PEDIATRIC IMAGING GERIATRIC IMAGING Spring 2011 OBJECTIVES Imaging

PEDIATRIC IMAGING & GERIATRIC IMAGING Spring 2011 OBJECTIVES • Imaging of pediatrics & geriatric patients • Age specific competencies • Pediatric pathology • Abuse and imaging

Your Role as a Radiographer • Atmosphere • Communication Tone • Age specific protocol for ALL patients • Answering questions about procedures • Dealing with the parents of kids with illnesses or injuries • Provide excellent studies • Ease anxiety • Make patient feel safe & comfortable to avoid restraints and anesthesia • Protect patients, self and others from unnecessary RADIATION EXPOSURE

RADIATION PROTECTION A MUST

Pediatric Imaging • Not just small adults • TECHNIQUE CHANGES – Size and density of part – TIME – short as possible • Communication an immobilization skills very important

• Talk with patient at eye level • Use language the child can understand • Assign jobs (tech takes picture, parent holds patient, patient holds still) • Cover needles syringes if the patient is having a contrast studies Communication

• Parents and child are anxious and fearful • Address the child and the parent – explain to the patient and parent the importance of cooperation. • Consider the room lighting – Children are afraid of the dark • Explain the procedure – Keep the explanation simple and short – Watch the tone in your voice and facial expressions – All of this conveys a message to the patient

Communication • Anxiety – Fear, frustration and raised tempers. • During and at the completion of the exam • Praise the child for their • Keep a calm perspective cooperation – instill confidence in your patient and • Offer incentives parent. – Stickers • Relate to the appropriate age of the patient

Families facing a recently diagnosed illness - cancer • Powerful emotions: shock disbelief fear anxiety guilt & sadness anger

• Pain: – Never lie to child – Describe pain in a way they understand – Let them know it will be fast • Use age appropriate protocol – Set techniques ahead of time – Use immobilization as needed

• Always have room ready before bringing in patient – supplies quick at hand • Show the collimator light – Other equipment as necessary • Shields – offer the apron to the parent first Establish Rapport

To effectively distract kids, know what they like • Infants – pacifier, bottle, toys with lights & sound • Toddlers & Preschool – bubbles, books, washable markers & paper, toys or video • School Age – games, music, television • The Magic of TV

What else can you do? • Help them to be comfortable before, during and after their procedures • Have faith in their health care team by providing excellent care • Other suggestions? • Experiences?

WAITING ROOM

Infants • • Keeping the parent involved & close Using a calm, soothing voice Pacifier or bottle Toys with light and/or sounds

Immobilization

X-table lateral chest better to show air fluid than supine lateral

PICC Line or CVA Insertion

The importance of including the costophrenic angles

Comparison of chest exams 12 hours apart

7 WEEK OLD Wheezing and respiratory distress are a common presentation of CHF in infants. Tachypnea alone may be the earliest sign.

AGE SPECIFIC COMPETENCIES

Age Specific Competencies • Stage 1: The Neonate (Birth to 29 Days) • Stage 1: The Infant/Young Toddler (29 Days to 18 Months) • Stage 2: The Toddler (18 Months to 3 Years) • Stage 3: The Preschooler (3 Years to 6 Years) • Stage 4: The School Child (6 Years to 12 Years) • Stage 5: The Adolescent (12 Years to 18 Years) • Stage 6: The Young Adult (19 Years to 40 Years) • Stage 7: The Middle Adult (40 Years to 65 Years) • Stage 8: The Mature Adult (65 Years and Older)

18 MO NEWBORN

Toddlers 18 mo. to 3 years • Use calm & soothing voice • Explain the procedure simply • Describe what the child will feel, see, hear taste or smell • Demonstration on a doll can be helpful • Distraction with dolls, trucks, books, bubbles, etc can be very helpful

Preschoolers 3 to 5 years • Explain the procedure with more detail and encourage questions • Avoid trying to reason with this age group • Give choices whenever possible • Touching or moving equipment • Doll demonstrations can be helpful • Toys & television can be helpful distractions

School Age 5 years and up • The same techniques that worked for preschool will work for school age • Childs capacity for logical thinking enables a more complex explanation of procedure • Use appropriate vocabulary

Bone development

STAGE AND AGE 8. Integrity vs. Despair Late adulthood 7. Generativity vs. Stagnation Adulthood 6. Intimacy vs. Isolation 20 s (young adults) 5. Identity vs. Role Diffusion 12 -18 (approx. ) 4. Industry vs. Inferiority 6 -12 (approx. ) 3. Initiative vs. Guilt 3 -6 2. Autonomy vs. Shame 2 -3 1. Trust vs. Mistrust 0 -1

SIGNIFICANT RELATIONS 8. Integrity vs. Despair humankind (my kind) 7. Generativity vs. Stagnation divided labor, shared household 6. Intimacy vs. Isolation partners: friends, sex, competition, cooperation 5. Identity vs. Role Diffusion peer and other groups 4. Industry vs. Inferiority neighborhood, school 3. Initiative vs. Guilt basic family 2. Autonomy vs. Shame parental persons 1. Trust vs. Mistrust maternal person

Stage 1: Trust vs. Mistrust (Birth-1 year) • Significant social influence: – Parents (especially mother) – Primary care taker • Main task: – To develop a life long sense of trust or mistrust • To promote positive resolution – Good quality of care (consistency and regularity in care)

Stage 1 Birth – 1 Year Trust vs. Mistrust • Totally dependant for daily care – Basic needs sleeping – Feeding – Sucking – Bathing – Affection • Mistrust evolves from inconsistent care and unmet needs

Stage 2: 1 -3 years (The Toddler) Autonomy vs. Shame and Doubt • Walk • Talk • Feeding and dressing themselves • Favorite pillow or stuffed animal • Simple familiar foods • Stranger danger

Stage 3: 3 -6 years (The Preschooler) Initiative vs. Guilt • Learning right from wrong • Vast imagination • Developing fine motor skills • Explain and demonstrate procedures

Stage 4: 6 -1 2 years (School Age) Industry vs. Inferiority • Personal achievement • Make a schedule • Working Learning • Keeping a journal • Playing • Punching bags

Stage 5: 12 -18 years (The Adolescent) Identity vs. Role Diffusion • Puberty – Body changes • Self conscious • Variety of interest • Privacy • Same sex staff should help with procedures

STAGE 7: 20’s (The Young Adult) Intimacy vs. Isolation • Stronger Ties • Dedication To Education And Occupation • Increased Commitment To Others • May Prefer The Help Of Significant Others • May Deny or Mask Symptoms

Stage 7: (Middle Adulthood) Generativity vs. Stagnation • Between the ages of 35 to 60, people will find themselves "responsible for maintaining the world. " • Family care giver • Maintain economic status • Help them understand the effect on work and home • Encourage family visits • Involve in decision making • They may offer advise or counsel

Stage 8: 60 + (Late Adulthood) Integrity vs. Despair • Family centered • Be a good listener • Reminiscent • Be encouraging • Increased sensitivity to environmental surroundings • Increased fall potential, keep patient areas clear

Late, Late Adulthood 79 & up

No matter what you might fear, And the state of your health, When all is said and done, The situation is pretty obvious…. . “You can EITHER live for the rest of your life, OR die for the rest of your life. ” Dr. Joseph Connors

And They Lived Happily …. .