CHAPTER 29 being required to answer for one’s actions. a legal document describing one’s health-care wishes if one is unable to communicate them. Agency for Healthcare Research and Quality (AHRQ) the right to make one’s own independent decisions. bringing about good by maximizing benefits and minimizing possible harm. the moral code, which guides professional conduct of duties and obligations. a powerful solution used to disinfect transducers. medical specialty concerning the reproductive system of the nongravid uterus. Health Insurance Portability and Accountability Act (HIPAA) federal agency overseeing many health-care functions, the primary being patient confidentiality. adherence to moral and ethical principles. the protection of cherished values that relate to how persons interact and live in peace. medical specialty concerning the reproductive system of the gravid uterus. new standard describing patient’s health-care rights. • Previously termed universal precautions. • Precautions compiled by the Centers for Disease Control and Prevention (CDC) and other federal agencies. • To provide safety to both the patient and caregiver. • Sonographer–patient interaction is unique. • Communication skills are an important aspect of the sonography profession. • Keeping the patient relaxed and comfortable is the responsibility of the system operator. Patient–Sonographer Interaction • The referring clinician or hospital chart may provide patient history. • The sonographer often needs to obtain additional patient history for the interpreting physician.
Patient care and technique
Standard precautions and infection control
SITUATION
CAUSES
TREATMENT
Cardiac distress
Heart attack
Respiratory arrest
Medication interaction
Cardiopulmonary resuscitation (CPR)
Automated external defibrillator (AED)
Choking
Obstruction
Abdominal thrusts
Respiratory distress
Heart attack
Stroke
Seizures
Fainting
Open airway
1-2 ventilations lasting 1-2 s each
Syncope
Dehydration
Postural hypotension
Medications
Diabetes mellitus
Stroke
Vasovagal reaction
Lay person supine with legs elevated
If sitting, place head down between knees
Patient–sonographer interaction
TIME FRAME
INTERACTION
Before examination
Review medical order
Verify that proper examination is scheduled
Review previous diagnostic studies, if available
Review institution’s examination protocol, if needed
Address patient by his or her first and last name
Introduce yourself to the patient and family
Explain examination requested by the physician before beginning the scan
Obtain patient history, including possible medication or latex allergies in a private environment
Verify that patient name and identification number are correct on imaging screen
Select the proper transducer frequency, limiting acoustic output in compliance with the as low as reasonably achievable (ALARA) principle
During examination
Maintain patient modesty and privacy
Alleviate and address patient’s concerns
Expand on examination protocol as needed
After examination
Explain expected time frame for the patient’s physician to receive a report
Clean transducer(s), equipment, and keyboard
Write technical impression of real-time examination
Patient history
SUBJECT
QUESTIONS
Menstrual cycle
Date of last menstrual period
Menstrual irregularities or abnormalities
Medications
Contraceptive
Follicular stimulating
Postmenopausal
Pelvic pain
Location
Severity
Acute or chronic
Associated with menstruation or ovulation
Pelvic surgery
Uterus and/or ovaries
Tubal ligation
Cesarian section
Appendectomy
Endometriosis
Previous pregnancy
Total number of pregnancies
Number of live births
Number of miscarriages
SUBJECT
QUESTIONS
Laboratory results
hCG levels
Alpha-fetoprotein
Amniocentesis
Maternal health history
Hypertension
Diabetes mellitus
Fertility assistance
Menstrual cycle
Last menstrual period
Estimated delivery date
Pelvic pain
Location
Severity
Duration
Previous pregnancy
Grava–Para
Fetal abnormalities
Multiple gestations
Vaginal discharge
Bleeding
Spotting
Clear fluid
Patient care and technique
