Sensory Evaluation & Pain
Level of Consciousness (LOC)
1. Ask the patient to state his or her name, name,
date, address, and the reason for coming to the
radiographic imaging department.
2. As you instruct the patient in positioning for your
examinations, note his or her ability to follow
directions. Also take note of any movement that
causes pain or other difficulty in movement, as
well as any alterations in behavior or lack of
response. Report these to the physician in charge
of caring for the patient.
3. Assess the patient‟s vital signs at this time if
current readings are not on the chart.
Glasgow Coma Scale
To voice 3
To painful stimuli 2
No response 1
Obeys command 6
Localizes pain 5
Withdraws from painful stimuli 4
Abnormal flexion 3
No response 1
Confused speech 4
Inappropriate words 3
Incomprehensible sounds 2
Characteristic of breathing
Eupnea Normal breathing
Tachypnea Rapid, shallow breathing
Bradypnea Regular breathing but decreased rate
Kussmaul’s respiration Rapid, deep breathing without pauses
Cheyne-Stokes respiration Breaths that gradually become faster,
and deeper than normal, followed by
periods of apnea
Biot’s respiration Rapid deep breathing, with abrupt
periods of apnea between each breath
Musculoskeletal / Mobility
Observe for ROM, swelling, deformity, or atrophy
Inspect for stance
- Base of support
- Weight-bearing stability
Inspect the gait for the following
- Position of feet
- Arm swing
Observe movement of patient during procedure
The body‟s pathological reaction to illness, trauma, or
severe physiologic or emotional stress.
Body fluid loss
Decreased tone of cardiac vessels
Obstruction of blood flow to the vital body organs
Cold clammy skin
Decreased urine output
Hypoactive bowel sound
Normal blood pressure
Increased anxiety level (client may begin to
2. Progressive Stage
Blood pressure falls
Severe pulmonary edema (Acute Respiratory
Tachycardia (as high as 150 beats/min)
Changes in mental status ( alteration from
confusion to lethargy, and loss of consciousness.
Renal, hepatic, gastrointestinal, and hematologic
a condition where the amount of
intravascular fluid decreases by 15% – 25%
or blood loss of 750 ml – 1,300 ml.
Class I Class II Class III Class IV
15% 15% – 30% 30% - 40% > 40%
BP Normal Normal Decreased Severely
< 100 BPM >100 BPM >120 BPM >140 BPM,
RR Normal 20 – 30 CPM 30 – 40 CPM >40 CPM
Normal Decreased Greatly
1. Stop the ongoing imaging procedure; place the patient
in supine position with legs elevated 30 degrees (unless
there is a head or spinal cord injury). Do not place the
patient in Trendelenburg position.
2. Notify the physician in charge of the patient and call for
3. Make certain that the patient is able to breathe w/o
obstruction caused by positioning or blood or mucus in
4. If the patient has blood loss from an open wound, don
gloves and apply pressure directly to the wound with
several thickness of dry, sterile dressing.
5. Have the emergency cart brought to the patient‟s side.
6. Prepare to assist with oxygen, intravenous fluids, and
medications. Have large gauge intravenous catheters on
7. Keep the patient warm and dry. Do not overheat the
patient; to do so will increase body metabolism and
increase the need for oxygen.
8. Assess pulse, respirations, and blood pressure every 5
minutes until the emergency team assumes this role.
9. Do not leave the patient unattended. Inform him or her
as appropriate of what is happening to alleviate anxiety.
10. Do not offer fluids to the patient, even if requested.
Explain that he or she may need examinations or
treatment that requires and empty stomach.
caused by a failure of the heart to pump adequate
amount of blood to the vital organs.
• Complaint of chest pain that may radiate to jaws and
• Dizziness and respiratory distress
• Restlessness and anxiety
• Rapid change in level of consciousness
• Pulse may be irregular and slow, may have tachycardia
• Difficult-to-find carotid pulse indicates decreased stroke
volume of the heart.
• Decreasing blood pressure
• Decreasing urinary output
• Cool, clammy skin
1. Summon the emergency team and have the
emergency cart placed at the patient‟s side.
2. Notify the physician in charge of the patient.
3. Place the patient in semi-Fowler‟s position or in
another position that will facilitate respiration.
4. Prepare to assist with oxygen, intravenous fluid, and
medication administration, Chest pain must be
5. Do not leave the patient alone; offer an explanation of
treatment as appropriate; alleviate the patients
6. Assess pulse, respiration, and blood pressure every 5
minutes until the emergency team arrives.
7. Do not offer fluids.
8. Be prepared to administer cardiopulmonary
resuscitation (CPR), if indicated.
occurs when a pooling of blood in the peripheral
blood vessels results in decreased venous return of
blood to the heart.
1. Neurogenic Shock
results from loss of sympathetic tone causing
vasodilation of peripheral vessels.
Spinal cord injury
Depressant action of medication
Lack of glucose
Adverse effects of anesthesia
Clinical Manifestations of Neurogenic Shock
• Warm, dry skin
• Initial alertness if not unconscious because of head injury
• Cool extremities and diminishing peripheral pulses
1. Summon emergency assistance
2. Notify the physician in charge of the patient.
3. Keep the patient in supine position, legs may be
elevated with physician‟s order.
4. Have the emergency cart brought to the patient‟s side.
5. If spinal injury is possible, do not move the patient.
6. Stay with the patient and offer support.
7. Monitor pulse, respirations, and blood pressure every 5
8. Prepare to assist with oxygen, intravenous fluids, and
2. Septic Shock
caused by the reaction of immune response against
bacteria or viruses and release chemicals that increase
capillary permeability and vasodilation.
• Hot, dry, and flushed skin
• Increase in heart rate and respiratory rate
• Fever, but possibly not in elderly patients
• Nausea, vomiting, and diarrhea
• Normal-to-excessive urine output
• Possible confusion, most commonly in the elderly
• Cool, pale skin
• Normal or subnormal temperature
• Drop in blood pressure
• Rapid heart rate and respiratory rate
• Oliguria or anuria
• Seizures and organ failure if syndrome is not reverse
1. Stop the procedure; notify the physician in charge of the
2. Notify the emergency team & have the emergency cart
3. Place the patient in a supine position.
4. Keep the patient as quiet and calm as possible.
5. Do not leave the patient unattended.
6. If the skin is very warm, cover patient w/ a lightweight blanket.
7. Monitor vital signs every 5 minutes.
8. Prepare for O2, intravenous fluid, & medication administration.
9. Keep the patient in comfortable position.
3. Anaphylactic Shock
a result of an exaggerated hypersensitivity reaction
(allergic reactions) to re-expose to an antigen that was
previously encountered by the body‟s immune system.
Iodinated contrast medium
Portal of Entry
1. Mild Systemic Reaction
Symptoms beginning within 2 hours of exposure to
Nasal congestion, periorbital swelling, itching, sneezing,
and tearing of eyes
Peripheral tingling or itching at the site of injection
Feeling of fullness or tightness of the chest, mouth or
2. Moderate Systemic Reaction
All symptoms listed above with rapid onset.
Flushing, feeling of warmth, itching, & urticaria
Bronchospasm and edema of the airways or larynx.
Dyspnea, cough, and wheezing
3. Severe Systemic Reaction
All symptoms listed in previous reactions with an abrupt
Decreasing blood pressure, weak, thready pulse, either
rapid or shallow.
Rapid progression to bronchospasm, laryngeal edema,
severe dyspnea, and cyanosis.
Dysphasia, abdominal cramping, vomiting, and diarrhea.
Seizures, respiratory and cardiac arrest.
1. Before beginning a procedure that require
administration of an iodinized contrast agent, make certain
that the emergency cart has been monitored and that all
emergency medications and equipment are up-to-date and
in working order.
2. Before starting any procedure that involves the
use of iodinated contrast medium, ask the patient
the ff questions:
“Are you allergic to any food or medicine?
“Do you have asthma or hay fever?”
“Have you ever have hives or other allergic
“Have you ever had an x-ray examination that
involved the use of contrast medium? If so, did
you have reaction during or following that
3. Do not leave the patient who is receiving an iodinated
contrast agent alone. Stop the infusion or injection
immediately, and notify the radiologist if any of the ff
occurs: the patient complains of itching, redness, or
swelling of the skin, or the patient seems unduly anxious.
4. If the patient complains of respiratory distress or has any
of the later symptoms listed previously, call the
5. Place the patient in semi-Fowler‟s position or in a sitting
position to facilitate respiration.
6. Monitor pulse, respiration, and blood pressure every 5
minutes until the emergency team arrives to assume
7. Prepare to assist with oxygen, intravenous fluid, and
medication administration. Have large-gauge venous
8. Prepare to administer CPR.
results from pathological conditions that interfere
with the normal pumping action of the heart, however,
the heart itself may be free of pathologic condition.
Tumors that interfere with blood flow through
an occlusion in one or more pulmonary arteries by
a thrombus or thrombi.
Orthopedic and abdominal surgical procedures
Congestive Heart Failure
Rapid, weak pulse
Dyspnea and tachypnea
Cough and Hemoptysis
Rapidly changing levels of consciousness
Coma, sudden death may result
1. Stop the procedure immediately, and call for
2. Notify the physician, and bring the emergency cart
to the patient‟s side.
3. Monitor vital signs.
4. Do not leave the patient alone; reassure the patient.
5. Prepare to assist with oxygen administration,
administration of intravenous medication, and
a group of metabolic diseases resulting from a
chronic disorder of carbohydrate metabolism.
1.An absolute insulin deficiency
2.Impaired release of insulin by the
pancreatic beta cells
3.Inadequate or defective insulin
4.Production of inactive insulin or insulin
that is destroyed before it can carry out
Acute Complications of Diabetes Mellitus
occurs when there is an excess amount of insulin
or oral hypoglycemic drug in their bloodstream, an
increased metabolism of glucose, or an inadequate
food intake with which to utilize the insulin.
Mild reaction: mild tremor, sweating, complaint of
hunger, tachycardia, nervousness, and irritability.
Moderate reaction: Dizziness, headache, numbness of
lips or tongue, confusion, profuse perspiration, cold
clammy skin, blurred or double vision, incoordination,
irrational behavior, slurred speech
Severe reaction: disorientation, difficulty arousing from
sleep, impaired motor function, diminishing level of
consciousness, seizures and rapid lapse into coma.
1. If the patient is conscious and complains of any early or
moderate symptoms or says that he or she is diabetic,
has not eaten, and feels shaky or weak, notify the
physician and administer some type of sugar
2. If there is nothing else available, the packets of sugar
kept in most coffee rooms are acceptable. If the patient is
carrying glucose tablets, 2 – 4 commercially prepared
glucose tablets should be taken. If orange juice is
available, you may offer it. Hard candy or 6 – 10 Lifesaver-
type hard candies are also acceptable.
3. If the patient complains of any of the latter symptoms,
check the chart or look for a bracelet that identifies the
patient as diabetic.
4. If the patient is having trouble swallowing or is
unconscious, place 2 teaspoons of granulated
sugar, corn syrup, or jelly into his mouth under his
tongue. It will be absorbed through the mucous
5. Stop the diagnostic imaging procedure immediately,
and call for emergency assistance.
6. Do not leave the patient unattended.
7. Monitor vital signs every 5 minutes.
8. Prepare to assist with administration of oxygen,
intravenous medications, and fluids.
2. Diabetic Ketoacidosis
a condition caused by an absence or markedly
inadequate amount of insulin resulting to
accumulation of ketone bodies.
• Weakness, drowsiness, headache, blurred vision,
abdominal pain, nausea, and vomiting.
• Sweet odor to the breath & orthostatic hypotension.
• Warm, dry skin; dry mucous membranes, extreme thirst,
• General weakness, lethargy, and fatigue.
• Flushed face, deep and rapid respirations.
• Tachycardia, weak, thready, pulse, and coma.
1. Check patient chart or look for a bracelet
identifying the patient as a diabetic. Remember that
patient‟s with this condition may not be identified as
2. Stop treatment and notify the patient.
3. Call for emergency assistance.
4. Do not leave patient unattended.
5. Monitor vital signs,.
6. Prepare to assist with administration of
intravenous fluids, medications, and oxygen.
Cerebral Vascular Accident (Stroke)
Caused by occlusion of the blood supply to the brain,
rupture of the blood supply to the brain, or rupture of the
cerebral artery, resulting in hemorrhage directly into the
brain tissue or into the spaces surrounding the brain.
• Possible severe headache
• Muscle weakness of flaccidity of face or extremities, usually
• Eye deviation, usually one-sided; possible loss of vision
• Difficulty in speech (dysphasia) or no speech (aphasia)
• May complain of stiff neck
• Nausea or vomiting may occur
• Loss of consciousness
a condition when the heart ceases to beat
effectively and the blood can no longer circulate
throughout the body, and the person no longer has
Loss of consciousness, pulse and blood
Dilation of the pupils within seconds
Possibility of seizures
a condition where the lungs ceases to function.
The patient stops responding
The pulse continues to beat briefly and quickly
becomes weak and stops
Chest movement stops and no air is detectable
moving through the patient‟s mouth
Radiographer‟s Response to Cardiac & Respiratory Arrest
1. If the patient is an adult and is found to be unresponsive,
shake the patient and ask, “Are you all right?” If no
response, call immediately for emergency medical
services. In a hospital, this would be calling a CODE. If
you are not near a telephone, shout for help, stating your
location. “I need help STAT in room 102.” Do not leave the
2. Assess the carotid pulse of an adult patient. Do not waste
time taking the blood pressure or listening for a
heartbeat! Do not asses the electrocardiogram contact if
one is in place.
3. If the adult patient is pulseless and the emergency
medical team has been summoned, place the patient in a
supine position on a hard surface. A backboard is
available for use in hospital rooms. In the diagnostic
imaging area, the tables have a hard surface and this may
not be an issue.
4. If a neck or spinal cord injury is suspected, the patient
must be log rolled into a supine position.
Begin Cardiopulmonary Resuscitation in the Clinical Area
1. Open the airway. Don gloves; remove any obvious
material in the mouth or throat. If the patient has
dentures that are loose, remove them. Avoid pushing a
foreign object farther back in the mouth or throat. Do not
perform blind fingersweeps! Direct the chin up and back.
Never sweep the mouth of an infant or small child unless
the object is clearly visible!
2. If you suspect a neck injury, use the jaw thrust
maneuver. Do not extend the neck.
3. Look, listen and feel for airway movement. If you don‟t
feel or hear air or see movement of breathing, tightly
place the bag- or mouth- mask over the patient‟s
mouth and nose.
Take a deep breath and slowly, over 2 full seconds,
with the least amount of your breath needed to make
the chest rise, exhale into the mouth-mask. Allow the
patient to exhale as you take in another deep breath
and repeat this maneuver. The rationale for this
sequence is to reduce the amount of air that enters
the stomach of the patient to prevent the complication
of regurgitation, aspiration, and pneumonia.
4. If the patient is not breathing and initial ventilations
attempts are not successful, assess for foreign body in
airway. If you are unable to administer successful rescue
ventilations and if you suspect airway obstruction, use
abdominal thrusts to remove obstruction. Recheck for
5. If patient is breathing, place him or her in a recovery
6. Assess for signs of circulation by checking carotid pulse,
and evaluate for coughing, movement, and breathing.
7. If no signs of circulation or breathing are present, and
AED is not readily available,
and the emergency team has
not arrived, begin chest
1. Move fingers up the lower margin of the patient‟s rib
cage to the area where the ribs and sternum meet.
When the area is located, place index finger above it
and place the heel of your hand beside the index finger
with your second hand on top of it.
2. Your hands should be located 1.5 inches from the tip of
the xiphoid process towards the patient „s head. The
finger should not touch the chest wall. Use the weight
of your body for compression of the chest wall, and
keep elbows straight.
3. Compress the sternum 1.5 – 2 inches directly
downward; then release the compression completely.
4. Keeping elbows straight, give 15 compressions in a
smooth, even rhythm.
5. Inflate the patient‟s lungs two or more times.
6. Reassess the patient‟s carotid pulse and
respiratory status. If the patient has no pulse or
respiration, continue with 15 compressions
followed by 2 inflations until the emergency team
7. Allow them to take over at a time specified for the