Patient Care Flashcards
1
Q
What should you do to increase the sensitivity of the palpating finger?
A
Swab the finger with alcohol
2
Q
How high should the IV bag be above the vein?
A
18-20 inches
3
Q
What is charting?
A
Any records you expect to add to a patient’s chart
4
Q
What role does the hospitalist play?
A
The doctor in charge of the hospital patients
5
Q
Factors to consider when choosing the appropriate cannula size?
A
- Purpose of the infusion
- Viscosity of the contrast to be administered
- Condition/availability of the exam
6
Q
When should an incident report be filled out?
A
- Accident/injury to patient, staff, or visitor
- Loss of/damage to property of patient, staff, visitor, or hospital
- Incorrect drug or procedure administration
- Incorrect events that occurred during procedure (incorrect injection)
7
Q
Systems of the body that experience physiological changes when IV contrast medium is injected
A
- cardiovascular
- respiratory
- urinary
- GI
- neurologic
- integumentary
8
Q
When should side rails be used?
A
When a patients state of consciousness is altered due to:
- sedation
- intoxication
- shock
- senility/reduced awareness of surroundings
9
Q
Purpose of consent forms
A
- Provide patient with information about procedure, risk, and benefits
- Establish a positive relationship with the patient
- Legal implications
10
Q
Things that should be on the first page (quick access) to chart
A
- allergies
- DNR
11
Q
What can you do if you know the patient may react to the contrast media?
A
Administer and antihistamine before the procedure, find out if another procedure can be performed
12
Q
Prevention of extravasation
A
- Check for backflow of blood to be sure the catheter location is correct
- Immobilize catheter at the injection site
- Stop injection immediately if patient complains of discomfort
13
Q
Areas susceptible to ulcers
A
- Scapulae
- Knees
- Heels of feet
- Sacrum
- Trochanters
14
Q
Concepts of Body Mechanics
A
Base of support: stability for body position/movement
Center of Gravity: center of body weight
Line of Gravity: vertical line passing through center of gravity
15
Q
What is the purpose of a cervical collar?
A
Maintain alignment of the spine and prevent further spinal injury, paralysis, or death
16
Q
What group of patients might have a gown with snaps?
A
- ICU
- cardiac for quick access
17
Q
Purpose of restraints
A
- Ensure patient safety
- Prevent undesirable motion
- Prevent disengaging therapeutic devices
- DO require a physician’s order
18
Q
What helps increase arterial blood flow to the area when looking for a vein?
A
Warming the puncture site with a towel for 3-5 mins OR the arm may be left to dangle to increase blood flow
19
Q
Mechanical factors that contribute to the formation of ulcers
A
- Immobility: extended time in one position
- Pressure: inadequate protection of skin or moving too rapidly
- Friction: movement back and forth on a rough surface
- Dampness: urine on gown or sheet, irritates skin
20
Q
Common body positions…
A
- Sim’s or Lateral recumbent
- Trendelenberg
- Fowler’s
- Semi-fowler’s
- Prone or supine
21
Q
Purpose of administrating contrast agents
A
- expand collapsible organs
- provide and outline of the surrounding tissue
- enhance presentation of organ
- differentiate closely located organs with similar composition
22
Q
Advantaged of E-charting
A
- Legible
- Accessible
- Easily stored
23
Q
Factors to consider when choosing an IV device?
A
- Size/location of vein
- Condition/age of patient
- Purpose of venipuncture
- Viscosity of contrast media to be delivered
- Department protocol/physicians orders
24
Q
What is a tracheostomy?
A
A surgical procedure that creates an opening into the trachea tp provide and temporary or artificial airway
25
What is the piggyback method?q
When meds are administered through an already existing IV
26
Who's responsibility is it to bring the patient's concerns to the radiologist/physician in charge?
The tech's
27
What factor is considered when deciding between a powder, liquid, or paste contrast?
Transit time: how long it will take to travel through the organ
28
Most common replacement fluids
- Normal Saline: an isotonic solution of 0.9% sodium chloride in water
- 5% dextrose solution in water
29
What is hypervolemia? What are its symptoms?
An abnormal increase in the volume of circulating blood
| -causes pain due to dilation of the vessels, flushing, red cell changes, nausea, vomiting, and dehydration
30
Patients most at risk of developing ulcers
- Elderly
- Malnourished
- Chronically ill
31
Patients most prone to falls
- Frail and elderly
- Weak
- Neurological deficits
- Head trauma
- Sedated or confused
32
Equipment used for immobilization
- Sponges
- Tape
- Sand bags
- Compression bands
- Velcro straps
- Sheets
- Lead shields
- Specialty devices
33
5 rules of body mechanics
1. Provide a base of support
2. Work at a comfortable height
3. Bend knees and keep back straight when lifting
4. Keep load well balanced and close to body
5. Roll or push heavy objects
34
The ________ of a contrast media is directly related to its viscosity
Concentration, because the more particles present in a drop of solution, the slower that drop is going to move
35
7 Rules of Immobilizers and Restraints
- Must be allowed as much mobility as safely possible
- Must be padded to prevent injury to skin beneath
- Normal anatomic position must be maintained
- Must use knots that will not become tighter with movement
- Circulation and respiration must not be impaired
- Must be easy to remove quickly
- no 2 point restraints, always 4
36
What is a physiochemotoxic reaction?
Result from the ability of the contrast to upset the homeostasis of the body, especially regarding the blood/circulatory system
37
What is an idiosyncratic reaction?
A reaction that cannot be related to any particular property of the contrast media
-random and unpredictable
38
How do tourniquets make the veins more prominent and easier to puncture?
Venous filling
39
What two test results are VERY IMPORTANT to consider before administering contrast?
Creatinine level and GFR
40
What is the most effective way to avoid using restraints
Therapeutic communication
41
Why is it important to know if a patient is diabetic before administering contrast media? What about asthma?
-predisposed for renal complications
-could be taking other meds that may react with contrast
Asthma: 3x more likely to have a reaction, meds
42
Size of needles
Gauge: size of bore
| Increasing gauge = decreasing size
43
Advantages of small bore needles
- can access smaller veins
| - smaller hole, less bleeding
44
Steps to deal with infiltration
- remove needle
- assure patient that pain is only temporary
- maintain pressure on vein until bleeding stops
- apply a cold pack for 20-60 mins and repeat 3 times a day until swelling gone
- have injection site check by radiologist
- fill out incident report
45
Rules of injection
- never borrow meds/equipment from emergency cart
- read label of drug 3 times before administering
- remove all air bubbles prior to injection
- surgical asepsis required
- know correct procedure and notice extravasation/infiltration
- do not administer meds via specialty IV catheters such as PICC lines
46
Ionic vs. Non-ionic contrast agents
Ionic: breaks down into positive and negatively charged particles (cations and anions), for every 3 iodine molecules there in 1 cation and 1 anion (3:2 compound)
Non-ionic: do no dissociate into charged particles when places in a solution, for every 3 iodine molecules there is 1 neutral molecule (3:1 compound)
47
Majority of injections in the DI department require what type of needle?
Angiocath needle
48
In order to be valid, consent must be...?
- Voluntarily given
- Informed
- Given specifically for the act performed (minor modifications and extensions implied)
49
What should be documented in the chart when they come for an x ray?
- Patient condition upon arrival
- track regular monitoring during patient's stay in radiography
- Patient condition upon discharge
50
What is loss of autonomy?
Loss of self. Most likely with inpatients because they don't get to make decisions for themselves anymore. The hospital staff make decisions for them (what to eat, when to eat, etc.)
51
When immobilizing a child...
- Use a sheet or commercial immobilizer
- 1-2 assistants if they have proper protections (lead gowns)
- Inform parent and child (simply) as to the purpose of immobilization
52
Which patients require a bolster?
-those that are arthritic, kyphotic, and post-operative (abdomen or spinal surgery)
53
Contraindications for not using the patient's arm veins
- burned/scarred areas
- cast on arm
- thrombosed veins
- edematous arms
- partial or radical mastectomy on one or both sides, (lymph nodes are often removed and without lymph vessels to removed fluid, swelling occurs)
54
What is the purpose of Bolsters?
-Relieve lumbosacral stress by straightening the lumbar curve (lordosis)
55
Patients requiring assistance
- Stroke
- Lower extremity fractures
- Post surgery
- Paralyzed/immobilized
- Joint replacements
- Spine trauma
56
Purpose of a requisition
- provide a work order that provides legal protection and proves a reason for a radiologic procedure
- includes patient history
- gives tech info about whether modifications need to be made to procedure and why
- part of a patient's medical records
57
Types of needles
- Angiocath: flexible and used for long-term insertion
| - Butterfly: inflexible and more apt to injure the vein and cause infiltration, should not be in longer than 2-3 hours
58
Routes of medication administration
- Topical: to surface of skin
- Sublingual: placed under tongue
- Buccal: placed in cheek
- Parenteral: injected directly into body to bypass GI system
59
Main things to take into consideration when assessing a patient's mobility
- Deviations from correct body alignment (poor posture, trauma, muscle damage)
- Range of joint motion (stiffness, instability, swelling, pain)
- Ability to walk (rhythm, speed, and characteristics)
- Respiratory, cardiovascular, metabolic, and musculoskeletal problems (impaired circulation)
60
What is traction?
The use of weights, pulleys, and ropes to treat bone and muscle disorders or injuries, parts are pulled into alignment
61
2 Phases of skin breakdown
- Ischemia: blanching and feeling of coldness
| - Reactive Hyperemia: heat and redness
62
Handling of casts
- keep casts elevated and supported
- support above and below injury site
- do not use fingers to lift the cast
63
Classifications of parenteral injections
- Intradermal: between layers of skin
- Subcutaneous: under the skin
- Intramuscular: into the muscle
- Intravascular: into vein, also intra-arterial
- Intrathecal: into spinal canal
64
What is a pulse oximeter?
Device that monitors the pulse rate and oxygen in blood levels
65
Types/Ways to infuse of inject
- Bolus: large amount, short time
| - Infusion: slow introduction of substance over a long period of time
66
Which patients do we allow to come in beds and not stretchers?
ICU patients
67
Routes used to administer contrast agents
- oral
- rectal
- intravenous
- intra-arterial
- intrathecal
- intra-articular
68
What side of a patient with a lower extremity fracture should you support?
The affected side
69
What is included on a requisition?
- name, age, gender
- ID #, provincial health info
- name of requesting and attending physicians
- clinical history that supports request
- allergy history
- accession #
- location of patient
- date procedure should be performed
- which x rays need to be performed
- urgency of exam
- OXYGEN INFORMATION
- ISOLATION INFORMATION
- time patient was called for exam (tech adds)
70
How does the presence of contrast media in the body affect water in the body?
Causes water found in the body tissues to move into the vascular system in an attempt to maintain the concentration equilibrium
71
Spinal trauma: when changing from recumbent to upright what should you do?
Patient should sit in lateral recumbent position first
72
What can you do to a patient's positioning to decrease apprehension and increase cooperation?
Elevate their head so they can see what is going on
73
What is a hyperosmolar solution?
Any contrast media solution that has a greater number of osmoles per litre than blood
74
How many drops per minute on an IV line is normal?
15-20 drops per min = 60ml/hr
75
What does nosocomial mean?
A hospital acquired infection
76
What causes a patient to move during the x-ray?
Pain
Discomfort
Lack of understanding
77
Charting must be...?
- Accurate
- Legible
- Objective
- Pertinent
- Complete
- Consistant
78
Types of traction
- Skin: attached to skin using tape/straps, short-term, less invasive
- Skeletal: long/term, attach directly to bone, invasive
79
Which routes of contrast administration require a general consent form and which require a contrast consent form?
General consent form: intrathecal, intra-articular
| Contrast consent form: intravenous, intra-arterial
80
Complications/risks of venipuncture
- fainting
- failure to insert needle successfully
- not inserting needle deep enough
- over-inserting the needle through the vein
- holding the bevel against the vein wall
- hematomas (needle completely through vein)
- excessive bleeding
- edema
- infection
- ruptured red blood cells from probing the needle in obese patients
- damaged, sclerosed, occluded veins
- collapsed veins
- allergies
81
Types of casts
- Plaster of paris: heavy, white material with lots of water in the material, must increase technique
- Fiberglass: lighter, radiolucent
82
What kind of questions require more than a "yes or no" answer?
Open-ended or feedback questions
83
What kind of consent overrules in certain situations?
Double Dr. Consent
84
What is the most common cause of urinary tract infections with catheterized patients?
The back flow of urine, if collection bag is held above bladder level
85
Advantages of oral reporting
- Quick
- Easy
- Good in an emergency
86
HOCM
High Osmolar Contrast Media
| -usually ionic contrast media
87
Signs of poor circulation
- finger and toes cold, numb, lack of normal colour
- pain/burning in distal extremity
- absence of pulse in distal extremity below cast site
88
Physical properties of contrast media
- chemical breakdown of contrast media when mixed into a solution
- number and size of the iodine compounds
- number and size of additional chemical compounds
89
Factors to consider when choosing an IV site?
- Duration of therapy: choose distal veins in unaffected/non-dominant arm, avoid areas of flexion and overused veins
- purpose of infusion: largest appropriate gauge
- condition of skin: choose soft skin and round straight veins, avoid previously damaged areas and crooked hardened or inflamed veins
- patient age: avoid small and/or distal veins in elderly patients
- other: avoid lower extremities as a physicians order is usually required
90
Characteristics of contrast media
- negative/positive
- ionic/non-ionic
- water soluble/non-water soluble
91
Where should you be located when speaking to a patient on a bed/stretcher?
At the side, never at the head end
92
How many techs does a log roll for a known or possible spinal precaution patient require?
5
93
Other health care providers who might be involved in a transfer
- Nurse
- Orderly
- Porter
- LPN
94
Other names for ionic and non ionic contrast
Ionic: 3:2 compound
| Non-ionic: 3:1 compound
95
What is infiltration?
When the IV fluid leaks into the surrounding tissue
96
X-ray procedure that require a parenteral-route injection must have a ______
Informed consent
97
Examples of info techs would chart
- Date/time
- Exam performed
- Post procedural care
- time called for patient
98
Steps after an incident occurs
- Take care of yourself and/or patient
- Notify physician and assist with medical intervention
- Fill out incident report
- Evaluate situation
99
What is osmolality?
Measure of concentration that considers the number of osmoles per litre in a solution
100
What side should you position yourself on of a stroke patient when assisting them?
Their weak side
101
Oxygen equipment
- method of delivery
- flow meter
- portable oxygen tank
- tracheostomy
- ventilator
- pulse oximeter
102
Is consent transferrable from one physician to another?
No
103
What determines the radiopaqueness of the media?
The amount of iodine present
104
How many people does a spinal precaution patient require for a slide?
5
105
What are normal oxygen level percentages?
95%-100%
106
Purpose of charts?
- Accurate records of the patient's care during hospitalization
- Means of communication between patient's health team
- Aid in treatment and care of patient
- Educate patient
107
Fall prevention equipment
- safety straps
- side rails
- compression bands
- brakes on equipment
108
Types of catheters
- Straight catheter: used to obtain a specimen or to empty a bladder, short-term
- Retention/Indwelling catheter: (foley most common): long-term, has small balloon at tip to keep in place
109
"Six Rights Rule"
1. The right dose
2. The right medication
3. The right patient
4. At the right time
5. By the right route
6. With the right documentation
110
How to verify patient identification? Inpatient vs. Outpatient
Inpatients: compare requisition info with ID band info
Outpatients: double ID (spell name, DOB, body part to be x-rayd)
-Use open ended or feedback questions
111
Methods of delivering oxygen
- nasal prongs/cannula: 1-3L
- oxygen mask: at least 5L
- non-rebreathing mask: mask with bag on it
- high-flow mask
112
What is viscosity?
The thickness of a liquid and its resistance to flow
113
LOCM
Low Osmolar Contrast Media
| -usually non-ionic contrast media
114
How is the concentration of iodine in a solution determined?
By the number of iodine molecules present in a litre of solution (mol/L)
115
Rules to prevent falls
- Learn condition of patient
- Keep floor clear of objects
- Store equipment in proper locations
- Keep side rails up when patients are on a stretcher
- Lock wheelchair if a patient is in it
116
Principles of body mechanics
- Alignment
- Balance
- Movement
117
Injection contrast examples
- visipaque
- optiray
- conray
118
Typical length of IV needles
-2.5 inches
119
How up to date must blood work be before administering contrast?
In the past 3 months
120
Why is a relevant to ask a patient if they have had an injection of contrast before and whether they had a reaction?
- patient history: common sensations felt
| - determines likelihood of a reaction
121
Types of consent
- Implied: emergency situations when it is not possible to obtain consent from patient, guardian, or legal representative
- Expressed: when a patient does not stop the procedure (walking into x-ray clinic)
- Informed: for any invasive procedures (must sign form)
122
Is oxygen considered a medication? Do you need permission of a physician?
Oxygen is considered a medication, no you don't need permission
123
Why do we get patients to open and close hand and make a fist when doing IVs?
- restrict circulation and enlarges veins
| - makes veins easier to identify and penetrate accurately
124
The difference between extravasation and infiltration?
Extravasation: fluid is outside the vessel
Infiltration: fluid has diffused into the surrounding tissues
125
What is orthostatic hypotension?
When a person stands up too fast and their blood pressure drops = fainting
126
What would you do if an inpatient came with no ID band
Check with their nurse or somebody in charge of that particular patient to confirm identity
127
Disadvantages of oral reporting
- Can be easily misunderstood
- Easy to make mistakes
- Can be paraphrased
128
Purpose of immobilizers
- Various devices to keep a patient from moving during the exam (tape, sand bags, lead shields)
- DO NOT require a physician's order
129
Oral contrast examples
- barium
- gas granules
- telebrix
- hypaque
- gastrofin
130
Variables that affect viscosity of contrast
- temperature: higher temp = lower viscosity
- size of particles: increased size = increased viscosity
- inner catheter diameter
- catheter length
- number of catheter holes (lumen)
131
What amount is classed as "high flow" oxygen?
8L or more through mask/min
132
How to put on and take off a gown
Putting on: injured side first
| Taking off: uninjured side first
133
Ways to prevent ulcers...
- Keep pressure off of knees, hips, and heels
- Change patient if damp
- Reposition patient every 10 mins
134
Order for diagnostic studies
1. Radiographic exams not requiring contrast media and any lab studies for iodine uptake
2. Radiographic exams of urinary tract
3. Radiographic exams of biliary system
4. Lower GI
5. Upper GI
