Transcript Basic patient care in Radiography

Basic patient care in
Radiography
Goal
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The student will be able to explain how to
admit patients for radiographic procedures
and care for their basic needs in a safe
and effective manner.
Objectives
When the student has completed this lesson, he will be
able to:
1. Give clear verbal instructions to ambulatory patients
about the correct manner of dressing or undressing for a
radiographic procedure, and assess the need for
assistance.
2. Give a written explanation of what is to be one with the
patient’s belongings while he is being care for in the
radiography/therapy department.
3. Demonstrate the correct manner of moving, transferring,
and positioning patients to prevent injury to himself and
to the patient.
4. Demonstrate the correct method of assisting the disable
patient with dressing or undressing for a diagnostic
examination.
Objectives
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list three safety measures that must be taken when
transferring a patient from a hospital war to the
radiography department an returning him to the ward.
List three situations in the radiography department
that might result in damage to the patient’s skin, and
explain how to prevent them.
Demonstrate the correct method of moving a patient
who is wearing a plaster cast.
List four signs of circulatory impairment that the RT
must recognize in a patient who is wearing a plaster
cast.
Demonstrate the correct manner of assisting a patient
with a bedpan or urinal.
1. Dressing / undressing the
patient for Radiography
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When a patient comes to the radiology department from
outside the hospital, he is frequently required to remove
all or some items of clothing before a radiographic
examination can be performed.
The RT is usually be the person who receives the patient
an informs him which items of clothing are to be
removed.
The patient’s discomfort or embarrassment can be
lessened if the RT will approach this situation in a
courteous an professional manner.
The patient should be taken to the specific place
(dressing/changing room/cubicle) where he is expected
to disrobe.
1. Dressing / undressing the
patient for Radiography
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The RT should show how to close the door or
raw the curtain of the dressing room/cubicle.
He should clearly explain how the patient is to
where the examination gown and where to go
afterwards. (some gowns open at the back)
The patient should be supplied with hangers for
his clothing.
The patient should be informed where to leave
his clothing.
Purses, jewelry, and other valuables should be
treated with special care.
Care of valuables
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Dressing rooms are not safe places to leave the
valuables.
RT should consider the patient’s concerns and explain
what must be done with them.
Metal items such as necklaces, rings, and watches are
not to be warn for certain radiologic examinations
A large envelope can be given to the patient to keep
such valuables.
The envelope can be kept in the patient’s purse or
pocket, or a secure place in the department.
A written record of the items should be kept.
The RT must not value patient’s belongings. An item that
may seen insignificant to the RT may be the patient’s
most treasured belonging.
2. Correct Body postures in moving
& transferring patients
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The rules of correct body mechanics should be
followed when moving & lifting patients to avoid
injury to oneself and to the patient.
Safe body mechanics require good posture.
The body should be in alignment with all parts in
balance. Good posture permits the
musculoskeletal system to work at maximal
efficiency with a minimal amount of strain on
joints, tendons, ligaments, and muscles. It also
helps other body systems to work efficiently.
Rules for correct upright posture
 The chest is held up and slightly forward with the waist
extended - (This helps the lungs to expand properly and
fill to capacity.
 The head is held erect with the chin held in. -(This puts
the spine in proper alignment)
 Stand with the feet parallel and at right angles to the
lower legs. Feet 4 - 8 inches apart. Boy weight equally
distributed on both feet.
 Keep the knees slightly bent. - They act as a ‘shock
absorber ‘ for the body.
 keep the buttocks in and the abdomen up and in. – This
prevents strain on the back and abdominal muscles.
Correct procedures to follow when
moving and lifting patients.
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Keep the heaviest part close to your body.
When the object is too heavy get assistance.
The force of friction opposes movement. Take
action to reduce friction.
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Friction can be reduced by reducing the surface area
to be moved, or employing some of the patients own
strength to assist with the movement.
Keep the patients arms across the chest to reduce
surface area.
Pulling rather than pushing reduces the friction.
A pull sheet placed under the patient will also work to
reduce the friction.
Correct procedures to follow when
moving and lifting patients.
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Keep the body’s line of balance close to the
center of gravity, which is at or just below the
waist line.
When picking up an object from the floor bend
the knees and lower the body, do not bend from
the waist.
The biceps muscles are the strongest muscles
and are effective in pulling; therefore pull the
weight - do not push it.
Correct procedures to follow when
moving and lifting patients
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When a patient has to be lifted,
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Balance the weight over both feet;
Hold the patient close to your body; bend your knees
Set your spine to support the weight.
Use your arms and leg muscles to lift
The spine must always be protected.
Instead of twisting your body to move with a load,
change foot positions.
Keep the body balanced over your feet.
Do s and Don’ts
Moving & transferring patients
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Before trying to transfer or move a patient
the RT must assess the patient’s ability to
aid in the process.
Assessing the patients mobility
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Identify any abnormalities in the patient’s body
alignment.
If there are any abnormalities, determine the
reasons for the problem.
It may be resulted from,
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poor posture
trauma
muscle damage or dysfunction of the nervous system
malnutrition
fatigue
emotional disturbances.
Assessing the patients mobility
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Support the affected limbs or body parts
with pillows, support blocks, or sandbags
Assess the mobility of the patient and the
limitations of joint motions.
Assess the patient’s ability to walk(his
gait)
Note the conditions of respiratory,
cardiovascular disease, endocrine disease
etc.
Final judgement
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How well or how poorly is the patient functioning? –
general condition of the patient.
Are his motions restricted any way? - mobility of
the patient.
Will he become fatigued and be unable to complete
the transfer without assistance? – strength and
endurance
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Can he sit or stand for as long a period as is required?
– ability to maintain balance
Is he responsive and alert? – ability to understand
Does he fear or resent the move? – acceptance of
the move.
Important rules regarding moving
or transferring patients
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Give only the assistance that the patient needs for
comfort and safety.
Always transfer across a shorter distance
Lock all wheels on gurneys (beds), trolleys, and
wheelchairs.
It is better to move a patient towards his strong side
while somebody assists at his weak side.
Patient should wear shoes for standing transfers, but
slippery bedroom slippers should not be worn.
Inform the patient about the plan of the move, an
encourage his help.
Give simple short commands, and help him to carry
them out.
Methods of patient transfer
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By
By
By
By
gurney (special patient bed)
trolley
wheelchair
walking (ambulation)
1. Moving a patient from trolley to x-ray
table or vice versa (reverse)
i. Using a pull sheet
ii. Three carrier lift
i. Using a pull sheet
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Obtain a heavy sheet (Bed sheet folded)
Get the assistance from another person
Turn the patient onto one side and move him to the
distal side of the trolley.
Place the sheet on the trolley and roll one half of it as
close to the patient as possible.
Turn the patient across the sheet roll and straighten
the sheet on the distal side.
Return the patient to supine position.
Cross the patient’s arms across the chest
Three or four people may be required to complete the
move; one should support the head, two on either
side, one may support the legs.
In unison all of them raise the patient with the sheet
and transfer from the trolley to the table or vice versa
Placing the sheet
Moving the patient
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Care must be taken if the two surfaces are not at the
same level, to avoid injury to the patient. The friction
can be minimized by using sliding boards
ii. Three carrier lift method
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Keep the trolley perpendicular to the table
Slide the patient to the inner side of the trolley
Three persons go to the side close to the patient
One stands to support the head and neck, one at the
buttocks and the other at the legs and ankles
Cross the patient’s arms across the chest
All three lifters place their arms under the patient- the
region of the body which they are going to lift
At the signal, the movers roll the patient off the table
and on to theirs chests.
All three pivot and placed the patient on to the surface
to which he is being transferred.
Step 1
Step 2
Step 3
Log roll (to turn an injured patient
to a lateral position)
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Place a pillow and support block at the side to which the
patient is going to be turned.
Place a pillow between knees to support the legs when
turned to side.
Two people will stand on either side of the bed, one at
the head
The sheet is brought up over the patient and grasped by
two persons at leg end
One at the head support the head and neck without
allowing the neck to bend or head to rotate.
Other two must support the body
In unison, the team rolls the patient to the desire side as
if he were a log keeping his head, neck and torso
immobile during the move.
the head should rest in lateral position on the support
block and pillow
Log roll method to turn a patient
witout bending his neck and spine
2. Moving a patient from x-ray table to
the wheelchair
1. First it is necessary to turn the patient from supine position to a sitting
position , to do that
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Stand in front of the table
Keep one arm under the patient’s shoulders and the other across his
knees
Instruct the patient to push himself up with the support of his upper arm
if possible, when he is asked to do so.
Then on the count of three, move the patient or help him to move to
a sitting position at the edge of the table with the knees flexed.
Keep the wheel chair parallel to the table and lock the wheels
Then stand in front of the patient
Place the patient’s arms across your shoulders
Put your knees around the patients knees
Help the patient stand and pivot, and thus lower onto the wheel chair.
(bending your knees and keeping your back straight)
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Moving a patient from Wheel
chair to table.
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Get help from another person
Put one of your shoulder under the armpit
(one person on either side of the patient)
Put the other arm around the pathent’s
back
Raise together
Turn around to turn your back to the table
and keep the patient sitting on the table
From wheel chair to table
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3. Care of severely ill patients on
trolleys and wheel chairs at the
radiology/radiotherapy department.
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The patient must be covered with a sheet as much as
possible.
A confused, disoriented or unconscious patient or child
must never be left alone, on a radiographic table or
trolley.
Patient who is unstable in suiting position should not
be left alone on a wheelchair
Take special care when changing dress of patients
with Intravenous canulas & drips
Pay attention to patients with various drainage tubes
(urinary catheters, IC tubes, Colostomy tubes etc.)
Keep the pt well covered and
secured
4. Protective positions of patients – if
required to be kept for a long time
Supine position
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Patient flat on the
back. Pillow may be
placed under the
head to tilt it forward.
Feet should be
supported to prevent
planter flexion.
Protective sidelying (Semiprone) position
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Patient lies on either
side with a pillow for
support under the
head and
neck.
The upper arm and
the leg supported on
pillows
Protective prone position
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Patient Lies on face
down. A small pillow
supports the head.
Patient should be
moved down so that
the feet drop over the
edge , or a pillow may
be placed under the
ankles.
Fowler’s position
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Patient semi-sits with his head raise from 45-60
degree angle
Semi-Fowler’s position
Head is raised from a 15-to
30 degree angle.
Arms must be supported to
prevent pull on shoulders.
Feet must be supported to
prevent planter flexion or foot
drop.
This position helps reduce
respiratory distress.
Sims’ position
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Patient lies on left or
right side. Lowe arm
forward an flexed.
Upper arm extended
behind the body.
Top knee bent
sharply and the
bottom knee slightly
bent.
Trendelenburg position -
The table or be is inclined with the patient’s head
is lower than the rest of the body.
4. Skin Care
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Skin breakdown can occur in a brief period
of time (1-2 hours) and result in a
decubitus ulcer.
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Mechanical factors that may result in skin
breakdown are:
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Immobility
Pressure
Shearing force
Friction
Causes of decubitus ulcers
1. Immobilizing a patient in one position for an extended
period of time creates pressure on the skin bearing the
patient’s weight. This results and restricts capillary
blood flow and tissue necrosis.
2. Moving a patient to or from one surface to another
without adequately protecting the skin may damage to
external skin or the underlying tissues, resulting tissue
necrosis.
3. The movement of the patient back & forth on a rough
or uneven surface such as wrinkled bed sheet can
cause friction and skin breakdown.
4. Allowing a patient to lie on a damp sheet can also lead
to skin damage.
5. Urine or fecal matter allowed to remain on the skin acts
as irritant an is damaging to the skin.
The areas most susceptible to
decubitus ulcers
Scapulae
 Sacrum
 Trochantors
 Knees
 Heels
(The chance of occurance of Decubitus
ulcers can be minimized by changing the
position of the patient every two hours).
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5. Care of patients with wet casts
(green cast)
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A fresh (wet) cast still contains water and
can accidentally be compressed.
The compression on a cast may produce
pressure on the patient’s skin which will
result in formation of a decubitus ulcers
under the cast.
A cast that becomes too tight may cause
circulatory impairment or compression of a
nurve
How to take take care not to apply
pressure on the cast?
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Slide the hands with open fingers and
flattened under the cast
Avoid grasping it with fingers.
Support the cast at the joints when
moving it
Move the casted extremity as a whole
unit.
How to take take care not to apply pressure
on the cast?
6. Assisting the patient with a bedpan
or urinal
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Although this is not in the duty list of the
radiographers it is necessary to learn the correct
procedure a you may be required to do so in case
of emergency.
Assisting the patient with a bedpan
Summary
End of lesson