Patient Care In Nuclear Medicine

Lab - Week 7

Part I

What type of patient are you going to image today? Usually there are no issues and the exam that he/she is going to have goes without a hitch. However, issues do arise and some of those issues might include: anger, hunger, depression, confusion, or age (very young/old). Today's lecture/discussion will focus on the "how to" handle that difficult patient." Rest assure at different points in your career you will be confronted by a patient with some form of anxiety, whether as a student or a technologist. Key - Always remain positive no matter how bad it gets!

Key points to consider:

1. We provide a service - the service of giving the best possible care under any situation.
2. You represent the NMT program and the hospital, hence consider yourself a PR person. Your attitude is observed by the patient and you are seen as a representative of the hospital. Inappropriate behavior, on your part, reflects poorly on you, the hospital, and the program.
3. When confronted by a volatile situation, don't become emotional! Keep your mind clear, focused, and always respond in a positive manner. If you get upset or angry during a confrontation, usually this only escalates the situation. If you find your self getting mad. Stop! Think what your doing! Get control! Then move forward in a positive manner.
4. Sometimes it's appropriate to find out what caused the patient's emotional state, see if you can diffuse it. In a worst case scenario call security.
5. My favorite response to any situation is, "Kill them with kindness." No matter what the situation always respond in a positive manner. It usually can stop an escalating situation.
6. When you put on your nuclear hat
   1. Always explain what it is you are about to do, from the injection to the discussion of what type of procedure the patient is going to have
   2. Think about it. The word nuclear is usually considered negative to someone who is ignorant to what we do. Hence, you may need to give a detailed explanation on what type of procedure he/she is going to undergo.
7. Finally, if you know anything about Patch Adams, laughter is great medicine. Use it!

Let us review and discuss in class, different types of patients - how would you handle these specific situations?

Part II

Prior to the nuclear medicine procedure

• The patient is in the nuclear medicine department for an exam. When you first meet this person introduce yourself , be confident, knowledgeable, show compassion. Greet them by name and never refer to the person as, "The bone scan patient" or the "The patient in room three." The following process is recommended.
  • Confirm that you have the right patient (two forms of ID)
  • The doctor's order matches the procedure that the patient is going to have.
  • Occasionally the order is not complete. As an example, a patient's order states the it is a limited bone scan to role out infection. This means that it really might be a 3-phase bone scan. Should this happen, you must call the referring physician or check with the nuclear doc to see if this procedure needs to be modified. What happens if you don't do this?
  • Match the exam with the patient's complaint and history. If there is no reason to complete a certain procedure based on the patient's condition, insurance may not cover the exam.
  • Take a medical history of the patient - correlating the reason for the exam.
  • If the exam does not match the prognosis then discuss it with the nuclear medicine physician and/or the referring physician before continuing with the procedure.
• Once you've confirmed that the exam is appropriate - explain the procedure thoroughly to the patient!
  • What is the purpose of the exam?
  • What does it mean to receive a radiopharmaceutical? Compare it to getting an radiographic procedure.
  • Consider radiation exposure. FYI - it's more than a chest x-ray. Information on mSv attended from MOZ. I don't know how accurate these numbers below really are
    • CT pelvis is about 6 mSv where a bone scan is ~6.3 mSV
    • A chest x-ray is ~0.1 mSv
    • A V/Q lung scan ranges between 0.28 mSv to 0.9 mSv
  • What are the chances of an allergic reaction?
  • How does the radiopharmaceutical work (Pathophysiology)?
  • How does the patient's complaint relate to what the procedure might find.
  • Define any special needs for a given procedure (examples):
    • Bone scan - the patient must drink a liter of water.
    • Renal scan - the patient should be well hydrated.
    • Gastric emptying - patient should have been NPO (12M).
    • Hepatobiliary scan - patient should be NPO for at least the last 2 hours, but no more than 24 hours.
• Ask the patient if there are any additional questions that he/she might have?
  • While preparing the IV, as you get ready to inject the dose explain to the patient what you are doing.
  • Inject the dose.
  • Have you ever had a medical procedure where the person doing the procedure doesn't tell you anything?
• When the patient is ready for the exam:
  • Assure that the imaging table has been sterilized and clean sheets are laid down.
• Help the patient get onto the imaging table.
• Ask the patient if he/she has any questions.
• Make the patient as comfortable as possible.
• Tell the patient that he/she cannot move during the procedure. This is very important. Even more so in a SPECT scan.
• Reduce the amount of talking during the procedure this may reduce patient movement during the acquisition.
• If the acquisition time is greater than several minutes, inform the patient how much time is left (unless they don't want to know).
• Always refer to the patient by his/her name.
• Someone should remain in the room, whenever possible.
• When the exam is over:
  • Have the patient wait while you confirm the quality of the images with either one of the technologists and/or the physician.
  • Once you are sure that the quality of exam is fine and no additional images are needed, excuse the patient, and tell him/her when the results will be available.
  • Make note to tell the physician reading the exam of any difficultly that you might have encountered when imaging the exam.
  • Never tell the patient what you see or don't see on the exam, unless the physician gives you permission.

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