Patient Care 2: Final Flashcards
Chest tube location
For air: anterior and superior
For fluid: posterior and inferior
3 main functions of a NE tube?
- Decompression
- Radiographic exams
- Feeding
Who can handle CVCs?
Only specially trained personnel or nurses who take additional training
What cause drug reactions? Radiographer’s response?
- over-the-counter drugs, prescribed medications, parenteral administration of meds, or illicit drug use
1. Radiographer’s response depends on the symptoms and severity of the reaction
Benefits of getting the patient history?
- Builds a rapport with the patient
- Builds patient trust and confidence
- Patients have a chance to ask questions and tech can ensure consent is valid
Patient’s physical environment includes what?
- Temperature
- Humidity
- Lighting
- Ventilation
- Colour of surroundings
- Noise
Causes of diabetes insipidus?
- hypothalamic injury (brain trauma, neurosurgery)
- sickle cell anemia
- hypothyroidism
- adrenal insufficiency
- inherited disorders of antidiuretic hormone production and sarcoidosis
Most common site for taking pulse? Where is the second choice?
Radial
Carotid
Steps of understanding information
- Compare the info to existing knowledge of the situation
- Critique the info collected and its integrity
- Diagnose the info by considering its meaning and relevance
What is the glasgow coma scale?
A scale used to assess LOC and reaction to stimuli in a neurologically impaired patient based on performance in 3 categories:
1. Eye opening: score 1-4
2. Verbal response: score 1-5
3. Motor response: score 1-6
The scores are added up. Lower scored predict poorer outcomes
Physical evaluation is an ongoing process of what 3 things?
- Observation
- Assessment
- Measurement
What does an ECG do? What is the graph that it produces called?
Measured electrical activity of the heart and displays the info graphically in waves on paper or on a screen
-electrocardiogram
Function/purpose of CVCs?
- Administer chemo or other long-term drug therapy
- Provide total parenteral nutrition (bypassing alimentary canal)
- Dialysis
- Blood transfusion
- Facilitate the drawing of blood for lab analysis
- Allow venous pressure monitoring
10 communication barriers for situation awareness
- Hierarchy: the more people the message has to flow through, the more likely the message will get distorted
- Unexpected messages: if the message stuns the receiver, the brain can get bogged down and prevents new messages from being processed
- Multiple incoming cues: we can’t multitask listening, instead we interleave = single tasking in multiple succession
- Emotions: when something triggers a emotional memory you may zone out and miss some components of the current message
- Physical distance: the greater the distance between the sender and the receiver, the greater potential for miscommunications
- Conflicting messages: when a receiver hears 2 messages that are in conflict they have to device which one to believe, can be wrong
- Relationships: humans can favour messages communicated by people they have good relationships with
- Expected messages: when the message is expected, the receiver can tune out the message and the messenger
- Volume of information: the receiver can suffer from info overload, they then filter info and can filter out important points
- Source of information: we evaluate the trustworthiness of the sender and base whether we believe the info on whether we trust them
How does a PAC get through the heart to the pulmonary artery?
A balloon
Why is LOC noted?
To establish a person’s baseline
Normal body temp for adults?
36-38 degrees Celsius
96.8-99.8 degreed Fahrenheit
Pulse locations?
- Radial
- Carotid
- Femoral
- Brachial
- Temporal: less common
- Dorsalis pedal
- Posterior tibial
- Apical: less common
- Popliteal: less common
What is hypovolemic shock? What is it caused by? Treatment?
Occurs when a large amount of blood or plasma has been lost, insufficient amount if fluid in circulatory system
- external hemorrhage, lacerations, plasma loss form burns, internal bleeding, severe dehydration from vomiting, diarrhea, or extreme diuresis
- fluid replacement for low volume shock, oxygen, medication to promote vasoconstriction
Diabetic coma vs. Insulin reaction?
Diabetic coma: too little insulin (hyperglycemia)
Insulin reaction: too much insulin (hypoglycemia)
How do you chart body temp?
- Oral: O
- Axillary: AX
- Tympanic: T
- Rectal: R
Put letter after temp
Location of non-tunneled CVCs?
- Subclavian vein
- Internal/external jugular vein
- Femoral vein
- Basilic or cephalic veins in arms (PICCs)
What is a CVA?
Cerebrovascular accident: (stroke) when blood flow to part of your brain in interrupted by a blockage or ruptured blood vessel
-signs include facial droop, arm weakness on 1 or both sides, slurred or difficult speech, extreme dizziness, sudden, severe headaches, muscle weakness or numbness, deviation of one eye, or temporary loss of consciousness
Respiration should be _______, ______, and _______?
- Quiet
- Effortless
- Uniform
Factors affecting pulse rate?
- Age: infants higher, elderly lower
- Gender: females higher
- Emotions: stress, fear raises
- Temperature: hot increases
- Posture: standing/sitting up require more energy
- Activity
- Medication
- Stimulants: caffeine and cigarettes
- Alcohol: vasodilators lower blood pressure, increasing heart rate
- Music
What are central venous catheters?
Tubes that are surgically inserted into a vein in the central circulation system
Provide access to the circulatory system on a repeated or continuous basis
What is septic shock? Phases? Causes?
When a massive infection occurs in the body
- gram-negative bacteria (most common) or gram-positive bacteria and viruses
- body releases chemicals that increase capillary permeability and vasodilation
- First phase
- Second phase
The purpose of taking an accurate and relevant history is to?
- avoid an incorrect exam being performed on the patient
- minimize the amount of radiation the patient receives
- efficiently uses the equipment, contrast, etc. involved with the exam
What is the most frequently seen type of shock in the radiographic imaging department?
Anaphylactic shock
Types of NG tubes?
- Dobbhoff: most commonly used, for feeding
- Levin: for decompression, single lumen with holes
- Salem-sump: decompression, double lumen
What are Swan-Ganz catheter used for?
- measure cardiac output
- measure right heart pressures
- indirectly measure the left heart and lung pressures
- diagnose right and left ventricular failure
- monitor specific meds
- assess effects of stress and exercise on heart function
- measure core temps
- reveal the amount of oxygen left in the blood after it has circulated through the body
What can happen if a patient moves during an ECG or if the electrodes become loose?
Movement: can falsely indicate an arrhythmia
Loose electrode: can flat line falsely indicating asystole
Common medical emergencies that occur in the DI department
- Seizures
- Vertigo/Orthostatic hypertension
- Nausea and vomiting
- CVA
- Syncope/fainting
- Drug reaction
- Contrast media reaction
- Shock
- Diabetes
Radiographer’s response to syncope/fainting
- No physician order required if patient remains conscious
- Place patient in sitting or recumbent position, elevate the feet
- Provide food, sugar, or juice to patients who have fasted and may become hypoglycemic
- Reassure patient to alleviate stress
- Spirits of ammonia can be used to bring patient to consciousness
- Patient should be assed by physician if consciousness is lost for more than a minute or two
Location of leads?
- white on right
- black on left
- green on side
- left and right at 2nd intercostal space on soft tissue
- side: level of 6th or 7th intercostal space
What is syncope?
Temporary loss of consciousness and postural tone caused by diminished cerebral blood flow, usually due to low blood pressure.
- considered a mild form of shock
- can occur when fear, pain, or an unpleasant event is beyond coping ability of patient’s nervous system
- can also be caused by overheating, dehydration, exhaustion, sudden changes in body position, or resulting from meds
When observing respiration rate, observe the _______, _____, ______, and ______.
- Rate: how many breaths/min?
- Depth: shallow or deep?
- Quality: supplying the O2 needs of the patient?
- Pattern: rapid or staggered?
What is gestational diabetes?
Occurs during pregnancy, hormonal changes can lead to blood sugar elevation in genetically predisposed individuals, usually resolves once the baby is born
Characteristics of a PAC?
- can be quadruple lumen depending on purpose
- often seen in ICU or CCU patients who require intensive monitoring
- considered a CVC or central line
Signs and symptoms of severe hypoglycemia?
- sudden onset of weakness
- sweating, tremors
- hunger
- cold, clammy skin, diaphoresis
- tachycardia
- headache
- impaired vision
- personality changes, agitated, and nervous
- loss of consciousness
Another name for a Swan-Ganz catheter?
Pulmonary artery catheter (PAC)
Factors that may interfere with taking an accurate measure of pulse?
- decreased sensation in fingers
- not using the right amount of pressure
- not finding correct site
- using thumb
- running or doing other rhythmic movements while trying to take pulse
When are disposable thermometers most often used?
- children
- ICU
- isolation
What is the difference between and sign and a symptom?
Sign: objective evidence that could indicate disease or illness that can be observed by another person. Discovered by examining the patient
Symptom: a feeling or physical occurrence experienced by the patient
How to prevent shock?
- avoid sudden changed in temp, keep patient warm
- reduce pain and stress
- reduce anxiety
Factors that affect body temp?
- Environment
- Time of day: cooler in morning
- Infection/disease/injury
- Age: decreases with age
- Emotional status: increases with stress
- Menstrual cycle: high during ovulation
- Physical activity: increases, but plateaus
- Site of measurement: oral vs. rectal
Patient who may require an NG tube for feeding?
- trauma
- disease
- altered state
- surgical procedure
3 main functions of NG tubes?
- Feeding
- Decompression
- Radiographic exams
Radiographer’s response to mild/moderate contrast reaction?
- calm and reassure patient
- identify allergen and avoid further contact
- apply cool compress to itchy areas
- observe patient for signs/symptoms of increased distress or changes
- document details of reaction in patient’s profile, on the requisition, and in the chart
- obtain medical assistance, consult with radiologist/physician/nurse to determine necessary observation of patient before discharging
What is the safest method of taking body temp?
Axillary
Match the terms with the definitions
Orientated, Lethargic, Medicated, Stupor, Fainting, Semiconscious, Confused, Unconscious
A. Reduced responsiveness
B. Knowledge of partial commands, can be woken up
C. Mentally dulled and altered by drugs
D. Aware of your surroundings
E. Lack of environmental awareness, non-responsive
F. Unsure what is happening, disorientated
G. Decreased awareness, low energy, lazy
H. Process of losing consciousness
Orientated: D Lethargic: G Medicated: C Stupor: A Fainting: H Semiconscious: B Confused: F Unconscious: E
Body temp locations?
- Oral
- Axillary
- Rectal
- Tympanic and temporal artery
Types of NE tubes?
- Miller-Abbott: double lumen, drainage and balloon to act as a bolus and promote peristalsis to advance tube
- Harris: single lumen
- Cantor: single lumen
What techniques can you use when questioning a patient?
- Open-ended questions
- Facilitation
- Silence
- Reflection of reiteration
- Clarification or probing, don’t lead on
- Summarization
Signs and symptoms of second phase septic shock?
- cool, pale skin
- drop in BP
- rapid heart rate and respiratory rate
- anuria
- seizures and organ failure
Average pulse rates for adults?
60-100 BPM
Key factors of situational awareness?
- Get information
- Understand the information
- Think ahead
What is the difference between passively and actively listening?
Passive: just listening
Active: listening and asking questions
How does a PAC get through the heart to the pulmonary artery?
A balloon
Respiration of fewer than 10 breaths/min may result in?
- Cyanosis
- Apprehension
- Restlessness
- Change in LOC
Classification of CVCs?
- Short or long term, non tunneled external catheters (PICC)
- Long term, tunneled external catheters (Hickman, Groshong, Raaf)
- Long term, implanted infusion ports (Port-a-cath)
What elements of a patient’s history should you consider?
- Onset of condition/pain
- Duration/frequency of condition
- Location of pain/issue
- Quality of pain (sharp or dull)
- What aggravates it?
- What alleviates it?
Most common patient with neurogenic shock?
Ones with spinal and head injuries
Signs and symptoms of severe hyperglycemia?
- terribly thirsty
- frequent and copious urination
- breath smells fruity or sweet
- decreased appetite
- nausea, vomiting
- weakness
- confusion
- coma
What is a partial (focal) seizure?
- simple or complex depending whether patient loses awareness
- can have motor, autonomic, sensory, or physiological symptoms
- may cause sever uncontrollable tremors
- often caused by extreme anxiety and hyperventilation
- can last over an hour
What is diabetes insipidus?
Excessive urination caused by inadequate amount of antidiuretic hormone in the body of failure of kidney to respond to hormone
What are central venous catheters?
Tubes that are surgically inserted into a vein in the central circulation system
Provide access to the circulatory system on a repeated or continuous basis
Why is a chest tube inserted? What is its purpose?
To re-establish correct intrapleural pressure and allow the lungs to expand normally
