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Patient Management 1 > Midterm > Flashcards

Midterm Flashcards

1
Q

Criteria for a profession

A

Provides a vital human service.
Possess a special body of knowledge that is continuously enlarged through research.
Practitioners are expected to be accountable and responsible.
Post-secondary education
Practitioners control their own practice
Professional decisions and conduct is guided by a code of ethics
Professional organizations that control the educational and practice requirements of its members.

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2
Q

what 2 professional organizations set standards of practice and educational requirements for medical radiation technologists?

A

Canadian Association of Medical Radiation Technologists (CAMRT)
College of Medical Radiation and Imaging Technologists of Ontario (CMRITO)

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3
Q

What is CAMRT?

A

National professional association and certifying body for radiological, nuclear medicine and MRI technologists and radiation therapists. (National Exam)
Competencies and Entry to Practice requirements.
Best practice guidelines: Statements developed to assist practitioners and patient decisions in specific healthcare circumstances.

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4
Q

What is the CMRITO mission statement?

A

The mission of the CMIRTO is to regulate the profession of medical radiation and imaging technology to serve and protect public interest

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5
Q

What does the CMRITO do?

A

Sets standards of practice by setting entry to practice requirement in Ontario
Registration to practice (annual licensing)
Professional Conduct (complaints & discipline process)

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6
Q

What are the CAMRT best practice guidelines?

A

is the means for providing the best possible outcome for patients based on judgments that consider patient needs, clinical experience, and the best available evidence.

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7
Q

How should you introduce yourself to the patient?

A

NOD
Name
Occupation
Duty

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8
Q

Why is an introduction to the patient important?

A

Patient trust is integral to successful care, and to patient satisfaction. Identifying oneself to the patient can help patients feel safer in the care of the MRT

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9
Q

How should patients be identified?

A

all patients are positively identified with two patient identifiers (full name and date of birth) prior to initiating a medical imaging or therapeutic procedure

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10
Q

What is the importance of patient identification?

A

Verify patient identifiers against all requests to ensure the procedures/treatments are provided to the correct patients.
Accreditation Canada cites client verification with two patient identifiers as a required organizational practice (ROP).
The World Health Organization encourages the use of at least two identifiers to verify a patient’s identity upon admission or transfer.

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11
Q

What is informed consent?

A

Is obtained or confirmed prior to initiating the procedure/treatment
The patient has the right to be informed regarding the procedure/treatment and its risks in a way that he/she can understand, and to have his/her questions answered in a similar manner.
Obtained in patients own language

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12
Q

Who can consent?

A

If the patient is capable based, then only the patient can consent to a procedure/treatment.
If the patient is incapable of giving consent, it is obtained from a substitute decision maker, according to provincial legislation.
The patient’s physician or another member of the healthcare team can NOT give consent on the patient’s behalf.
Consent is not required in an emergency situation ONLY if the delay to find an interpreter or substitute decision maker will prolong suffering or will put the patient at risk of sustaining serious harm.
In these cases, a physician may give the order to proceed with the procedure/treatment without consent.
The facts and circumstances surrounding the decision to proceed without informed consent are carefully documented.

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13
Q

What are the rules regarding withdrawing consent?

A

The patient has the right to withdraw consent at any time before or during the procedure/treatment.
If consent is withdrawn, the procedure/treatment must be stopped.
Withdrawn consent is documented.
All relevant information is provided to the patient so that the decision to withdraw consent is informed.

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14
Q

What are the opportunities in radiological technology?

A

Radiography
Cardiovascular/interventional technologist
Interventional technologist
Mammography
Computed tomography

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15
Q

Use of markers and annotations?

A

Radiographic images are permanently labelled at the time of exposure to indicate patient orientation and uniquely identify the MRT performing the procedure

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16
Q

Why are permanent markers important?

A

Reducing the chance of error (e.g., wrong side identified)
Reliable transmission to PACS
Confidence in future consultation/ investigation
Digital markers (annotations) are not a suitable substitute for image marking at time of exposure.
Markers may be important if the examination is to be used in a court case.
Images that include personal identification markers allow the possibility of MRT testimony and may lend credibility to his or her expertise.
Digital right and left markers may not be admissible in legal proceedings, since they are not permanent markers:
Images may be marked anywhere
Images may be flipped
Image layout can be altered

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17
Q

What is intentional tort?

A

Is a purposeful deed committed with the intention of producing the consequences of the deed.
Immobilizing a patient without his or her consent (false imprisonment).
Falsely stating a patient has a socially unacceptable disease (defamation of character).
Causing extreme emotional distress, resulting in illness through outrageous or shocking conduct.

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18
Q

What is unintentional tort?

A

May be committed when a radiographer is negligent in the performance of patient care and the patient is injured as a result.
Improper labeling of radiographic images.
Omitting to apply gonadal shielding on a pregnant woman.
Handing the radiologist a syringe for a procedure with the incorrect medication.
Leaving a patient unattended with bed rails down and the patient falling off the stretcher.

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19
Q

Claustrophobia

A

fear of enclosed or narrow spaces
affects 4% of population

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20
Q

How to manage claustrophobia and anxiety?

A

Education about the procedure, how long it will last and how it will feel can help alleviate anxious feelings for the patient.
A dry run (walk through) of the procedure can also help
Communication throughout the procedure or treatment can be an effective method to reassure and distract an anxious patient.
Newer open bore machines have been shown to decrease the incidence of claustrophobia among patients.
Sedation

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21
Q

What are commonly encountered complications during sedation?

A

Hypotension
Desaturation
Excessive/prolonged sedation
Nausea and/or vomiting

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22
Q

What is disease?

A

absence of health, any deviation from or interruption of the normal structure or function of any part, organ, or system, caused by microorganisms

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23
Q

What is infection?

A

establishment and growth a micro-organism on or in a host, resulting in injury to the host, caused by pathogenic organisms

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24
Q

What are the 3 functions of pathogens?

A
  1. multiply
  2. cause tissue damage
  3. secrete organic exotoxins (bacteria) as part of their growth and metabolism
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25
Q

What are exotoxins?

A

proteins that cause damage or dysfunction, by damaging host cell membranes or by entering target calls and directly altering function

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26
Q

What are exotoxin side effects?

A

fever, nausea and vomitting

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27
Q

What is an exotoxin example?

A

Vibrio Cholerae- results in release of exotoxins that bind to gut epithelial cells. Massive release of electrolytes and fluid is induced that manifests as severe diarrhea.

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28
Q

What are the 4 types of pathogens?

A
  1. bacteria
  2. viruses
  3. fungi
  4. parasitic protozoa
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29
Q

What is bacteria?

A

Microscopic, single-celled organisms.
Prokaryotes - lack nuclei and membrane-bound organelles.
May reside in host as a group or cluster called a colony.
May be classified according to their morphology (size & shape), biochemistry or genetic constitution.

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30
Q

What are bacteria morphologies?

A

spherical(coccus), rod shaped(bacilli), spiral(spirillium)

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31
Q

Common bacterial infections

A

strep throat, bacterial pneumonia, food poisoning and salmonellosis

TREATED BY ANTIBIOTICS

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32
Q

What are viruses?

A

Microscopic, single celled.
Cannot live outside a living cell - lack components for their own survival; inability to synthesize specific required proteins
Carry their own DNA or RNA but never both. DNA and RNA are surrounded by protein coat known as capsid.
Classified by the chemical nature of their nucleic acid, size and symmetry.
Virion (viral particle) attaches to host cell, inserts its own genetic information, and then redirects host cell to produce new viruses.
Not affected by antibiotics.

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33
Q

What are sporadic viruses?

A

Some viruses can travel within the nervous system.
They reappear sporadically and emerge at the nerve ending, causing various symptoms. They then leave the site and travel up the nerve again. This pattern can be repeated several times resulting in a latent or dormant infection.
Herpes simplex virus 1(HSV1) resulting in cold sores
Herpes simplex virus 2(HSV2) resulting in genital herpes (treated with suppressive or acute therapy)

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34
Q

What are common viruses?

A

Rhinovirus (Common cold)
Human Papillomavirus (Warts; Genital Warts, Cervical & Anal Cancer)
Epstein-Barr virus (Mononucleosis)
SARS-CoV-2 (COVID 19)

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35
Q

What are fungi?

A

Macroscopic or microscopic.
Eukaryotic (has nucleus and membrane-bound organelles).
Much larger than bacteria
Medically important fungi are dimorphic.
Two forms: yeast aka candida (single celled) or molds depending on growth conditions.
Classified according to type and method of sexual reproduction

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36
Q

What is conidia?

A

asexual spores

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37
Q

What are fungi classifications?

A
  1. superficial- causes discolouration of the skin
  2. Cutaneous- involves the keratinized tissue of the hair, nails and skin
  3. Subcutaneous- enters the human host as a result fo trauma to the skin, rarely disseminate
  4. Systematic- enters the circulatory and lymphatic systems and can be fatal
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38
Q

What are parasitic protozoa?

A

Unicellular organisms that are neither plant nor animal.
Larger than bacteria
Eukaryotic
Can ingest food particles, and some are equipped with digestive systems.
Live on or in other organisms at expense of host.

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39
Q

What is the motility of parasitic protozoa?

A

Ameboid- slow cellular flowing locomotion
Flagellum- protein tail facilitates motility
Cilia- numerous short hair like projections/tails facilitate motility
sporozoans- non motile, do not form spores

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40
Q

What are the 6 steps of infectious disease?

A

-Encounter
-Entry
-Spread
-Multiplication
-Damage
-Outcome
(all require breach upon host)

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41
Q

Encounter

A

Infectious organism coms into contact with the host; varies according to host and microorganism.
During our life span, the body encounters new organisms; some are quickly eliminated while others are efficient colonizers.
Colonizers either become part of the microbes that are normally found in the body or cause disease.

42
Q

Entry

A

Access to the organism through a portal of entry (digestive, urinary, respiratory systems directly connected to the external environment)

43
Q

Types of entry

A

Ingression: attachment of organism to cell surface and excretion of toxins. E.g., Cholera, Pneumonia
Penetration: Pathogens invading past the epithelial barrier
Flagella used by bacteria that causes syphilis
Vectors such as mosquitoes or fleas
Cuts or wounds

44
Q

Spread

A

The propagation of the infectious organism
Requires overcoming body’s immune defences
Dissemination (degree of spreading) is a function of the logistics of both the host and the microbe.

45
Q

Multiplication

A

At the point of entry they are not prevalent enough to cause symptoms or clinical manifestiation
In order for a colony to be established and systems to show, multiplactions can vary
Exponential growth

46
Q

Growth

A

Damage can be direct- to cells such as exotoxins that can damage host cells
indirect- alter things within the host such as metabolism
1 microbe can induce a host response iWt does this by trying to eliminate the pathogen but in the process it destroys a lot of healthy cells
Can show up as inflammation

47
Q

What are the 4 steps in the chain of infection?

A
  1. host
  2. infectious microorganism
  3. mode of transportation
  4. reservoir
48
Q

What is exogenous transmission - direct contact?

A

*Ex. Handholding, coughing, sexual contact etc.
*Droplet: Contact with infectious secretions that come from the conjunctiva, nose or mouth of the host as the person cough, sneezes or talks.
*Large particulate droplets can travel 3-5 feet.
*Ex. Common cold, Influenza, Pneumonia, Meningitis (have to be transmitted by droplet)
*Airborne: Residue from evaporated droplets of diseased microorganisms is suspended in air for long periods on aerosol droplets or dust. This residue is infectious if inhaled by a host.
*Ex. Tuberculosis

49
Q

What is exogenous transmission - indirect transmission?

A

*Transfer of pathogenic microbes by touching a fomite (inanimate object that have been contaminated) by an infected person or,
* Through a vector (ex. insect or animal carrier)

50
Q

What is endogenous transmission?

A

result of encounters with organisms already present in or on the body, the normal flora

51
Q

Reservoir

A

Site where an infectious organism can remain alive, multiply and from which transmission can occur.
E.g., People, animals, inanimate objects (contaminated linen, food)
A person who serves as a reservoir but does not display any clinical symptoms is called a carrier, i.e., they carry they infectious agent and are able to transmit disease

52
Q

Nosocomial

A

hospital acquired infection

53
Q

latrogenic

A

acquired as result of an intervention performed by a practitioner

54
Q

what are the sources of health care associated infections?

A

medical personnel
patient flora
contaminated health care environment
invasive procedures
blood borne pathogens

55
Q

Methicillin-resistant Staphylococcus aureus (MRSA)

A

Penicillin resistant
Colonizes on skin and in nose
Persons hospitalized for prolonged periods are most susceptible
Transmitted by direct (hands) or indirect contact (fomite)
Likely to develop when antibiotics are used too often or incorrectly
Can occur in wounds, burns, IV sites.
Patients are put on isolation precautions to prevent spread
Vancomycin-resistant S. Aureus (VRSA)

56
Q

Vancomycin Resistant Enterococcus (VRE)

A

Penicillin resistant
Colonizes on skin and in nose
Persons hospitalized for prolonged periods are most susceptible
Transmitted by direct (hands) or indirect contact (fomite)
Likely to develop when antibiotics are used too often or incorrectly
Can occur in wounds, burns, IV sites.
Patients are put on isolation precautions to prevent spread
Vancomycin-resistant S. Aureus (VRSA)

57
Q

Clostridium difficile (C. diff)

A

Caused by antibiotics that disrupts normal bacteria of the GI tract.
Symptoms range from diarrhea to life threatening inflammation of the colon (pseudomembranous colitis).
Most commonly affects older adults.
C. Diff. spores are passed in feces and spread to surfaces and objects when people who are infected don’t wash their hands thoroughly. Spores can persist for weeks or months.
Patients are put on isolation precautions to prevent spread.

58
Q

Common infectious diseases

A

HIV & AIDS
AIDS related infections: Pneumocystis carinni (type of Pneumonia), Candida, Herpes Simplex, Kaposi sarcoma (malignant tumor of the endothelium), AIDS dementia, TB etc.
Hepatitis
Tuberculosis

59
Q

When to wear gloves?

A

You have a cut on your hands
Patient has catheters, chest tubes or drainage bags
Patient has open or infected wounds
You are inserting an IV or patient has an IV
Patient is vomiting, incontinent, bleeding or undergoing chemotherapy

60
Q

When to wear face protection

A

Masks and respirators: protect mouth/airway
Respirators: protect respiratory tract from airborne infectious agents
Goggles: protect eyes
Should fit snuggly over and around eyes
Personal glasses are not a substitute for goggles
Face shields: protects face, nose, mouth and eyes
Should cover forehead and extend below chin and wrap around face
Use during patient care activities likely to generate splashes of blood, body fluids, secretions or excretions.

61
Q

Use of antiseptics

A

A chemical substance that will inhibit the growth, but not necessarily kill pathogenic microorganisms
Alcohol: antiseptic that is a disinfectant applied on skin
Betadine: iodine-based antiseptic that is used on skin

62
Q

Standard precautions - tier 1

A

To be used at all times when any healthcare worker is caring for a patient.
Decisions about PPE (personal protective equipment) use determined by type of clinical interaction with patient.
Should be used when performing procedures that may require contact with blood, body fluids, secretions, mucous membranes and non-intact skin.

63
Q

Standard Precautions - tier 2

A

Designed to place a barrier to the spread of highly infectious diseases.
There are 3 modes of disease transmission: airborne, droplet & contact.

64
Q

Contact Precautions

A

Gloves for contact with a patient or environment of care.
Gown if contamination of clothing likely
Segregated space if possible
Ex. C-Diff, MRSA, VRSA, VRE etc.

65
Q

Droplet Precautions

A

Infections may occur when an infectious individual coughs, sneezes or speaks in the vicinity of a susceptible host
Involves contact of the mucous membranes of the eyes, nose, or mouth of a host with large droplets that contain infectious microorganisms
Door may be left open as droplets do not travel far (3-5 feet)
PPE: surgical mask, eye protection, gown & gloves.
Patient should wear a surgical mask when leaving the room

66
Q

Airborne Precautions

A

Occurs when microbes are spread through evaporated droplets that remain suspended in air or are carried on dust particles in the air.
Can remain suspended in the air for long periods and may be inhaled by persons in the room or air space
N95 “fit tested” respirator to be worn by healthcare workers. Filters inspired air.
Patient should wear surgical mask which filters expired air.
Negative pressure isolation room required

67
Q

Reverse Isolation

A

Patients at greater risk of acquiring infection
Aseptic techniques and PPE required to prevent cross-infection
*Immunosuppressed
*Chemotherapy
*Neonates
*Transplant patients
*Burn patients

68
Q

5 Moments for Hand Hygiene

A

Moment 1 - Before touching a patient
Moment 2 - Before a clean or aseptic procedure
Moment 3 - After a body fluid exposure risk
Moment 4 - After touching a patient
Moment 5 - After touching patient surroundings

69
Q

What are the types of hand hygiene?

A
  1. Alcohol-based hand rub (ABHR) (this is the preferred method unless the hands are visibly soiled).
  2. Hand washing with soap and water (best when hands are visibly soiled; the mechanical action of washing, rinsing and drying aids in the removal of microorganisms
70
Q

Barriers to proper hand hygiene

A

Long, artificial nails or nails with chipped polish (difficult to clean, and may harbour microorganisms).
Rings, hand jewelry, bracelets and wrist watches (hides bacteria and may compromise glove integrity).

71
Q

CAMRT airborne precautions

A

Using N95 masks for MRTs, where fit-testing has been completed
Using surgical masks for patients, MRTs without N95 fit-testing, and others coming into contact with the infectious agent
Instructing patients to observe respiratory hygiene/cough etiquette
Limiting the movement and transport of patients
Keeping doors to rooms closed

72
Q

CAMRT Droplet precautions

A

Using a surgical mask (patient, MRT and others coming into contact with the patient)
Using gloves and gowns
Instructing patients to observe respiratory hygiene/cough etiquette
Using eye protection when within 1-2 meters of patient
Limiting the movement and transport of patients

73
Q

CAMRT contact precautions

A

Strict hand hygiene for all those who come into contact with the patient.
Using personal protective equipment such as gloves and gowns.
Carefully disposing of gloves and other items that come into contact with the patient.
Proper cleaning of equipment, according to facility policy.

74
Q

What is a microorganism?

A

any organism of microscopic or submicroscopic size

75
Q

What is a pathogen?

A

an organism that causes disease

76
Q

What is a prokaryote?

A

A unicellular organism that lacks a nucleus and membrane bound organelles

77
Q

What is an endospore?

A

a thick-walled protective spore that forms inside a bacterial cell and resists harsh conditions

78
Q

What is a capsid?

A

protein coat surrounding a virus

79
Q

What is a vision?

A

a fully formed virus that is able to establish an infection in a host cell

80
Q

What is asepsis?

A

free of infection
Use of techniques that exclude microorganisms.
The goal of aseptic technique is to protect the patient from harmful infection by eliminating and preventing the spread of microorganisms.

81
Q

What is medical asepsis?

A

Any practice that reduce the number and spread of micro-organisms.
Cleaning removes germs, dirt, and other impurities from surfaces, but doesn’t necessarily kill them.
Lowers the number of microorganisms on surfaces or objects—either by killing them or removing them—to a safe level, according to public health standards or requirements.
May be performed by disinfection.

82
Q

What is disinfection?

A

The destruction of pathogenic microbes, toxins, vectors and other pathogens by use of chemical agents.
Disinfecting kills majority (99%) of microorganisms on surfaces or objects.
A topically applied disinfectant is known as an antiseptic.

83
Q

Chemical disinfectants and antiseptics

A

Chlorine (bleach) (Bactericidal & Sporicidal)
Iodine (Bactericidal, Fungicidal, Virucidal)
- antiseptic used in Betadine & Surgidine
- may also be used as disinfectant
Alcohols (70 - 90%) (Bactericidal, Tuberculocidal, Fungicidal, Virucidal)
Isopropyl Alcohol (IPA): 70% aqueous solution (rubbing alcohol)
Hydrogen Peroxide
- 3% for wound cleaning
- 6% effective disinfectant against some bacteria, fungi and viruses

84
Q

What is surgical asepsis?

A

complete removal of microorganisms and their spores from the surface of an object
Involves cleaning an area/object followed by a sterilization process if possible

85
Q

What is sterilization?

A

Destruction of microbes by steam under pressure or other means, both chemical and physical

86
Q

When is surgical and medical asepsis required?

A

Major and minor surgical procedures
Administration of parenteral medication
Catheterization of the urinary bladder
Dressing changes
Venipuncture

87
Q

What are the types of physical sterilization?

A
  1. Heat (steam under pressure)
  2. UV C light
88
Q

Heat - steam under pressure

A

Moist heat is more effective and rapid at killing than dry heat.
Accomplished in a device known as an Autoclave.
Items must be able to withstand high heat, steam and pressure.
Effective killing is accomplished at 250֯ F at a pressure of 15- 30 lb/inch2 for 15 minutes.
Dry heat: 320֯ F for 120 minutes.

89
Q

UVC light

A

Ultraviolet light at specific wavelengths can produce maximal killing of microbes.
UV light is used in germicidal lamps for control of airborne contaminants.
Cannot penetrate glass, paper, body fluids and thin layers of cells.

90
Q

Chemical sterilization

A

Used when item is sensitive to heat or irradiation (electronics/plastics).
Ethylene oxide - Gas
Toxic/harmful to humans

91
Q

Autoclave

A

A strong, pressurized, steam heated container/chamber.
Used to sterilize instruments and infectious/medical waste.
Uses a combination of temperatures and pressures to sterilize.

92
Q

Autoclave procedure

A

Items can be wrapped in packs or wrappers.
Time varies depending on whether the item is wrapped or not.
“Flash” sterilization is fast and involves an unwrapped item.

93
Q

Sterile pack and tray checklist

A

Remember to check:
- Expiry date
- Integrity of autoclave tape: Steam indicating ink
- Punctures
- Wetness

94
Q

Introducing solutions into the sterile field

A

Cleanse the lip of the container by pouring or squirting a small amount into a waste container or sink
Pour into sterile container from sale side of lip.
Check label at least twice (when gathering & before pouring)
When a sterile solution is to be poured into a container on a sterile field, the container is placed at the edge of the sterile field.

95
Q

Moving items within the sterile field

A

sterile forceps are used to manipulate items within the sterile field

96
Q

Surgical scrub steps

A

Before entering the surgical suite, the radiographer must:
1.Don scrubs
2.Cover hair with a cap
3.Cover shoes
4.Place a mask over mouth and nose
5.Remove jewelry
Purpose is to remove and reduce concentration of micro-organisms.
The sterile scrub consists of scrubbing with an antimicrobial agent

97
Q

sterile gowns are considered sterile

A

at the front from the shoulder to the waist (or level of the sterile field).
sterile gowns are considered sterile from the cuff to 2 inches above the elbow.

98
Q

antiseptic skin prep

A

2% Chlorhexidine Gluconate
70% Isopropyl alcohol
Betadine/Surgidine

99
Q

Draping for sterile procedure

A

Following the skin prep, sterile drapes may be applied.
These are used to provide a barrier to infection and also to create a sterile field on which to place sterile instruments.
Usually, single use, single-thickness, impermeable drapes are used.
Sometimes cloth drapes may be used.
A fenestrated drape is often used.
If used, the drape should be applied in a such a way that the opening leaves only the operative, prepped area exposed.

100
Q

Basic principles of sterile techniques

A

. only sterile items are used in sterile field
2. if in doubt about sterility of a object, consider it unsterile
3. an unsterile object should be removed, covered or replaced
4. a sterile field must be continually monitored to be considered sterile
5. create sterile fields as close to the time of use as possible
6. sterile persons should avoid unsterile aras
7. anything below the level of the table or waist, as well as undersurface of drape is considered unsterile, anything that falls below this is considered contaminated8. gowns are considered sterile on the sleeves and the front from waist up
9. persons in sterile gown and gloves must pass each other back to back
10. unsterile people can not reach above or over sterile field
11.sterile materials must be kept dry. packages that become wet must be resterilizes or discarded
12. if a solution soaks thorough sterile field to non sterile field, the wet area must be rewrapped
13. sterile gloves must be kept in sight and above waist

Patient Management 1 (2 decks)

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