Patient Assessment & Vital Signs

Patient Assessment &Vital Signs Rad Tech A – Week 12

Patient Interview Role of Radiologic Technologist Elements of the Clinical History Vital Signs Oxygen Therapy Oxygen Devices Chest Tubes and Lines Patient Assessment &Vital Signs

RT’s Role in Clinical HX

Desirable Qualities for Establishing Open Dialogue • Respect • Genuineness • Empathy • Polite • Professional demeanor

Rad Tech’s Role in Clinical Hx • Extract as much information as possible- (Pertinent to the problem) • Radiologists often do not even speak with the patient. • Radiologist can be instructed to give special attention to the exact anatomic area where pain is focused.

PATIENT INTERVIEW • Radiologic Technologists Must Obtain Important Medical History. • Clinical History • Information available regarding a patient’s condition.

Chief Complaint • Focuses attention to the single most important issue. • Patients may have several complaints, but thorough history taking can reveal the main issue or why the patient is there for treatment.

Clinical Indication • Tech must collect a focused history specific to the procedure being performed. • Several elements comprise a “complete history”. • Sacred Seven…

Obtaining Good Information • Must be a cooperative event between patient and RT. • Establish an “open dialogue” • Respect, genuineness, and empathy • Maintain polite and professional demeanor during the interview • Document findings/information

Data Collection Process • Objective: Signs that can be seen ex: Bleed from an injury • Subjective: Perceived by the affected individual ex: Headache

Questioning Skills • Open-ended questions • Facilitation • Silence • Probing • Repetition • Rewording • Summarization

Leading Questions • This is an UNDESIRABLE method of questioning. • Introduces biases into the history. • Ex: Does the pain travel down your leg? • Vs. • Where does the pain start and where does it end?

Sacred Seven (p.128-129 RTA Book)) • Localization • Chronology (date of symtoms/event onset) • Quality – description of symptoms (burning) • Severity – light to intense (scaled) • Onset – how long • Aggravating or alleviating factors • Associated manifestations – other symptoms that may or may not be related

Role of the RT Qualities of the Interviewer Types of data collected for a good history Questioning Skills Sacred Seven Avoid Leading Questions REVIEW

VITAL SIGNS

Vital Signs • Body Temperature • Respiratory Rate • Pulse / Heart Rate • Blood Pressure

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 Vital Signs

Homeostasis • Our bodies are always trying to maintain HOMEOSTASIS – a constancy in the internal environment of the body, naturally maintained by adaptive responses that promote healthy survival. • Ex: sweating to cool body temperature

Body Temperature • The human body has an ideal temperature, and it works to maintain it, this is called: THERMOREGULATION • Ideal temperature: 98.6 degrees F (oral) • Acceptable range: 97.7 to 99.5 degrees F • Measurement: oral, axillary, tympanic, rectal

Normal average body temperature: 98.6 F Humans can survive between 106 F and 93.2 F. Hypothermia Fever, febrile Hyperthermia below normal range Measuring Body Temperature Oral Rectal Axillary Tympanic Body Temperature

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

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 • Persistent elevation of BP: Hypertension • Persistent low BP: Hypotension

Blood Pressure • Systolic pressure = 95-140 mmHg • Diastolic pressure = 60-90 mmHg • 120/ 80 Normal

Respiratory Rate • Respiratory System delivers oxygen to the body’s tissues & eliminates carbon dioxide. • Major muscle of ventilation: diaphragm • Measured in “breaths per minute” • Adults: 12 – 20 bpm • Children: 20 – 30 bpm • Newborns: 30 – 60 bpm

Respiratory Rate • Breaths per minute: Adult = 12 to 20 • Children under 10 = 20 to 30 per min • Dyspnea • Apnea

Pulse Oximeter • Normal PulseOximeter = 95% to 100%

Methods of Delivering Oxygen • Nasal Cannula • Masks • O2 Tent and Oxyhood • Ventilators

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.

Chest Tubes & LinesThe Rad Tech’s Role • Early detection of problems associated with malpositioned lines. • X-rays assist physicians in determining if tubes and lines are placed correctly • Correct positioning and technical exposure are crucial

Tubes & Lines cont’d • Endotracheal Tubes (ET tubes) – Known as “intubation” -translaryngeal -tracheostomy -nasotracheal • Must be precise in placement: 1-2 inches superior to the tracheal bifurcation (carina)

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

Tubes & Lines (last one) • Common insertion sites for CV lines: -subclavian vein -internal jugular vein -femoral vein • Most evaluated by a chest x-ray • Extreme caution must be used when positioning for images!

 Intubation of the rt main-stem bronchus with complete occlusion of the lt bronchus causing lt lung atelectasis.

(A) Distal tip of endotracheal tube in rt main bronchus; (B) Central venous catheter in the lt subclavian vein.

Rt hydrothorax caused by displacement of a central venous line during dressing change; 1300 ml of intravenous fluids were evacuated via thoracentesis.

Patient Assessment & Vital Signs