Unit 5: Complex Patient Care Scenarios Flashcards
You have just finished positioning a patient for a supine abdomen x-ray. Just as you finish placing your marker in the light field, your patient mentions to you that they “really have to use the bathroom” and appears embarrassed. How do you respond?
- Respond quickly and professionally if a patient requests a washroom.
- Assess patient’s ability.
- Assist patient with footwear, and make sure they are covered (robe/sheet).
- Help patient off radiographic table.
- Patient may have been fasting or be on medication that makes them unsteady.
What should you do after you help a patient off the table to the washroom?
- Help the patient into the closest washroom.
- Never leave patient unattended.
- Explain you will be right outside the door if they require assistance.
- Locate and explain the use of the emergency call button.
- Check on patient frequently.
What should you do once a patient is done using the washroom?
- Help patient wash hands, if they are unable to do so.
- Accompany patient back to examination area.
- Wash your hands!!
When should bed pans be used for females unable to get up to the bathroom?
A non-ambulatory female patient who is not catheterized, must be offered a bedpan for both defecation and urination.
When should bed pans be used for a male that is unable to get up to the bathroom?
The male patient who is not ambulatory must be offered a bedpan for defecation.
What are the 2 main types of bed pans?
- Standard
- Fracture
What are standard bed pans made of and how deep are they?
Metal or plastic or paper
2” high
What is a fracture bed pan and when would you use it?
- Shallower and contoured for patient comfort.
* The tapered end improves comfort and ease of placement with immobile patients.
* For patients who cannot lift their hips as high.
How do you position a bed pan when the patient can assist?
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- Ensure privacy. Make sure patient is always covered.
- Make sure you have tissues/towels.
- Put on gloves.
- Place one hand under the lower back and ask patient to raise their hips.
- Place pan under the hips.
- Assist sitting the patient up (if possible).
- Make sure the side rails are up on the stretcher.
- Make sure tissue and washcloth are within patient’s reach.
- Turn away from patient to provide privacy.
Maintain communcation
What should you do once an assisting paitent is done using the bed pan?
- When patient is finished, help them off pan.
- Lie the patient down, placing one hand under the lumbar spine and have the raise hips.
- Remove the bed pan.
- Cover with a towel and dispose the contents in the washroom or designated area.
- Remove gloves and wash your hands!!
How should you position a bed pan for a patient that cannot assist?
- Get help
- One person rolls patient onto their side
- Other puts the pan under the patient
- When removing, hold the pan before rolling the patient
- If assistance is needed to clean the perineal area, the technologist must provide this support
What is the Hygie System?
Hygienic cover with super-absorbent pad designed to turn up to 500ml of liquid wastes into a gel within seconds.
What is the purpose of hygenic covers?
This helps reduce the risks of splashes, spills and germ dispersal which contribute to the prevention of cross-contamination and healthcare-associated infections.
What are the benefits of the Hygie system?
- The single-use product offers increased hygiene level, blocks odors, and reduces cleaning tasks.
- It is easy to discard without risk.
- Makes collection and transportation safer.
What are urinals and how do you use them?
- Specifically designed for patients with a penis
- Can be used with the patient supine
What might you have to do with the urine after a patient uses a urinal?
Measure the output
Otherwise, dispose of the urine and return to the patient
If the urinal is not returned with the patient, what should you do?
Place it in a non-sterile bag and send it to be sterilized.
You go to remove the bed pan and the patient has had a bowel movement that has created an unpleasant odor. How do you respond?
- Maintain professionalism.
- You may have to clean the patient.
- Use several tissues and fold them over to form a thick pad.
- Wipe the patient’s perineum from front to back
What are the general rules for handling cast anatomy?
- Support a casted or reduced extremity at both joints.
- When moving a fractured (and/or casted) extremity, support both proximal and distal to the fracture, with opened, flattened hands.
- Avoid grasping the cast tightly with fingers
- Lift under the cast using opened, flattened hands
Why should you not squeeze to lift a cast?
Puts pressure against patients skin and may lead to decubitus ulcers, impaired blood flow, or nerve damage.
How much should a casted patient be checked for impaired circulation or nerve compression
Every 15 mins.
What are the signs of impaired circulation or nerve damage
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- Pain
- Coldness
- Numbness
- Burning/Tingling of fingers or toes
- Swelling
- Skin color changes
- Inability to move fingers or toes
- Decrease in or absence of pulse
What does the type of cast depend on?
On the type of injury, the length of time requiring immobilization and the physician’s preference.
What are plaster casts?
Coating gauze with plaster of paris
What are fibre-glass casts?
From rolls of material that is impregnated with polyurethane resin
What are the 3 types of casts?
- Air cast/boot
- Plaster cast
- Fibre glass
When are leg braces used?
After knee surgery or immediately after a knee injury.
What are the recommendations when using leg braces?
Length and body position
Used to keep the leg straight and is recommended to be worn between 2-8 weeks depending on the injury, surgery and doctor recommendation
Give an example of a straight knee brace:
Zimmer splint
What type of brace allows a patient to lock and unlock the knee range of motion which some surgeons may recommend?
Called a ROM (range of motion) brace or hinged brace.
What should you never do when imaging patients in traction? Why?
Never remove OR pull the traction device or let the weights rest on anything. This may result in a reduced fracture to become misaligned.
What type of imaging is done with patients in traction?
Requires a portable imaging exam.
What is total joint replacement hip/knee arthroplasty required for?
Required due to degenerative joint disease or joint deformity due to trauma.
What is it called when a diseased joint is replaced with a prosthesis.
Arthroplasty
What is the most common complication after hip replacement?
Dislocation
What movements should you avoid for a patient with post-operative hip arthroplasty
- Never allow patients to cross their legs (Adduction)
- Avoid abduction
- Avoid hyperextension or flexion
- Avoid internal or external rotation
What is the proceedure when transferring patients with post hip arthroplasty?
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- Lower side rail on the side of the stretcher the transfer is going to take place.
- Place stretcher against the table
- Adjust the heights of the table and stretcher to be the same
- If no abduction sponge present, place a large pillow/sponge between their legs
- Using a draw sheet, roll the patient away from the table (towards you)
- Place slider board behind patient, creating bridge between the edge of the radiographic table and the stretcher.
- Allow patient to roll back on to board.
- Slide the patient over the board and onto the table.
On an IV system, label:
1.Spike/cannula
(plastic)
2. Piggy back port
3. Drip chamber
4. Piggy back junction
5. Roller clamp
6. Injection port
If medication is running through a piggy-back connection, how much higher should it be positioned to the saline?
It should be set up 6” (15cm) higher than saline.
When administering medication through IV, what is the processes of connecting the IV?
Connect tubing to solution first, and then to patient
What is priming?
Emptying tubing of all air before connecting to patient.
How high should the medication bag height be above the vein?
18 – 24 inches above vein
What types of devices are used to regulate the flow of medication?
An infusion pump or simple clamp
What should the rate of the flow of medication be in an IV bag?
15 – 20 drops per minute
What is extravasation?
Delivery of solution into surrounding tissue outside the vessel from the bag being too high, resulting in interstitial administration
What can extravasation result in?
- Pulmonary Edema
- Tissue necrosis
- Overdose on Medication
What happens if the IV bag is too low?
- Blood runs back into tubing.
- Blood clots in line
- Line must be replaced
What can too low of an IV bag result in ?
- Inadequate Medication
- Poor visualization of Contrast media
How often should you check the infusion site to be certain that the contrast media or infusion is not infiltrating into surrounding tissue?
Every 30 min
What are the two things you should look out for when assesssing if the solution is going into surrounding tissue?
- Pain or discomfort
- Swelling or redness in surrounding tissues
What should you do if sings of solution going into surrounding tissue is present?
STOP the IV and ask a physician/nurse for direction
Can you remove an IV catheter while its delivering medication?
Never
When may you remove an IV catheter?
You may remove an IV catheter inserted for the sole purpose of a medical imaging exam, or if the IV has resulted in extravasation.
As a tech, what should you do once you are done administrating medication through an IV cathetier?
Why?
Best practice is to secure and leave IV in place for admitted or ER patients. This avoids further needle pokes for access
What do you do if you notice Contrast Extravasation?
- Explain what is suspected and what you are doing
- Stop the infusion immediately
- Remove the IV access
- Apply a cold pack and elevate the arm
- Notify the Radiologist and/or nurse caring for patient.
- Provide patient with post-care instructions.
- Complete an Incident Report
Describe in detail on a seperate peice of paper the steps for Changing gown on patient with IV bag attached:
Do it
Define Ileostomy:
An artificial opening (stoma) in the small intestine (ileum) for the purpose of evacuating feces.
What is an artificial opening (stoma) in the large intestine (colon) for the purpose of evacuating feces called?
Colostomy
When would a ileostomy or a colostomy be used on a patient?
cancer, diverticulitis, Crohn’s, ulcerative colitis
Where will Ostomy patients have a dressing or drainage pouch ?
In place over the area of the stoma.
When should patients be advised to bring an extra colostomy or illiostomy bag?
If they are an outpatient
Wat should you do once you are done imaging (with contrast) a patient with a colostomy or illiostomy bag after removing dressing?
- assist with re-applying the drainage pouch.
- Help the patient to the washroom, if needed.
- Provide towels or wash cloths to assist the patient with cleaning up.
- Encourage the patient to drink lots of fluids for the next few days.
- Remind the patient that the stools may be whiter or lighter in color.
- Patient may ask you if they can eat-Instruct them that they may return to the diet they were following prior to the barium exam prep.
What do you do if a patient informs you that they have a colostomy/ileostomy prior to plain images of the abdomen?
- Ask the patient if the bag is full.
- Provide the opportunity for the patient to empty the contents in the washroom prior to the imaging.
- Make sure the patient has the necessary supplies.
The bag used for the piggyback connection should be placed how many inches lower or higher than the primary bag, to allow for proper delivery of its contents.
6 inches higher
What movement does a the triangluar hip pillow not allow movement for?
Abduction
Post-procedural care for patients who have had a barium study of the colon should include what?
- Increase in fluid intake
- Reminder of the colour of the stool
