PATIENT CARE AND MANAGEMENT MIDTERM.PPTX

Patient care and management

1. Infection Control

2. Microorganisms *Microorganism came from the Greek word mikros , "small" and organismos , "organism“; *Is an organism that is microscopic (too small to be seen by the naked human eye).

3. There are BASICALLY four types of microorganisms: Bacteria Fungi Viruses Parasites

4. There are BASICALLY four types of microorganisms: 1. BACTERIA *One-celled microorganisms without a typical nucleus. *It contain both DNA and RNA. *Significant diseases caused by bacteria include: * Tuberculosis caused by M. tuberculosis, *Streptococcal Pharyngitis (Strep Throat) * Necrotizing fasciitis (Flesh-eating Bacteria), * Infectious diarrhea and hemolytic uremic syndrome

5. There are BASICALLY four types of microorganisms: 2. VIRUSES *Needs aerobic environment to live and reproduce *They are the smallest microorganisms known to produce disease in man. *Has either DNA or RNA Significant diseases caused by virus include: *Influenza *Human Immunodeficiency Virus (HIV), *Hepatitis B *Epstein-Barr Virus * Varicella , which causes chicken pox and herpes zoster shingles. *Coronavirus

6. There are BASICALLY four types of microorganisms: 3. Fungi *Requires moisture and darkness to survive cause skin infections, such as athlete's foot and ringworm ; *respiratory infections, such as histoplasmosis and coccidioidomycosis ; and * Pneumocystis carinii pneumonia (PCP) and pharyngeal and esophageal candidiasis in individuals with compromised immune system

7. There are BASICALLY four types of microorganisms: 4. Parasites *Has two types: * Helminths and Protozoa *Common protozoal diseases include: * Amebiasis -an infection of the intestines with a parasite called Entamoeba histolytica (E. histolytica) * Giardiasis - a diarrheal disease caused by the microscopic parasite Giardia duodenalis * - caused by a tiny one-celled parasite named Trichomonas Trichomoniasis Vaginalis * Toxoplasmosis -a disease that results from infection with the Toxoplasma gondii parasite (one of the most common parasites)

8. Infection Cycle

9. There are five main modes of transmission *Air borne *Vehicle *Vector borne *Contact *Droplet

10. DROPLET contamination often occurs when an infectious individual coughs, sneezes, speaks, or sings in the vicinity of a susceptible host. involves contact of the mucous membranes of the eyes, nose, or mouth * Influenza, M eningitis, Diphtheria, Pertussis, Streptococcal Pneumonia VECTOR * insects and animals are the carrier of disease. * Some examples of vectors are mosquitoes that transmit malaria or dengue fever , fleas that carry bubonic plague , and ticks that spread Lyme disease or Rocky m ountain spotted fever

11. AIRBORNE Tiny droplet nuclei that remain suspended in air . * M . Tuberculosis, Rube l la, Varicella Viruses VEHICLE Transmitted indirectly by materials contaminated with the infectious microbes Food, water, drug and blood

12. CONTACT TRANS MIS SION M ost frequent mode of transmission of nosocomial infections >Direct-contact transmission body surface-to-body surface contact >Indirect-contact transmission touching objects that has been contaminated by an infected person.

13. STAGES OF INFECTION P RO DR O M AL Disease process begins; microbe reproduces. INCUBATION Pathogen enters the body and begins to produce non-specific CONVALESCENCE Symptoms diminish and eventually disappear. FULL DISEASE M ost communicable. Disease at its fullest extent.

14. Techniques for infection control

15. free from pathogens

16. Hand washing * It is the best method of preventing the spread of microorganism. * Hand washing before and after every contact to patient .

17. Medical Hand Washing * With a firm, circular rubbing motion, wash the palms, back of the hands, each fingers and finally the knuckles. Rinse hands. Wet wrist and forearms to the elbows. Apply soap and apply with the same circular motion. Rinse, allowing water to run down over the hands. Keep your HANDS AND FOREAR M S LOWER THAN THE ELBOW

18. Surgical Hand Washing Wet hands until 2” above the elbow. Apply antimicrobial agent. Scrub hands and arms. Use orange stick for fingernails. Rinse thoroughly. Never turn off the faucet using the scrubbed hands. If knee or foot control is absent, use paper towel in touching the faucet. While performing the SURGICAL HAND WASHING until the procedure has been completed…. keep HANDS ABOVE THE ELBOW.

19. Rules for Surgical Asepsis Sterile field must only be created as close as possible to the time of use and must be continuously kept in view If the sterility is in QUESTION, it is considered UNSTERILE Only sterile items are used within the sterile field Any sterile area or instrument TOUCHED by the non sterile person or object is considered CONTA M INATED Gowns and Gloves that are being contaminated must be changed Accepted Sterile areas are: Table top From waist up to the shoulder in front Sleeves (from cuff up to the 2” above the elbow) Anything drops below the table top or sterile person’s waistline is considered UNSTERILE Edges of the wrapper are UNSTERILE Any sterile pack that becomes DA M P or WET is UNSTERILE

20. Sterile Gloving Technique Glove the dominant hand first. Using your non dominant hand, Grasp the folded cuff for the dominant hand glove. Same with the other hand. Pull glove over cuff of the gown

21. Skin Preparation Work in a circular motion FRO M CENTER OUTWARD. Do not back over the skin that has been scrubbed. ftaintain sterility along the procedure.

22. Methods of Sterilization Steam Under Pressure * Effective and convenience means of sterilization for items that CAN withstand high temperature and moisture * Autoclave chamber provides the necessary pressure Gas – Use for items that CANNOT withstand moisture and high temperatures.

23. Methods of Sterilization Chemical * Referred to as low-temperature sterilization. A maximum temperature of 54 C to 60 C. Dry Heat * Used for anhydrous oils, petroleum products, and bulk powders. * It may also be used on delicate cutting instruments that may be decolorized by other sterilization means.

24. Methods of Sterilization Ionizing radiation * Is used in commercial sterilization. * Cobalt-60 is the most common source of radiation sterilization. M icrowaves * This method uses low-pressure steam and non-ionizing radiation of microwaves to destroy microbes.

25. Disinfection Boiling – may be used when no other methods of sterilization are available but many spores are able to resist the heat of boiling. Ultraviolet irradiation –kills microorganism when they come in direct contact. This is not practical means of disinfecting for hospital because there is no assurance that the ultraviolet has come in contact with the microbes.

26. Universal Precaution The system is based on the use of barriers for all contacts with blood and certain body fluids known to carry bloodborne pathogens, rather than focusing on the isolation of a patient with a diagnosed bloodborne disease. Emphasis is placed on blood and certain body fluids being potential sources of infection, regardless of diagnosis .

27. Universal Precaution Wear Gloves, Gowns, Go g gles and m ask whenever in contact with blood and body fluids. Hypodermic needles should not be recapped , bent, broken, or separated from syringe. After use, immediately place in a specified puncture-resistant container.

28. Body Substance Precaution * This system focused on the use of barriers for all moist and potentially infectious body substances from all patient. * Include precautions for contamination by feces, nasal secretions, sputum, sweat, tears, urine, and vomitus

29. Standard Precaution * Standard Precautions apply to: * Blood * All body fluids * Secretions and excretions (except sweat), regardless of whether they contain visible blood * Nonintact skin * M ucous membranes * Precautions for three modes of transmission: * airborne, droplet, and contact.

30. Removing Contaminated Garments Untie WAIST TIES of the Gown Remove GLOVES Perform HAND HYGIENE. Untie TOP GOWN TIES Remove M ASK Remove GOWN Repeat hand hygiene.

31. CHAIN OF INFECTIONS 1. Infectious agent : a pathogen brings disease to its host. Bacteria, protozoa, fungi, virus 2. Reservoir : a part of organ for reproduction of pathogens. Also, this is a host that harbors the pathogen and serves as a source of the infective agent that it transmits to a potential host 3 . Portal of exit : refers to any route that the pathogen can leave the reservoir. This depends on the characteristics of the reservoir. In humans this include the alimentary: vomiting, diarrhea & saliva.

32. CHAIN OF INFECTIONS 4. Mode of transmission : refers to how an infectious agent also called pathogen can be transferred from one person, object or to animals. 5. Portal of Entry : refers to the manner in which a pathogen enters a susceptible host 6. Susceptible host : the final link of the chain. Susceptibility of a host depends on genetic or constitutional factors specific immunity & non specific factors that affect individual’s ability to resist infection

33. STAGES OF INFECTION 1. First stage (latent period): pathogenic microorganisms enter the body & lies dormant. At this point the disease become communicable. NO clear SYMPTOMS 2. Second stage (incubation period): during this stage the microbe reproduces and disease process begins. There is already a signs & symptoms. 3. Third stage (actual disease process): when the signs & symptoms of the disease reach their fullest extent or produce only subclinic symptoms 4. Fourth phase (convalescence): gradual symptoms and signs disappear.

34. NOSOCOMIAL INFECTION: Infections acquired in the course of medical care. Regardless whether it is detected during the stay or after. ASEPSIS: it is a condition in which no living disease causing microorganisms are present. It covers al those procedures designed to reduce the risk of bacteria, fungal or viral contamination. Using sterile draping, sterile instruments and the gloved (no touch) technique Note: Doff means removed gloves, Don means wear glove MEDICAL ASEPSIS: it includes al practices intended to confine specific microorganisms to a specific area, limiting the number, growth and transmission of microorganisms.

35. SURGICAL ASEPSIS (sterile technique): it includes all practices that destroy all microorganisms and spores Medical Asepsis uses the Clean Technique , while Surgical Asepsis employs the Sterile Technique . The former limits the spread of microorganisms, whereas the latter aims to destroy microorganisms and spores

36. Vital Signs

37. Vital Signs Also refers to as Cardinal Signs Important physical assessment. Involves: Pulse rate Temperature Blood pressure Respiration rate

38. Body Temperature Is a physiologic balance between heat produced in body tissues and heat lost environment . Controlled by hypothalamus When the body’s metabolic activity increases, body temperature increases.

39. Temperature This lets you know the degree of warmth your patient's body is. Types of thermometers: Digital Thermometer Glass Thermometer Electric thermometer

40. Measuring Body T emperatu r e TYMPANIC o Uses aural thermometer AXILLARY Safest method Normal: 36.4C-36.7C (97.6-98F) RECTAL Most accurate and reliable o Normal: 37.5C (99.6F) ORAL Most Accessible Normal: 37C

41. Factors affecting body Temperature o Age o Stress o Exercise o Diural Variations o Hormones o Environment

42. ALTERATIONS IN BODY TEMPERATURE o Pyrexia or Hyperthermia : a body temperature above normal o Hypothermia: a body temperature below normal o Febrile : client who has fever o Afebrile : client without fever

43. 4 COMMON TYPES OF FEVER ▪ Intermittent Fever : the body temperature alternates at regular interval, between periods of fever, normal temperature and subnormal temperature. ▪ Remittent fever : a wide range of temperature fluctuations occur over 24 hour period . ▪ Relapsing Fever : short febrile period of a few days and are interspaced with 1 or 2 days of normal temperature. ▪ Constant fever : body temperature fluctuates but is always above normal.

44. Pu l se Is a wave of blood created by contraction of the left ventricle of the heart. Normal pulse range Adult is 60 -90bpm Infant is 120 bpm 4-10 yrs old child is 90 -100bpm

45. Factors Affecting Pulse o Age o Stress o Exercise o Sex o Fever o Medications o Hemorrhage o Position Changes

46. Pulse Sites

47. Respiration This is the process of measuring a patient's breath in and out. Normal ranges: o Adult 16-20 rpm o Infant 30-60 rpm

48. Assessing Respiration Rate Observe the chest wall for symmetry Observe skin color Areas: gums, nail beds, earlobes and mouth Observe chest rise and fall for one full minute

49. Blood Pressure This is the force of the blood pushing against the walls of the arteries in the body Men has usually high BP than women. Your BP is higher after a large meal. Emotions and strenuous activity usually causes systolic BP to increase.

50. Blood Pressure Range Category Systolic mm Hg Di a stolic mm Hg Normal 95 to 119 60 to 79 Prehypertension 120-139 80-89 High Blood Pressure Stage 1 Hype r t ens i on 140–159 90–99 Stage 2 Hype r t ens i on 160 100

51. Taking the Blood Pressure

52. RT Actions for Hypertensive Crisis Assist patient into a semi-fowler’s position. Monitor blood pressure every 5 to 15 minutes until diastolic is below 90 but not less than 75. Inform the Doctor or Nurse in charge.

53. Oxygen Therapy Oxygen therapy is a key treatment in respiratory care.The purpose is to increase oxygen saturation in tissues where the saturation levels are too low due to illness or injury.

54. Oxygen Delivery Systems Oxygen is delivered to the respiratory tract under pressure by artificial means. Oxygen is humidified to prevent excessive drying of mucous membranes usually done by passing through distilled water because it is only slightly soluble in water.

55. Oxygen Delivery Devices Nasal Cannula is a plastic disposable device with two hollow prongs that deliver oxygen to the nostrils. It is the most common and inexpensive device used to administer oxygen. Nasal Catheter A French-tip catheter is inserted into one nostril until it reaches the oral pharynx.

56. Types Of Face Masks

57. Medical Emergencies in the Diagnostic Imaging

58. Emergencies in Diagnostic Imaging CODE BLUE o calling a code for medical emergency. Crash cart o emergency cart containing equipment and medicine needed for patients who suddenly becomes critical.

59. Emergencies in Diagnostic Imaging Assessment of patient’s neurologic functioning: o Glasgow Coma Scale o LOC

60. Levels Of Consciousness (LOC) 1.Alert and conscious 2.Drowsy but responsive 3.Unconscious but reactive to painful stimuli 4.Comatose

61. Shock is a life-threatening condition that occurs when the body is not getting enough blood flow. This can damage multiple organs. Shock requires immediate medical treatment and can get worse very rapidly.

62. Shock Caused by: Fluid loss Cardiac failure Decrease tone of vessels Blood flow obstruction to vital organs

63. General Response to Patient Suffering Shock Stop the diagnostic imaging Notify the physician in charge of the patient and call for emergency assistance Monitor vital sign every 5 minutes Check Airways Do not leave patient unattended.

64. Hypovolemic Shock Losing about 1/5 or more of the normal amount of blood in your body causes hypovolemic shock. Symptoms: Anxiety and restlessness Thirst Pallor and Cold Hypotension , Arrythmia, Tachypnea Oliguria or Anuria General weakness

65. Hypovolemic shock RT actions: Stop the diagnostic imaging, place patient in flat, supine position with legs elevated slightly If there is an open wound , wear gloves and apply pressure with certain sterile dressing Do not leave patient unattended.

66. Cardiogenic Shock is a state in which the heart has been damaged so much that it is unable to supply enough blood to the organs of the body. Symptoms Angina pectoralis Dizziness and respiratory distress Cyanosis Restlessness and anxiety Rapid change in level of consciousness Arrythmia, tachycardia Hypotension Oliguria Cool, clammy skin

67. Cardiogenic shock RT actions: Place the patient in a semi-fowlers’ position or a position comfortable for the patient. Keep the patient warm and quite. Do not give patient anything to eat or drink. Be prepared to begin CPR and assist in oxygenation, IV fluids and medical administration .

68. Septic Shock is a serious condition that occurs when an overwhelming infection leads to life-threatening low blood pressure. RT actions: Stop the procedure and notify the physician in charge of the patient. Place the patient in a flat, supine position and keep him quite. If the patient’s skin is warm cover him with a blanket . Take the vital signs every 5 minutes. Prepare to assist with the administration of oxygen, intravenous fluids, and medication

69. Neurogenic Shock occurs when concussion, spinal cord injury, psychic trauma or spinal anaesthesia causes abnormal dilatation of the peripheral blood vessels. This causes a fall in blood pressure as blood pools in the veins. Symptoms : Hypotension Bradycardia Warm, dry skin Subnormal body temperature Visible signs of poor tissue perfusion

70. Neurogenic Shock RT actions: o Do not move the patient in case of suspected spinal cord injury. o Prepare to assist in oxygen, IV fluid and medical administration.

71. Anaphylactic Shock It is a result of an exaggerated hypersensitivity reaction. The common causes are drugs, iodinated contrast agents, chemotherapeutic agents, anaesthetics, certain foods and insect venoms. Symptoms: Tightness in the chest and throat Itchiness in the site of medication Nasal congestion ; sneezing and coughing Nausea, vomiting and diarrheal usually accompanied by reaction to food.

72. Anaphylactic Shock RT actions: Place patient in semi fowlers position. The medications usually given for anaphylactic shock are epinephrine, diphenhydramine, hydrocortisone, and aminophylline

73. Diabetes Mellitus Is a chronic disease involving disorder of carbohydrate, protein and fat metabolism. The normal blood sugar level is 80 to 115 mg/dl or 70 – 110 mg/dl.

74. Four Types of DM Type 1 DM occurs usually in person younger than 30 years of age body's failure to produce insulin Type 2 DM results from insulin resistance , a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency. DM associate with other medical conditions Pancreatic diseases or hormonal abnormalities may produce diabetic symptoms Gestational diabetes it is caused by hormone secreted by the placenta that prevent the action of insulin.

75. Diabetes Mellitus Symptoms of type 1 and type 2 diabetes: Increased thirst ( polydypsia ) Frequent urination (polyuria) Extreme hunger Unexplained weight loss Fatigue Blurred vision Slow-healing sores Frequent infections, such as gum or skin infections and vaginal or bladder infections

76. Hypoglycemia A DM patient had an excessive insulin or oral hypoglycemic drug Also caused by inadequate intake of food utilizing insulin and/or increase metabolism of glucose Falls below 50-60mg/dl

77. Fainting/ Syncope Is the transient loss consciousness usually caused by insufficiency in the supply of blood to the brain Signs and symptoms: Pallor Complaints of dizzines and nausea Hypercapnea,Tachycardia Cold, clammy skin RT action: Have the patient lie down, if possible. Place in Trendelenburg position but make sure patient is safe. If unable to place in that position, assist client to supine position. Summon medical assistance

78. Convulsive Seizure Seizure – unsystemic discharge of neurons of the cerebrum that result in adrupt alteration in brain function. RT Action: Most importantly, prevent the patient from injuring himself . Do not attempt to put anything into the patients mouth. Do not restrain the arms or legs but protect them from injury. Do not attempt to move the patient to the floor if he is on a radiographic table, do not allow the patient to fall to the floor. After the seizure, position the patient to Sim’s and put the face downward so that secretions may drain from his or her mouth.

79. Cerebral Vascular Accident Caused by occlusion of the blood supply to the brain, rupture of the blood supply or cerebral artery. Also termed Stroke or Brain attacks Sign and symptoms: Confusion Dizziness or stupor Dysphasia/Aphasia Ataxia Possible severe headache , and muscle weakness Numbness

80. Respiratory Failure or Cardiac Arrest Respiratory Arrest This may result from airway obstruction caused by patient’s position, tongue, disease, drug overdose, foreign object, injury, or coma. Cardiac Arrest Caused by disruption of the electrical activity of the heart RT Actions: Call CODE OF BLUE , but never leave the patient Assess carotid pulse. Do not waste time to take BP! If there’s no pulse detected, perform CPR

81. CPR Open airways Ventilate patient, if no response begin chest compression. Place the heel of the hand 1.5” superior to the xiphoid process. Keep elbows straight and use body weight to help compress the sternum 1.5”-2” deep. 30 smooth, even rhythm compression Inflate lungs twice. Reassess carotid pulse and respiration. Repeat maneuver if patient shows no response ONE RESCUER CPR RATIO: 30COMPRESSION;2 INFLATIONS

82. Airway Obstruction Performing Abdominal Trust Maneuver: Stand behind the patient and grasps both hands above the patient’s umbilicus and below the xiphoid process of the sternum. Position the lower hand with the thumb inward; the other hand firmly grips the lower hand. Make a rapid upward movement that forces the abdomen inward and thrust upward toward the diaphragm to force air up to the trachea to dislodge the foreign object.

83. Airway Obstruction Performing Abdominal Trust Maneuver: For babies (<1 y/o) The infant should be picked up and five back blows should be administered, followed by five chest thrusts . Be careful to hold the infant with the head angled down to let gravity assist with clearing the airway. Also be careful to support the infant's head . If the infant turns blue or becomes unresponsive, CPR should be administered.

84. DEALING WITH INFANTS Secure infants.They want to be warmth and wrapped. Settle them . Rock or walk around with them, held firmly and gently. They relate faces. Talk to them softly .

85. DEALING WITH TODDLERS They may say “”Me want…” or “Me do it…” or “No” and their social skills do not yet include cooperation Toddlers feel more secure when they can hold onto something familiar Go to Child’s eye level Have eye contact and use positive touch

86. DEALING WITH YOUNG CHILDREN You may encourage them by offering VALID CHOICES . They are curious and probably ask questions. Keep your explanations simple , direct and honest . Honest praise is good motivation in this group.

87. DEALING WITH EARLY ADOLESCENCE Young teens may usually behave like adults They be act as self centered They may show exaggerated sense of modesty

88. DEALING TO THE PATIENT IN AGITATED OR CONFUSED It is best to approach patient from his side, not face to face Give the angry patient an opportunity to express his angry Never make an argument with the patient

89. DEALING TO INTOXICATED PATIENT Categorized as those patient involved in accidents that result in injuries and others. Keep communication simple, direct and non-judgmental. Do not argue with the patient. Note that under no circumstances should an intoxicated patient be allowed to leave the health care facility accompanied by an intoxicated companion

90. TRAUMA RADIOGR A PHY

91. Do not remove dressings, splints and pneumatic anti shock garments Do not move patient from stretcher or blackboard unless ordered by the physician Perform cross-table latera l as an initial radiography. But never move the patient collar or neck when doing so. Do not disturb , move or remove impaled objects. Work quickly , efficiently and accurately to minimize repeat exposure Trauma Radio g r a p h y

92. Closed head injury (blunt inju r y ) Wherein the tissue may swell Variable vital signs and LOC Lucidity Abnormal gait Hemiparesis Open head injury Abrasion, contusion and laceration of the skull Loss of hearing Racoon’s eye Head injury

93. Radiographer’s Action Elevate head 15-30 degree if possible Do not flex or turn patient’s head for it may increase intracranial pressure Check vital signs Apply pressure using sterile dressing Observe airway obstruction Head injury

94. Radiographer’s Action Check airway obstruction Do not suction through nasal passages Fallen teeth must be on a container soaked with sterile water Facial Injury

95. Radiographer’s Action Use log roll technique when transferring Do not remove collars , sand bags, anti shock garments Do cross table lateral projections as initial examination Spinal Cord Injury

96. 80% OF THE EXAM WILL BE BASED ON THE ONE LECTURE YOU MISSED AND THE ONE BOOK YOU DIDN’T READ

97. YOUR DESIRE WILL BE YOUR MAGIC POTION TO S U C C EED…