RTEC-A
Week 11
Patient Skills &
Communication
1
Patient Communication
1. Interacting with the patient
2. Interacting with family and friends
3. Methods of Effective Communication
4. Age as a factor in Patient Interactions
2
Radiologic Technologist
1.
Helping others
2.
Working with people
3.
Making a difference
4.
Thinking critically
5.
Demonstrating creativity
6.
Achieving results
3
Abraham Maslow’s
Hierarchy of Needs
4
Patient Dignity
1. Patients are usually in the lower levels of
Maslow’s Hierarchy
2.
Must always be remembered and
respected
3. Difficult to maintain dignity when ill
5
Why is this important?
PATIENT NEEDS
1.
2.
Altered states of consciousness
Environment
3.
Fear of unknown
4.
Vulnerable
5.
Coping Mechanisms
6
Classification of Patients
1. Inpatients
2. Outpatients
– Family
– Friends
7
Methods of Communication
1.
Verbal
2.
Humor
3.
Paralanguage
4.
5.
1.
Professional
Appearance
2.
Physical Presence
3.
Visual Contact
Body Language
Touch
1. Palpation
8
Verbal Communication
9
Communication thru Humor
10
Paralanguage
Defines all of the audio information in a
conversation beyond word choice
Simply listening to someone’s voice, even
if you can’t make out the words, conveys
their emotional state
11
Body Language
You could be talking to someone and your body language will
convey something else entirely.
Make eye contact occasionally you show an interest in that person
and in what he or she is saying.
A smile sends a positive message. Smiling adds warmth and
confidence about you.
Arms crossed or folded over your chest say that you have shut other
people out and have no interest in them or what they are saying.
Placing your arms at your side can make you look and feel confident
and relaxed to other people around you.
12
Touch and Palpation
13
Radiographer’s Responsibility
1. Introduction
2. Explanation of exam
3. Inform patient how they will receive
their results
4. Risks of examination
14
Rad Tech’s Role in Clinical Hx
1. Extract as much history as possible
2. Radiologists often do not even speak
with the patient.
3. Radiologist can be focus on anatomy of
interest
15
Desirable Qualities for Establishing
Open Dialogue
1.
Respect
2.
Genuineness
3.
Empathy
4.
Polite
5.
Professional
demeanor
16
Data Collection
1. Objective: Signs that can be seen
2. Subjective: Perceived by the affected
individual
17
Questioning Skills
1.
Open-ended questions
2.
Facilitation – encourages pt to elaborate
3.
Silence – give pt time to remember
4.
Probing questions – focus interview, provide more
information
5.
Repetition – rewording, clarifies info
6.
Summarization – verifies accuracy
18
Leading Questions
This is an UNDESIRABLE method of
questioning.
– Introduces bias to history
19
Chief Complaint
1. Focuses attention to the single most
important issue.
2. Patients often have many complaints
– Focus on primary reason for exam
20
You never know what you are
going to get?
21
Special Condition Patients
Traumatized Patients
Visually Impaired Patients
Speech and Hearing Impaired Patients
Non-English Speaking Patients
Mentally Impaired Patients
Substance Abusers
22
23
Gerontology
The study of aging and diseases of the
elderly.
By the end of the 20th century 33
million, more than 12% of total
population.
In 1900 only 4%, of population
24
Key to a Successful Exam
Plan of action
Systematic problem-solving process
– Assessment of data
– Setting a goal
– Establishing a plan
– Safety in completing assignment
– Evaluating the work
25
Communication
The key to a successful exam for
Technologist and Patient.
26
Human Diversity
What is Human Diversity?
1. Is also known as cultural diversity.
2. It means the inherent differences among
people.
3. It addresses the entirety of the ways
people are different and alike.
Characteristics of Human Diversity
Age
Disability
Economic status
Education
Geographic location
Organizational level
Political affiliation
Sexual orientation
Ethnicity
Family status
First language
Gender
Lifestyle
Physical characteristics
Religion
Work style or ethic
Globalization
People go into other countries for:
– Work
– School
– Medical care
– Visit / Vacation
– Live / Relocate
– Refuge / Safety
Globalization’s Effect
Nation, societies and businesses have become
multicultural or cross cultural
Strategies must be employed to understand
cultural differences
Strategies needed to mediate conflicts
A concerted effort toward Cultural competency
Significant Diversity Traits
Age
Ethnicity
Race
Gender or sexual orientation
Mental or physical disability
Age
Cultures assign different values
Baby Boomers (1946 – 1964)
– 75 million born
– Overall healthy and educated
– Will be in the work force longer
Age biases in western society
–
–
–
–
Valuing you over age
Viewing aging as a “bad” thing
Forgetting contributions offered by the aging
Considering seniors as mentally inferior
Ethnicity and National Origin
Ethnicity refers to a person’s racial, national, religious,
linguistic and cultural heritage.
Overcoming Linguistic Differences
–
–
–
–
Bilingual staff
Medical interpreters
Encouraging bilingualism
Forms in different languages
Many different cultures as demonstrated in everyday life
and by statistical data: U.S. Census 2000.
Ethnocentrism and Racism
Ethnocentrism is the belief that norms and
values of their culture should be standard
Racism is the belief that one race or
culture is superior to others
Gender or Sexual Orientation
Male vs. Female
– 1900 female roles
– Today's women
– Glass ceiling
Gender role
stereotyping
Sexual orientation
– Heterosexual
– Homosexual
– Bisexual
Ksix
Homophobia
Gender identity
Mental or Physical Disability
Mental or physical ability is the capacity to
perform cognitive and psychomotor tasks
with average ability
Those with disabilities have been shunned
– Seen as objects or assistance, protection and
treatment
600 million or 10% of the world have some
form of disability
Elements of Cultural Competency
Valuing Diversity
Possessing the capacity for cultural self
assessment
Having a consciousness of the dynamics of
cross cultural interaction
Institutionalizing cultural knowledge
Developing adaptations of service based on an
understanding of multiculturalism
Empathetic Practices
Communication
Assessment and communication
Negotiating
Areas of Cultural Diversity
related to Health Care
Communication
Space
Time
Environmental control
Biologic Variations
Social organizations
Patient Vital Signs
Medical Emergencies
and
Infection Control
Homeostasis
A constancy in the internal environment of the
body
Naturally maintained by adaptive responses
that promote healthy survival
Primary mechanisms:
–
–
–
–
–
Heartbeat
Blood pressure
Body temperature
Respiratory rate
Electrolyte balance
Vital Signs
Body Temperature
Respiratory Rate
Pulse / Heart Rate
Blood Pressure
Sensorium (mental alertness)
Importance of Vital Signs
Indicates the patient’s immediate condition
Can show improvement due to treatment
Can show a decline in condition
Body Temperature
Normal temperature: 98.6 ° F
– 1° - 2°F daily variation
– Still considered normal: 97.7 °F – 99.5 °F
Human body functions within a narrow
range of temperature variations
– Humans can survive between 93.2 ° F
and 106 ° F
Thermoregulation
Shivering when cold
Sweating when hot
Measuring Body Temperature
– Oral
– Rectal
– Axillary
– Tympanic
– Temporal
Abnormalities in Body
Temperature
Hyperthermia
– Fever, febrile
– Temperature higher than
99.5 °F
Hypothermia
– below normal range of 97.7
°F
– Due to
Environment
Medically induced
Damage to hypothalamus
Respiratory Rate
Respiratory System delivers oxygen to the
body’s tissues & eliminates carbon dioxide
– Pt will die without the removal of CO2 and addition
of O2
Major muscle of ventilation: diaphragm
Measured in
“breaths per minute”
– Adults: 12 – 20 bpm
– Children: 20 – 30 bpm
– Newborns: 30 – 60 bpm
Abnormalities of Respiratory Rate
Tachypnea
– Greater than 20 breaths per minute (adult)
Bradypnea – decrease is breathing
Dyspnea- difficulty breathing
Apnea- no breathing
Methods of Delivering Oxygen
Nasal
Cannula
Masks
Ventilators
Oxyhood
Pulse Oximeter
Normal Pulse Oximeter = 95% to 100%
Pulse
Adult
– 60 to 100 beats
per minute
Children under 10
– 70 to 120 beats
per minute
Measurement
Radial artery
Brachial
Carotid artery
Apical pulses
Abnormalities of Pulse Rate
Tachycardia
– Pulse rate increases by more than
20 bpm in resting adult
– Greater than 100 bpm
Bradycardia
– Decrease in heart rate
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
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
120/80 mmHg
considered normal
Abnormalities of Blood Pressure
Hypertension
– Persistent elevation above 140/90 mmHg
Hypotension
– Persistent less than 95/60 mmHg
RTA
Medical Emergencies
and Infection Control
Caution – some images may be disturbing to the viewer
…but this is what we may see in the course of our work
TRAUMA- X-RAY READY
SPINAL INJURY PT
X-TABLE LATERALS
CERVICAL SPINE
Dislocation of the C3 and C4
articular processes
Note that C7 is not well
demonstrated
Some studies of
spinal trauma have
recorded a missed
injury rate as high
as 33%.
GSW TO ABD
QSW
MARKING ENTRANCE /EXIT WOUNDS
Fractured Forearm
Trauma and Surgical
Radiography
NEAR DROWING
Compound Fx of Femur
General Priorities
1. Ensure an open
airway (ABC’s)
2. Control Bleeding
4. Attend to wounds
or fractures
5.Provide emotional
support
3. Take Measures to
Prevent shock
6. Continually
reevaluate and
follow up
Medical Emergencies
What a Radioilogic
technologist should
know
Common Radiology
Emergencies
Medical Emergencies
Sudden change in medical status
requiring immediate action.
For RT’s medical emergencies are rare
– Recognize emergencies
– Remain calm and confident
– Avoid additional harm to the patient
– Obtain appropriate medical assistance quickly
– Know where crash cart is, emergency phone
and code blue buttons
Major Medical
Emergencies
1.
2.
3.
4.
5.
6.
7.
ALOC
Shock
Anaphylactic shock
Diabetic Crisis
Respiratory Distress
Cardiac Arrest
Cerebrovascular accident
Head Injuries
Levels of consciousness
1. Least severe
–
Responsive
More serious
2.
–
Can be roused, but drowsy
Even more serious
3.
–
Responds to pinches or
pinpricks
Most serious
4.
–
Comatose, non-responsive
Shock
Hypovolemic
– Loss of blood or tissue
Cardiogenic
– Cardiac disorders
Neurogenic
– Spinal anesthesia or damage to spinal cord
Vasogenic
– Caused by sepsis, deep anesthesia or anaphylaxis
Anaphylactic Shock
An allergic reaction to contrast media
– Iodinated
Can happen quickly or have a delayed
reaction
– Requires prompt recognition and treatment
from the technologist
– More severe usually have quick onset
– Less severe takes longer for reaction
Prevention and Signs - Symptoms
Restlessness
Maintain normal body
temperature
Apprehension
Handle pt’s gently
Tachycardia
RT should work calmly
and confidently
Sudden blood pressure
drop
– Anxiety
Cold –clammy skin
– pallor
Diabetic Crisis
1. Hypoglycemia
2. Hyperglycemia
Hypoglycemia
Excessive insulin
Can result from normal dose of insulin & no food
Need carbohydrate
Hyperglycemia
Excessive sugar
Usually seen in diabetics
Pt. needs insulin
Respiratory Distress
1. Asthma
2. Choking
Asthma
1. Stressful situations
2. Inhaler or medical assistance
3. Remain calm and confident
Choking
1. Cannot speak
2. Universal distress signal
3. Encourage to cough
4. Heimlich Maneuver
Cardiac Arrest
1.
Crushing pain in chest
2.
Pain down arm
3. Begin CPR and use AED
Cerebrovascular
Accident
1. Paralysis on one or both sides
2. Slurred or loss of speech
3. Dizziness
4. Loss of vision
5. Complete unconsciousness
Minor Medical Emergencies
1.
2.
3.
4.
5.
6.
7.
Nausea and vomiting
Epistaxis
Vertigo and syncope
Seizures
Falls
Wounds
Burns
Nausea and Vomiting
Tell pt to breath deeply and slowly
Turn on side if possible or turn head
Get emesis basin and moist cloths
Epistaxis - nosebleed
Vertigo and Syncope
1. Lack of blood flow to brain
2. Feel dizzy after laying down or standing for awhile
3. Lay patient down
4. Orthostatic hypotension
5. Loosen tight clothes and put moist cloth on head
Seizures
Minor
– Brief LOC
– Stare into space
– Slightly confused and weak
Severe
– Muscle contractions on one or both sides
– Drool
– Aura may occur and you must lay them on floor
Pillow under head and move all objects around them
– Afterwards
ABC check
Clear mucus
PT is weak, disoriented and has no memory of seizure
Falls, wounds and burns
Falls
– Get appropriate help as needed and report incident to
supervisor and get a medical assessment of pt
Wounds
–
–
–
–
Do not remove dressing
Pay attn to any changes in dressing
Place extremity above level of heart
Apply pressure
Burns
– Maintain sterile precautions
– Be extra gentle
Radiologic Technology
You never know
when a medical
emergency may
occur.
Helping your
patients depends
on your abilities to
stay calm and
perform you duties!
Zoomed lower
pelvis
demonstrating
multiple fractures
(arrows).
Zoomed bony thorax shows rib fractures
FX RADIAL HEAD
greenstick
Open fracture
comminuted
Rt leg torn off after patient hit by a car
Third Degree Burn
INFECTION CONTROL
Microorganisms that cause
disease:
Bacteria
Viruses
Fungi
Protozoa
Microorganisms
Can grow in or on an animal or plant and
cause diseases.
Host: animal or plant that provides life
support to another organism.
Disease: Any change from the normal
structure or function in the human body.
Infection: Growth of a microorganism on or
in a host.
Varicella Zoster (Shingles)
Disease
Disease occurs
only when the
microorganism
causes injury to
the host
Pathogen
A disease producing microorganism.
– Multiply in large numbers and cause an
obstruction
– Cause tissue damage
– Secrete substance that produce effects in
the body
Exotoxins ( high body temp, nausea, vomiting)
Bacteria
Strep Throat
Bacterial
Pneumonia
Food Poisoning
Viruses
Common cold
Mononucleosis
Warts
Oral Warts
Smallpox
Fungi
Athlete’s Foot
– Tinea pedis
Ringworm
Protozoan
Trichomonas
Vaginalis
– STD
Plasmodium
Vivax
– Malaria
Chain of Infection
Nosocomial Infections
Iatrogenic Infection
Compromised Patients
Patient Flora
Hospital Environment
Blood borne Pathogens
Types of Nosocomial Infections
Iatrogenic Infection – related to physician
activities
Compromised Patients - weakened
resistance; immunosuppressed
Patient Flora - microbes in healthy people
Contaminated Hospital Environment
Blood borne Pathogens – Hepatitis B and HIV
Blood borne Pathogens
Disease-causing microorganisms that may
be present in human blood. Ex: Hepatitis,
Syphilis, Malaria, HIV.
Two most significant blood borne
pathogens: Hepatitis B and HIV
Syphilis
Syphilis in the eye
How Blood borne Pathogens
are Transmitted:
You must make contact with contaminated
fluids and permit them a way to enter your
body.
Contaminated body fluids can be saliva,
semen, vaginal secretions, or other fluids
containing blood (urine).
Controlling the spread of Disease
Chemotherapy
Immunization
Asepsis
– Medical
– Surgical
Disinfectants
Physical Methods of
Controlling Diseases
Handwashing
Standard
Precautions
– Gloving
– Gowns
– Face masks
– Eyewear
Personal Protective Equipment
(PPE)
Gloves
Masks
Gowns
Protective Eyewear
Caps
Universal Precautions
Since there is no way you can know if a person
is infected, you should ALWAYS use universal
precautions:
Wash your hands
Wear gloves
Handle sharp objects carefully
Properly clean all spills
Wear mask, eye protection, and apron if
splashing is a possibility.
Airborne Precautions
Patients infected with pathogens that remain
suspended in air for long periods on aerosol
droplets or dust.
TB, Chickenpox, Measles
Respiratory protection must be worn when
entering pt room.
Pt should wear mask.
Droplet Precautions
Patients infected with pathogens that
disseminate through large particulate
droplets expelled from coughing,
sneezing, or even talking.
Rubella, Mumps, Influenza
Surgical mask must be worn when within 3
feet of the pt.
Pt should wear a mask.
Contact Precautions
Patients infected with pathogens that spread by
direct contact with the pt or by indirect contact
with a contaminated object (bedrail, pt dressing).
Methicillin-resistant staphylococcus aureus
(MRSA), Hepatitis A, Varicella, Flesh-eating
Virus
All PPE should be used and equipment must be
disinfected after use.
So What, and Who Cares?
Students and Techs are challenged both
physically and mentally by the microbial world.
In this world of newly found, life-threatening
diseases, education has become the key to
survival.
Health care providers must be committed to
infection control so that diseases can be
conquered!
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Infection Control - El Camino College