1. History Taking

2. History Taking
One of the most valuable opportunities to acquire clinical information that can contribute to the diagnostic process

3. Data Collection Process
Objective data
Signs that can be seen, heard or felt
Includes laboratory reports
Subjective data
Perceived by the affected individual only
Pain and its severity

4. Questioning Skills Open ended questions Facilitation Silence Probing
Let the patient tell the story
Facilitation
Nod or say yes
Okay, go on
Silence
Gives the patient time to remember
Probing
Provides more detail
Repetition
Clarifies information
Summarization
Verifies accuracy

5. Seven elements for a complete history
Localization
Exactly where does it hurt?
Chronology
How long ago did the injury happen?
Quality
Acute/chronic
Crushing injury
Severity
Intensity of pain
Onset
When did it start?
Aggravating factors
What or when is the symptom aggravated
Associated manifestations
Do other symptoms accompany the chief complaint

6. 1. Practice taking histories on our patient
2. Classwork

7. Safe Patient Movement

8. Base of support The feet and the space between the feet
Standing w/ feet farther apart improves stability

9. Center of Gravity Gravitation forces appear to act from this point
Moving heavy objects hold the object close to the center of gravity
Center of gravity should be over base of support

10. Mobility muscles Stability muscles Found in limbs
Have tendons and cross two or more joints
Biceps
hamstrings
Stability muscles
Found in the torso
Provide postural support
Abdomen/back muscles
Use mobility muscles for lifting, postural muscles for support
Lifting should be done by bending and straightening knees while keeping the back straight

11. Principles of Lifting Ask patient if they can move first
Check chart for any restrictions
Explain the transfer and execute it slowly enough for pt to feel secure
Stand with feet apart
Align pts center of gravity with yours
Keep back stationary and let legs do lifting
Avoid twisting

12. Be aware of orthostatic hypotension
When blood pressure drops once a person stands from a recumbent position
Dizziness, fainting, blurred vision, slurred speech
Move slowly and ask how they are feeling throughout

13. Wheelchair Transfers Standby assist (let’s practice!)
Pts transfer to table on their own
Position wheelchair to 45°angle to table

14. Standby assist cont. Move footrests Lock wheelchair Tell pt to
Sit on edge and push down on arms of chair
Stand up slowly
Reach out and hold onto table
Give footstool if needed
Turn slowly until you feel table behind you
Hold onto table w both hands
Sit down

15. Wheelchair Transfers
Assisted standing pivot transfer (let’s practice!)
Can bear weight on their legs
Position wheelchair at 45° to table w/ pts stronger side closest to table Pt
Sit on edge and push down on arms of chair
Stand up slowly
Technologist

16. Assisted standing pivot transfer
Bend at your knees
Keep back straight
Grasp transfer belt or waist
Place one foot outside the patients foot
Place knee at the medial surface of pts knee

17. Assisted standing pivot transfer
As pt rises, you rise also by straightening your knees

18. Assisted standing pivot transfer
Both of you pivot toward table until pt can feel the table against the back of the thighs

19. Wheelchair Transfers Two-person lift
Pt can not bear weight on lower extremities
Stronger technologists lifts the patients torso while other person lifts the patients feet
Technologist lifting torso gives directions

20. Two person lift Lock wheelchair Move armrests and leg rests
Ask pt to cross his arms over chest
Stronger technologist
Stands behind pt, reaches under axillae, grasps pts crossed forearms
Second technologist
Squats in front of pt and cradles pts thighs and calves

21. Wheelchair Transfers Hydraulic Lift Techniques
Patient is too heavy to lift

22. Hydraulic lift Pts sling attaches to the spreader bar by hoooks
Hook the chain to the sling from inside out

23. Hydraulic lift Begin to raise the patient
When the pt has cleared the seat, the wheelchair can be remove and pt can be positioned on table

24. Cart Transfers
Roll pt onto his side away from direction of the transfer
Place device in midpoint of back
Roll the pt supine

25. Cart Transfers
The draw sheet is gently pulled to move the patient onto the table. If necessary, the patient may be rolled again to remove the moving device.

26. Cart Transfers
Cart-to-table transfer without a moving device. A, Begin by rolling up the draw sheet on both sides of the patient. B, The person directing the transfer supports the patient’s head and upper body from the far side of the radiographic table. An assistant supports the patient’s pelvic girdle from the cart side. A second assistant supports the patient’s legs from the tableside. The patient’s arms can be crossed over the chest to avoid injury or getting in the way.