methods of patient care1 unit 3 monitoring the patient: vital signs and medical emergencies chapters...

Methods of Patient Care 1

UNIT 3 Monitoring the Patient: Vital Signs and Medical Emergencies

Chapters 15 & 19


Vital Signs: Oxygen, Chest Tubes and Lines

Chapter 15


Homeostasis Relative constancy of the body’s

internal environment maintained by adaptive responses to promote healthy survival

Primary mechanisms of Homeostasis: Heartbeat Blood pressure Body temperature Respiratory rate Electrolyte balance


Vital Signs Vital (cardinal) signs

Body temperature Pulse Respiration Blood pressure (Mental alertness)

Must be able to measure each vital sign in the event of an emergency

Must be able to assess changes in vital signs May be an indication of a problem or first sign of

adverse or positive reaction to treatment


Body Temperature Thermoregulation - physiologic balance

between heat produced in body tissues & heat lost to the environment

Must remain stable (despite extremes in environment) if body’s metabolism is to function efficiently

Hypothalmus (body’s thermostat) plays an important role in regulating heat loss: Initiates peripheral vasodilation Sweating (diaphoresis) Respiratory system removes excess heat through

ventilation


Body Temperature Hypothalmus plays an important role in preserving heat

Initiates shivering (to generate heat) Initiates vasoconstriction (to

conserve heat) Normal & abnormal conditions in

the body can produce changes in body temperature Age, weight, emotions, physical

exercise, digestion of food, disease


Body Temperature

Pyrexia Body temperature above normal limits = fever Disturbance in the heat-regulating centers of

the body, usually as a result of a disease process

Body temperature increases = demand for oxygen increases

High fever for prolonged period of time – may cause irreparable damage to CNS

Symptoms Increased pulse & respiratory rate, general

discomfort or aching, flushed dry skin that feels hot to the touch, chills, loss of appetite


Body Temperature - Variations For Adults: Variation of 0.5 – 1 degree above

or below average is within normal limits For Children:

3 months – 3 years 99°F – 99.7°F

5 years – 13 years 97.8°F – 98.6°F

Hypothermia Body temperature below normal limits

Hyperthermia Body temperature (oral) higher than 99.5o F. Febrile – having a fever


Body Temperature

Range of human temperature (orally) Rare for person to survive with body

temperature between 105.8°F & 111.2°F and below 93.2°F


5 Common Routes to Measure Body Temperature

1. Oral – under tongue

2. Axillary - armpit

3. Tympanic – in the ear

4. Temporal - temple

5. Rectal – in rectum


Measuring Body Temperature

Site should be chosen with care depending on patient’s age, state of mind, & ability to cooperate in the procedure

Specify site when recording temperature


Measuring Body TemperatureOral

Oral Taken by mouth Average = 98.6°F (37°C)

Precautions: Patient might bite down on thermometer Patient cannot hold thermometer under

tongue with lips closed for 3 – 5 minutes Be cautious of mercury thermometers

Oral method is most common method used for adult or cooperative child


Measuring Body TemperatureAxillary

Axillary Taken in axilla or armpit Average = 97.6°F - 98°F

(36.4°C – 36.7°C) Safest method of

measuring body temperature but only somewhat unreliable

Glass thermometer under armpit for 5-10 minutes

Electronic or disposable thermometers for 1 minute


Measuring Body TemperatureRectal

Rectal Taken at anal opening to the rectum Average = 99.6°F (37.5°C)

Rectal site Most reliable measurement of body temperature;

close proximity to core temperature Should not be used if patient is restless or has

rectal pathology Use a thermometer with a blunt tip, never an

oral thermometer Insert 1 – 1 ½ inches into rectum, hold it in for 2

– 3 minutes


Measuring Body TemperatureTympanic

Tympanic Taken at external

auditory canal Average = 99.6°F

(37.5°C) Uses specialized

electronic thermometer Closely correlates to

rectal temperature Tympanic and rectal

preferred method for all infants


Measuring Body TemperatureTemporal

Temporal Taken across forehead or

along temporal region of the skull

Average = 99.6°F (37.5°C)

Now thought to be closely equivalent to rectal temperature

Requires use of temporal artery (TA) thermometer


Measuring Body Temperature

Other instruments Temperature-sensitive patches Disposable, single-use thermometer

Accuracy of these instruments is uncertain


Respiratory Rate Oxygen is essential for survival

Human brain cannot function for longer than 4 – 5 minutes without an adequate oxygen supply

One respiration is assessed as the rise and fall of the chest (1 inspiration/1 expiration)

Normal respiration Adult - 12-20 breaths/min. Children under 10 - 20-30 b/m Newborn – 30-60 b/m


Assessing Respiration

Count adult respirations for 10 sec. and multiply by 6

Count pediatric for a minimum of 1 minute.

Must also assess: Depth: shallow, normal, deep Pattern: regular, irregular


Assessing Respiration

Keep patient in present position Patient should not be aware that

his/her respirations are being observed; may alter breathing patterns

Observe the chest wall for symmetry of movement Should be an even rise & fall of the

chest


Respiration Abnormalities

Tachypnea – rapid breathing(> 20 b/min) Possible causes: exercise, fever, anxiety,

pain, infection, heart failure, chest trauma, dec. O2 in blood, CNS disease

Bradypnea – slow respirations Possible causes: drug overdose, head trauma,

hypothermia Dyspnea – difficulty breathing Apnea – absence of respiration


Respiration Abnormalities

Less than 10 breaths/min May result in cyanosis, apprehension,

restlessness, change in level of consciousness

Oxygen supply is inadequate to meet needs of the body


Pulse

As heart beats, blood is pumped in a pulsating fashion into arteries

Can be felt by holding artery beneath skin against solid surface such as bone.


Pulse points Apical– over the apex of the heart (heard

with stethoscope) *Radial – over the radial artery at the

wrist at the base of the thumb *Brachial – at elbow (antecubital fossa) or

upper arm in infants *Carotid– over the carotid artery at the

front of the neck Femoral– over the femoral artery in the

groin Popliteal– at the posterior surface of the

knee


Pulse points

Dorsalis pedis (pedal) – at the top of the feet in line with the groove between the extensor tendons of the great & 2nd toe

Posterior tibial– on the inner side of the ankles

**most common sites


Pulse measurement

Measured in beats/minute Normal average pulse rate

Adult man or woman in resting state = 60 – 100 beats/min

Child 4 – 10 years old = 70-120 beats/min Infant = 120 beats/min

Pulse rate is inversely proportional to blood pressure Rapid pulse rate – low blood pressure Slower pulse rate – high blood pressure


Pulse Abnormalities Tachycardia - abnormally rapid heart rate over 100

beats/min Possible causes: exercise, fever, anemia, respiratory

disorders, CHF, hypoxemia, shock, pain, anger, fear, anxiety and certain medications.

Bradycardia - abnormally slow heart rate below 60 beats/min Possible causes: unrelieved pain, heart problems,

heart failure, hypothermia, physical fitness (!)

Pulse irregularities can be life threatening Accompanied by fainting, dizziness, palpations.


Assessment of Pulse Radial pulse is most often

used Apical pulse

Best for infants & children Femoral, popliteal, pedal

pulses Taken bilaterally to assess

peripheral blood flow Carotid is used during

CPR


Assessment of Pulse

Must also assess: strength, regularity

Be careful not to press too hard with fingers; may not be able to feel pulse

Do not use thumb to count pulse because it has its own pulse!


Assessment of Respiration

Keep patient in present position Patient should not be aware that

his/her respirations are being observed; may alter breathing patterns

Observe the chest wall for symmetry of movement Should be an even rise & fall of the

chest


Assessment of Respiration

Observe skin color Cyanosis

Bluish discoloration in gums, nail beds, or in earlobes

Sign of respiratory distress

Count the number of times the patient’s chest rises & falls for one minute Immediately after pulse count as you appear to

be continuing to count the pulse rate


Blood Pressure The measure of the force

exerted by blood on arterial walls during contraction and relaxation of the heart.

Depends on Peripheral vascular

resistance Cardiac output Blood volume Blood viscosity Elasticity of the vessel

walls


Blood Pressure

Peripheral vascular resistance Normal physiologic state of blood vessels –

partially contracted Changes in physiologic state – may cause blood

vessels to contract or dilate Contraction – increased blood pressure Dilation – decreased blood pressure

Cardiac output Increased cardiac output = increased blood

pressure Decreased cardiac output = decreased blood

pressure


Blood Pressure

Blood volume Decreased blood volume = decreased

blood pressure Hemorrhage, dehydration

Blood viscosity Number of red blood cells in the blood

plasma Increased number of RBCs = thickened

blood Thicker, viscous blood = increased

blood pressure


Blood Pressure

Elasticity of vessel walls Normally elastic (healthy) Age or build-up of atherosclerotic

plaque Reduced flexibility of arteries = increased

blood pressure

Age As a person ages, blood pressure

usually increases as body systems that control blood pressure deteriorate


Blood Pressure

Systolic pressure (top number) Highest point reached during

contraction of the left ventricle of the heart as it pumps blood into the aorta

Diastolic pressure (bottom number) Lowest point to which pressure drops

during relaxation of the ventricles Indicates minimal pressure exerted

against arterial walls


Assessing Blood Pressure Measured in mm of Hg. Requires the use of sphygmomanometer and

stethoscope. Normal blood pressure values

Adult Systolic = 110 – 140 mm Hg Diastolic = 60 – 80 mm Hg

Children Systolic = 90 – 120 mm Hg Diastolic = 50 – 70 mm Hg

Adolescents Systolic = 85 – 130 mm Hg Diastolic = 45 – 85 mm Hg


Blood Pressure Abnormalities Hypertensive Systolic blood pressure is

consistently greater than 140 mm Hg

Diastolic blood pressure is consistently greater than 90 mm Hg

No symptoms exist; can cause damage to vital organs

Possible causes: Stress, medications,

obesity, smoking Higher incidence in men

and African-Americans


Blood Pressure Abnormalities Hypotensive

Systolic blood pressure is less than 90 mm Hg

Diastolic blood pressure is less than 60 mm Hg

Very low BP can cause syncope, dizziness, confusion, blurred vision

Possible causes: Shock from severe bleeding, burns, vomiting,

diarrhea, trauma or heat exhaustion Requires immediate care


Equipment Needed to Measure Blood Pressure

Sphygmomanometers Mercury Aneroid

Cuff with inflatable bladder Thumbscrew valve to maintain or release

pressure Pressure bulb to inflate cuff Rubber tubing that leads to gauge &

pressure bulb Stethoscope


Oxygen Therapy

Hemoglobin Protein in RBCs that contains iron &

transports oxygen in the blood Major supply of oxygen

Oxygen tension (partial pressure) Amount of oxygen in either air or

blood PO2 (oxygen); PCO2 (carbon dioxide)


Oxygen Therapy

Hemoglobin also assists with removal of carbon dioxide (waste product of respiration)

Excessive carbon dioxide in blood affects blood pH pH decreases (blood becomes more

acidic)


Oxygen Therapy

Pulmonary function – best measured by lab testing of arterial blood (arterial blood gases) Concentrations of oxygen, carbon dioxide,

bicarbonate, acidity, saturation of hemoglobin with oxygen (SaO2)

Normal limits of arterial blood gases pH: 7.35 – 7.45 PaCO2: 32 – 45 mm Hg PaO2: 80 – 100 mm Hg HCO3: 20 – 26 mEq/L SaO2: 97%


Oxygen Therapy Hypoxemia

Pulmonary function is disturbed resulting in decreased levels of oxygen in arterial blood

Oxygen therapy is indicated

Tissue Hypoxia Inadequate oxygen at the cellular level

Hypercapnea Carbon dioxide being retained in the

arterial blood


Pulse Oximetry

Pulse oximeter - used to monitor oxygen saturation of hemoglobin (SaO2)

Sensor attached to fingertip or earlobe Photodetector attached to sensor is

able to distinguish between oxygenated & deoxygenated hemoglobin of blood pulsing through tissue location of sensor

Normal SaO2 = 95 – 100% Less than 85% - not receiving adequate

oxygen


Hazard of Oxygen Administration

Oxygen is listed in the U.S.Pharmacopeia and is defined as a drug Must be prescribed by a physician (dose measured

in liters/minute) Minimum dose should always be given Excessive amounts of oxygen may produce

toxic effects on lungs & CNS, or may depress ventilation Mild toxicity – reversible tracheobronchitis Severe toxicity – irreversible parenchymal lung

injury



COPD – chronic obstructive pulmonary disease Destructive disease of the lungs in which

inspiratory & expiratory lung capacity is diminished

Chemo receptors no longer respond to stimulus of carbon dioxide to breathe, instead uses hypoxemia

Excessive O2 administration can cause respiratory arrest.



Equipment must be clean & only used for one person Equipment potential source of infection to the

patient – infection & bacteria thrive in oxygenated environment

Oxygen is combustible Smoking is prohibited Prevent sparks from equipment

Do not allow tank to fall or regulator to become cracked

May act as a projectile!


Oxygen Delivery Systems

Oxygen is delivered to the respiratory tract under pressure

Low flow vs. High flow rate Low-flow (variable oxygen concentration) –

unknown amount of room air is mixed with 100% oxygen

High-flow (fixed or precise oxygen concentration) Oxygen is humidified to prevent excessive

drying of mucous membrane Oxygen is passed through distilled water


Oxygen Delivery Systems Tanks and flow meters are green Wall units – fixed source

Convenient source Flow meter attached to outlet to

regulate flow Flow rate – measured in liters per

minute (LPM) Tanks – portable source

2000 pounds per square inch of pressure

2 regulators Flow Amount of oxygen is tank


Oxygen Delivery SystemsNasal Cannula

Nasal cannula – most common device

Low flow device Delivers low concentrations

of O2 Disposable plastic device

with two hollow prongs that deliver oxygen into nostrils

Other end attached to oxygen supply, which may or may not pass through a humidifier, with flow meter attached


Oxygen Delivery Systems-Nasal Cannula

Concentration of oxygen = 24-36% 1 – 4 LPM usually prescribed for adults; ¼ -

½ for children Higher rates dry that nasal mucosa Have oxygen turned on & flowing at desired

rate before placing device on patient Prevents sudden burst of oxygen into

patient’s nostrils Nasal prongs must be kept in place in both

nostrils


Oxygen Delivery SystemsMasks Mask Types

Simple Nonrebreathing Partial rebreathing Aerosol Airentrainment

Used to deliver oxygen for short periods of time Placed over nose & mouth, & attached over ears

and behind head Mask does not fit tightly against face –

concentration 30 – 50%


Oxygen Delivery SystemsMasks

Simple Masks

Low flow devices Flow rate > 6LPM to

prevent CO2 buildup Deliver 35-60% O2 Convenient for short-

term O2 therapy Not commonly used



Nonrebreathing mask Delivers a higher percentage of

O2 May supply 100% oxygen

Reservoir bag attached filled with oxygen to provide a constant supply of oxygen

Valve prevents exhaled gases from entering bag

Partial rebreathing mask (looks similar) Delivers 60 – 90% oxygen Does not have valve between

mask & bag Allows patient to breathe

mixture of oxygen & carbon dioxide



Aerosol mask Commonly used when high O2

concentration and humidity are needed

Attached to a nebulizer containing normal saline solution

Minimum flow rate - 6LPM Can deliver 21-100% O2 Can be adapted to fit face

masks, tracheostomy collars or endotrachial tubes



Air entrapment mask High flow device Provides consistent concentrations of O2

24%, 28%, 35%, 40%, 50%


Oxygen Delivery SystemsTent and Oxyhood

Oxygen tent Need for humidity & higher

concentration of oxygen Used most commonly with

children

Oxyhoods Used more for infants Plastic box fits over infant’s

head O2 concentration 21-100%


Oxygen Delivery SystemsVentilator

Ventilator Continuous oxygen therapy for long periods of

time Catheter is inserted into trachea & tubing is

connected to portable tank Mechanical ventilators (respirators)

Control or partially control inspiration & expiration

Common with patients on critical care units Consult with nurse for assistance when doing

examinations on patients on respirators Portable chest radiography often used to

determine correct tube placement


Chest Tubes and Lines Endotracheal Tubes used for:

Mechanical ventilation or oxygen delivery

Upper airway obstruction Gastric acid reflux or aspiration Provision for tracheobronchial

lavage Intubation via

Mouth Nose Tracheostomy


Chest Tubes and Lines

Placement of endotracheal tube is confirmed with chest radiography Correct placement:

Distal tip 1-2 inches superior to tracheal bifurcation


Chest Tubes and Lines Thoracostomy Tubes (Chest tubes)

Used to drain the intrapleural space and mediastinum

Indications: Pneumothorax Hemothorax Pleural effusion Empyema Post cardiac surgery

Tubes are sutured in place


Chest Tubes and Lines Central Venous Lines

AKA: central venous catheters, venous access devices

Also: subclavian lines, access ports, port-a-cath, peripherally inserted central catheters (PICCs)

Catheters inserted into a large vein Used to administer drugs/chemotherapy Manage fluid volume Blood analysis/transfusions Monitor cardiac pressures Long term intravenous treatments

Antibiotics Chemotherapy

Subclavian vein most common insertion site

Internal jugular Femoral antecubital


Chest Tubes and Lines Pulmonary artery (PA) – Swan Ganz

catheter Monitors pulmonary arterial pressures

Complications: Dislodgement Occlusion

Catheter flushing prevents this Insertion problems

Up to 1/3 of CV catheters are initially placed incorrectly!

Radiography is essential to confirm line placement


Medical Emergencies

Chapter 19


Medical Emergency

Emergency – a situation in which the condition or medical status of a patient requires immediate action.


Radiographer’s Responsibilities

Be able to recognize symptoms & initiate appropriate treatment or obtain medical assistance

Be able to assess behaviors that determine a patient’s level of neurologic & cognitive functioning,

Recognize changes Maintain calm and confident demeanor


Radiographer’s Responsibilities Call a “Code” when

necessary Know emergency number Know location of emergency

equipment Emergency (Crash) cart

Be familiar with contents

Be familiar with oxygen administration equipment & assist with its use

Be sensitive to patient complaints of pain & discomfort


Levels of Consciousness

Alert and Conscious (least serious) Patient can respond to questions &

stimuli Drowsy

Patient can be aroused with loud speaking and gentle physical contact

Unconscious Responds only to painful stimuli

Comatose (most serious) Unresponsive to all stimuli


Radiographer Responsibilities in Patient Assessment

Assess patient at the beginning, middle and end of procedure

Signs/symptoms of a deteriorating head injury include: Irritability Lethargy Slow pulse rate Slow respiratory rate


Head Injuries: Assessment of Neurologic & Cognitive Functioning

Glasgow Coma Scale (maximum rating 15) Eye opening Verbal response Motor response

(movement)

Note changes


Assessment of Neurologic & Cognitive Functioning

Changes in level of consciousness (LOC) Ask the patient to state his or her name,

date, address, & reason for coming to the hospital

Note patient’s ability to follow directions during positioning for radiographic exams

Assess patient’s vital signs


Shock

Shock – failure of the circulatory system to support vital body functions

Body’s pathological reaction to illness, trauma, or severe physiologic or emotional stress

Life-threatening condition that may occur rapidly & without warning

May be caused by body fluid loss, cardiac failure, decreased tone of blood vessels, or obstruction of blood flow to the vital body organs


Types of Shock Hypovolemic***

Cause: loss of blood or tissue fluid Cardiogenic

Cause: cardiac disorders Neurogenic

Cause: spinal anesthesia; damage to spinal cord

Vasogenic Cause: sepsis, deep anesthesia,

anaphylaxis*** ***most common


Anaphylactic Shock Due to Contrast Media Reactions

Associated with administration of iodinated contrast media

Contrast reactions range from mild to severe

Obtaining an Allergic history from the patient is required prior to administration.


Classifications of Contrast Media Reactions Mild Reaction – mild antihistamine can counter the

reaction Localized itching Urticaria (hives) Nasal congestion Nausea and/or vomiting

Moderate Systemic Reaction Rapid onset of previous symptoms Flushing, feeling of warmth, itching, & urticaria Anxiety Bronchospasm & edema of airways or larynx Dyspnea, cough, & wheezing

Serious reaction – life threatening Laryngeal edema Shock Cardiac arrest


Shock: Signs and Symptoms

Restlessness Apprehension Tachycardia Decreasing BP Cold, clammy skin Pallor


Shock Continuum

Compensatory stage – 1st stage Changes in physiologic function in cells

of body Not clinically detectable except for

increase in heart rate Progresses

Blood is shunted away from lungs, skin, kidneys, & GI tract to accommodate brain’s & heart’s critical need for oxygen


Shock Continuum

Symptoms Skin – cold & clammy Urine output decreases Respirations increase Bowel sounds – hypoactive Anxiety levels increase; patient may

become uncooperative


Shock Continuum

Progressive stage – 2nd stage Mean arterial pressure falls

All body systems, including heart, are inadequately perfused

Heart pumps inadequately Fluid leaks from capillaries in reaction

to the body’s state Body systems begin to fail


Shock Continuum

Symptoms Blood pressure falls Respirations – rapid & shallow Acute respiration distress syndrome / shock

lung Severe pulmonary edema from leakage of

fluid from pulmonary capillaries Tachycardia Mental status changes – confusion, lethargy,

loss of consciousness Renal, hepatic, GI, & hematologic problems

occur


Shock Continuum

Irreversible stage – final stage Organ systems suffer irreparable

damage Recovery unlikely Symptoms

Blood pressure remains low Renal & liver failure Release of necrotic tissue toxins &

overwhelming lactic acidosis


Hypovolemic Shock

Occurs with large amounts of intravascular fluid loss occurs

Amount of intravascular fluid decreases by 15 – 25% or 750 – 1300 mL Internal or external hemorrhage Loss of plasma from burns Fluid loss from prolonged vomiting,

diarrhea, or medications


Cardiogenic Shock

Caused by failure of the heart to pump an adequate amount of blood to the vital organs

Those vulnerable Patients with cardiac pathology


Cardiogenic Shock

Clinical manifestations Chest pain that may radiate to jaws & arms Dizziness & respiratory distress Cyanosis Restlessness & anxiety Rapid change in LOC Pulse may be irregular & slow Decreased blood pressure Decreased urinary output Cool, clammy skin


Neurogenic Shock

Results from loss of sympathetic tone causing vasodilation of peripheral vessels

May be caused by spinal cord injury, severe pain, neurologic damage, lack of glucose, or adverse effects of anesthesia


Neurogenic Shock

Clinical Manifestations Hypotension Bradycardia Warm, dry skin Initial alertness if not unconscious

because of head injury Cool extremities & diminishing

peripheral pulses


Vasogenic Shock - Sepsis

Occurs when body is invaded by bacteria Body’s immune system responds by

releasing chemicals that increase capillary permeability & vasodilation



Clinical Manifestations 1st phase

Hot, dry, flushed skin Increase in heart rate & respiratory rate Fever Nausea, vomiting, diarrhea Normal-to-excessive urine output Possible confusion



2nd phase Cool, pale skin Normal or subnormal temperature Drop in blood pressure Rapid heart rate & respiratory rate Oliguria or anuria Seizures & organ failure if syndrome not

reversed


Vasogenic Shock - Anaphylaxis

Common medications given Epinephrine, diphenhydramine,

hydrocortisone, aminophylline Document reaction Monitor patients who have received

iodinated contrast media for 30 minutes after injection


Preliminary Treatment for Shock


Diabetic Crises

Diabetes mellitus Group of metabolic diseases resulting from a

chronic disorder of carbohydrate metabolism Caused by either insufficient production or

inadequate utilization of insulin Secreted by islets of Langerhans located in the

pancreas Persons with diabetes mellitus are susceptible

to infections


Diabetes


Diabetic Crises - Hypoglycemia

Hypoglycemia – low blood sugar Excessive amounts of insulin are present Too much insulin; not enough food/sugar Blood glucose level falls below 50 – 60

mg/dL Patient goes into insulin shock (insulin

reaction) Can occur when a patient takes insulin

but is fasting prior to a GI procedure


Diabetic Crises - Hypoglycemia

Signs/Symptoms: Intense hunger Weak Shaky Excessive sweating Confused & irritable

Aggressive, hostile Response:

Administer sugar or carbohydrate to increase blood sugar level


Diabetic Crises - Hyperglycemia

Hyperglycemia – condition of excessive sugar in the blood (typically associated with diabetes) If left untreated can result in diabetic

coma Blood glucose level – greater than 600

mg/dL Patient needs insulin


Diabetic Crises - Hyperglycemia

Signs/Symptoms Weakness, drowsiness, headache,

blurred vision Sweet, fruity odor to the breath

(ketoacidosis) Orthostatic hypotension Warm, dry skin Dry mucous membranes Polydipsia Polyuria


Respiratory Distress aand Respiratory Arrest

Asthma – A chronic condition of the respiratory tract characterized by dyspnea and wheezing

An episode can be brought on by the stress

Patient may have inhaler; if not seek medical assistance


Respiratory Distress aand Respiratory Arrest

Choking Complete obstruction –

patient cannot speak Partial obstruction –

patient can speak Universal sign –

clutching throat Heimlich maneuver

Increases intrathoracic pressure to dislodge obstruction


Respiratory Arrest

Clinical manifestations Patient stops responding Pulse continues to beat briefly &

quickly becomes weak & stops Chest movement stops & no air is

detectable moving through patient’s mouth


Cerebral Vascular Accident (aka. CVA, Stroke, “brain attacks”)

Most common in patients over 75 years of age

Causes Occlusion of blood supply to

the brain Rupture of blood supply to the

brain Rupture of a cerebral artery,

resulting in hemorrhage directly into the brain tissues

Vary in severity Occur with little or no

warning


Cerebral Vascular Accident (Stroke)

Warning signs (can be temporary or permanent) Severe headache Numbness, flaccidity of face or

extremities usually one-sided Paralysis on one or both sides Slurred speech or loss of speech Dizziness Loss of vision in one eye Ataxia Loss of consciousness


Vertigo and Syncope

Vertigo – dizziness Often precedes fainting Patient should be assisted to sitting or recumbent

position to prevent falling Can be a result of orthostatic hypotension

Syncope – fainting Self-correcting temporary state of shock Results from lack of blood flow to the brain Patient should be assisted to recumbent position

with feet elevated; damp cloth to forehead


Seizures Unsystematic discharge of neurons of

the cerebrum that results in an abrupt alteration in brain function

Characterized by involuntary contraction of muscles

Accompanied by a brief loss of consciousness (minute-several

minutes) Range from mild to severe (Petit mal

vs grand mal)


Petit Mal Seizures

More common during childhood & adolescence

Patient abruptly stops all activity & may exhibit eye or muscle fluttering

Sudden loss of consciousness; blank facial expression

Cessation of motor activity, may result in fall

May only last 10 – 30 seconds


Grand Mal Seizures Preceded by an “aura”

warning of seizure activity Certain smells, flashing

lights, spots before the eyes, dizziness

Sudden contraction of thoracic & abdominal muscles forces air through throat causing patient to cry out

Patient may slump over and experience convulsions


Grand Mal Seizures

Respiration may cease, cyanosis can occur Jaw clenched, eyes roll upward, pupils dilate Patients may lose control of bladders &

bowels Lasts 2 – 5 minutes

Postictal period Time after seizure Patient may go into deep sleep or appear groggy

and confused


Patient Safety During a Seizure

Stay with patient & gently secure him or her to prevent injury Do not attempt to insert hard objects

into mouth; may damage tissues or teeth

Do not put your fingers in patient’s mouth; they may be bitten

Do not restrain arms or legs, but protect them from injury

Maintain an open airway


Falls in the Imaging Department

Minimize the physical impact of the fall Do NOT attempt to “catch” the patient,

but “ease” the patient to the floor. Notify the radiologist/physician Complete an incident report to

document the event.


Radiographer’s Response to the Patient in Pain

Need to be sensitive to patient’s need for pain control while in your care

Pain expression differs with age, gender, cultures, mental status, fatigue, coping style

Acute pain vs. chronic pain Health care facilities must have a pain

assessment tool to rate the degree of pain the patient is feeling Numerical scale 1 – 10

Faces that smile or frown


Radiographer’s Response to the Patient in Pain

Must make sure patient remains as comfortable as possible

Never ignore a patient’s complaint of pain Carefully assess patient’s physical &

emotional condition preceding procedure

Educate the patient concerning all aspects of the exam

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