Ch 4 Patient Handling And Safety Flashcards
Arrt standard of ethics 2 parts p 4
Code of ethics
Rules of ethics
Code of ethics p 4
Assist certificate holders and candidates in maintaining a high level of ethical conduct and providing protection , safety and patient comfort
Patient bill of rights goals p 6
Strengthen consumer confidence in healthcare system
Reaffirm importance of strong relationship
Reaffirm patient safeguard in their personal info
Patient bill rights p 6-7
Read
Informed consent p 8
Types info patients must be given so they can make informed decisions about medical treatment
Metformin p 13
When start taking again?
Refrain from taking 48 hrs following prevent lactic acidosis
Kidney function should be checked to resume
Consent form used for ? P 14
Contrast agents
Surgical procedures
Sedation
Payment arrangement
Are consent forms required by law? P 14
No
Screening for contrast agents p 17
Previous contrast reaction
Allergies to iodine or barium
Conditions such as hypertension, heart disease , asthma, sickle cell anemia, renal impairment , and diabetes
Renal function tests0 17
Bun
Gfr
Creatinine
Bun ( blood urea nitrogen) p 17
Kidneys ability to remove impurities from the blood
Range 5-25 mg/dl
Gfr ( glomerular filtration rate) p 17
Excretory function of kidneys
Range: 95-120 ml/min
Creatinine p 18
How well it’s removed from bloodstream by kidneys
Range: 0.6-1.7 mg/dl
eGFR p 18
Formula
Range
75 x serum creatinine
Normal: > 60
Tests determine blood coagulation ability
Pt Ptt Inr D-dimer Platelet count
Pt test p19
Chemical interaction to blood clot
Range; 10-14sec
Ptt test p 19
Chemical interaction to blood clot
Range: 20-40 sec
INR test p 19
Standardize prothrombin time for those taking anticoagulants
Ranges:
- 2.0-3.0 for patients on anticoagulant drugs
- 2.5- 3.5 for patients with high risk of clot formation
D-dimer test p 19
Normally less than 500 micrograms/liter fibrin equivalent under units
Platelet count range p19
Normally 150,000/ mm3 to 400,000/mm3
High INR indicates/ low INR
? P 20
High chance of bleeding
High chance of clotting
D-dimmer test used for most? P 20
Deep vein thrombosis
Positive d-diner test indicates ?21
Abnormal high levels of fibrin degradation products in the body
D-diner tests to diagnose? P 21
Conditions that cause the blood coagulate inappropriately
D-dimmer is ordered usually in conjunction with ct______ to rule out _______ ? P 21
Ct pulmonary angiography
Pulmonary embolism
Two ways radiation can cause damage ? P 22
Direct interaction with DNA bonds
Indirect effect by ionization of chemicals in the body
Results of radiation exposure during pregnancy ? P 22
Increased prenatal deaths
Abnormalities
Mental retardation
Neonatal deaths
Radiation safety p 22
Methods and tools used protect patients and personnel from ionizing radiation exposure
When is radiation exposure most damaging ? P 22
First trimester
Most common unit for measuring radiation?
Rad
1 rad= ___
0.1 joules of energy
Rem and sievert p 23
Effective dose or dose equivalent
1sv=____ R.E.M.
100
1 rad= ____ R.E.M.
1
Ct scans account for about ____rem( ___msv)p 23
- 31 rem
1. 5 msv )
Radiation strictly from X-rays are measured in ___or ____. ______
Rad/gy
Sv/ rem
Effective dose from ct produce range ? P 24
1-10 msv
Greater the distance traveled through the tissue and the the denser tissue the X-ray photons penetrate, the _____ the dose is decreased along the photons path
More
Dose at the entrance of the patient a skin is ______ than at the center of the body p 24
Greater
Ct effective dose p 25
Ct head
Ct abdomen
1 radiography exposure
5 radiography exposure
2msv
8 msv
- 1 msv
- 5 msv
Radiation penumbra and why? P 26
Radiation extends outside the intended slice because collimating of X-ray beam is imperfect
Ct dose index (ctdi) p 26
Average dose along z-axis( long axis of body) , over the central slice of series of collected slices and accounted for,the radiation within the slice thickness as well as penumbra. Dose not factor in variation in dose from gaps and adjacent tissues
Msad- multi slice average dose p 27
Indicator of radiation dose which corrects ctdi by factoring gaps and overlaps between slices or Helical due toslected table increment or pitch
Since slice obtained with mdct is not indivudually collimated , it does not have radiation penumbra . Only ______slices of slice volume have penumbra effect with mdct
P 28
End
Ctdi100 p28
Possibility of having multiple slices in single rotation and accounts for slices
CTDIw p 29
Weighted average of the center and peripheral ctdi100 to arrive at single measurement based on single rotation of multi row detector scanner
CTDIvol p 29
Accounts for helicAl studies performed on multi row detector scanners and indicates the average radiation dose over all three directions (x,y,z axis)
CTDIvol= CTDI vol
———–
Pitch
Dlp ( dose length product) p 30
Integrated dose in terms of total scan length
Effective dose p 31
Calculated sum of the absorbed dose of all tissues in the body, each individually multiplied by weighting factor for that organ or region. Since different parts of the body are having varying sensitivities to adverse effects of radiation, the effective dose is an indication of the overall risk to patient from radiation
Alara
As low as resonabily possible
Safe level of radiation
No level is assumed safe
Ct system factors affecting dose
X-ray tube to patient distance
Filtration
Pre patient collimating
Multi row detector design along with noise reduction strategies
Further tube from patient the _____ dose
Less
Filtration takes out soft rays which does _____ dose. P 32
Less
More collimation the _____ dose
Less
Mdct scanners have _____ dose
More
Ways mdct scanners try reduce dose (2) p 33
Evaluates size of anatomy and attenuation
Ma automatically adjusted
Mas decreased dose_____
Decrease
MVP only decrease to minimize dose to (2) p 35
Small patients
Kids
Scanning less of the body dose______
Less
Slice thickness ( single row ) , slice thickness up then dose_____
P 35
Down
Mdct, slice thickness does what to dose? P 36
No affect
Increasing table increment _____ dose
Less
Increasing pitch _____ dose
P 37
Less
Pediatric and small patient reducing two gives less dose ?
Kvp
Mas
Ways reduce dose
Less repeats scans Reformat rather than rescan Reduce multiple scans Use prospective cardiac synchronization Use shield
Two methods synchronizing cardiac scan ? P 40
Prospective synchronization
Retrospective synchronization
Prospective synchronization p 40
Applied during the scan , serial scanning performed during cardiac r wave which is a portion of cardiac cycle
Retrospective synchronization p 40
Applied after the scan, using a helical scan through the entire cardiac cycle
Prospective cardiac gating frequently used for ? P 41
Calcium scoring
Retrospective gating used for ? P 41
Moore accurate. When patient has irregular heart beat and looking at coronary arteries
Dose check standard p 42
Designed to intervene with a message to the tech that ask to confirm of exam settings before proceeding with a scan that might lead to high exposure
Dose notification value p 42
Used to trigger a message when single planned and confirmed scan is likely to exceed a pre programmed CtDIvol and or DLP value
Dose alert value p 42
Used to trigger a message when the cumulative dose at location plus the dose for next landed and confirmed scan is likely to exceed pre programmed value
Medical worker dose p 44
Maximum effective dose of 20 msv per year , averaged over 5 years , with no more than 50msv in one year
Oximetry p 47
Measuring concentration of oxygen in the blood
Normal oxygen saturation is?
95-100%
Arrhythmia p 48
Irregular heart beat
Sinoatrial (sa node) p 48
Located right atrium
Provides main control and source of the heart . Provides nutrients and hearts natural pavemaker
Atrioventricular (av node) p 48
Pathway of impulses from atria to ventricles
Normal heart rate p 48
60-100 beats per min
Sinus tachycardia p 49
Fast heart beat
Sinus bradycardia p 49
Slow heart beat
Supraventricular arrhythmia p 49
Don’t originate in ventricles
Ventricular arrthhmias p 49
Come from ventricles
Atrial contraction p 49
P wave - both left and right
Ventricular contractions p 49
Qrs complex - both left and right
Ventricular relaxation p 49
T wave
Software used during ecg gating during which wave?
R wave
Diastole p 50
Atria and ventricles relaxed
Atrial systole p 50
Sa node triggers atria contract
Ventricular systole p 50
Ventricles contract
Cardia arrest p 51
Loss of heart function
When should cpr be started? P 51
Patient shows signs of cardiac failure
Cardiac arrest signs:
No pulse No respiration Vomiting Seizure Damp bluish or grayish skin tone Incontinence or defacation
Seizure p 52
Convulsive moments or periods of unconsciousness
Signs of seizure;
Uncontrollable muscle contraction Facial twitching Blank facial expression Loss of motor activity Difficulty breathing Confusion
If patient has a seizure , what to do? P 52
Remove all restraints and objects that could harm. Ease patient into resting position on table, chair or floor
Stroke p 51
Results of lack blood flow to the brain
___________ is necessary to minimize brain dame during a stroke
Rapid response
Sign of stroke:
Inability to communicate Bilateral or unilateral numbness or paralysis Pupil disparity Incontinece Hypertension
Severe reaction to contrast ? P 53
Anaphylactic shock
Shock p 52
Insufficient blood flow to the tissues and vital organs
Signs of shock :
Altered level of consciousness Hypotension Cool bluish or grayish tones Tachycardia Restlessness
What to mess to give if patient in anaphylactic shock from ct contrast?
Epinephrine
Normal oral temperature
97-99 f
Normal axillary temp
96.5-98.5 F
Normal rectal temp
97.5-99.5 F
Most common place for pulse ? P 53
Radial
Places for pulse ?
Apical , radial, femoral, popliteal, pedal
Normal adult pulse
70-100 beats per min
Child pulse range
95-110 beats per min
Infant pulse range
100-180 beats per min
Blood pressure
Diastolic
Blood pressure measurement usually taken at? P 54
Brachial artery
Adult blood pressure range
60-80
Child blood pressure range
45-85
Adult respiratory rate
12-20 breaths per min
Child respiration rate
15-30 breaths per min
Infants respiratory rate
25-50 breaths per min
Airborne precaution p 60
Dissemination of either airborne droplet nuclei ( 5um or smaller ) that remain suspended in the air
Airborne pathogen?
Tuberculosis
Airborne precaution patient placement (3)p 60
- monitored negative air pressure in relation to surrounding area
- 6-12 air changes per hour
- appropriate discharge of air outdoors or monitored high efficiency filtration of room air before the air is circulated to other areas of the hospital . Keep door closed and patient in the room
Respiratory protection from tb
N95 mask
Droplet transmission
Contact of conjunctive or the mucous membranes of the nose or mouth of susceptible person with large particle droplets ( larger than 5um) containing micro organisms generated by person who has a clinical disease or who is a carrier
Droplet precaution examples p 61
Talking
Sneezing
Cough
Droplet precaution distance
3 ft or less
Types droplet precautions
Influenza and sars
Droplet precaution standard
Wear mask if 3 ft from patient
Contact precaution p 62
Reduce risk of transmission of epidemiologically important microorganism direct or indirect contact
Direct contact p 62
Skin to skin contact and physically transfers the microorganisms to susceptible host from infected or colonized person
Ex bathing, turning patients
Indirect contact p 62
Contact of susceptible host withy contaminated intermediate object usually inanimate in patients environment
Nasal cannula p 65
Often used for oxygen therapy
Types masks p 66
Simple
Nonrebreather mask
Venturi mask
Tracheostomy p 66
SurgicAlly created opening in the trachea
Negligence p 11
Breach or failure to fulfill the expected standard of care
Malpractice p 11
Failure to do something that a reasonable person , guided by those considerations which ordinarily regulate human affairs, would do.
