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Chapter 3- Essentials of Patient Care for the Sonographer
Terms in this set (104)
patient, profession, yourself
As a sonographer, you have 4 main obligations: to your _____, to your sonologist, department, or institution, to the _____, and to ______
Florence Nightingale advocated focusing on the patient, rather than the disease, as a way to recognize the many unique dimensions of the sick and wounded. Such focus is known as ________
the observable and measurable signs of life that include the following: pulse, respiratory rate, body temperature, and blood pressure.
Changes in ____ and medical condition can alter the normal vital sign ranges.
pulse, pulse, regularity
The _____ offers an easy and effective way to measure heart rate and is recorded as beats per minute (bpm). The beat of the _____ should be evaluated for rate, rhythm, and ______ as well as strength and tension
Normal adult pulse should be between ___ and ____ bpm
Any irregular heartbeat is termed an _____ or _______.
______ can be caused by strenuous exercise, strong emotions, fever, pain, coronary artery disease, electrolyte imbalances, changes in heart muscle, injury from a heart attack.
Among the most common arrhythmias are _____ and _______.
_______ is defined as a heart rate of more than 100bpm.
pulse, blood pressure
Sonographers are not routinely required to assess vital signs unless performing specific ultrasound studies (e.g. cardiovascular, obstetrical), or in an emergency situation. When they do, the focus is on the _____, respiration, and ______.
It is essential to take careful and accurate measurements of each of the vital signs, as well as to include observations about the patient's _______ and any comments patients make about how they feel or how they react while in your care.
When the heart actively pumps, blood is forced into large and small arteries during contractions of the left ventricle. The amount of force created when blood hits the arterial walls produces an advancing pressure wave that causes the arterial walls to expand. This expansion produces the feeling of a ______ that can be felt at any artery that passes over bone.
The arteries most commonly used for recording the pulse are the _____ and ____ arteries.
The pulse of women, children, and the elderly are slightly ______ than they are for adult males, whereas rates in athletes in good condition are slightly ____.
______ may be temporary, caused by exertion or nervousness, or it may be secondary to cardiac disease.
A heart beat of fewer than 60 bpm is _______ and may arise from disease in the heart's electrical conduction system.
Both sinus node dysfunction and heart block can cause a problem with pulse called ________.
In normal adults, the strength of the pulse should be full and strong, a factor that is influenced by arterial wall elasticity, blood volume, and the mechanical actions of the heart. If no abnormalities are detected, the pulse should be counted for ______ sec and then multiplied by ____.
When taking pulse, if irregularities are noted in the rate, rhythm, regularity, strength, or tension, the pulse should be counted for a full _____.
radial artery, thumb
When taking a pulse, first explain the procedure to the patient and then have the patient bend his elbow with his arm at his side, palm down. The _______ can be located by placing the index, middle, and ring fingers on the anterior surface of the thumb side of the patient's hand. Gentle pressure should be applied to avoid obstructing blood flow. Never use your ____ to take the patient's pulse, as the strong pulse within your own may be confused with that of the patient.
If the radial pulse is difficult to count, try the _____. To find it, place your fingers just below the angle of the patient's mandible.
______ is a convenient, noninvasive method of monitoring blood oxygen levels. For a variety of reasons, this information is useful in determining whether the lungs, heart, and blood are working synchronously to deliver oxygen to various parts of the body. A low blood oxygen level can be a sign of an illness or injury.
The pulse oximetry test is performed by using an oximeter, a specially designed photoelectric device that measures the difference between levels of the red pigment hemoglobin, which carries _______ in the blood.
The most commonly used oximeters are called pulse oximeters because they respond only to pulsations such as those of the pulsating ________ in the area to be tested.
The amount of oxygen in the blood is given as a percentage. A normal reading for a person breathing room air is in the high ____.
The oximeter acts purely as an indicator that something somewhere is interfering with the ________ of blood levels and that further investigation is required.
When performing the pulse oximetry test, the patient's hand should be positioned at _______ level to eliminate venous pulsations and to promote accurate readings.
blood pressure, heart
A pulse oximetry test may not be accurate in certain conditions such as when a patient has very low ______ or very poor ____ function, or with conditions that can change heart color.
The patient's wearing of nail polish
Improper positioning of the probe
Excessive movement by the patient
Hypothermia or cold injury to the extremities
Chronic obstructive pulmonary disease
Shock associated with blood loss or poor perfusion can lead to a lower than expected _______ reading.
______, or breathing, is the process of inhaling and exhaling air. Its primary function is to obtain oxygen for use by the body's cells and to eliminate the cells' production of carbon dioxide.
Normal breathing is quiet, effortless, and has a regular rhythm. In an adult at rest, respiration occurs at a rate of ____ to ____ breaths per minute.
When assessing a patient's respiratory rate, the rhythm, ____, and character of the respiration must also be noted.
______ is a shortness of breath or feeling of not getting enough air, which may leave a person gasping.
_____ is breathing that stops spontaneously for any reason. It may be temporary, starting and stopping at intervals, or prolonged.
To count respirations, note the number of inhalations per minute. This is also done while continuing to hold the patient's wrist after the _____ has been counted
______ is hard breathing with a whistling or high-pitched sound, resulting from constriction, or obstruction of the breathing tubes
_______ is rapid breathing in excess of body requirements. Such breathing results in an excessive loss of carbon dioxide from the body.
______ is a life-threatening stoppage of breathing that requires emergency medical assistance. It is caused either by excessive loss of oxygen or by an increase of excessive carbon dioxide in the blood.
blood pressure, decreases
______ is the pressure exerted by circulating blood against the walls of the blood vessels. As blood travels away from the heart, the pressure of the circulating blood ______, spreading through the arteries and capillaries, and back toward the heart through the veins.
Blood pressure usually refers to the ______ pressure in the major blood vessel of the upper arm.
The manual measurement of blood pressure is usually performed with a ______, blood pressure cuff, and stethoscope.
mm of Hg
The sphygmomanometer measure blood pressure in units called ______.
The ________ blood pressure occurs when the ventricles contract to pump blood to the body. The ______ pressure occurs near the end of the cardiac cycle when the ventricles are filling with blood.
True or false: When taking a patient's blood pressure, both feet don't necessarily have to be flat on the floor.
The cuff needs to go about ____ inch above the elbow when taking blood pressure.
True or false: When taking a patient's blood pressure, you should be able to place one finger under a cuff that is tightened correctly.
True or false: When taking blood pressure, position the patient's arm, placing it on a table, desk, or the bedside.
When taking blood pressure, choose a stethoscope with a flat style _____. Place the stethoscope earpieces into your ears; then feel for the brachial artery pulsation (usually found at the crease of the elbow) and place the diaphragm there
200, systolic, diastolic
When taking blood pressure:
Squeezing the balloon, rapidly inflate the cuff to about _____ mmHg, or until no sound is heard. If you inflate too slowly, you will get a false reading.
Loosen the valve slowly (no faster than 5 mmHg/sec) to let some of the air out and listen for the first heart beat. Check the position of the pointer of the dial. This first sound is the ______ reading.
Continue deflating the cuff slowly. Check the positing of the pointer for the diastolic number. The last audible sound is the ______ reading.
Release the cuff and record both readings as a fraction.
Always use blood pressure cuffs that are correctly sized for the patient. Cuffs that are too small may yield readings 10 to 50 mmHg too _____, falsely indicating ______.
On occasion, blood pressure may be measured in the main artery of the _____. The ratio of the blood pressure measured at the ankle- to the brachial blood pressure- gives the ankle brachial pressure index (ABPI)
______ is defined as 140 mmHg or greater over 90 mmHg or greater.
_____ is defined as 130-139 mmHg over 80-89 mmHg
isolated systolic hypertension
_______ exists when the systolic pressure is above 140 mmHg but the diastolic pressure is still below 90 mmHg.
isolated systolic hypertension
________ primarily affects older people and is characterized by an increased pulse pressure.
_________ is the difference between the systolic and diastolic blood pressures.
isolated systolic hypertension
Hardening of the arteries contributes to the pulse pressures associated with ________.
Previously thought to be harmless, a high _____ is now considered a precursor of health problems and potential end-organ damage. Patients with this type of hypertension have a 2 to 4 times greater risk for enlarged heart, heart attack, and stroke.
Blood pressure that falls too far below 90/60 is considered to be ______.
True or false: Blood pressure readings can be affected by a variety of factors, including cardiovascular disorders, neurologic conditions, kidney and urologic disorders, obesity, and some medications
_____ bedpans have a flat lip in the front that makes them easy to slide under a patient who has problems lifting the pelvis for bedpan placement. A regular bedpan is somewhat larger and deeper with a rounded lip designed to support the buttocks.
True or false: When helping female patients with a bedpan, the upper torso needs to be slightly elevated to prevent urine from running up the patient's back.
When assisting male patients with a bedpan:
1. Don protective gloves
2. Spread the patients' legs, lifting the sheet with one hand and sliding the penis into the urinal with the other. It may be necessary to hold the urinal in position until the patient has finished.
3. Always check the chart before emptying the bedpans or urinals to see if there is an order for _________ or if urinary intake and output need to be measured.
______ are kidney-shaped containers that are used to collect vomit. Check the chart for any orders to collect emesis for laboratory study.
The practice of giving liquid substances directly into a vein is called _______. This is the fastest way to deliver fluids and medications.
IV therapy is often used to correct _____ or electrolyte imbalances or to deliver medications or blood transfusions.
Fluids can be administered intermittently or continuously, with the continuous method called an ______.
The chief components of a standard IV infusion set include
1. a prefilled, sterile plastic bag (or glass container) of fluids
2. an attached drip chamber that makes it easy to see the rate of flow, and allows the fluid to flow one drop at a time.
3. A long, sterile tube with a clamp that leads from the drip chamber to the insertion site of the IV.
(The ________ regulates or stops the flow)
4. The IV line is attached to a short _______ that is inserted into a peripheral vein.
For adult patients receiving IV therapy, arms and hand veins are commonly used. For infants, the _____ veins are sometimes used.
Patients who are receiving IV fluids may come to the ultrasound department with either a standard IV set or possibly an electronic flow regulator in place. Once the patient is transferred to the scanning table, it is important to make sure that the height of the IV fluid container is ____ to ____ cm above the level of the patient's vein.
An IV placed too high may cause too rapid a flow rate and fluid may ______ into surrounding tissues. Conversely, if the container is placed too low, blood may flow back into the catheter or tubing and may clot, causing the fluid to stop flowing.
If the IV needle is accidentally dislodged, the IV fluid may enter the surrounding tissue rather than the vein. The patient may complain of discomfort, and you may observe swelling (edema) of the tissues around the injection site. _____ off the flow and notify the nursing staff for instructions and to determine if you should continue the study.
________ (electronic flow regulators) are often used for patient-controlled pain medications, parenteral nutrition, and the continuous administration of medication. They will emit a warning sound when the solution is low, the flow is interrupted, or when the battery power of the pump is too weak. Avoid the temptation to rush the study, but notify the nursing staff immediate.y
nasogastric tube, nasogastric tube
A ________ is a flexible tube made of rubber or plastic. It is passed through the nose and down through the nasopharynx and esophagus into the stomach to 1) remove contents of the stomach, including air 2) decompress the stomach and 3) remove small objects or fluid, such as poison from the stomach. A ______ can also be used to instill medications and put substances such as nutrients directly into the stomach when a patient cannot take food or drink by mouth.
remove, decompress, remove
A nasogastric tube can be used to
1. ______ the contents of the stomach, including air
2. _______ the stomach
3. ____ small objects or fluid, such as poison
If used for drainage, the NG tube is usually attached to a collector bag ____ the level of the patient's stomach, thus using gravity to empty the stomach contents.
pull, leaks, raise, open, increases
With patients using an NG tube, remember:
1. never ____ on the tube when moving the patient
2. Check for _____ in both the NG tube and suction equipment. If found, report.
3. Never ____ or _____ the drainage bottle
4. If the amount of material being suctioned rapidly _____, report it immediately
5. If the patient begins to gag or vomit while the tube is in place, report it immediately
Urinary ______ are used for removing fluids from the body. They are thin, sterile tubes that are inserted into the bladder as a way to manage urinary incontinence, urinary retention, to collect sterile fluid for laboratory diagnosis, and to fill the bladder prior to imaging studies.
The most commonly used catheter is the _____, a flexible latex tube that has openings in the tip and below the opening; the tubing inflates on demand like a small balloon. Once in place, the balloon is inflated with sterile water to effectively occlude the cervix of the bladder where the urethra begins.
When catheterized patients are transferred from wheelchairs or stretchers to the scanning table, the collecting bag must be held ______ the level of the patient's bladder.
Because it can be left in the bladder for a long period of time, the Foley catheter is also known as an ______ catheter.
oxygen therapy, oxygen
________ is an essential treatment for many conditions. Its primary purpose is to decrease the work of breathing for patients experiencing respiratory difficulties. ______ should be treated as a drug whose dosage or concentration is ordered by a physician.
Oxygen systems consist of three main parts
2) a breathing mask or ______
3) connecting tube
pressure gauge, flow meter, humidifier bottle
Oxygen tanks have different parts:
A ______ to show how much oxygen is left in the tank
A ______ to control the rate of oxygen coming out of the tank
A _______, where water is mixed with oxygen and the oxygen is warmed before the delivery to prevent the membranes of the patient's nose, mouth, and throat from becoming too dry
transport, secure, smoke, alcohol
Whether patients come to the ultrasound department with a tank or cylinder, or will be using in-wall systems, there are special safety precautions to follow:
1. Do not ______ any oxygen tank unless it is secured to a tank/cylinder cart
2. _______ the tank in an upright position and away from heat sources because of the risk of combustion. This includes electrical equipment such as heating pads and radios
3. No one should ______ where oxygen is being used
4. Any combustible material, such as _____, perfumes, and propane must be kept away from oxygen tanks
5. Do not place a cylinder beside a patient when transporting the patient by stretcher
Delivery of oxygen to the patient requires tubing connected to the oxygen source on one end and attached at the other end to a patient's mask, ______, or a tent
________ are usually used to deliver low-to-medium concentrations of oxygen in situations when precise accuracy is not required. The patient-end of the ______ is placed into each of the patient's nostrils and held in place by an elastic band around the patient's head.
A _______ is a piece of tubing that is longer than a cannula. It is inserted into the nostril and into the back of the patient's mouth. This method provides more effective oxygen delivery and is used when the patient must have additional oxygen at all times. This is fastened to the patient's forehead or cheek by a piece of adhesive tape to hold steady, and must be long enough to allow the patient to move around comfortable
simple mask, reservoir mask, partial re-breather, non-rebreather
There are a variety of oxygen masks for delivering oxygen to patients with specific needs. The ______ is used to provide short-term therapy, and delivers both oxygen and humidity. The _______ is a low-flow device identified by the presence of a bag, which much remain constantly inflated by one third. The _______ mask delivers oxygen concentrations of 40-60%, having openings in the mask allowing the patient to inhale room air if the oxygen source fails. The _______ mask delivers the highest possible oxygen concentration 60-90% because the patient only breathes air from the bag. It is effective for short term therapy.
Sonographers should especially note the level of inflation on the _______ mask, because if the bag completely deflates, the patient no longer has a source of air to breathe
The ______ mask is a high-flow mask designed to administer precisely controlled low oxygen concentrations, but with variable air flow to produce a constant oxygen concentration regardless of breathing rate. It is identified by the presence of a hard plastic adapter with large windows on either side.
fire, flow meter
The following precautions should be observed when working with patients receiving oxygen therapy:
1. Observe all _____ regulations in effect at your institution
2. Check the _____ to be sure that oxygen is being delivered to the patient
3. Be sure the tubing connected to the oxygen source is taped to the patient to help keep it from accidentally being pulled when moving the patient
4. Make sure the patient is not lying on the tubing or that it is not kinked.
5. In most hospitals, inhalation therapy or respiratory therapy departments are responsible for their patient's treatment. They should be called to make any adjustments after checking with the patient's physician or nurse
sterile gel, sterile gel
If a patient with a wound is in need of an ultrasound and the wound is situated within the scanning field, sterile technique is required to scan over the open wound
1. Apply gloves
2. Apply _______ to the would area and cover it with thin plastic film
3. Next, place more ______ over the film to create an airless contact between transducer and the wound area
_______ are sometimes created for patients with certain health conditions or diseases. As a result of these, a stoma is apparent, which is a small hole surround by a ring of mucosal tissue.
If your department schedules ostomy patients, it is a good idea to keep a small supply of the following items on hand:
1. new bags
2. plastic bags for disposal
3. closure clamps
4. water or bag-cleaning solution
5. washcloths and towels
6. toilet or ________
8. facial tissues
9. paper tape
The term ______ refers to using the correct muscles to complete a task safely, efficiently, and without undue strain to any joints or muscles
center of gravity, base of support, close, tuck, abdomen, up, in
The basic principles of body mechanics require the following:
1. Maintaining a stable ______ by by keeping it low, your back straight, and bedding at the hips and knees
2. Maintaining a strong ______ by keeping feet apart, placing one foot slightly ahead of the other with toes pointed in the direction of the activity, then flexing your knees to absorb jolts and turing with your feet, instead of your hips
3. Maintaining a center of gravity by keeping your back straight and keeping objects being lifted _____ to your body
4. Maintaining proper body alignment through good posture: _____ buttocks, pull _____ in and up, keep back flat, your head_____, and chin _____ as you keep your weight forward and supported on the outside of your feet
Lifting should be done with strong _____ muscles, not the back.
_______ are the basic infection-control guidelines used to reduce the risks of infection spread through the following three transmission modes: airborne infection, droplet infection, and contact infection
hand washing, barriers, disposal
The most important weapon against the spread of infection is proper ______, followed by the use of _____ (gloves, gowns, and masks) and he proper handling and _____ of infectious waste materials.
You should wash your hands any time you come into contact with:
All body fluids except ______
Dried blood and dried body fluids
Hospital-acquired infections are known as ________ infections. Contracted as a result of medical treatment, they usually manifest within the first 48 hours of treatment. The most common are UTI, pneumonia, and surgical incision site infections.
_________ established new standards for the uses of health care information. It created three types of standards: privacy, security, and administrative simplification.
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