PRINCIPLES OF PATIENT CARE IN CT

MASLOW’S HIERARCHY OF NEEDS

1. PHYSIOLOGIC NEEDS

2. SAFETY & SECURITY

3. LOVE & BELONGINGNESS

4. SELF-ESTEEM

5. SELF-ACTUALIZATION

PATIENTS WHO COME TO RADIOLOGY DEPT.ARE

TRYING TO SATISFY THEIR BASIC NEED - SAFETY

TERMINALLY ILL PATIENTS

ARE GOING THROUGH THE GRIEVING PROCESS

THE GRIEVING PROCESS

1. DENIAL

2. ANGER

3. BARGAINING

4. DEPRESSION

5. ACCEPTANCE

PATIENT ASSESMENT

VITAL SIGNS

TEMPERATURE

• 99.6 ° F R

• 98.6 ° F O

• 97.6 ° F Ax

PULSE DETECTION SITES

• APICAL

• RADIAL

• CAROTID

• FEMORAL

• POPLITEAL

• TEMPORAL

• DORSALIS PEDIS

AVERAGE PULSE RATE IN

• ADULT MAN OR WOMAN - 60-90 BEATS/MIN

• CHILD 4-10 YEARS - 90-100 BEATS/MIN

• INFANT - 120 BEATS/MIN

PULSE ASSESSMENT

• TACHYCARDIA

• BRADYCARDIA

RESPIRATION RATES

• 10-20 B/MIN – ADULT

• 20-40 EARLY CHILDHOOD

• 30-60 NEONATAL

• < 10 B/MIN FOR ADULT CYANOSIS

CYANOSIS

BLOOD PRESSURE

• SYSTOLIC 110-140 mmHg

• DIASTOLIC 70-90 mmHg

INFUSION AND COLLECTING CONTAINERS

• IV BAG –24 “ ABOVE PATIENT

• URINE COLLECTION BAG – BELOW PATIENT LEVEL

• BE BAG – ABOVE PATIENT LEVEL

• CHEST TUBE – BELOW PATIENT LEVEL (DO NOT BENT OR CLAMP TUBING)

PATIENT TRANSFER

PULL SHEET

SLIDING BOARD

WITH SPINAL CORD INJURY

CT EXAM

• WHAT TYPE OF PROCEDURE?

NON-INVASIVE OR INVASIVE?

CONSENT?

CT PROCEDURES REQUIRING CONSENT

• ARTHROGRAPHY

• BIOPSY

• CTA

• MYELOPGRAPHY

CONSENT TYPES

• INFORMED

• IMPLIED

INFORMED CONSENT

Informed consent is the process by which a fully informed patient can participate in choices about her health care. It originates from the legal and ethical right the patient has to direct what happens to her body and from the ethical duty of the physician to involve the patient in her health care

IMPLIED CONSENT

The explanation of implied consent says that consent assessed when the surrounding circumstances lead a reasonable person to believe that consent has been granted even though word of agreement were not direct, express or explicit.

EMRGENCY SITUATIONS

IV CONTRAST PROCEDURES

REQUIREMENT

• CONSENT

• LABORATORY VALUES WITHIN NORMAL RANGE

BUN 7-20 mg/dl

CREAT.- 0.6 –1.2 mg/dl

PATIENT PREP.

• NPO 4 HOURS PRIOR TO THE EXAM

• IODINE ALLERGY- STEROID THERAPY

(PREDNISONE)

• HYPERVENTILATION BEFORE EXAM FOR BETTER BREATHOLD

UTILIZED

GAUGE SUITABLE FOR CTA

18 OR 20

CONTRAST ADMINISTERED WITH POWER INJECTOR

POWER INJECTOR PARAMETERS

VOLUME OF CONTRAST-ml

RATE ml/sec

TIME OF INJECTION – sec

SCAN DELAY TIME - sec

CONTRAST WARMER

TO REDUCE ITS VISCOSITY

EXTRAVASATION STEPS

• STOP THE INJECTION

• PUT THE WARM COMPRESS ON THE INJECTION SITE

IODINE WATER SOLUABLE CONTRAST AND GLUCOPHAGE

WITHELD 48 PRIOR AND AFTER THE PROCEDURE

MOST COMMON SHOCK IN CT

• ANAPHYLACTIC!

SHOCK:

PHYSIOLOGIC REACTION TO : ILNESS, TRAUMA OR SEVEREEMOTIONAL DISTURBANCE

SHOCK SYMPTOMS:

• HYPOTENSION

• WEAK PULSE

• RAPID PULSE

• RAPID BREATHING

SHOCK

• HYPOVOLEMIC

• SEPTIC

• CARDIOGENIC

• NEUROGENIC

• ANAPHYLACTIC – MOST COMMON IN CT

ORAL CONTRAST PROCEDURES

TYPES OF ORAL CONTRAST

• BARIUM SULFATE

• WATER SOLUABLE (GASTROGRAPHIN)

• AIR

• CARBON DIOXIDE (EFFERVESCENT AGENTS)

BARIUM SULFATE CAN NOT BE USED IF:

• PATIENT HAD A RECENT BIOPSY

• BLEED IN THE GI TRACT

IT CAUSES BARIUM PERITONITIS IF ESCAPES INTO PERITONEUM

PREPARATION

• LIGHT EVENING MEAL

• BOWEL CLEANSING

• NPO AFTER MIDNIGHT (EXCEPT FOR CONTRAST AND MEDS)

• DETRMINE IF PATIENT HAD BE RECENTLY!

BARIUM SULFATE CONCENTRATION

• 1-3%

WATER SOLUABLE CONTRAST

CONCENTRATION

• 2-5%

EX. 100 cc OF WATER AND 20 –50 cc OF GASTROGRAPHIN

BIOPSY

You will have diet restrictions prior to the procedure, usually no solid foods 6 hours before the appointment and clear liquids

( water, black tea/coffee, apple, cranberry,grapefruit, grape juice, jello or broth)

only two hours before the appointment.

If you take blood thinners such as coumadin you doctors needs to tell you its OK to stop this for 1 week before this procedure.

BLOOD LEVELS

• PT

• PTT

• PLATELETS COUNT

PT-PROTHROMBIN TIME

DefinitionThis is a test that measures the clotting time of plasma (the liquid portion of the blood).

Why is the Test Performed?The PT is a broad screening test for many types of bleeding disorders. It evaluates blood clotting disorders, usually bleeding.

Normal ValuesThe normal range is 11 to 13.5 seconds ("normal"

varies somewhat in different labs).

For a person on full anticoagulant therapy, the PT should be 2 to 3 times the laboratory "control"

value.

PTT-PARTIAL THROMPOPLASTIN TIME

DefinitionThis is a test that measures clotting time in plasma (the liquid portion of blood). It focuses on a specific pathway in the blood clotting process.

Why is the Test Performed?This test is used to evaluate a wide variety of disorders of blood coagulation. It is useful in the evaluation of disorders of both excessive clotting and excessive bleeding.

Normal Values•APTT: 25 to 35 seconds

Platelet CountDefinitionThis is a test to measure the number of platelets in blood.

Platelets are necessary for normal blood clotting (hemostasis). Most important, they aggregate (clump together) to plug small holes in damaged blood vessels.

Why is the Test Performed?The platelet count can be affected by many disease states. It may also be measured to assess the cause of excess bleeding.

Normal Values150,000-400,000/mm3 (millimeters cubed)

PHARMACOLOGY

THE STUDY OF DRUG ACTIONS ON AND INTERACTIONS WITH LIVING ORGANISMS.

EXCRETION

• MOST DRUGS ARE EXCRETED BY KIDNEYS.

OTHER EXCRETION ROUTES:

PERSPIRATION, TEARS, FECES, BREAST MILK, SALIVA

FACTORS THAT INFLUENCE DRUG ADMINISTRATION

• AGE• GENDER• HORMONAL DIFFERENCES• EMOTIONAL OR PSYCHOLOGICAL

STATE• TIME OF DAY• THE CHANNEL OR ROUTE OF

ADMINISTRATION

DRUG ADMINISTRATION ROUTES

• ORAL• TOPICAL• PARENTERAL• SUBLINGUAL• INTRATHECAL• RECTAL• TRANSDERMAL• INHALATION

PARENTERAL DRUG ADMINISTRATION

• SUBCUTANEOUS

• INTRADERMAL

• INTRAMUSCULAR

• INTRAVENOUS

• INTRATHECAL

INTRATHECAL

DRUG NAMES • TRADE NAME -ASSIGNED BY THE

MANUFACTURER

• CHEMICAL NAME - EXACT CHEMICAL FORMULA

• GENERIC NAME - GIVEN BEFORE THE OFFICIAL APPROVAL FOR USE

• OFFICIAL NAME - GENERIC AND OFFICIAL NAMES ARE USUALLY THE SAME

ACTING ON THE NERVOUS SYSTEM

• CHLORAL HYDRATE – SEDATIVE- ORAL, RECTAL

• MORPHINE SULFATE – CONTROL OF SEVERE PAIN- ORAL, PARENTERAL

• LIDOCAINE – ANESTHETIC- PAIN BLOCKER – TOPICAL, PARENTERAL

ANALGESICS,ANTIPYRETICS,

ANTI-INFLAMMATORY

• ASPIRIN

• ACETOMINOPHEN

(TYLENOL)

• IBUPROFEN

(ADVIL, MOTRIN)

ORAL

TO TREAT CARDIOVASCULAR DISEASE

• LASIX- ( DIURETIC ACTION)- IV, ORAL

• HEPARIN - IV AND COUMADIN- (ANTICOAGULANTS) ORAL

• NITROGLYCERIN – (VASODILATOR)

ANGINA PECTORIS – SUBLINGUAL, TOPICAL

TREATMENT OF ALLERGIC RESPONSES

• EPINEPHRINE (ADRENALIN) (SEVERE ALLERGIC RESPONSE)- BRONCHODILATOR-VASOCONSTRICTOR-PARENTERAL , INHALATION

• BENADRYL (DIPHENHYDRAMINE) (MILD REACTION)– ORAL , PARENTERAL

LEGAL ASPECTS

ORDINARY NEGLIGENCE

•Failure to exercise the care toward others which would reasonably be expected of a person in the circumstances, or taking action which a reasonable person would not.

GROSS NEGLIGENCE

•Intentional failure to perform a duty, reckless disregard of the consequences as affecting the life or property of another

ASSAULT

•Threat to inflict injury with an apparent ability to do so. Also, any intentional display of force that would give the victim reason to fear or expect immediate bodily harm

BATTERY

•In many common law jurisdictions, the crime of battery involves an injury or other contact upon the person of another in a manner likely to cause bodily harm

FALSE IMPRISONMENT

•confinement without legal authority

DEFAMATION OF CHARACTER

•In English and American law, and systems based on them, libel and slander are two forms of defamation of making a false statement of fact that injures someone's reputation.

LIBEL

•Written defamation that causes injury to another person

SLANDER

•words falsely spoken that damage the reputation of another

FRAUD

•An intentional perversion of truth; deceitful practice or device resorted to with intent to deprive another of property or other right

INVASION OF PRIVACY

•Violation of person’s right to be left alone and free from unwarranted publicity and intrusions

PATIENT CONFIDENTIALITY

THE SECURITY OF HEALTH INFORMATION IS THREATENED BY

• EMPLOYEES

• SOFTWARE FAILURE

• HARDWARE FAILURE

• HACKERS

As health care providers, we all have a responsibility to uphold confidentiality for patients. In a busy hospital setting it can be difficult. Increasing workloads lead to elevator or cafeteria discussions of Mrs. Smith's metastases or Mr. Jones' pancreatitis. This is not acceptable. The person next to you in line could be a patient's friend, relative, or media member that is not entitled to this privileged information.

Healthcare agencies and providers must provide confidentiality and privacy of the healthcare information that they collect,

maintain, use, and/or transmit. Confidentiality means that only certain individuals will have

the right to access the information and that it is secure from others. Confidentiality is at risk when the potential for improper access to information exists. It is our responsibility to

protect patient information.

LEGAL DOCTRINES

RESPONDEAT SUPERIOR

•A legal term referring to the fact that, under specific circumstances, an employer (or principal) is legally liable for the actions of his or her employees while in the course of their employment