Patient Care Flashcards
Patient Interactions
1
Q
American Hospital Association (AHA) Patient Care Partnerships (“Patient’s Bill of Rights”) states:
A
- High quality patient care
- A clean and safe environment
- Protection of the patient’s privacy
- Involvement in your care
- Help when the patient leaves the hospital
- Help with the patient’s billing claim
2
Q
“A patient’s Bill of Rights” is intended to:
A
provide patient’s with an explanation of what to expect during hospital stays, and to explain their rights and responsibilities.
3
Q
Informed Consent definition:
A
when provided with comprehensive and thorough information, competent patients will be able to make decisions in an informed manner. Informed consent is required before performing most invasive procedures and before admitting a patient to a research study. The document used must be written in a language understood by the patient and be dated and signed by the patient and at least one witness present.
4
Q
Informed Consent - A patient must be informed of:
A
- nature of procedure, treatment, or disease
- expectations of treatment and likelihood of success
- treatment alternatives and outcome without treatment
- known risk factors of treatment
- consent can be revoked at any time during the procedure
5
Q
T/F - patient consent for routine procedures is given on admission and is implied by the continued acceptance of hospital care
A
True - pg. 83 pt care book
6
Q
Informed consent guidelines:
A
- pt must receive a full explanation of procedure and its risks and benefits and must sign before sedated or anesthetized
- pt must be competent to sign
- only parents/legal guardian can sign for minor
- only legal guardian may sign for mentally incompetent pt
- consent forms must be completed before being signed
- only physician named on consent form may perform procedure
- any condition stated on form must be met
- informed consent can be revoked by pt at any time after signing
7
Q
HIPAA
A
- Health Insurance Portability and Accountability Act
- no info may be released to employers, financial institutions, or other medical facilities w/out specific permission by the pt.
enacted under the U.S. Department of Health and Human Services (HHS) to protect the privacy rights of patients
8
Q
HIPAA Law Requirements:
A
- pt must receive a clear, written explanation of how the health provider may used the disclosed info
- pt will be able to see and copy records and request amendments
- history of routine disclosures must be available to pt
- healthcare providers must obtain consent before sharing routine info on tx, payment, and healthcare operations. separate auth. is needed for non routine and non-health purposes
- pt have the right to request restrictions on uses and disclosures of their info
- pt may file complaints w a covered provider or with HHS about violations of these rules
9
Q
HIPPA standards*:
A
- no schedules or other documents that include pt names may be posted in public areas
- use only pt first names when summoning from public areas - to preserve a degree of anonymity
- all health record info used for statistical/research must be de-identified by eliminating any names, numbers, codes, or biometric identifiers associated w a specific person
- release of info - only specific info authorized may be released. authorization copy must also be kept on file
- only specific individuals trained in HIPPA compliance are allowed access to protected healthcare info
- all computer files that contain/ may contain pt info must be encrypted - secure access is required for this data
10
Q
American Hospital Association (AHA) Patient Care Partnerships (Patient’s Bill of Rights):
Privacy
A
the right to privacy implies that the pt modesty will be respected and that every effort will be made to maintain the pt sense of personal dignity
11
Q
American Hospital Association (AHA) Patient Care Partnerships (Patient’s Bill of Rights):
Information
A
pt has a right to information, but this does not obligate the radiation therapist to provide any and all info that may be requested. RT’s must be prepared to explain radiation therapy procedures and to identify themselves and the radiologist. pt has the right to copies of billing records, medical records, and imaging records
12
Q
American Hospital Association (AHA) Patient Care Partnerships (Patient’s Bill of Rights):
Living Will
A
written legal documents stating the medical tx or life-sustaining tx the pt wants if they were seriously or terminally ill
13
Q
Palliative Treatment as beneficence
A
may be considered a form of beneficence care because it relieves pain and suffering
14
Q
Advanced Directives
A
Tells your doctor what kind of care you would like to have if you become unable to make medical decisions
15
Q
DNR
A
Do Not Resuscitate - a request not to have cardiopulmonary resuscitation if your heart stops or if you stop breathing
16
Q
Health Care Proxy/ Durable Power of Attorney
A
- states whom you have chosen to make health care decisions for you
- becomes active any time you are unconscious or unable to make medical decisions
17
Q
Autonomy
A
emphasizes the right of pt to make decisions for themselves, free of interference by others
18
Q
beneficence
A
“doing good” and calls on healthcare professionals to act in the best interest of pt, even when it might be inconvenient or sacrifices must be made
19
Q
Civil Battery
A
consists of the actual act of harmful, unconsented, or unwarranted contact w/ an individual; touching w/out permission
20
Q
Civil Assault
A
the threat of touching in an injurious way. this can be avoided by explaining the full procedure to the pt beforehand
21
Q
false imprisonment
A
the intentional confinement w/out authprization by a person who physically constricts another with force, or confining clothing or structures
22
Q
Negligence
A
neglect or omission of reasonable care
23
Q
malpractice
A
result of professional misconduct, incompetence, or lack of skills
24
Q
Tort Law
A
a legal wrong against a person/property, excluding contract disagreements/disputes
25
Intentional Tort:
- civil assault
- civil battery
- false imprisonment
- libel
- slander
- invasion of privacy
26
unintentional tort:
- negligence
| - malpractice
27
Libel
written defamation of character
28
slander
oral defamation of character
29
invasion of privacy
info released, or pt exposed improperly or unnecessarily
30
Doctrine of Respondent Superior
holding the employer responsible for negligent acts of an employee
31
Res Ipsa Loquitor
"the thing speaks for itself" - a defendant can explain events and a court can decide outcome w no witness present
32
scope of practice for a profession
written context of what a professional can do based on education and preparation
33
standard of practice for a profession
delineates the proper procedure and how an action should be performed
34
personal liability
must take responsibility of own actions
35
Doctrine of Foreseeability
knowledge of actions or lack of information that could cause injury
36
risk management
identifies causes of accidents and implements programs to prevent them
37
incident reports
report of any happening that is not routine operation
38
ARRT Standards of Ethics
known as the "rules of ethics". 22 rules of ethics that truly govern the professional behaviors of RTs, RRAs, and candidates for ARRT certification. Not aspirational like the code of ethics; they are enforceable. individuals found in violation are subject to private reprimand to permanent revocation of certification.
39
Interpersonal Communication
- communication is critical to building helping relationships w pts and coworkers
- patients undergoing treatment for cancer likely have both physiological and social needs
- helping relationships in cancer care should address the physiological, psychological, and social needs of the pt and their caregiver
40
Challenges in Communication: Languages
translators should be provided in hospital before patient's appt
41
Challenges in Communication: Hearing and Speech Impairments
Interpreters should be provided by hospital before pt appts
42
Challenges in Communication: Impaired Cognition
Adjust communication strategies to match comprehension level of pt
43
Challenges in Communication: Literacy
- read info to pt
| - provide video w information
44
Maslow's hierarchy for physiological considerations of cancer patient's:
a. food, water, sleep
b. safety, security
c. Love, belonging
d. self-esteem
e. self-actualization
Therapist's should assist in helping patients maintain normal function of life as much as possible. As well as direct them to personnel who can assist them in different matters i.e. transport, nutritionist, family support groups, engage in everyday conversation
45
Five stages of grief for psychological considerations of cancer patient's:
a. Denial
b. Anger
c. Bargaining
d. Depression
e. Acceptance
following diagnosis of ca can induce responses similar to the stages of grief described by Dr. Elisabeth Kubler-Ross
Can also be felt by caregivers and fam
46
Pain statistics
75% of patients w advanced disease report pain and 30-50% of pt undergoing tx report pain
47
Anxiety
may come following diagnosis or during therapy
48
Social considerations of cancer patient's:
a. support from family/friends/people w similar illness
b. participation in normal life activities
c. intimacy
- w pt permission - invite fam and friends to be involved in the pt care
- encourage pt to participate in as much normal daily activity as possible
- provide resources and referrals for pt who have specific questions on resuming intimate relations - avoid terms like "impotent", "undersexed"
49
Modes of Communication
- verbal
- written
- nonverbal
- nodding
- eyebrow movement
- hands making a fist while laying down
- eyes closed
- tears
- smiles
- laughing
50
Tools used for effective communication:
- handouts
- videos
- books
- personal testimony
- other patients
- support groups
- solid and honest communication
- solidify trust between pt and RT
- allow pt to ask questions
- compassionate and straightforward
- assess pt comprehension level
- repetition of info
51
Nonverbal Communication:
- Eye contact - in U.S. this is considered a positive behavior, but not in all cultures
- Touching - touch can be either very positive or very negative and varies culturally. It should have a professional purpose that is clear to pt.
- Appearance - Clean and neat appearance and work area is always best
Largely based on cultural background.
52
Patients who do not speak English:
- need an interpreter over a family member/ friend interpreting - they may add or take away information
- your duty may be to arrange an interpreter
- when using an interpreter, always look directly at pt and speak to them as though they were able to understand you
- if a translator is unavailable, use demonstrations or pencil sketches, and extensive use of nonverbal encouragement
- friendly smile and warm touch can be worth many words
53
Hearing Impaired Patient Protocol:
- talk to them, not about them
- get pt attention before starting to speak to them
- face the person, w light on your face preferably
- speak lower in register, as well as louder
- speak clearly and at moderate pace
- avoid noisy background situations
- rephrase when you are not understood
- be patient
when in doubt you can ask them for suggestions to improve communication. hearing range can be quite different
- important to remember that impairments in sight, hearing, and speech are communication impairments and not a reflection on the individuals ability to think
54
Deaf Patient Protocol:
+ Chart should be flagged when a pt is totally deaf
+ Some deaf people are adept to lip reading and speaking to a limited degree
+ Certified interpreter is essential
+
You may become aware that a patient is totally deaf when they:
- do not respond to noises or words spoken out of the range of vision
- uses lip movements without making a sound or speaks in a flat monotone
- points to the ears and mouth while shaking the head in a negative motion
- important to remember that impairments in sight, hearing, and speech are communication impairments and not a reflection on the individuals ability to think
55
Impaired Vision Patients:
- some pt prefer to follow by listening to your footsteps and using a cane where others may wish to put a hand on your shoulder/elbow
- good communication is key to determining which method of helping a pt may prefer
- pt with failing vision may need more description or procedures and their surroundings than other visually impaired
- important to remember that impairments in sight, hearing, and speech are communication impairments and not a reflection on the individuals ability to think
56
Inability to Speak/Aphasia:
- may be impaired as a result of injury to language centers in the brain
- stroke pt may be unable to speak/write and is best to ask nursing staff the best way to communicate w pt
- throat ca is another. may use a handheld tool called an electrolarynx which is placed on the external throat wall - not always easy to understand
- important to remember that impairments in sight, hearing, and speech are communication impairments and not a reflection on the individuals ability to think
57
Impaired Mental Function:
- must assess the pt ability to understand and follow instructions
- ability may vary from infantile to capabilities close to normal
- in general, the same simple, clear, and direct instructions offered to children are appropriate
- repetition may be necessary
- importanhnot to speak to them as if they are children and address appropriately, with respect and dignity
58
Age-specific communication - neonate-infant:
neonate:
- address w smiling face and soothing voice
- need to be kept tightly wrapped and warm
- involve parents and keep them in vision as much as possible
infant:
- start fearing strangers and begin to differentiate themselves from others
- smile to elicit smiles from others. sucking, chewing, and vocalizing are important activities
- keep w parent as much as possible
- limit staff, provide familiar objects, and incorporate play to distract from exam
- always provide safe environment and never leave alone
- keep crib rails pat all times
59
Age-specific communication - Toddler (1-2):
- starting to be independent and resist control - handle with a gentle but firm approach and set clear limits
- allow toddler to make choices
- explain immobilization necessities to parents
- be calm, cheerful, and unhurried
- allow fav toy or blanket for security
- instruct using demonstration rather than speech
- keep spoken instruction short and simple
- try to speak at eye level (fear due to adult stature)
- "make friends"
60
Age-specific communication - Preschooler (3-5):
- start to demonstrate increasing independence
- conversational and share information
- encourage them to cooperate, ask if they want to climb on table on their own or need help
- explain things in a sensitive way and show how to do things
- keep simple, direct and honest
- don't hesitate to ask for more experienced help
61
Age-specific communication - School Age (6-12):
- can think logically about anything that can be touched and seen
- give concrete info about procedures
- be honest about everything including any potential pain
- still necessary to use demonstrations and models to explain
62
Age-specific communication - adolescent (13-18):
- special sensitivity due to emotional needs
- can act like adults, but revert to childlike behaviors when frightened or confused
- teenagers fear threats to physical appearance and loss of control of independence
- show empathy
- avoid being authoritarian and include them in decision making
- modesty and privacy are v important
- lessen fear and anxiety by asking about their hobbies, fav sports, school, or friends
- if parents present, involve them, but important not to talk about them
- provide thorough explanations
- professional approach coupled w warm reassurance
63
Age-specific communication - Young Adults (19-45):
- searching for and finding their place in society
- moving from dependence to responsibilities w edu, marriage, children, and aging parents
- involve them and loved ones fully in decision making and procedure
- tailor everything to their level of understanding
64
Age-specific communication - Middle Adult (46-64):
- may be experiencing lifestyle changes and physical and cognitive changes
- onset of many chronic conditions starts in this time
- may need special assistance from family members
- dealing w family can be difficult and always involve social services or chaplain or even security personnel if necessary
65
Cultural Factors to consider:
- increase awareness to diversity in needs, expectations, and fears in the pt
- ea society develops unwritten rules in how we communicate, how close we stand, acceptable touching of others, and reflections of courtesy to those around us
- cultural differences in nonverbal behavior can be highly significant
- in some cultures personal space is highly important, while in others embracing and touching is important
- eye contact can vary in meaning as well
66
positioning aids:
- should help facilitate a certain position
- they do not immobilize
- whatever position would be comfortable and easily accommodate tx strategy
---example: commercial head holders, prone pillows, knee sponges, wing boards, Duncan masks, chin straps and shoulder pulls
67
Immobilization devices:
- help limit movement of pt during tx
- decreases setup and targeting errors
- thermoplastic molds
- vac-locs
68
Treatment Setup - Head and Neck:
- usually supine due to comfort, lateral beams, and easy to make sure lenses ar excluded from tx
- H&N positioning and immobilization should include a rigid plastic head holder that cradles head while supporting neck
- thermoplastic molds
- shoulder pulls and adjustable straps
- shoulder retractor apparatuses
- bite blocks - as positioning aid or immobilization device
- IMRT contouring and setting gantry angles can be modified if you cannot use shoulder restraints
69
Treatment Setup - Breast:
- typically supine (prone may be used w large breasted pt)
- ensure legs and ankles are not crossed
- wing boards are suitable
- wing board and breast board can be used together to reduce slope of breast
- wing board allows: arms above head, making torso more symmetric
- breast boards have attachments to her reproduce elbows, wrist and hand positions
-chin should be raised and head turned away from treated breast
- allow breast to find natural position
-vac-loc is a viable alternative to a breast board
-
70
Thermoplastic mold:
- size that covers head only works well for tx above clavicles
- longer style (s-frame) tht covers head and shoulders works for tx areas in h&n, and supraclavicular regions
- thermoplastic molds like aquaplast - can be warmed in water to manipulate to form to pt face, neck and shoulders and secured to table. dries quickly and becomes rigid
- positioning markers can be applied to mask
- while drying, use fingers to mold labella, chin, entry of auditory meatus
71
Treatment Setup - Chest, abdomen, pelvis, and extremities:
- vac-loc or alpha cradle systems are used
- wing board
- chin extension may be necessary based on tx fields
- for pelvic region, vac-loc should extend from buttocks to feet
- exact position of feet should be easily replicated
- supine is most comfortable, but prone can decrease tx to sm bowel and decreases gluteal folds
- for prone, belly boards are desirable
72
Hospice Care Protocol:
- hospice team provides physical, emotional, psychological and spiritual help
- in home or in facility
- support of pt and family for end of life
73
What is an antiemetic used for?
nausea
-medications include: torecan, norazine, compazine
74
whites an analgesic?
pain killer
meds include: Tylenol, pejcoset, MS contin
75
What are some anti-inflammatories?
hydrocortisone, diprolene
76
name some anti-diarrheal meds:
Imodium, lomotil
77
What is carafate?
a protectant that adheres to ulcer sites; inhibits pepsin
78
what is xylocaine elixir?
a topical or oral anesthetic
79
Name an anti-microbial:
peridex - kills or inhibits growth of microorganisms
80
Name the stages of skin reactions:
Stage 1 inflammation - color pinkish red, slight edema
Stage 2 inflammation and dry desquamation - skin becomes dry and scaly due to shedding of the epidermis, this is usually itchy
Stage 3 inflammation, edema, and moist desquamation - skin thins and starts to weep due to epithelial layer losing its integrity. tx may be temporarily discontinued to allow repair
Stage 4 depilation of hair in tx field - permanent hair loss
81
Late side effects of skin reactions:
- fibrosis - tissue scarring
- telangiectasis - abnormal dilation of superficial capillaries and arteries
- impairment of lymphatic drainage (lymphedema)
82
Management of skin reactions:
- clean skin w mild soap, dry skin well, use cornstarch to reduce moisture
- avoid tight fitting clothes and harsh fabrics
- avoid exposing to extremely hot/cold temps, sunlight, chemicals
83
what is cachexia?
weakness or wasting of the body due to sever illness
84
3 keys components to physical assistance and transfer:
+balance - strong base of support, spread feet apart
+alignment - keep back straght when lifting, bend knees, avoid twisting. keep object close to body
+proper movement - use abdominal and leg muscle rather than back. bend knees and lift w legs
85
keys to pt transfers:
- pt may wish to move themselves or have pain needed to be considered
- general rules for lifting include: feet apart, one foot slightly in front of other, weight to be moved is kept close to lifter, who bends at knees and hips rather than waist, maintain normal curve at lower back
86
wheelchair transfers:
- if pt has weakness or impairment on one side of body, position body on strong side in direction of movement
- lock chair
- raise foot rests and stand facing pt
- pt feet together and assist feet on either side, lean forward bending at knees and hips
- pt should reach around shoulders, while you reach around hips
- raise pt to feet and pivot 90 degrees so pt back faces table
- ease into sitting position, then w hand between shoulders and hand under knees, ease into supine position on table
- reverse these actions when assisting off the table
87
stretcher transfers:
- should be completed with a min. two caregivers
- number of lifters depends on many different factors.
- draw sheeting slide board can assist stretcher pts.
- ideally a draw sheet is already in position.
- pull draw sheet taut, roll edges and grip firmly, team leader specifies a count, pt is lifted just high enough to clear tbl and stretcher and eased down
88
What is the minimum number of methods of identification necessary when greeting a pt to confirm identity?
- 2
89
Assisting w urinary catheters:
- keep catheter line below site of origin
- check for leakage
- never pull out
- keep untangled
90
When assisting in oxygen administration:
- do not use around flames or sparks
- do not stand O2 cylinder upright unless it is secured
- do not carry cylinder by regulator or valve
91
assisting w chest tubes:
- keep lower than injection site
- keep hemostat available to shut off
- keep upright, never lay down
- always handle w two hands
92
Assisting pt w IVs (aka infusion catheter):
- keep IV above injection site
- free from tangles
- keep pump plugged in
- if leakage is spotted, do not clean until verification of liquid is identified
- handle w gloves
93
medical reasons to not use contrast media:
-pts. w renal disease, diabetes, allergies, asthma, sickle cell anemia, thyroid disease, pregnancy, old age, hypertension, or coronary disease may suffer life threatening reactions and should be carefully evaluated
94
Adverse reactions to contrast media:
minor: nausea, retching, mild vomiting
moderate: fainting, chest or abdominal pain, headache, chills, severe vomiting, dyspnea, extensive urticaria, and edema of face/larynx
severe: syncope, convulsions, pulmonary edema, life-threatening cardiac arrhythmia, cardiac or respiratory arrest
- Death
95
urticaria definition
hives
96
dyspnea definition
difficult or labored breathing
97
edema definition
swelling
98
syncope definition
temporary loss of consciousness caused by a fall in blood pressure - fainting
99
Application of the 6 rights of med administration:
1. to identify he right pt
2. select the right meds
3. give the right dose
4. give the meds at the right time
5. give meds by right route
6. ensure right documentation
100
Latex allergies w pt:
- should be included in pt. chart
| - gloves, stethoscopes, blood pressure cuffs and other items containing latex should not be used
101
What is anaphylactic shock?
life-threatening condition due to a sever allergic reaction causing bronchial airway to constrict
102
symptoms of anaphylactic shock:
- difficulty breathing
- swollen or tingling lips
- drop in blood pressure
- vomiting
- metallic tastier the mouth
- itching skin
- hives
- dizziness
- temporary loss of consciousness
103
What is the tx for anaphylactic shock?
epinephrine
104
What are the ABCs of CPR?
A. Check airway - open airway by lifting chin w one Hand and push down on the forehead w other hand, tilt head back, listen for sound of breathing, feel for breath on cheek
B. Breathing - pinch nose shut and keep head tilted, airtight seal; give two full breaths
C. Circulation - after giving two full breaths, locate the carotid artery pulse to see if the heart is still beating. if no pulse, ratio 30 chest compressions to 2 breaths
105
What is respiratory arrest?
- caused by airway obstruction
| - obstruction may be partial/complete
106
what are the signs of respiratory arrest?
- complaining of difficulty in breathing
- no chest rise and fall
- progressive color change caused by lack of oxygen
107
What are seizures?
- sudden change of behavior due to abnormal electrical activity in the brain
108
what do you do/not doin the case of a pt having a seizure?
- do not try to restrain pt
- do not try to move pt
- move dangerous objects away from pt
- do not place anything in the pt mouth or try to move the tongue
109
what do you do after a pt has had a seizure
- check breathing
- stay and talk to the pt
- do not offer something to drink/eat
110
What do you do in the case of syncope/fainting?
help person who has fainted to the ground
- shake and call pt name
- check for pulse
111
what is a stroke?
cerebral vascular accident (CVA) that occurs when blood supply to part of the brain is disrupted causing brain cells to die
112
what are the signs of a stroke?
- sudden numbness or weakness of the face, arm, or leg on one side
- sudden confusion or trouble speaking
- sudden trouble seeing in one or both eyes
- sudden trouble walking, or loss of balance
- sudden severe headache w no known cause
113
what is the universal sign of a pt choking? What should you do?
- pt clutching their throat w both hands
- encourage pt to continue coughing
- do not assist unless pt is no longer able to cough or speak
- clear obstruction-Heimlich maneuver, abdominal thrust or back thrust for infants
114
Requirements for hospice pt:
terminal illness, life expectancy of less than 6 months, care within a defined geographic location
it is palliative care for terminally ill pts
115
Infectious Disease Cycle: What is the cycle of infection?
- Reservoir host
- exit portal
- transmission
- entrance portal
- susceptible host
to stop disease, cycle can be broken at any point
116
Infectious Disease Cycle: What are pathogens?
- bacteria, viruses, fungi, protozoa, algae, or lesser known agents such as chlamydiae, rickettsiae, and prions
117
Infectious Disease Cycle: What is a reservoir? portal of exit? source? host?
- reservoir- where the microorganism lives and reproduces
- portal of exit - where diseases are to be passed to others - respiratory tract, gastrointestinal tract, blood, skin
- source is the place from which the microorganism comes
- host - the person to whom the infectious agent is passed
118
Infectious Disease Cycle: what is the mode of transmission?
the movement of the infectious agent from the source to the host. to cause disease, the infectious agent must gain entrance to the body
119
Infectious Disease Cycle: What is direct contact?
direct contact transmission is where the susceptible host makes physical contact w the source of infection. person-to-person spread can occur through simple touching.
-via direct contact or droplet
direct contact examples: simple touching, mononucleosis (kissing), sexual intercourse (aids)
120
Infectious Disease Cycle: What is indirect contact?
involves an object that is contaminated from contact w an infectious agent and then comes into contact w and infects another individual
example: needle stick from HIV pt, airborne
121
Infectious Disease Cycle: Droplet direct contact is..?
involves the rapid transfer of the infectious agent through the air over short distances, as occurs when an individual coughs, talks, sneezes, close to another person's face. droplets are large relatively heavy particles that spread over short distances
122
Infectious Disease Cycle: What is airborne transmission? Where'd does it come from?
- spread that involves an infectious agent disseminated through the air over a long distance, typically described as 6 ft or more, or even as far as miles away.
- are either the remains of droplets that have evaporated, or the infectious agent is contained in dust particles, or sloughed skin squames (routinely shed superficial skin cells)
123
Infectious Disease Cycle: What is vector borne transmission?
involves a vector that transports an infectious agent to a host
- a fly that transports an infectious agent on its body or legs or mosquito that carries malaria, ticks containing lie disease
because vermin are not commonly found in health care facilities in the U.S., vector borne is not nearly as common
124
Infectious Disease Cycle: Common vehicle spread - fomite
this type of spread involves transmission through a contaminated inanimate vehicle - known as a fomite, for contamination to multiple persons
125
Infectious Disease Cycle: susceptible host:
person to whom the infectious agents passed. whether clinical disease develops in a host depends on the body location at which the infectious agent is deposited and on the host's immune status and related defense mechanisms.
126
Infection Control: What is asepsis?
condition free from germs
127
Infection Control: Medical supplies and Equipment - Critical Items:
products or instruments normally inserted into normally sterile areas of the body or into the bloodstream, and must be sterile for use.
ex: needles, surgical instruments, urinary catheters and implants
128
Infection Control: Medical supplies and Equipment - Semicritical Items:
those that contact mucosal areas but do not normally penetrate body mucosal surfaces
ex: endoscopes, thermometers, laryngoscopes, and anesthesia equip
129
Infection Control: Medical supplies and Equipment - noncritical items
do not ordinarily touch the pt or touch the pt intact skin; therefore do not need to be sterile
ex: tabletops, bedpans, crutches, and blood pressure cuffs
130
Infection Control: Medical supplies and Equipment -
| What is sterilization? How can it be achieved?
- a process that destroys all microbial life forms, including resistant spores
- through physical or chemical processes
131
Infection Control: Medical supplies and Equipment - What is disinfection?
process that reduces microbial life forms and can range from high-level disinfection to low-level disinfection
it is the single most important practice to reduce the transmission of infectious agents in healthcare settings
132
Infection Control: Medical supplies and Equipment - What are the different ways sterilization can happen?
heat, gas, ozone, radiation, chemical liquids
133
CDC Standard Precautions - What is an HAI?
Healthcare Associated Infection
134
CDC Standard Precautions - What is the single most crucial way to prevent HAIs?
Hand Hygiene
135
CDC Standard Precautions - What is hand hygiene?
the actions taken to reduce the transient flora that colonize the superficial layers of normal skin
136
CDC Standard Precautions - What does HCW stand for?
Healthcare Worker
137
CDC Standard Precautions - when and how is it necessary to wash hands?
- wash hands w soap and water about 40-60 sec if visibly soiled or after caring for pt w known or suspected diarrhea
- before touching a pt or performing an aseptic task
- immediately after glove removal and after final contact w pt
- if they will be moving from contaminated body site to clean-body site during pt care
- after contact w inanimate objects in the immediate vicinity of where the pt was
138
CDC Standard Precautions - When and how is it necessary to use hand sanitizer?
- alcohol based hand rub is preferred except for reasons of visibly dirty hands or after contact w diarrhea pt because of superior microbial activity, reduced skin drying and convenience
- cover hands and rub till dry 20-30 sec
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CDC Standard Precautions - Gloves protocol:
- clean, non sterile gloves are adequate for most protocols
- wear when touching blood, body fluids, secretions, excretions, and any contaminated items, mucous membranes, or non intact skin
- change between tasks and procedures
- remove promptly before touching non contaminated items
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CDC Standard Precautions - mask, eye protection and face shield protocol:
- wear to protect mucous membranes from eyes, nose, and mouth during procedures likely to generate splash or sprays of body fluid, secretions, or excretions.
- wear a mask when performing an aseptic task
- don't confuse a mask and a particulate respirator
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CDC Standard Precautions - gown protocol:
- clean, non sterile gown is adequate for most protocols
- wear to protect your skin and to prevent soiling your clothing and prevent soiling your clothes
- remove promptly
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CDC Standard Precautions - What are safe needle practices for tattooing ?
- wearing gloves when tattooing is optional (W&L pg. 203)
- do wear gloves if blood is anticipated/broken skin is present in area where hands will be placed to perform tattoo
- clean area w alcohol, wipe, and allow area to dry
- never administer w same ink syringe even if needle is changed
- dipose in sharps container
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CDC Standard Precautions - Disposal of linens -
- federal standards state that laundry is to be handled as little as possible and bagged or placed in a container at the location where it is used
- for RT this means in tx room, dressing rm, and exam rm
- should be handled, transported, and laundered in a manner that prevents the transfer of pathogens
144
CDC Standard Precautions - How do you dispose of needles?
in a sharps disposal container or puncture-resistant container
145
CDC Standard Precautions - How do you dispose of pt care equip and articles?
- depends if it is reusable or disposable
- if sharp, a sharps container. if it can be bagged, bagged as long as the outside of bag remains sterile- if not, then double bagged.
- depends where the item falls on contamination scale: critical, semi critical, noncritical
146
CDC Standard Precautions - How to handle blood and body fluids in the healthcare environment:
- should be cleaned up immediately
- OSHA does not specify a single specific procedure/single specific disinfectant
- either use EPA approved hospital cleaner or 1 part bleach to 10 parts water (bleach must be fresh to be effective)
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What does OSHA stand for?
Occupational Safety and Health Administration
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Occupational Safety and Health Administration - What are transmission based precautions? What are the three types?
- aimed at pt w a confirmed diagnosis a suspected diagnosis of an epidemiologically important pathogen that warrants additional precautions beyond standard precautions
- airborne, droplet, and contact
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Occupational Safety and Health Administration - What are neutropenic precautions?
there are different levels of neutropenic precautions.
ANC = 1500 - avoid crowds, wash hhands
ANC = 1000 - above, as well as heightened house cleaning
ANC = 500 - all aove, as well as wear mask in public, limit visitors, no fresh fruit/veg, no fresh or artificial flowers, no raw foods
150
Occupational Safety and Health Administration - What does nosocomial mean?
healthcare associate infections. when a pt contracts an infection from a healthcare setting
151
Handling and Disposal of Toxic or Hazardous Material - what are the types of materials used in the radiation therapy setting?
metals, chemicals, radioactive material, chemotherapy
152
Handling and Disposal of Toxic or Hazardous Material -- what are the different types of metals used in rad ther?
cerrobend - which contains cadmium and lead.
- cadmium is toxic and can cause damage to lungs and kidneys. can be measured in blood, urine, hair, or fingernails.
- lead can damage brain and be measured in blood. can be absorbed through skin contact
exposure can happen by eating or drinking contaminated foods, or inhaling.
153
Handling and Disposal of Toxic or Hazardous Material -- what are the different types of chemical used in rad ther?
chemicals involved in film processing
154
Handling and Disposal of Toxic or Hazardous Material -- what are the different types of radioactive material used in rad ther?
such as cesium and iodine - radioactive isotopes
155
Handling and Disposal of Toxic or Hazardous Material -- what do you do in handling a chemotherapy spill?
- isolate the spill
- use double gloves, gown and eye protection
- if airborne contamination - use respirator
- if liquid, absorb w towel. if solid, cover and wipe w a wet absorbent sponge
- place all contaminated items in a biohazard bag
- all contaminated surfaces should be thoroughly cleaned
- properly dispose
156
Handling and Disposal of Toxic or Hazardous Material --Disposal of radioactive materials?
- materials w short half lives can be stored until there is sufficient radioactive decay, making it virtually harmless
- if the source does not exceed a certain activity limit, it can be released in the sewer system where it will decay
- can also be correctly packaged and labeled and sent away to an authorized recipient
157
Handling and Disposal of Toxic or Hazardous Material -- What is the Material Safety Data Sheet?
- sheet that lists the properties of materials that are used in the workplace
- intended to provide procedures in handling materials/chemicals in the workplace
- includes necessary info such as: melting point, boiling point, flash pint, toxicity, health effects, first aid, reactivity, storage, disposal, protective equipment, nd spill handling procedures
158
Pt. and Med Record MGMT: Evaluation - Define epidemiology:
the study of disease incidence.
the branch of medicine that deals with the incidence, distribution, and possible control of diseases and other factors relating to health.
factors such as age, gender, race, occupation, and geographic location can determine which type of ca effects which group of people
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Pt. and Med Record MGMT: Evaluation - Define etiology:
study of the cause of the disease:
- identifying carcinogens
- genetic factors
- helps to establish screening programs and preventative ca edu
160
Pt. and Med Record MGMT: Evaluation - Cancer Screening Tests for prostate? breast? cervix? colorectal cancer?
- prostate - blood PSA
- breast - mammogram
- cervix - papanicolaou smear (Pap smear)
- colorectal cancer - fecal occult blood test, colonoscopy
161
Pt. and Med Record MGMT: Evaluation - What percent of tumors are carcinomas?
-75-85%
162
Pt. and Med Record MGMT: Evaluation - What percent of tumors are sarcomas?
- 10-15%
163
Pt. and Med Record MGMT: Evaluation - What percent of tumors are other tissue types, not carcinomas or sarcomas?
5-10%
164
Pt. and Med Record MGMT: Evaluation - Where do carcinomas originate?
epithelium - tissues that cover a surface or line a cavity
165
Pt. and Med Record MGMT: Evaluation - where do sarcomas originate?
bone, connective, or soft tissue
166
Pt. and Med Record MGMT: Evaluation - how do carcinomas spread?
lymphatics
167
Pt. and Med Record MGMT: Evaluation - how do sarcomas spread?
blood
168
Pt. and Med Record MGMT: Evaluation - what is the most common metastatic site for sarcomas?
the lungs
169
Pt. and Med Record MGMT: Evaluation - what is the only way to definitively diagnose cancer?
biopsy
170
Pt. and Med Record MGMT: Evaluation - What are the 7 warning signs of cancer?
- Change in bowel or bladder habits
- A sore that does not heal
- Unusual bleeding or discharge
- Thickening or lump in the breast or elsewhere
- Indigestion or difficulty in swallowing
- Obvious change in a wart or mole
- Nagging cough or hoarseness
171
Pt. and Med Record MGMT: Evaluation - What are the major cancer risk factors?
most common risk factors for cancer include aging, tobacco, sun exposure, radiation exposure, chemicals and other substances, some viruses and bacteria, certain hormones, family history of cancer, alcohol, poor diet, lack of physical activity, or being overweight.
172
Pt. and Med Record MGMT: Evaluation - what are the major diagnostic tests?
biopsy, x-rays, computed tomography (CT), Magnetic Resonance Imaging (MRI), Visualization/biopsy through a scope, PET scan, thyroid scan, bine scan, ultra sound, WBC, hemoglobin
173
Pt. and Med Record MGMT: Evaluation - How is a biopsy necessary in diagnosing cancer?
confirms the presence of cancer cells
174
Pt. and Med Record MGMT: Evaluation - How are x-rays used?
x-rays can be taken of the chest, abdomen, bones, etc. Dye can also be used to better visualize anatomy.
175
Pt. and Med Record MGMT: Evaluation - What is computed tomography?
CT - x-rays that provide 3D sectional anatomy w good contrast between tissue and bony anatomy
176
Pt. and Med Record MGMT: Evaluation - What is an MRI?
Magnetic Resonance Imaging - uses magnets opposed to radiation to visualize 3D images of anatomy. provides good contrast between soft tissues
177
Pt. and Med Record MGMT: Evaluation - What are the different visualization/biopsy through scopes?
endoscope, proctoscope, cystoscope
178
Pt. and Med Record MGMT: Evaluation - What are the different nuclear medicine studies?
PET scan, thyroid scan, bone scan
179
Pt. and Med Record MGMT: Evaluation - What are ultrasounds used for in cancer diagnostics?
for cystic (benign) tumors versus solid tumors (malignant), and for localization (biopsy, tx depth)
180
Pt. and Med Record MGMT: Evaluation - What lab values are necessary to look at for cancer diagnostics?
tumor markers, kidney, liver, thyroid function, blood values (e.g. WBC, hemoglobin)
181
Treatment Side Effect - tx for nausea?
antiemetic - tore can, norazine, compazine
182
Treatment Side Effect - tx for pain?
pain killers - Tylenol, Percocet, MS contin
183
Treatment Side Effect - tx for inflammation?
anti-inflammatory - hydrocortisone, diprolene
184
Treatment Side Effect - tx for diarrhea?
anti-diarrheal - ammonium, lomotil
185
Treatment Side Effect - tx for ulcers?
protectant - carafate (adheres to ulcer site; inhibits pepsin)
186
Treatment Side Effect - medications used to numb?
topical or oral anesthetic - xylocaine elixir
187
Treatment Side Effect - What is peridex?
an anti-microbial used to kill or inhibit growth of microorganisms
188
Treatment Side Effect - what are the skin reactions in rad therapy?
skin reactions are specific to tx areas and range in stages 1-4 of severity.
189
Treatment Side Effect - what is stage 1 skin reaction?
inflammation, color pinkish red, slight edema
190
Treatment Side Effect - what is stage 2 skin reaction?
inflammation and dry desquamation - skin becomes dry and scaly due to shedding of the epidermis, this is usually itchy
191
Treatment Side Effect - what is stage 3 skin reaction?
inflammation, edema, and moist desquamation - skin thins and starts to weep because the epithelial layer has lost its integrity. Tx may be temporarily discontinued to allow skin cells to repair and heal
192
Treatment Side Effect - what is stage 4 skin reaction?
depilation of the hair in the tx field - permanent hair loss
