Infection Control, Vital Signs, Oxygen

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Infection Control, Vital Signs, Oxygen Medical
Emergencies

• RTEC 93

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Infection Control

• Microorganisms
• Infectious Disease
• Chain of Infection
• Nosocomial Infection
• Disease Control
• Environment

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Standard Precautions
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What do you think?

• What is the potential hazard to the patient when
  strict aseptic techniques is not used when
  administering intravenous medication or contrast?

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Microorganismsthat cause disease

• Bacteria
• Viruses
• Fungi
• Protozoa

• Can grow in or on an animal or plant and cause
  diseases.
• Host animal or plant that provides life support
  to another organism.

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Disease

• Disease occurs only when the microorganism causes
  injury to the host

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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)

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6 Steps of Infection

• Encounter
• Entry
• Spread

• Multiplication
• Damage
• Outcome

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Chain of Infection

• Host
• Infectious Microorganism
• Mode of Transmission
• Vector/ Fomite
• Reservoir

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Nosocomial Infections

• Infections originating in the hospital an
  infection not present before admittance to the
  hospital.

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Nosocomial Infections

• Iatrogenic Infection
• Compromised Patients
• Patient Flora
• Hospital Environment
• Bloodborne Pathogens

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Types of Nosocomial Infections

• Iatrogenic Infection related to physician
  activities
• Compromised Patients - weakened resistance
  immunosuppressed
• Patient Flora - microbes in healthy people
• Contaminated Hospital Environment
• Bloodborne Pathogens Hepatitis B and HIV

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Third Degree BurnWho needs protection from
infection if this is your patient?
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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.

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What are the 3 Transmission-based Isolation
Precautions?

• Contact
• Droplet
• Airborne

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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.

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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.

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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.

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Controlling the spread of Disease

• Chemotherapy
• Immunization
• Asepsis
• Medical
• Surgical
• Disinfectants

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Physical Methods of Controlling Diseases

• Handwashing
• Standard Precautions
• Gloving
• Gowns
• Face masks
• Eyewear

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Hand washing

• Single most important means of preventing the
  spread of infection.
• 7 to 8 minutes of washing to remove the microbes
  present, depending on the number present. Per
  JCAHO 10-15 seconds
• Most effective portion of hand washing is the
  mechanical action of rubbing the hands together.

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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 per JCAHO
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Fingernail Compliance

• No more than ¼ inch long
• No artificial nails
• No chips on nail polish

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When do you wash your hands?

• When hands are visibly soiled
• Before and after patient contact
• After removal of gloves
• After using the toilet
• After blowing or wiping the nose
• Upon leaving an isolation area

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When do you wash your hands?

• Before Eating
• How long do you wash?
• 10-15 Seconds

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When should sharps boxes be emptied?

• When they are 2/3 full

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What are some examples of proper usage of gloves?

• Wear gloves when you anticipate possible
  contamination
• When handling chemicals like disinfectants for
  cleaning
• Remove gloves immediately after performing task
  and performing hand hygiene
• Hallways should be considered a
• glove free
  zone

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When do you use disinfectant jell?

• Before and after patient care when hands are not
  visibly soiled
• Before performing invasive procedures for hand
  decontamination
• To decontaminate hands after contact with
  patients intact skin, i.e., after taking vital
  signs

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What can you use for cleaning equipment and
surfaces?

• Disinfectant wipes

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How do you know equipment is clean?

• Clean equipment is covered with plastic
• A clean bed or gurney is dressed
• Medical equipment is cleaned between patients or
  when soiled
• Not sure ? Always clean and disinfect.

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What are examples of Standard Precautions?
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What are examples of Standard Precautions?

• Use of PPE (personal protective equipment)
• Protective housekeeping
• Practicing good hygiene

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Review

• Microorganisms
• Disease
• Pathogen
• Bacteria
• Viruses
• Fungi
• Protozoan
• 6 Steps of Infection

• Chain of Infection
• Nosocomial Infection
• Controlling Disease
• Physical Methods of Controlling Diseases
• Handwashing
• Standard Precautions
• Universal Precautions

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Questions?

• Infection Control

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Vital Signs

• Vital Signs
• Oxygen Therapy
• Oxygen Devices
• Chest Tubes and Lines

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Vital Signs

• Indication of Homeostasis
• Primary Mechanisms
• Heart beat
• Blood pressure
• Body temperature
• Respiratory rate
• Electrolyte balance

• Physical assessment include measurement of vital
  signs
• Body Temperature
• Pulse
• Respiration
• Blood Pressure
• Mental Status

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Body Temperature

• Normal average body temperature 98.6 F
• Humans can survive between 106 F and 93.2 F.
• Hypothermia
• Hyperthermia

• Measuring Body Temperature
• Oral
• Rectal
• Axillary
• Tympanic

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Pulse

• Pulse rate Adult 60 to 100 beats per minute
• Children under 10 70 to 120 beats per minute
• Tachycardia
• Bradycardia

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Respiratory Rate

• Breaths per minute Adult 12 to 20
• Children under 10 20 to 30 per min
• Tachypnea
• Bradypena
• Dyspnea
• Apnea

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Pulse Oximeter

• Normal Pulse Oximeter 95 to 100

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Blood Pressure

• Blood Pressure
• Systolic pressure 95-140 mmHg
• Diastolic pressure 60-90 mmHg
• Hypertension
• Hypotension

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Oxygen

• Oxygen constitutes 21 of atmospheric gases
• If O2 levels in the body drop below 21
  homeostasis is altered.
• Hypoxia Inadequate amount of oxygen at the
  cellular level.

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Oxygen Devices

• Nasal Cannula
• Masks
• Nonrebreathing mask
• Aerosol mask
• Air-entrainment mask
• Tent and Oxyhood

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Chest Tubes and Lines

• Endotracheal Tube (ET)
• Ventilator
• Chest Tubes
• Nasogastric tube (NG)
• Central Lines

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Central Line Injections by RT

• The California Law does not address arterial
  injection by RT
• Employers policies
• Saline flush

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Review

• Vital Signs
• Homeostasis
• Body Temperature
• Pulse
• Respiration
• Blood Pressure
• Mental Status

• Electrolyte balance
• Pulse Oximeter
• Oxygen
• Oxygen Devices
• Chest Tubes
• Chest Lines

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Questions?

• Vital Signs

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Medical Emergencies
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Medical Emergencies

• Definitions
• What should the RT know?
• Common Radiology Emergencies

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Medical Emergencies

• Definition Sudden change in medical status
  requiring immediate action.
• For RTs medical emergencies are rare, however as
  medical personnel we must be prepared to
  recognize emergencies.

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What an RT should know..

• How to..
• Avoid additional harm to the patient
• Obtain appropriate medical assistance quickly
• Recognize emergency situations
• Remain calm and confident

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Anaphylactic Reaction

• An immune response to foreign material
• Bronchospasm wheezing and edema in the throat
  and lungs
• Can lead to shock
• Requires prompt recognition and treatment from
  the technologist
• Why do RTs care about Anaphylactoid RXNs.?
  See Pg. 336

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Water Soluble Iodine

• High atomic 53
• Radiopaque
• Used to radiograph
• Vessels
• Arteries
• Veins
• Function of internal organs

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Iodine Contrast Material

• Ionic Iodine Contrast
• Anion -
• Cation
• More patient allergic reactions
• Non-Ionic Contrast
• Less patient allergic reactions

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Patient Assessment Check List

• Information update !!

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Medications containing metformin

• Glucophage
• Glucovance
• Glyburide
• Glipizide

• Rosiglitazone
• Metaglip
• Avadment
• Fortamet

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Creatinine clearance vs Creatinine

• In general, creatinine clearance is the removal
  of creatinine from the body.
• In renal physiology, creatinine clearance (CCr)
  is the volume of blood plasma that is cleared of
  creatinine per unit time.
• The result of this test is an important gauge
  used in assessing excretory function of the
  kidneys

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Creatinine clearance vs Glomerular filtration
rate (GFR)

• Clinically, creatinine clearance is a useful
  measure for estimating the glomerular filtration
  rate (GFR) of the kidneys.
• creatinine clearance overestimates actual GFR by
  10-20.
• This margin of error is acceptable considering
  the ease with which creatinine clearance is
  measured

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Radiology Department

• Patients are usually sent to the radiology
  department only after they have been stabilized.
• However

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Become familiar with..

• In your work environment
• Emergency assistance protocol (how to get help)
• Emergency Cart/Crash Cart Location

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Important Conditions to be Aware of

• Level of Consciousness ALOC
• Altered Level Of Consciousness
• Anaphylatic Shock vasogenic shock
• Hypoglycemic/Hyperglycemia
• NPO Nothing by Mouth

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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!

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Questions?

• Infection Control
• Vital Signs
• Medical Emergencies

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Vascular System
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Vascular access is legal for RTs where? upper
or lower extremity ?

• What are characteristics of arteries?
• What are characteristics of veins?
• Rapid flow, Contain valves, Dark red blood, Flows
  away from heart, Flows toward the heart,
  Pulsating

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Venipuncture Anatomy

• Most Common sites for IV introduction in
  Radiology
• Anticubital space
• Anterior forearm
• Dorsum of the hand
• Radial wrist (ouch)

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Anticubital Space Anterior Forearm

• Cephalic Vein
• Accessory cephalic
• Basilic Vein
• Median veins
• Antecubital Vein
• Median cubital
• Most common site for extravasation
• Pg. 316

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Anticubital Space

• Are located over an area of joint flexion
  therefore any motion can dislodge the cannula and
  cause infiltration.
• A flexible IV catheter is the needle of choice
  for placement of a venous access in the
  antecubital space.

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Posterior Hand Radial Wrist

• Cephalic Veins
• Basilic Veins
• Radial Vein

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Pharmacology for the Radiologic Technologist
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Drug Classifications

• Name generic or brand
• Action
• Method of legal purchase (prescription or
  non-prescription)

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Classification by Name

• Chemical name actual chemical structure
• Generic name when it becomes commercially
  available (never capitalized) nonproprietary
  name
• Brand name give by a drug manufacture
  trademark, trade name, proprietary name

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Example

• Chemical name 7 chloro-1,3-dihydro-1-methyl-5-ph
  enyl-H-1,4-benzodiazepin-2-one
• Generic name diazepam
• Brand name - Valium

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Drug Reactions

• Anaphylaxis
• VS
• Anaphylactoid

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Principles of Drug Administration

• The golden rules of drug administration
• The five rights of drug administration
• Right drug Right amount
• Right patient Right time
• Right route

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Drug Routes

• Oral by mouth
• Sublingual under the tongue
• Topical directly onto the skin
• transdermal
• Parenteral by injection or other than oral -
  intramuscular, subcutaneous, intravenous

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Charting Drug Information

• Any time a drug is administered to an inpatient
  it must be charted
• Information includes
• Drug name
• Dose of the drug
• Route of administration (if parenterally, then
  the side of injection)
• Date Time

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Legal Considerations

• Errors with drug administration is the most
  common legal problems for radiologic
  technologists
• Techs must follow charting protocols and document
  all errors in drug administration

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Pg. 319

• Do Not Use
• abbreviations

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Questions?

• "The pessimist sees difficulty in every
  opportunity. The optimist sees the opportunity
  in every difficulty." Winston Churchill