Final Exam

Question 1

What are body mechanics?

Answer 1

• Biomechanics examines the action of forces on bodies at rest
  or in motion.
• Can be used to design safer work environments.
• Fundamental to good patient handling techniques are the
  concepts of the base of support (BOS), center of gravity (COG),
  and mobility and stability muscles.

Question 2

What is the Base of Support?

Answer 2

• The BOS is the foundation on which a body rests.
• BOS is the area between the feet, including the
  plantar surface area, in a standing position.
• A wide base of support is essential for stability.

Question 3

What is the centre of gravity?

Answer 3

• A hypothetical area of the body where the mass
  of the body is concentrated; gravitational forces
  appear to work on the entire body from this
  specific point.
• In anatomical position, typically at level of
  second sacral segment.
• Moving heavy objects is relatively easy and safe
  if the object is held close to the mover’s COG.

Question 4

Mobility muscles?

Answer 4

extremity muscles - use for lifting

Question 5

Stability muscles?

Answer 5

stability (postural muscles)
use for support

Question 6

what are the lifting principles?

Answer 6

• Lifting should be done by bending and straightening the knees.
• The back should be kept straight or in a position of slightly increased lumbar lordosis.
• Allow ample time, and handle patients gently.
• Always inform the patient of what you are going to do and how you intend to proceed
• Execute the transfer slowly enough for the patient to feel secure
• patients centre of gravity should be close to the mover’s centre of gravity

Question 7

What are the mechanics about how you should lift a patient?

Answer 7

• When lifting patients, keep the back stationary and let
  the legs do all the lifting.
• Twisting should be avoided.
• After the patient is standing, help him or her to pivot
  around to a bed or X-ray table and to sit down.

Question 8

What are the legalities of an incorrect transfer?

Answer 8

• Never assume patients realize their abilities.
• The radiographer is the person responsible for the move and the decision on how that is done.
• Falling below the standard practice of care may result in the patient being critically injured and the radiographer being held legally liable.

Question 9

How do you asses patient mobility?

Answer 9

• The patient’s general condition
• Immobility or limitations in range of joint motion
• The ability to walk and weight bear
• Respiratory, cardiovascular and/or musculoskeletal
  problems
• Attached equipment such as IV pump, urinary catheter

Question 10

What is orthostatic hypotension?

Answer 10

• Drop in blood pressure when a person stands too quickly.
• This condition becomes increasingly serious when a patient has been recumbent for a long period of time.
• Rising too quickly can deprive patients of oxygen rich blood to the brain.
• Symptoms of orthostatic hypotension include dizziness, fainting, blurred vision and slurred speech.

Question 11

What to assess for wheelchair transfers?

Answer 11

• Assess patient condition.
• Determine patient’s strong and weak sides.
• Always position the patient so that he or she transfers toward the strong side.
• Lock wheelchair locks and move footrests out of the way.

Question 12

What are the types of wheelchair transfers?

Answer 12

• Standby assist
• Assisted standing pivot
• Two-person lift
• Hydraulic lift

Question 13

Standby Assist Wheelchair Transfer?

Answer 13

• Used for patients who can
  transfer from a wheelchair to a table on their own.
• Position the wheelchair at a 45- degree angle to the table.
• Talk to the patient prior to their movement to determine how much, if any, assistance is
  required.
• Provide movement instructions to the patient continually during transfer.

Question 14

Assisted Standing Pivot TransferWheelchair Transfer

Answer 14

• For patients who cannot transfer independently but can bear weight on their legs.
• Position the wheelchair at a 45-degree angle to the table with the patient’s stronger side closest to the table.
• Consider using a transfer belt to enable a secure grip on the patient (especially if they are wearing loose clothing).

Question 15

2 Person Lift Wheelchair Transfer

Answer 15

• Use on patients who are lightweight and cannot bear weight on their lower
  extremities.
• The stronger person should life the patient’s torso while the second person lifts
  the patient’s legs.
• The person lifting the torso usually directs the movement.
• Verbally plan out the procedure before the execution of the transfer to allow for troubleshooting.
• Lock the wheelchair in place.
• Remove the armrests (if possible) and swing away or remove the leg rests.
• Ask the patient to cross their arms over their chest.
• The stronger person stands behind the patient, reaches under the patient’s
  axillae, and grasps the patient’s forearms.
• The second person squats in front of the patient and cradles the patient’s
  thighs in one arm and the calves in the other.
• On command, the patient is lifted to clear the wheelchair and is moved as a unit to the desired location.

Question 16

Hydraulic Lift Wheelchair Transfer

Answer 16

• Used when patients are too
  heavy to lift manually.
• Health professionals should
  familiarize themselves with
  and practice using the
  equipment before attempting
  to lift a patient
• Patients need to be seated or recumbent on a lift sling, before using this type of lift.
• Sending a patient back to the ward to return sitting on a sling is better than risking injury to the patient, the
  mover, or both by attempting transfer without using a sling.
• Communication is critical to lift success

Question 17

Stretcher/Gurney/Cart Transfer

Answer 17

• Position the stretcher alongside the table on the patient’s strong or less affected side.
• Make sure wheels are locked and immovable.
• Allow patient to assist with the move based on the patient’s ability and condition.
• If the patient cannot assist, use transfer aids.
  If the patient cannot transfer on their own, cart transfers usually require three people.
• For the actual lateral transfer, both transfer surfaces must be side to side, as close as possible, and at the same height.

Question 18

What are the types of stretcher to table transfers?

Answer 18

Sheet transfer
Lateral transfer board
Log roll

Question 19

What are slider boards?

Answer 19

• Lateral transfer is best accomplished using a sliding/slider board
• Glossy plastic board
• Radiolucent

Question 20

Log Roll

Answer 20

• In the event a trauma patient must be moved, a procedure known as the log roll must be used.
• The objective of the log toll procedure is to maintain correct anatomic alignment of the spine in order to prevent the possibility of neurologic injury

Question 21

Patient Transfer Roll Boards

Answer 21

• Minimal effort is required to preform the transfer
• This reduces the strain on the caregiver’s body while providing a comfortable experience for the patient

Question 22

Positioning the Patient for DI Exams

Answer 22

• When a patient must spend a long period in the DI
  department, it is the radiographer’s duty to assist the patient to maintain normal body alignment for
  comfort and to maintain normal physiologic
  functioning.
• There are several positions that the patient may be
  requested to assume to facilitate diagnosis or
  treatment

Question 23

Supine/Dorsal Recumbent

Answer 23

• Patient is flat on their back.
• The feet and neck will need to be protected when the patient is in this position.
• Pillow for neck
• The feet should be supported to prevent plantar flexion (footdrop) if the
  patient is to remain in this position for several hours.

Question 24

Lateral Recumbent

Answer 24

• Patient is on side with knees flexed
• Relieves pressure on most bony prominences
• Patient may be supported with pillows/sndbags or sponges to maintain position

Question 25

Prone

Answer 25

• Patient lies face down.
• A small pillow may be
  provided to support the
  head.
• The patient may be moved
  down the table to allow feet
  to drop over the edge, or a
  pillow/sponge may be placed
  under the lower legs at the
  ankles to prevent foot drop

Question 26

Fowler

Answer 26

• Semi-sitting position with head raised at an angle of
  45 to 90 degrees.
• This position is used for patients in respiratory
  distress.

Question 27

Semi-Fowler

Answer 27

• Patient’s head is raised at an angle of 15 – 30 degrees.
• Feet must be supported to prevent foot drop.

Question 28

Sims’ position

Answer 28

• Patient lies on either side with the body inclined slightly forward with the top knee bent sharply and the bottom knee slightly bent.
• The forward arm flexed, and the posterior arm extended behind the body.
• The position is frequently used for diagnostic imaging of the lower bowel as an aid in inserting the enema tip.

Question 29

Trendelenburg/Reverse Trendelenburg

Answer 29

• The table or stretcher is inclined with the patient’s
  head lower than the rest of the body.
• Patients are occasionally placed in this position during
  imaging procedures and for the promotion of venous
  return.

Question 30

Skin Damage

Answer 30

• Skin breakdown can occur in a brief period and result in a
  pressure sore known as a decubitus ulcer that may take weeks or months to heal.
• Mechanical forces that may predispose skin to breakdown are immobility, pressure and shearing force.
• Elderly patients are particularly vulnerable to skin damage.

Question 31

Immobilization

Answer 31

• Motion distortion is one of the most significant contributing factors to
  unacceptable image quality.
• Positioning inaccuracies also contribute to suboptimum image quality.
• Motion distortion can result from involuntary and voluntary patient motion
  and position.
• Patient restraint can be simple or complex.

Question 32

Immobilization Principles

Answer 32

• Communication with the patient is the most effective means of immobilization.
• Use the shortest exposure time possible.
• Use immobilization aids when possible.
• Empathy with the patient’s condition can be effective in
  facilitating good immobilization.
• Be aware that some immobilization devices can leave artifacts on images.

Question 33

Positioning Sponges

Answer 33

• A common method of reducing patient motion involves the use of positioning sponges.
• Positioning sponges allow for increased accuracy by
  supporting the patient or anatomic area of interest.
• Make sure sponges are free of artifacts.

Question 34

Sandbags

Answer 34

• Sandbags are extremely helpful in reducing voluntary motion.
• Radiopaque
• Must be placed gently on or against the area adjacent to the anatomy of interest as to not injure or cause further damage.
• Commonly used in lateral c-spine and acromioclavicular imaging to depress shoulders

Question 35

Tape

Answer 35

• Note the placement of a cloth sponge between the tape and skin to prevent skin damage.
• The resourceful radiographer will use creative techniques such as tape to
  help in patient immobilization. It is best used on patients who are cooperative and need assistance in holding perfectly still during exposure

Question 36

Stability Bar

Answer 36

• Located on most upright bucky units.
• Moves the patient’s arms above their head but
  also serves to provide stability and steadiness.
• By eliminating swaying, the need for repeat exams
  can be reduced and patient radiation exposure
  can be kept to a minimum.
• Adjustable: can be used with the patient standing
  or sitting.

Question 37

Velcro Straps

Answer 37

• Can serve as safety precaution when performing a procedure on a patient who is nor completely cognizant – sedated, diminished mental capacity.
• Should never be left unattended; the straps only to facilitate the protection of the patient from injury.
• Velcro straps are designed to easily attach to the imaging table.
• Can be moved to cover any part of the body and can also be used to apply compression to the abdomen in certain procedures.
• Can be applied to patients to support the patient firmly during positioning of table

Question 38

Trauma Spine Immobilization

Answer 38

• The most common spinal trauma traction device is the cervical collar.
• All projections can be produced with the cervical collar in place.
• Often these patients are also on a spinal backboard.
• Cervical collars should not be
  removed until a qualified practitioner has assessed images, and determined
  it is safe to move the patient

Question 39

Trauma Spine Imaging

Answer 39

• The use of a trauma spine
  backboard is common.
• It is typically radiolucent,
  to some degree.
• They are effective in
  helping to immobilize
  patients in a variety of
  situations.

Question 40

Pediatric Immobilization

Answer 40

• Effective communication techniques and development of a rapport with the patient are critical.
• Kindness, patience, honesty, and understanding, conveyed to children on their level.
  Threats and force must be avoided, and restraints applied gently.
• Work with parents.
• Follow department policies and procedures.

Question 41

Sheet Restraints

Answer 41

• One of the simple, inexpensive and reliable ways of immobilizing or restraining a child.
• Mummy Wrap.
• Beneficial for children who are still too young to
  understand cooperation.

Question 42

Commercial Infant Immobilization Devices

Answer 42

• Upright restraint device: Pigg-O-Stat
• Useful for upright chest and abdomen imaging
• Can accommodate children up to 3 – 4 years of age, depending on size.
• Once secured, the patient can be rotated 360 degrees to demonstrate lateral and oblique projections.
• Pigg-O-Stat has a built-in, adjustable lead shield.
• Patient movement can be easily observed since the device is made of
  see-through plastic.

Question 43

Octostop Restraint Board

Answer 43

• Patient can be rotated 360° into eight different positions.
• Radiolucent material
• Durable
• Limited to pediatric patients up to 1 year old

Question 44

Geriatric Patients

Answer 44

• Greatest fear is falling!
• Communication is critical to effective immobilization of
  older patients.
• Take extra care to make a geriatric patient feel secure.
• Ensure their comfort before, during and after the exam.
• Use the radiolucent table pad, pillows and blankets.
• Work smoothly and avoid disorienting the patient.

Question 45

You have just finished positioning a patient for a
supine abdomen x-ray. Just as you finish placing your
marker in the light field, your patient mentions to you
that they “really have to use the bathroom” and
appears embarrassed. How do you respond?

Answer 45

• Respond quickly and professionally if a patient requests a washroom.
• Assess patient’s ability.
• Assist patient with footwear, and make sure they are covered (robe/sheet).
• Help patient off radiographic table.
• Patient may have been fasting or be on medication that makes them unsteady

Question 46

Use of bedpans

Answer 46

• The male patient who is not ambulatory must be offered a bedpan for
  defecation.
• A non-ambulatory female patient who is not catheterized, must be
  offered a bedpan for both defecation and urination.
• Clean bedpans are stored in a specific area of the radiology department.
• If not disposable, bedpans must be sterilized between uses.

Question 46

Types of Bedpans

Answer 46

1. Standard
   - Metal or plastic or paper
   - 2” high
2. Fracture
   - Shallower and contoured for patient comfort.
   - The tapered end improves comfort and ease of placement with immobile patients.
   - For patients who cannot lift their hips as high.

Question 47

What is the Hygiene System

Answer 47

• Hygienic cover with super-absorbent pad
• The unique super-absorbent pad included in each Hygienic Cover® is designed to
  turn up to 500ml of liquid wastes into a gel within seconds.
• This helps reduce the risks of splashes, spills and germ dispersal which contribute
  to the prevention of cross-contamination and healthcare-associated infections.
• After using the Hygienic Cover®, close it securely and discard it in the designated
  area.

Question 48

Urinals

Answer 48

• Specifically designed for patients with a penis
• Can be used with the patient supine
• May have to position the patient
• May have to measure outputs
• Otherwise, dispose of the urine and return to the patient

Question 49

Handling Casted anatomy

Answer 49

• Support a casted or reduced extremity at both joints.
• When moving a fractured (and/or casted) extremity,
  support both proximal and distal to the fracture, with
  opened, flattened hands.
• Avoid grasping the cast tightly with fingers

Question 50

Handling Newly Applied Casts

Answer 50

• Lift under the cast using opened, flattened hands – Do
  not squeeze to lift it as this may cause compression
  (change shape of cast), producing pressure against
  patient’s skin.
• May lead to decubitus ulcers, impaired blood flow, or
  nerve damage.

Question 51

Signs of impaired circulation or nerve damage

Answer 51

• Pain
• Coldness
• Numbness
• Burning/Tingling of fingers or toes
• Swelling
• Skin color changes
• Inability to move fingers or toes
• Decrease in or absence of pulse

Question 52

Patients in traction

Answer 52

• Requires a portable imaging exam.
• Never remove OR pull the traction device or let the weights rest on anything.
• This may result in a reduced fracture to become misaligned.
• Get help.
• C-spine, femur, tibia etc.

Question 53

Precautions for Post-operative hip arthroplasty

Answer 53

• Never allow patients to cross their legs (Adduction)
• Avoid abduction
• Avoid hyperextension or flexion
• Avoid internal or external rotation

Question 54

IV standards

Answer 54

• Bag height 18 – 24 inches above vein
• An infusion pump or simple clamp may be used to
  regulate the flow.
• Flow should be 15 – 20 drops per minute.

Question 55

IV standards - too high

Answer 55

• Too high – extravasation (delivery of solution into surrounding tissue outside the vessel, resulting in interstitial administration).
  Can result in:
• Pulmonary Edema
• Tissue necrosis
• Overdose on Medication

Question 56

IV standards - too low

Answer 56

Too low – blood runs back into tubing. Blood clots in line, Line must be replaced
Can result in:
- Inadequate Medication
- Poor visualization of Contrast media

Question 57

Ileostomy

Answer 57

An artificial opening (stoma) in the small intestine (ileum) for the purpose of evacuating feces

Question 58

Colostomy

Answer 58

An artificial opening (stoma) in the large intestine (colon) for the purpose of evacuating feces