Principles of Patient Care

CHAPTER 7


Principles of Patient Care



CHAPTER OBJECTIVES


After completing this chapter, the reader will be able to perform the following:


image Identify the general principles for all special studies


image Identify the need for strict confidentiality


image List and describe the components of the patient preexamination and history


image Identify the need for pharmacologic awareness


image Identify the need and describe the process for obtaining an informed consent


image Identify the need for preprocedure equipment preparation


image Describe the need and process for proper documentation


image Describe the process of patient instruction


image Describe the patient’s preprocedural, intraprocedural, and postprocedural care


image Define contrast material administration and filming


image Identify the risks associated with the catheterization procedure


image Identify the requirements for patient discharge


The discussion of patient care in this chapter will be limited specifically to patient care throughout the procedure. Sterile techniques such as gloving, gowning, and sterile field maintenance will not be revisited. This material is presented in depth in several radiography reference texts and should already be well known and practiced by the advanced radiographer. These texts have been referenced in the bibliography at the end of the chapter. The intent of this chapter is to present the responsibilities of the radiographer to the patient before, during, and after the procedure.


Advanced level radiography is becoming increasingly complex. The radiographer is an integral member of the angiographic or interventional team having additional responsibility for the process and the patient. The additional responsibilities include some of the activities that were designated to the nursing staff assisting at the study. These additional responsibilities also make the individual more vulnerable to litigation. Attention to three major areas can provide protection for the advanced practitioner: knowledge, careful attention to details, and documentation.


The knowledge needed includes not only the equipment and the procedure but also pharmacology and some basic nursing procedures. Much of this knowledge will be learned during the training process; however, it is incumbent upon the radiographer to practice these skills and constantly strive to improve them.


The importance of careful attention to details cannot be stressed enough. Subtle changes in the patient throughout and after the procedure can be indicators that, if noticed promptly, could enable the radiographer to short circuit a major reaction or side effect. This attention to detail should also extend into the familiar realm of equipment preparation and care. Regular maintenance of a quality assurance program and consistently following a routine check-off procedure can eliminate most equipment failure problems. The check-off procedure is also a valuable tool for minimizing equipment-related patient injury.


Finally, documentation demonstrates that the individual has exhibited professionalism. Properly done, documentation provides an accurate record of the particulars of the procedure and the actions of the radiographer. It indicates a responsibility for performing at a high standard of patient care. Documentation also can provide the advanced level practitioner with an excellent defense during subsequent litigation.



GENERAL PRINCIPLES


All advanced radiographic studies, diagnostic and interventional, are performed following the same general procedure:



In this chapter, we consider the basic principles of patient care common to all angiographic procedures. There may be some variations during the clinical performance of the examinations owing to differing hospital and departmental protocols; however, every angiographic examination should include all of the elements listed here.



Confidentiality


The passage of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its subsequent revisions in 2001 and 2002 changed the way that health care providers treat patient information. The privacy and security aspects of the act were implemented in 2003 and regulated electronic transaction standards, privacy standards, security standards, and the use of unique identifiers to protect patient information. Most of the regulations do not affect the operations of advanced procedures and would not necessarily impact on daily practice. The privacy standards, however, should be understood so that inadvertent violations to the act will not occur. The protected information would include any information that includes the patient’s name, birth date, medical record number, or any indicator that could identify the information as belonging to a particular individual.


Initially, the patient must be made aware of the institution’s privacy policy. This is usually done in the admitting office, and patients generally are required to sign that they received and understood the policy.


Family members usually accompany the patient to the institution for the procedure. They are usually anxious to speak with the health care practitioner regarding the outcome of the procedure and the status of the patient’s treatment. The patient must authorize any communication with family members regarding the patient’s health status before any information is disclosed by the health professional. In any case the act states that the amount of information given should be limited to the minimum necessary for the situation.


The advanced procedure team must have safeguards in place to protect the patient’s information. The safeguards should include the security of the patient’s chart, which should be stored away from any public access area. Protection of the patient’s rights also pertains to any public display of the patient’s radiographs or digital images. Conversations among members of the advanced procedures team must always be carried out in a secure manner. These conversations should be made in a private location, and reasonable measures should be taken so as not to be heard.


Both intentional and unintentional violations of the HIPAA regulations can result in either criminal or civil penalties. The criminal penalties include a monetary fine up to $250,000 and a prison term of up to 10 years. Civil violations carry a monetary fine of $25,000 per violation.



Preexamination History and Consultation


Depending upon the situation, a consultation with the physician prior to the day of the procedure should provide the patient with the indications, aims, nature, and risks of the study. Angiography can be performed on an inpatient basis or on an outpatient basis through ambulatory surgery. At times the physician performing the study will meet with the patient on the day of the procedure.


During this meeting the procedure should be clearly explained, and any potential therapeutic interventions should be discussed as well. A short history of the patient is taken to determine what symptoms or signs warranted the procedure, and previous surgery should be discussed along with a review of the patient’s organ systems, current medications, chronic illnesses, and allergies that could potentially provoke any reactions to the contrast agent. The physician should also perform a physical examination to assess the proposed puncture site to determine any contraindications for vessel access. Depending on the access site, the physician should physically check the following parameters. In the case of femoral access lower extremity pulses and the physical appearance of the limbs should be examined and noted. When the brachial artery approach is chosen, proximal and distal pulses should be taken.


The patient’s chart should also be assessed to review any previous examinations as well as to review the patient’s blood work. Although there are no hard and fast rules as to the type of blood work that is necessary, if any, this part of the preprocedure history may be moot. Depending upon the patient, the procedure, and hospital or physician protocol, possible blood work could include any combination of the following tests: hemoglobin and hematocrit, blood urea nitrogen (BUN), creatinine, prothrombin time (PT), platelet count, international normalized ratio (INR), and activated partial thromboplastin time (aPTT). The results should be reviewed and pertinent information should be noted on the patient’s chart, such as the status of the patient’s renal function, bleeding tendency, and whether there have been previous reactions to contrast agents. Box 7-1 lists the normal values for a variety of laboratory tests.



BOX 7-1   Normal Adult Laboratory Values

























































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Feb 27, 2016 | Posted by in GENERAL RADIOLOGY | Comments Off on Principles of Patient Care

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LABORATORY TEST NORMAL VALUES
Chemistry
Bilirubin (total) 0.1–1.0 mg/dl
Bilirubin (direct) 0.3 mg/dl
Blood urea nitrogen (BUN) 10–22 mg/dl
Creatinine
  Female 0.6–1.3 mg/dl
  Male 0.8–1.5 mg/dl
Potassium 3.6–5.0 mEq/L
Sodium 139–147 mEq/L
Alkaline phosphatase 16–95 IU/L
Hematology
Hematocrit
  Female 37%–47%
  Male 42%–52%
Hemoglobin
  Female 12–16 g/L