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how can information about a patient's condition be obtained?
- History and pysical examination
- Diagnostic imaging
- Laboratory findings
- Electrodiagnotic studies
- Pulmonary dignosis
- Plethysmography and phleborheography
What is the first step in determining the etiology of a patient's conditon?
Gathering medical, social (including any ethnic and/or religious information that may impact the course of treatment), and psychological information about the patient and, if applicabel, the patient's family.
how is the etiology of a patient's condiion generally achieved?
in a personal interview with the patient or some other responsible party if the patient is unable to respond as a result of age or condition.
What are seveal tools and methods available to the physicain to facilitate the physical exam?
- Direct visualization
- Enhanced visualization (otoscope/ophthalmoscope)
- Indirect visualization (pharyngeal mirror)
- Palpation external (abdominal or thyroid) and/or internal (pelvi exam or digital rectal exam)
- Auscultation (stethoscope)
A term that refers to the various techniques now available for producing images of the human body.
What was the historically predominant imaging technique available.
Radiograph or X-ray
Remains a viable source of diagnostic information
Radiography, or roentgenography
Penetrability of the X-ray beam is relate to the unit of energy called what measured in what, the standard unit of an absorbed dose of ionizing radiation
- rads (radiation absorbed dosage)
Preoperative plain radiographic films of the ches are fequently ordere by whom for identification of lung abnormalitis that may interfere with the exchange of gases during aneshesia
plain radiographic films from a fixed X-ray tube or portable X-ray machines are used for what?
- identify the location of abnormalities and foreign bodies
- locate retained sponges, sharps, or instruents
- Discover fluid or air witin body cavities
- verify the correct location for an operative procedure
- aid in bone realignment and prosthesis placement
- verify placement of indwlling catheters, tubes, and drains
radiographic views require that the film be placed underneath the pt. are what?
_____ demand placement next to the body.
- Anterior/posterior (AP)
- lateral views
What is the primary goalof the STSR during intraoperative radiography?
To protect the sterile field from contamination
why may the tube itself may be covered with a sterie drape or the wound may be proteced with a sterile towel.
if the X-ray tube is to be positined over the operative field
utilizes X-rays to locate tumors of the breast intheir early stages.
Can be performed in conjunction witha needle aspiration biopsy during which a very fine, long needle my be used to biopsy a tumor after it is localized
Used to evaluate the spine for patients with neck, back, or leg pain
as largely replace the myelography technique, but it may still be used in some cases
Magnetic resonance imaging (MRI)
Utilizes X-rays to project images of body structures onto a monitor
Fluoroscope images may be viewed durig movement and projected in __________ allowing the action of joints and organs to be viewed directly
The portable image intensifier is referred to as the ______ because of its configuration
frequently used in conjunction with a special radiographic table that allows X-rays to pass through the tabletop, referred to as being radiolucent
Fluoroscopy has many intraoperative applications
- Angiography (including cardiac catheterization)
- Retrograde urography
- Aid in bone realigment and prosthesis placement
- verification of catheter placement (epicural/central venous pressure) and lead (pacmaker) introduction
- to direct instrumentation (neurosurgery/orthopedics)
Remains the reference standardfor assessing the caue and severity of peripheral vascular disease.
an invasive procedure that must be accoplished under sterile conditions
What is the essental equipment for angiography
X-ray unit thatis capable of making both fluoroscopic (recorded on videotape) and still pictures, film changers for still shots, pressure injectors, contrast media, catheters, guidewires, and needle/cannula assemblies
Allows tracking of the course of the injected contrast medium as it travels through the portion of the arterial or venous system being studied.
useful fr areas of nonslective angiography where large amounts of contrast solution must be injected quickly
a pressure injector
As defined in radiology, is the difference in optical density in a radiograph that results from a difference in radiocency or penetrailty of an oject.
the brand name reflects what?
the area of intended use
The steps of the ercutaneous intra-arterial catheter placement described by Seldinger and called teh seldinger technique
- 1. The skin and subcutaneous tissues in the femoral region are injected with Xylcaine 1%
- 2. A small incision is mad witha #11 knife blade.
- 3. Subcutaneous tissues are spread with a hemostat for fee passage of the catheter and guidewire.
- 4. needle/cannula is than inserted into the femoral artery at an angle of 45-60 degree
- 5. stylet is gently and slowly withdrawn until blood spurts forcefully from the proximal end o the cannula
- 6. guidewire is then inserted through the cannula and into the artery.
- 7. cannula is removed over the guidewire and, while pressure is aaplied t the puncture site, thecatheter is threaded over the guidewire and into the artery.
- 8. the tip of the guidewire protruding from the distal end, the catheter is positioned at the proper level under luoroscoph, and the guidewire is removed.
- the catheter is then flushed with heparinized sailine.
- contrast material is injected and X-rays are taken
permits teh evaluation of eart function,visualization of coronary arteries and cardiac chambers I(especially the left ventricle), andthe measurement of pressures within the cardiac chambers.
cardiac catheterization is used to diagnose what
coronary artey, valvular, pulmonary, and congenital heart disease.
what is included in left heart studies?
left ventriculogram, coronary artery arteriogram, and measurement of left ventricular pressures.
refers to the percentage of blood that is pumped out of a filled ventricle with each heartbeat.
Right heart studies are accomplished with the aid of a __________
balloon-tipped, swan-ganz pulmonary arery catheter attached to a transducer and monitor.
As a diagnostic tool properaively, and intraoperatively during cholecystectomy or common bile duct exploration, a catheter cn be inserte and contrat medium injected into the biliary system to outline calculi or other obstructions under fluoroscopy
the use of a specialized X-ray machine that produces pictues of a body part in "slices" for evaluation by a radiologist
Computed axial tomography (CT or CAT scan)
The CT scan uses ________ to create an image for approximately 4,000 different tissue densities that are sorted into 16 different groups.
The detailed cross sections of the CT scan are useful for dtection and examination of ______ within the body
CT scanning is better than MRI for emergencies related to the ____ because it is faster and better able to detect _________.
also useful for the dtection of ____ _____ and can be used with contrast for the dtection of tumors and infection.
Combines CT and radioisotope brain scanning
Positron emission tomography (PET scanning)
PET scanning helps to ientify how different areas of the brain function by _______ or _____
highlightingchemical or metabolic activity
Uses two different forms of energy to create an image
Magnetic resonance imaging (MRI)
MRI uses these radio waves in a strong magnetic field to form pictures of _______
parts of teh body in slices
MRI is especially good for imaging ________ so it is often used for the evaluation of
- soft tissue
- brain disordrs and for providing images of a herniated diskand its realtionship to the spinal cord
high-frequency sound waves are directed into the body and reflected from the tissues t a recording device for diagnostic purposes.
a useful diagnostic tool for examination of the heart and abdominopelvic cavity. also useful fo identifying carotid artery stenosis.
a noninvasive study that provides a twodimensional image of the heart by directing beams of ultrasonic waves from a sonar-like device throught the chest wall
A slightly mor invasive procedure, involves the introduction of a transduer attached to the end of a gastroscope into the esophagus, bringing the probe into closer approximationwith the heart.
transesophageal echcardiography (TEE)
used in the OR to determine the patency of arterial anastomosis
sometimes referred to as a a nuclear medicine study or radionuclide imaging, involves the intravenous injection of a radioactive isotope into the patient prior to the imaging study
Collections of isotopes in a certain area are referred to as a ________ and may indicate the presence of a pathologic condition.
A bone scan is an example of an
Radiation kills cells by interfering with their _____
ued in predetermined doses to treat specific types of neoplasms that are susceptible to radiation by exposure of the radation source
drawn from the patient for visual or computerized examination in the laboratory setting
venous or arterial blood
vary according to the type of test to be performed
involves cleaning the urnary meatus prior to voiding and "catching" the sample midstream into a sterile collection device.
obtained under sterile conditins and placed in a sterile specien container
entire sample tested for electrolytes and nitrogenous wastes
the excision of tissue or aspiration of flui to determine the nature of the disease or for treatment of a condition is called _______
the tissue or fluid is referred to as ______
Red blood cell (RBC) count
- 13.5-18 g/dL
- 11.5-15.5 g/dL
How must the STSR pass off the specimen
in a sterile manner to the circulator
Should a counted sponge be used for passig off and transporting? Why if not what should be
No it can be passed off on a Telfa pad or in the appropriate container
the removal of fluid through a needle attached to a syringe
entails the removal of a porton of the tissue mas or lesion for pathological study
Formalin or normal saline will alter what type of biopsy
are placed in a preservative such as formaln
Tissue or fluid that is suspected of being infected may be cultured so that the pathogen can be identified and treated
Culture and sensitivity
remains a valuable tool n dentifying bacteria
Bacteria that retain the blue dye are called ______ and those that fade to pink are ___
- gram positive
- gram negative
withdrawn ("tapped") from the lumbar area of the spinal column for analysis
Cerebrospinal fluid (CSF)
involves the placement of a needle into a posterior porion of the pleural space for the analysis of pleural effusion
a valuable tool for the detection and evaluation of all forms of heart disease, especially myocardial infarction
performed byplacing a number of electrodes in predetermined locations on the skin of the arms, les, and torso to record the electical activity of the heart
allows for 24-hour monitoring for asymptomatic and symptomatic dysrhythmias.
a display and recording of the electrical activity of the brain by measurement of changes in electric potentials.
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