1. Basic patient care in Radiography

2. Goal The student will be able to explain how to admit patients for radiographic procedures and care for their basic needs in a safe and effective manner. The student will be able to explain how to admit patients for radiographic procedures and care for their basic needs in a safe and effective manner.

3. Objectives When the student has completed this lesson, he will be able to: 1. Give clear verbal instructions to ambulatory patients about the correct manner of dressing or undressing for a radiographic procedure, and assess the need for assistance. 2. Give a written explanation of what is to be one with the patient’s belongings while he is being care for in the radiography/therapy department. 3. Demonstrate the correct manner of moving, transferring, and positioning patients to prevent injury to himself and to the patient. 4. Demonstrate the correct method of assisting the disable patient with dressing or undressing for a diagnostic examination.

4. Objectives 5. list three safety measures that must be taken when transferring a patient from a hospital war to the radiography department an returning him to the ward. 6. List three situations in the radiography department that might result in damage to the patient’s skin, and explain how to prevent them. 7. Demonstrate the correct method of moving a patient who is wearing a plaster cast. 8. List four signs of circulatory impairment that the RT must recognize in a patient who is wearing a plaster cast. 9. Demonstrate the correct manner of assisting a patient with a bedpan or urinal.

5. 1. Dressing / undressing the patient for Radiography When a patient comes to the radiology department from outside the hospital, he is frequently required to remove all or some items of clothing before a radiographic examination can be performed. When a patient comes to the radiology department from outside the hospital, he is frequently required to remove all or some items of clothing before a radiographic examination can be performed. The RT is usually be the person who receives the patient an informs him which items of clothing are to be removed. The RT is usually be the person who receives the patient an informs him which items of clothing are to be removed. The patient’s discomfort or embarrassment can be lessened if the RT will approach this situation in a courteous an professional manner. The patient’s discomfort or embarrassment can be lessened if the RT will approach this situation in a courteous an professional manner. The patient should be taken to the specific place (dressing/changing room/cubicle) where he is expected to disrobe. The patient should be taken to the specific place (dressing/changing room/cubicle) where he is expected to disrobe.

6. 1. Dressing / undressing the patient for Radiography The RT should show how to close the door or raw the curtain of the dressing room/cubicle. The RT should show how to close the door or raw the curtain of the dressing room/cubicle. He should clearly explain how the patient is to where the examination gown and where to go afterwards. (some gowns open at the back) He should clearly explain how the patient is to where the examination gown and where to go afterwards. (some gowns open at the back) The patient should be supplied with hangers for his clothing. The patient should be supplied with hangers for his clothing. The patient should be informed where to leave his clothing. The patient should be informed where to leave his clothing. Purses, jewelry, and other valuables should be treated with special care. Purses, jewelry, and other valuables should be treated with special care.

7. Care of valuables Dressing rooms are not safe places to leave the valuables. Dressing rooms are not safe places to leave the valuables. RT should consider the patient’s concerns and explain what must be done with them. RT should consider the patient’s concerns and explain what must be done with them. Metal items such as necklaces, rings, and watches are not to be warn for certain radiologic examinations Metal items such as necklaces, rings, and watches are not to be warn for certain radiologic examinations A large envelope can be given to the patient to keep such valuables. A large envelope can be given to the patient to keep such valuables. The envelope can be kept in the patient’s purse or pocket, or a secure place in the department. The envelope can be kept in the patient’s purse or pocket, or a secure place in the department. A written record of the items should be kept. A written record of the items should be kept. The RT must not value patient’s belongings. An item that may seen insignificant to the RT may be the patient’s most treasured belonging. The RT must not value patient’s belongings. An item that may seen insignificant to the RT may be the patient’s most treasured belonging.

8. 2. Correct Body postures in moving & transferring patients The rules of correct body mechanics should be followed when moving & lifting patients to avoid injury to oneself and to the patient. The rules of correct body mechanics should be followed when moving & lifting patients to avoid injury to oneself and to the patient. Safe body mechanics require good posture. Safe body mechanics require good posture. The body should be in alignment with all parts in balance. Good posture permits the musculoskeletal system to work at maximal efficiency with a minimal amount of strain on joints, tendons, ligaments, and muscles. It also helps other body systems to work efficiently. The body should be in alignment with all parts in balance. Good posture permits the musculoskeletal system to work at maximal efficiency with a minimal amount of strain on joints, tendons, ligaments, and muscles. It also helps other body systems to work efficiently.

9. Rules for correct upright posture  The chest is held up and slightly forward with the waist extended - (This helps the lungs to expand properly and fill to capacity. The head is held erect with the chin held in. -(This puts the spine in proper alignment) The head is held erect with the chin held in. -(This puts the spine in proper alignment) Stand with the feet parallel and at right angles to the lower legs. Feet 4 - 8 inches apart. Boy weight equally distributed on both feet. Stand with the feet parallel and at right angles to the lower legs. Feet 4 - 8 inches apart. Boy weight equally distributed on both feet. Keep the knees slightly bent. - They act as a ‘shock absorber ‘ for the body. Keep the knees slightly bent. - They act as a ‘shock absorber ‘ for the body. keep the buttocks in and the abdomen up and in. – This prevents strain on the back and abdominal muscles. keep the buttocks in and the abdomen up and in. – This prevents strain on the back and abdominal muscles.

10. Correct procedures to follow when moving and lifting patients. Keep the heaviest part close to your body. Keep the heaviest part close to your body. When the object is too heavy get assistance. When the object is too heavy get assistance. The force of friction opposes movement. Take action to reduce friction. The force of friction opposes movement. Take action to reduce friction. Friction can be reduced by reducing the surface area to be moved, or employing some of the patients own strength to assist with the movement. Friction can be reduced by reducing the surface area to be moved, or employing some of the patients own strength to assist with the movement. Keep the patients arms across the chest to reduce surface area. Keep the patients arms across the chest to reduce surface area. Pulling rather than pushing reduces the friction. Pulling rather than pushing reduces the friction. A pull sheet placed under the patient will also work to reduce the friction. A pull sheet placed under the patient will also work to reduce the friction.

11. Correct procedures to follow when moving and lifting patients. Keep the body’s line of balance close to the center of gravity, which is at or just below the waist line. Keep the body’s line of balance close to the center of gravity, which is at or just below the waist line. When picking up an object from the floor bend the knees and lower the body, do not bend from the waist. When picking up an object from the floor bend the knees and lower the body, do not bend from the waist. The biceps muscles are the strongest muscles and are effective in pulling; therefore pull the weight - do not push it. The biceps muscles are the strongest muscles and are effective in pulling; therefore pull the weight - do not push it.

12. Correct procedures to follow when moving and lifting patients When a patient has to be lifted, When a patient has to be lifted, Balance the weight over both feet; Balance the weight over both feet; Hold the patient close to your body; bend your knees Hold the patient close to your body; bend your knees Set your spine to support the weight. Set your spine to support the weight. Use your arms and leg muscles to lift Use your arms and leg muscles to lift The spine must always be protected. The spine must always be protected. Instead of twisting your body to move with a load, change foot positions. Instead of twisting your body to move with a load, change foot positions. Keep the body balanced over your feet. Keep the body balanced over your feet.

13. Do s and Don’ts

14. Moving & transferring patients Before trying to transfer or move a patient the RT must assess the patient’s ability to aid in the process. Before trying to transfer or move a patient the RT must assess the patient’s ability to aid in the process.

15. Assessing the patients mobility Identify any abnormalities in the patient’s body alignment. Identify any abnormalities in the patient’s body alignment. If there are any abnormalities, determine the reasons for the problem. If there are any abnormalities, determine the reasons for the problem. It may be resulted from, It may be resulted from, poor posture poor posture trauma trauma muscle damage or dysfunction of the nervous system muscle damage or dysfunction of the nervous system malnutrition malnutrition fatigue fatigue emotional disturbances. emotional disturbances.

16. Assessing the patients mobility Support the affected limbs or body parts with pillows, support blocks, or sandbags Support the affected limbs or body parts with pillows, support blocks, or sandbags Assess the mobility of the patient and the limitations of joint motions. Assess the mobility of the patient and the limitations of joint motions. Assess the patient’s ability to walk(his gait) Assess the patient’s ability to walk(his gait) Note the conditions of respiratory, cardiovascular disease, endocrine disease etc. Note the conditions of respiratory, cardiovascular disease, endocrine disease etc.

17. Final judgement How well or how poorly is the patient functioning? – general condition of the patient. How well or how poorly is the patient functioning? – general condition of the patient. Are his motions restricted any way? - mobility of the patient. Are his motions restricted any way? - mobility of the patient. Will he become fatigued and be unable to complete the transfer without assistance? – strength and endurance Will he become fatigued and be unable to complete the transfer without assistance? – strength and endurance Can he sit or stand for as long a period as is required? – ability to maintain balance Can he sit or stand for as long a period as is required? – ability to maintain balance Is he responsive and alert? – ability to understand Is he responsive and alert? – ability to understand Does he fear or resent the move? – acceptance of the move. Does he fear or resent the move? – acceptance of the move.

18. Important rules regarding moving or transferring patients 1. Give only the assistance that the patient needs for comfort and safety. 2. Always transfer across a shorter distance 3. Lock all wheels on gurneys (beds), trolleys, and wheelchairs. 4. It is better to move a patient towards his strong side while somebody assists at his weak side. 5. Patient should wear shoes for standing transfers, but slippery bedroom slippers should not be worn. 6. Inform the patient about the plan of the move, an encourage his help. 7. Give simple short commands, and help him to carry them out.

19. Methods of patient transfer By gurney (special patient bed) By gurney (special patient bed) By trolley By trolley By wheelchair By wheelchair By walking (ambulation) By walking (ambulation) 1. Moving a patient from trolley to x-ray table or vice versa (reverse) i. Using a pull sheet ii. Three carrier lift

20. i. Using a pull sheet 1. Obtain a heavy sheet (Bed sheet folded) 2. Get the assistance from another person 3. Turn the patient onto one side and move him to the distal side of the trolley. 4. Place the sheet on the trolley and roll one half of it as close to the patient as possible. 5. Turn the patient across the sheet roll and straighten the sheet on the distal side. 6. Return the patient to supine position. 7. Cross the patient’s arms across the chest 8. Three or four people may be required to complete the move; one should support the head, two on either side, one may support the legs. 9. In unison all of them raise the patient with the sheet and transfer from the trolley to the table or vice versa

21. Placing the sheet

22. Moving the patient Care must be taken if the two surfaces are not at the same level, to avoid injury to the patient. The friction can be minimized by using sliding boards Care must be taken if the two surfaces are not at the same level, to avoid injury to the patient. The friction can be minimized by using sliding boards

23. ii. Three carrier lift method 1. Keep the trolley perpendicular to the table 2. Slide the patient to the inner side of the trolley 3. Three persons go to the side close to the patient 4. One stands to support the head and neck, one at the buttocks and the other at the legs and ankles 5. Cross the patient’s arms across the chest 6. All three lifters place their arms under the patient- the region of the body which they are going to lift 7. At the signal, the movers roll the patient off the table and on to theirs chests. 8. All three pivot and placed the patient on to the surface to which he is being transferred.

24. Step 1 Step 2

25. Step 3

26. Log roll (to turn an injured patient to a lateral position) 1. Place a pillow and support block at the side to which the patient is going to be turned. 2. Place a pillow between knees to support the legs when turned to side. 3. Two people will stand on either side of the bed, one at the head 4. The sheet is brought up over the patient and grasped by two persons at leg end 5. One at the head support the head and neck without allowing the neck to bend or head to rotate. 6. Other two must support the body 7. In unison, the team rolls the patient to the desire side as if he were a log keeping his head, neck and torso immobile during the move. 8. the head should rest in lateral position on the support block and pillow

27. Log roll method to turn a patient witout bending his neck and spine

28. 2. Moving a patient from x-ray table to the wheelchair 1. First it is necessary to turn the patient from supine position to a sitting position, to do that Stand in front of the table Stand in front of the table Keep one arm under the patient’s shoulders and the other across his knees Keep one arm under the patient’s shoulders and the other across his knees Instruct the patient to push himself up with the support of his upper arm if possible, when he is asked to do so. Instruct the patient to push himself up with the support of his upper arm if possible, when he is asked to do so. Then on the count of three, move the patient or help him to move to a sitting position at the edge of the table with the knees flexed. Then on the count of three, move the patient or help him to move to a sitting position at the edge of the table with the knees flexed. 2. Keep the wheel chair parallel to the table and lock the wheels 3. Then stand in front of the patient 4. Place the patient’s arms across your shoulders 5. Put your knees around the patients knees 6. Help the patient stand and pivot, and thus lower onto the wheel chair. (bending your knees and keeping your back straight)

29. 1 2 3

30. Moving a patient from Wheel chair to table. Get help from another person Get help from another person Put one of your shoulder under the armpit (one person on either side of the patient) Put one of your shoulder under the armpit (one person on either side of the patient) Put the other arm around the pathent’s back Put the other arm around the pathent’s back Raise together Raise together Turn around to turn your back to the table and keep the patient sitting on the table Turn around to turn your back to the table and keep the patient sitting on the table

31. From wheel chair to table 12

32. 3. Care of severely ill patients on trolleys and wheel chairs at the radiology/radiotherapy department. The patient must be covered with a sheet as much as possible. The patient must be covered with a sheet as much as possible. A confused, disoriented or unconscious patient or child must never be left alone, on a radiographic table or trolley. A confused, disoriented or unconscious patient or child must never be left alone, on a radiographic table or trolley. Patient who is unstable in suiting position should not be left alone on a wheelchair Patient who is unstable in suiting position should not be left alone on a wheelchair Take special care when changing dress of patients with Intravenous canulas & drips Take special care when changing dress of patients with Intravenous canulas & drips Pay attention to patients with various drainage tubes (urinary catheters, IC tubes, Colostomy tubes etc.) Pay attention to patients with various drainage tubes (urinary catheters, IC tubes, Colostomy tubes etc.)

33. Keep the pt well covered and secured

34. 4. Protective positions of patients – if required to be kept for a long time Supine position  Patient flat on the back. Pillow may be placed under the head to tilt it forward. Feet should be supported to prevent planter flexion. Feet should be supported to prevent planter flexion.

35. Patient lies on either side with a pillow for support under the head and neck. Patient lies on either side with a pillow for support under the head and neck. The upper arm and the leg supported on pillows The upper arm and the leg supported on pillows Protective side- lying (Semi- prone) position

36. Protective prone position Patient Lies on face down. A small pillow supports the head. Patient Lies on face down. A small pillow supports the head. Patient should be moved down so that the feet drop over the edge, or a pillow may be placed under the ankles. Patient should be moved down so that the feet drop over the edge, or a pillow may be placed under the ankles.

37. Fowler’s position Patient semi-sits with his head raise from 45-60 degree angle Patient semi-sits with his head raise from 45-60 degree angle Semi-Fowler’s position Head is raised from a 15-to 30 degree angle. Arms must be supported to prevent pull on shoulders. Feet must be supported to prevent planter flexion or foot drop. This position helps reduce respiratory distress.

38. Sims’ position Patient lies on left or right side. Lowe arm forward an flexed. Patient lies on left or right side. Lowe arm forward an flexed. Upper arm extended behind the body. Upper arm extended behind the body. Top knee bent sharply and the bottom knee slightly bent. Top knee bent sharply and the bottom knee slightly bent. Trendelenburg position - The table or be is inclined with the patient’s head is lower than the rest of the body.

39. 4. Skin Care Skin breakdown can occur in a brief period of time (1-2 hours) and result in a decubitus ulcer. Skin breakdown can occur in a brief period of time (1-2 hours) and result in a decubitus ulcer. Mechanical factors that may result in skin breakdown are: Mechanical factors that may result in skin breakdown are: Immobility Immobility Pressure Pressure Shearing force Shearing force Friction Friction

40. Causes of decubitus ulcers 1. Immobilizing a patient in one position for an extended period of time creates pressure on the skin bearing the patient’s weight. This results and restricts capillary blood flow and tissue necrosis. 2.Moving a patient to or from one surface to another without adequately protecting the skin may damage to external skin or the underlying tissues, resulting tissue necrosis. 3.The movement of the patient back & forth on a rough or uneven surface such as wrinkled bed sheet can cause friction and skin breakdown. 4.Allowing a patient to lie on a damp sheet can also lead to skin damage. 5.Urine or fecal matter allowed to remain on the skin acts as irritant an is damaging to the skin.

41. The areas most susceptible to decubitus ulcers Scapulae Scapulae Sacrum Sacrum Trochantors Trochantors Knees Knees Heels Heels (The chance of occurance of Decubitus ulcers can be minimized by changing the position of the patient every two hours). (The chance of occurance of Decubitus ulcers can be minimized by changing the position of the patient every two hours).

42. 5. Care of patients with wet casts (green cast) A fresh (wet) cast still contains water and can accidentally be compressed. A fresh (wet) cast still contains water and can accidentally be compressed. The compression on a cast may produce pressure on the patient’s skin which will result in formation of a decubitus ulcers under the cast. The compression on a cast may produce pressure on the patient’s skin which will result in formation of a decubitus ulcers under the cast. A cast that becomes too tight may cause circulatory impairment or compression of a nurve A cast that becomes too tight may cause circulatory impairment or compression of a nurve

43. How to take take care not to apply pressure on the cast? Slide the hands with open fingers and flattened under the cast Slide the hands with open fingers and flattened under the cast Avoid grasping it with fingers. Avoid grasping it with fingers. Support the cast at the joints when moving it Support the cast at the joints when moving it Move the casted extremity as a whole unit. Move the casted extremity as a whole unit.

44. How to take take care not to apply pressure on the cast?

45. 6. Assisting the patient with a bedpan or urinal Although this is not in the duty list of the radiographers it is necessary to learn the correct procedure a you may be required to do so in case of emergency. Although this is not in the duty list of the radiographers it is necessary to learn the correct procedure a you may be required to do so in case of emergency.

46. Assisting the patient with a bedpan

47. Summary End of lesson