Patient Preparation

• NP and PA


  Can order diagnostic tests
• CPOE


  Computerized Physician Order Entry

  
• PROTOCOL SELECTION

  1. Review each CT request

  2. Consider the patient's medical history

  3. Assign a specific protocol
• ROOM PREPARATION

  Scanner calibration and tube-warm up procedures
• Questions on the CT history form seek to achieve

  • Patient safety
  • Correct selection of protocol
  • Providing information useful for interpreting the examination
• PATIENT SAFETY questions


  • About renal impairments
  • About previous allergies
  • About thyroid conditions
  • Childbearing age
• PROTOCOL SELECTION


  • Electronic health records
  • Information obtained from the patient is usually determined once he/she arrives in the department
• Many diseases or conditions have similar findings on CT images
• Laboratory Tests


  • Blood urea nitrogen (BUN)
  • Serum Creatinine
  • Prothrombin Time (PT)
  • Partial Thromboplastin time(PTT)
  • Platelet Count
• Blood urea nitrogen (BUN)

  Indicates Renal Function
• Serum Creatinine


  Indicates Renal Function
• Prothrombin Time (PT), Partial Thromboplastin time(PTT), Platelet Count

  Indicate Blood coagulation ability

  
• Many conditions (e.g. stroke, heart disease) are treated with medications that inhibit coagulation
• PATIENT EDUCATION AND INFORMED CONSENT

  • How the procedure is carried out
  • Approximate length of the procedure
  • Whether contrast agents will be administered (administration and potential side effects)
  • What is expected of the patient
  • Any follow-up necessary after examination has been completed
• A complete informed consent includes the discussion of

  • The nature of the procedure
  • Reasonable alternatives to the proposed intervention
  • The relevant risks, benefits, and uncertainties related to each alternative
  • Assessment of the patient's understanding
  • The acceptance of the intervention by the patient
• In the case of CT examinations of a more invasive nature (biopsies), there is a universal agreement that there is a need of a signed consent
• IMMOBILIZATION AND PATIENT RESTRAINT DEVICES

  • Allows as much mobility as is safely possible
  • Areas of the body to which immobilizers are applied must be padded to prevent injury to the skin beneath the device
  • Normal anatomic position must be maintained
  • Knots that will become tighter with movement are prohibited
  • The immobilizer must be easy to remove quickly if necessary
  • Neither circulation nor respiration must be impaired by the immobilizers
• If leg immobilizers are necessary, wrist immobilizers must also be applied to prevent the patient from either unfastening the device or in an attempt to leave the table/gurney, unintentionally hanging themselves
• Best early indicators of a problem are changes in

  • Body temperature
  • Pulse
  • Respirations
  • Blood pressure
• Other important indicators include

  • Pain
  • Pulse oximetry values (indicates blood oxygenation)
  • Pupil size, equality, and reactivity
• Body temperature is often taken by placing the thermometer in the

  • Tympanic thermometers (also with disposable protective sheaths)
  • Single-use chemical strip thermometers (e.g. 3M Tempa-Dot)
  • Mercury-free glass thermometer
• Oral, rectal and tympanic are higher than axillary measurements because the measuring device is in contact with the mucous membrane
• Average and normal range of body temperature by route

  • Oral: 98.7 degrees F (37.0 degrees C), 96.8 to 100.4 degrees F (36.0 to 38.0 degrees C)
  • Rectal: 99.1 degrees F (37.7 degrees C), 97.2 to 100.8 degrees F (36.7 to 38.7 degrees C)
  • Axillary: 97.7 degrees F (36.4 degrees C), 95.8 to 99.4 degrees F (35.4 to 37.4 degrees C)
  • Tympanic: Calibrated to oral or rectal scales
• Specific locations where the pulse is most easily felt

  • Temporal pulse (superficial temporal artery)
  • Facial pulse (facial artery)
  • Carotid pulse (carotid artery)
  • Radial pulse (radial artery)
  • Brachial pulse (brachial artery)
  • Femoral pulse (femoral artery)
  • Popliteal pulse (popliteal artery)
  • Pedal pulse (tibialis posterior artery)
  • Pedal pulse (dorsalis pedis artery)
• Respiratory rate by age

  • Adult: 14 to 20
  • Adolescent youth: 18 to 22
  • Children: 22 to 28
  • Infants: 30 or greater
• Blood pressure


  • Pressure exerted by circulating blood on the walls of the vessels
  • Generally refers to the arterial pressure (pressure measures in the larger arteries)
  • Continually changing depending on : activity, temperature, diet, emotional state, posture, physical state and medications used
  • Systolic pressure: peak pressure in the arteries; occurs near the beginning of the cardiac cycle
  • Diastolic pressure: Heart's resting phase; arterial pressure is the lowest
• Healthy adult blood pressure

  • 120 mm Hg/80 mm Hg
• Hypertension


  Blood pressure that is abnormally high; opposite of hypotension
• Normal blood pressure ranges

  • Adults: Systolic (90 to 140 mm Hg), Diastolic (60 to 90 mm Hg)
  • Children: Systolic (65 to 130 mm Hg), Diastolic (45 to 85 mm Hg)
• SUMMARY OF STEPS


  • 1.) Prepare room
  • 2.) Verify order
  • 3.) Verify patient identity
  • 4.) Obtain medical history
  • 5.) Explain examination and obtain consent
  • 6.) Continually assess patient
• Clinicians who may order diagnostic tests

  • Nursing Practitioners (NP)
  • Physician Assistants (PA)
• Different Laboratory Tests

  • Blood urea nitrogen (BUN)
  • Serum Creatinine
  • Prothrombin Time (PT)
  • Partial Thromboplastin Time(PTT)
  • Platelet Count
• Blood Urea Nitrogen (BUN) normal range

  7-25 mg/dL
• Serum Creatinine normal range

  0.6-1.7 mg/dL
• Prothrombin Time (PT) normal range

  11-14 seconds
• Partial Thromboplastin Time (PTT) normal range

  25-35 seconds
• Platelet Count normal range

  150000 - 400000 mm3
• Should attempt to answer the clinical question(s) posed with the least risk to the patient.

  Protocol selection
• ASSESSMENT AND MONITORING VITAL SIGNS

  • Technologists should begin to assess the patient when they first introduce themselves.
  • Important to notice: patient’s breathing, skin discoloration, and overall health before the patient lies on the CT table
• The best early indicators of a physiologic change in a

  patient.

  Vital Signs