1. Patient Assessment & Vital Signs Rad Tech A – Week 12

2. Patient Assessment &Vital Signs Patient Interview Role of Radiologic Technologist Elements of the Clinical History Vital Signs Oxygen Therapy Oxygen Devices Chest Tubes and Lines

3. RT’s Role in Clinical HX

4. Desirable Qualities for Establishing Open Dialogue Respect Genuineness Empathy Polite Professional demeanor

5. Rad Tech’s Role in Clinical Hx Extract as much information as possible- (Pertinent to the problem) Radiologists often do not even speak with the patient. Radiologist can be instructed to give special attention to the exact anatomic area where pain is focused.

6. PATIENT INTERVIEW Radiologic Technologists Must Obtain Important Medical History. –Clinical History Information available regarding a patient’s condition.

7. Chief Complaint Focuses attention to the single most important issue. Patients may have several complaints, but thorough history taking can reveal the main issue or why the patient is there for treatment.

8. Clinical Indication Tech must collect a focused history specific to the procedure being performed. Several elements comprise a “complete history”. Sacred Seven…

9. Obtaining Good Information Must be a cooperative event between patient and RT. Establish an “open dialogue” –Respect, genuineness, and empathy Maintain polite and professional demeanor during the interview Document findings/information

10. Data Collection Process Objective: Signs that can be seen ex: Bleed from an injury Subjective: Perceived by the affected individual ex: Headache

11. Questioning Skills Open-ended questions Facilitation Silence Probing Repetition Rewording Summarization

12. Leading Questions This is an UNDESIRABLE method of questioning. Introduces biases into the history. Ex: Does the pain travel down your leg? Vs. Where does the pain start and where does it end?

13. Sacred Seven (p.128-129 RTA Book)) Localization Chronology (date of symtoms/event onset) Quality – description of symptoms (burning) Severity – light to intense (scaled) Onset – how long Aggravating or alleviating factors Associated manifestations – other symptoms that may or may not be related

14. REVIEW Role of the RT Qualities of the Interviewer Types of data collected for a good history Questioning Skills Sacred Seven Avoid Leading Questions

15. VITAL SIGNS

16. Vital Signs Body Temperature Respiratory Rate Pulse / Heart Rate Blood Pressure

17. Vital Signs Indication of Homeostasis Primary Mechanisms –Heart beat –Blood pressure –Body temperature –Respiratory rate –Electrolyte balance Physical assessment include measurement of vital signs Body Temperature Pulse Respiration Blood Pressure Mental Status

18. Homeostasis Our bodies are always trying to maintain HOMEOSTASIS – a constancy in the internal environment of the body, naturally maintained by adaptive responses that promote healthy survival. Ex: sweating to cool body temperature

19. Body Temperature The human body has an ideal temperature, and it works to maintain it, this is called: THERMOREGULATION Ideal temperature: 98.6 degrees F (oral) Acceptable range: 97.7 to 99.5 degrees F Measurement: oral, axillary, tympanic, rectal

20. Body Temperature Normal average body temperature: 98.6 F Humans can survive between 106 F and 93.2 F. –Hypothermia Fever, febrile –Hyperthermia below normal range Measuring Body Temperature –Oral –Rectal –Axillary –Tympanic

21. Pulse Pulse rate: Adult = 60 to 100 beats per minute Children under 10 = 70 to 120 beats per minute Tachycardia Bradycardia

22. Blood Pressure Measure of the force exerted by blood on the arterial walls during contraction & relaxation. Measured pressure when the heart is relaxed: Diastolic Measured pressure when the heart is contracted: Systolic Measured with a Sphygmomanometer

23. Blood Pressure cont’d Recorded in millimeters of mercury (mm Hg) with systolic over diastolic Normal adult systolic: 95-140 mm Hg Normal adult diastolic: 60-90 mm Hg Persistent elevation of BP: Hypertension Persistent low BP: Hypotension

24. Blood Pressure Systolic pressure = 95-140 mmHg Diastolic pressure = 60-90 mmHg 120/ 80 Normal

25. Respiratory Rate Respiratory System delivers oxygen to the body’s tissues & eliminates carbon dioxide. Major muscle of ventilation: diaphragm Measured in “breaths per minute” Adults: 12 – 20 bpm Children: 20 – 30 bpm Newborns: 30 – 60 bpm

26. Respiratory Rate Breaths per minute: Adult = 12 to 20 Children under 10 = 20 to 30 per min Dyspnea Apnea

27. Pulse Oximeter Normal PulseOximeter = 95% to 100%

28. Methods of Delivering Oxygen Nasal Cannula Masks O 2 Tent and Oxyhood Ventilators

29. Oxygen Oxygen constitutes 21% of atmospheric gases If O2 levels in the body drop below 21% homeostasis is altered. Hypoxia: Inadequate amount of oxygen at the cellular level.

30. Chest Tubes & Lines The Rad Tech’s Role Early detection of problems associated with malpositioned lines. X-rays assist physicians in determining if tubes and lines are placed correctly Correct positioning and technical exposure are crucial

31. Tubes & Lines cont’d Endotracheal Tubes (ET tubes) – Known as “intubation” -translaryngeal -tracheostomy -nasotracheal Must be precise in placement: 1-2 inches superior to the tracheal bifurcation (carina)

32. Chest Tubes and Lines Endotracheal Tube (ET) –Ventilator Chest Tubes Nasogastric tube (NG) Central Lines

33. Tubes & Lines (last one) Common insertion sites for CV lines: -subclavian vein -internal jugular vein -femoral vein Most evaluated by a chest x-ray Extreme caution must be used when positioning for images!

40.  Intubation of the rt main-stem bronchus with complete occlusion of the lt bronchus causing lt lung atelectasis.

41. (A) Distal tip of endotracheal tube in rt main bronchus; (B) Central venous catheter in the lt subclavian vein.

42. Rt hydrothorax caused by displacement of a central venous line during dressing change; 1300 ml of intravenous fluids were evacuated via thoracentesis.

54. Review Vital Signs Homeostasis Body Temperature Pulse Respiration Blood Pressure Mental Status Electrolyte balance Pulse Oximeter Oxygen Oxygen Devices Chest Tubes Chest Lines