PRINCIPLES OF PATIENT CARE IN CT. MASLOWS HIERARCHY OF NEEDS 1.PHYSIOLOGIC NEEDS 2.SAFETY & SECURITY...
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Transcript of PRINCIPLES OF PATIENT CARE IN CT. MASLOWS HIERARCHY OF NEEDS 1.PHYSIOLOGIC NEEDS 2.SAFETY & SECURITY...
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