1 RTEC-A Week 11 Patient Skills & Communication

2 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

3 Radiologic Technologist 1. Helping others 2. Working with people 3. Making a difference 4. Thinking critically 5. Demonstrating creativity 6. Achieving results

4 Abraham Maslow’s Hierarchy of Needs

5 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

6 Why is this important? PATIENT NEEDS 1. Altered states of consciousness 2. Environment 3. Fear of unknown 4. Vulnerable 5. Coping Mechanisms

7 Classification of Patients 1. Inpatients 2. Outpatients –Family –Friends

8 Methods of Communication 1. Verbal 2. Humor 3. Paralanguage 4. Body Language 5. Touch 1.Palpation 1. Professional Appearance 2. Physical Presence 3. Visual Contact

9 Verbal Communication

10 Communication thru Humor

11 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

12 Body Language You could be talking to someone and your body language will convey something else entirely. body language body language 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.

13 Touch and Palpation

14 Radiographer’s Responsibility 1. Introduction 2. Explanation of exam 3. Inform patient how they will receive their results 4. Risks of examination

15 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

16 Desirable Qualities for Establishing Open Dialogue 1. Respect 2. Genuineness 3. Empathy 4. Polite 5. Professional demeanor demeanor

17 Data Collection 1. Objective: Signs that can be seen 2. Subjective: Perceived by the affected individual

18 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

19 Leading Questions This is an UNDESIRABLE method of questioning. –Introduces bias to history

20 Chief Complaint 1. Focuses attention to the single most important issue. 2. Patients often have many complaints –Focus on primary reason for exam

21 You never know what you are going to get?

22 Special Condition Patients Traumatized Patients Visually Impaired Patients Speech and Hearing Impaired Patients Non-English Speaking Patients Mentally Impaired Patients Substance Abusers

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24 Gerontology The study of aging and diseases of the elderly. By the end of the 20 th century 33 million, more than 12% of total population. In 1900 only 4%, of population

25 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

26 Communication The key to a successful exam for Technologist and Patient.

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 AgeDisability Economic status Education Geographic location Organizational level Political affiliation Sexual orientation Ethnicity Family status First language GenderLifestyle 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 AgeEthnicityRace 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 Gender identity Sexual orientation –Heterosexual –Homosexual –BisexualKsixHomophobia

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 CommunicationSpaceTime Environmental control Biologic Variations Social organizations

Patient Vital Signs Medical Emergencies and Infection Control

Homeostasis A constancy in the internal environment of the body 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 Ventilators Nasal Cannula Oxyhood Masks

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: mm Hg Normal adult diastolic: 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 3. Take Measures to Prevent shock 4. Attend to wounds or fractures 4. Attend to wounds or fractures 5.Provide emotional support 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. 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. ALOC 2. Shock 3. Anaphylactic shock 4. Diabetic Crisis 5. Respiratory Distress 6. Cardiac Arrest 7. Cerebrovascular accident

Head Injuries Levels of consciousness 1. Least severe –Responsive 2. More serious –Can be roused, but drowsy 3. Even more serious –Responds to pinches or pinpricks 4. Most serious –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 Maintain normal body temperature Handle pt’s gently RT should work calmly and confidently RestlessnessApprehension –AnxietyTachycardia Sudden blood pressure drop Cold –clammy skin –pallor

Diabetic Crisis 1. Hypoglycemia 2. Hyperglycemia

Hypoglycemia Excessive insulin Can result from normal dose of insulin & no food Can result from normal dose of insulin & no food Need carbohydrate

Hyperglycemia Excessive sugar Usually seen in diabetics Pt. needs insulin Pt. needs insulin

Respiratory Distress 1. Asthma 2. Choking

Asthma 1. Stressful situations 2. Inhaler or medical assistance 3. Remain calm and confident

Choking 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. Nausea and vomiting 2. Epistaxis 3. Vertigo and syncope 4. Seizures 5. Falls 6. Wounds 7. 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

comminuted Open fracture

Rt leg torn off after patient hit by a car

Third Degree Burn

INFECTION CONTROL

Microorganisms that cause disease: BacteriaVirusesFungiProtozoa

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 MononucleosisWarts

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 ChemotherapyImmunizationAsepsis –Medical –Surgical Disinfectants

Physical Methods of Controlling Diseases Handwashing Standard Precautions –Gloving –Gowns –Face masks –Eyewear

Personal Protective Equipment (PPE) GlovesMasksGowns 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!