelling, functional loss and deformity of the limb, grating sound or feel,discoloration of surrounding tissue caused by hemorrhage within the tissue(closed fx) overt bleeding(open fx)
radiographers response for fx	keep affected area immobilized,movement must be directed by MD,inform pt before movement,use sterile gloves if cin contact w/wound,support joint and limb above and below fx,move as single unit with two people one at either end
what are some examples of abdomenal trauma	blunt or penetrating trauma,appendicitis,bleeding ulcers,
clinical manifestations of abdominal trauma/acute distress	abrasions,lacerations,entry&exit wounds,contutionsrigid abdomen,abdomonal pain,nausea and vomiting,extreme thirst,symptoms of hypovolemic shock
radiographers response for abdomen trauma/acute distress	dont remove antishock garments, gloves for open wounds, sterile gloves if in direct contact,if unable to stand alternative method transport w/basin and tissues, NPO, observe for shock symptoms
who are the pediatric patients	neonates NICU, pediatrics PICU, infants, toddlers pre-schoolers school aged children adolescents,
true or false each group requires the same care	FALSE special care and knowledge for each group and cases vary
pediatrics is infancy to what age	15
when caring for children 5-things must be done	educate parents and child if possible, assess needs an dlevel of independence, privacy, safe surroundings(dont leave alone)
ways to establish rapport w/child	talk to from comfortable distance, keep explanations simple and brief, come to their level to speak face to face
TorF 6mos-3yrs the child has separation anxiety	TRUE
Is a birth to 6mos child fearful of strangers	NO
at what age is a child more verbal and independent	3-6yrs
How does a child 6-12yrs respond	interested, understand cause and effect
at what age does a child have heightened awareness of their body	12-19yrs. image,privacy
what is the NICU	care for high risk new born infants, immature immune systems more susceptible to infection
what is protocol for entering NICU	surgical scrub or 2-min scrub for medical asepsis, cleaning portable,IR, shields, and markers, standard precautions/barrier precautions
who helps position infant in NICU	nurse
you shoud provide lead apron for nursing assistant	YES
why provide shielding for the NICU	receive many images,much exposure to radiation, radiosensitivity of rapid and changing cell growth
Some standard principles for projections in the NICU	ALARA(time distance shielding), collimation, short exposure time,high MA to reduce exposure, if you have an dinfection or cough or cut on your hand let some one else go to the NICU
some ways to approach adoledcents or older children	non-judgemental attitude, therapeutic communication, identify and educate pt, privacy, simple terms allow questions,allow parent if pt wishes and policy allows, allow choices if possible
immobilizations should be used	only when necessary
If pt is immobilized a parent doesn't have to be notified or given reason for it	FALSE
IT is your ethical and legal obligation to report these three types of child abuse	physical abuse or neglect, emotional abuse, sexual abuse
what are some child abuse indicators	child says harmed, knowledge of unusual injury to child, parent unable to explain
what are some behavior indicators of child abuse	excessively compliant,fearful,passive, agressive or physically violent child or caretaker attempts to hide injuries, detailed or age-inappropriate comments of sexual behavior
who medicates pt	MD,nurses
radiographers administer _________ w/assessment of questionare and consent form	contrast media if pt is awake, responsive and any allergy out of way
can the pt be released right after contrast exam	no, risk of complications assessed before,child must be awake prior to discharge
questions to ask for assessment of administering medication	any allergies to food or meds, response to medication, what meds given at home, supervision after discharge, any unusual circumstances MD should know about, is parent educated in action,purpose,side effects of drugs administered
should all persons be assessed by chronological age or individual basis	individual basis
things a tech should pay attention to	normal changes of aging and affects of disease, polypharmacy can affect pt response level, depression is common
some symptoms for dementia/alzheimer disease which is not part of normal aging process	disorientation confusion paranoia hallucinations
pt w/dementia will be able to understand and remember directions and can be left unattended	FALSE
risk of falling form x-ray table is great 2-things to prevent it from happening	care to prevent falls, assist in positioning and getting on and off the table
skin is more_______ and pt less responsive to ______	fragile, painful stimuli
momentary blindness is caused by rapid changes in lighting, it affects pediatric or geriatric pts	geriatric
you can assume a geriatric pt has hearing loss and you can yell	dont assume, but be sure pt is able to hear directions
symptoms of pulmonary system	breathless fatigue cough refleex less effective more prone to aspirate, drink contrast upright, chronic pulmonary disease cannot lie flat more than brief period due to dyspnea use 2nd full inspiration to ensure lung expansion
neurologically geriatric pt fully responsive to pain stimuli and process information quickly	FALSE
what are the special considerations for cardiovascular geriatric pts	hypothermia cold caused by decreased circulation, avoid chilling. postural hypotension feeling dizzy by rapid positioning changes
name some special conditions for geriatric pts for GI system/hepatic/GU	exams scheduled early,UGI pt must drink slowly to avoid choking, BE-problem holding barium,aging liver potential drug reactions bed pan & urinal close-limited capacity, handle dentures carefully
can pt have weight on surgical site	no
should chart be checked for weight bearing and mobility	YES
how is geriatric pt checked to determine rate of healing	radiographs requested several days post-op
manifestations after hip replacement	dislocation of prosthesis abduction &adduction must be prevented-keep in extention. hips not flexed more than 90deg. weight bearing restriction for varying legths of time
manifestations of knee replacement	continuous passive motion device weight bearing restricted knee cannot be hyperflexed pt should not kneel
what type of tube is inserted through the nasopharynx into the stomach	nasogastric tube
what is a nasogastric tube used for	keep stomach free of gastric contents,diagnostic exam,administor feeding&meds, treat intestinal obstruction,control bleeding,during disease process pre or post-op to assist with healing
what is a nasoenteric tube (NG)	inserted through nasopharynx into duodenum or jejunum by way of peristalis
what tube is used for decompression,diagnosis,treatment, feeding tubes to obtain nourishment for longer period of time	Nasoenteric Tube (NE)
name some nasogastric tubes	levin,sump, sengstaken-blakemore(S-B)
two most common NG tubes found in radiology and description	levin-single lumen, Sump-double lumen must never be clamp and second lumen remains outside
what NG is a triple lumen and is seen more in the ICU and can be done portabley	S-B NG
name a NE tube and where it enters body	cantor,single lumen, enters small intestine
how is progress and placement of tube observed	under fluroscopy and radiographs
does radiographer place tube or assist	assist
what type of tube is taped in place	NG tubes, not NE because peristaltic action keeps tube in position
things to remember about NG tubes	don't put pressure on them, pt NPO unless physician order
what tube can a radiographer remove with physician order	NG tube
what tube can only be removed by MD or RN	NE tube
what should a radiographer do to reduce risk of aspiration on pt w/ NE and NG tubes	pt in sem-fowlers position during and 30min after administration of any agent in tube
when should placement of a tube be verified, and how	before administering medication,food,water or contrast- radiograph or test aspirated fluid for acidity
if a pt w/tube is on a continuous or intermittent suction device it can be discontinued and the pt can be transferred to imaging dept.	NO, suction devices can be discontinued w/DR orders, must know length of time suction can be delayed
how do you know the amount of pressure for suction,	check order
what is the maximum amount of suction for an adult	25mm Hg
is a single or double lumen tube okay to clamp for transport purpose	only single can be clamped, double can have syringe inserted into "blue pigtail" w/barrel pointed upward and pinned to pt gown
what is gastronomy	surgical opening into stomach
what is the placement for gastronomy tube	through surgical opening of stomach a tube is placed inside stomach to abdominal wall
radiographer should watch these things for a G-tube	prevent infection,dislodgement,sensitive to pt feelings, tube is clamped after feeding
what is a gastronomy tube used for	feeding on temp or perm basis
how do you know a pt has just gotten a gastronomy tube	dressing will be in place, older may not have
what is central venous catheter	long term med administration,blood transfusions,hypersmolar solutions,total parenteral nutrition,measure Central Venous Pressure
placement for CV catheter	brachiocephalic vein at junction of superior vena cava or within superior vena cava,line is seen medial to anterior border of the 1st rib
how are CV catheters confirmed for correct placement	portable chest or c-arm fluro during actual insertion
what is the difference between partial and total parenteral nutrition	PPN-placed in lg peripheral vein,TPN-least common, lg vein in central venous system,controlled by IV pump,hypersmotic solutions would damage peripheral veins
CV catheter uses and names	tunneled to exit the anterior chest, inserted into subclavian or internal jugular vein then into SVC or r.atrium, names-hickman,broviac,groshong
what is PICC	peripherally inserted central catheter
where is PICC placed	pt arm and advanced until its tip lies in central vein
implanted ports are needed for	pt who need frequent IV meds or transfusions
where is the implanted port felt and placed	not visible can be felt, implanted into subcutaneous tissue in the chest
needle and catheter insertion on an implanted port	catheter-from port into subclavian or internal jugular vein, huber needle-inserted to access central vein through the port
CVC have more than one lumen and several access ports at the ________ site. They come in single, double and multiple lumens for______ and ___________ care	exit, short and longterm care
things radiographer should be aware of for CVC	prevent infection,need DR orders to change dressing, prevent dislodging
Is it in the radiographers scope of practice to do suctioning	NO, but need to determine if suctioning is needed and use sterile technique, maintain equip in dept
signs suctioning is needed	profuse vomiting in pt that can't change position,audible rattling or gurgling sound from throat,signs or respitory distress
what to do if suspected suctioning needed	conscious person in semi-fowlers, unconscious in lateral side lying pos. assist to clear airway, pt w/spinal cord injury w/vomiting log-roll with face directed downward while keeping head and neck immobile
opening created surgically to relieve respitory distress or improve respitory function. can be permanent or temp.	tracheostomy
what helps seal and protect air leaks and aspiration of gastric contents for a tracheostomy	adults have cuff
things to be aware of while caring for pt w/tracheostomy	pt fearful,unable to speak, afraid of choking,semi-fowlers most comfortable position,explaining full procedure can alleviate anxiety, required suctioning requires RN present
mechanical ventilation is used for	pt who cannot breath, respiration is inadequate to O2 blood levels, gas exchange blood disorders, disease that affects mechanics of breathing
pulmonary emboli and severe respitory disease are _______________	gas exchange disorders that may require mechanical ventilation
extrapulmonary disorders such as CVA and Guillain-Barre syndrome are______________	diseases that affect mechanics of breathing and may require mechanical ventilation
what type of ventilators are more common, purpose and requirement	positive pressure ventilators, inflate lungs by exerting positive pressure on the lungs stopping inspiration when a preset pressure is attained, to use they require an artificial airway(endotracheal or tracheostomy)
things radiographer should be aware of with a patient on ventilator	notify nurse and have them stand by, move pt safely w/help if needed,don't put pressure on any tubings, don't disconnect power to any equip., use medical asepsis tech,watch for pt to breath because they cannot "hold" breath
purpose and insertion of endotracheal tubes	inserted through mouth into trachea,cuff is inflated,hence open airway established. The tube prevents aspiration of foreign objects into bronchus
correct placement of endotracheal tube	5-7cm above carina (tracheal bifurcation), 20% of tubes require repositioning after initial insertion
chest images are taken on pt with endotracheal tube with the initial insertion and	on a daily basis to ensure tube has not shifted,handle pt with care so to prevent this
what happens if endotracheal tube is inserted is inserted to far and enters the R. bronchi	collapse left lung
if the tube is not positioned far enough down into trachea, too high,	may cause air to enter stomach, pt regurgitates gastric contents leading to aspiration pneumonia
what is placed for a pt that has pressure in pleural cavity is normally lower thatn atmospheric pressure because of disease or injury	chest tube
a total or partial collapse of the lung , absence of gas from part or whole lung is	atelectasis
what is a surgical opening into chest cavity	thoracotomy
pneumothorax,atelactasis,hemothorax require placement of ______________ into the pleural cavity	one or more chest tubes
chest tube is attached to ________ to remove any air or fluid from the pleural cavity to reestablish correct intrapleural pressure and allow lungs to expand normally	water-sealed drainage unit
things a radiographer must know about the water-sealed drainage unit	could have 1,2 or 3 chambers,don't clamp, keep straight w/o tension or kinking, keep at chest level, water sealed chambers must remain below pt chest,know when to notify nurse
when should a nurse be notified about a drainage unit	if water sealed chamber is continuously bubbling, or pt has rapi,shallow breathing,cyanosis, or complaint of pressure on chest
Tissue drains are placed where	at or near wound when lg amounts of drainage are expected to prevent infection and fistulas
what is a fistula	abnormal passage from a hollow organ to the body surface, or from one organ to another
common tissue drains	hemovac,jackson-pratt, penrose
what is penrose drain	soft rubber tube that drains into surgical dressing
what is jackson-pratt and hemovac and which one is most common	hemovac most common, drains maintain constant,low,negative pressure by means of small bulb, drainage goes from tubing into bulb
placement for T-tube	common bile duct
placement for Cecostomy tube	in cecum
placement for cystostomy	in kidney
patient care for tissue drains/tubes	identify type of tube during assessment, plan care to prevent tension, consider infection control----(use STERILE aseptic technique)

Created by: StudyGroup

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