Elec ii

Prepared by:

BSN, Level II

Sarah Jane A. Cristobal

MONITORING TECHNOLOGY

Telemetry

is the monitoring and analyzing

of data that are received at a distance

from their source. It usually refers to a

certain way of monitoring a hospital

patient's heart activity


Telemetry

It allows the patient to get up

and move around, at least within the

device's transmitting range.


Telemetry

To provide skilled cardiac

monitoring to patients who require

cardiac monitoring, but other wise do not

warrant ICU placement.


The ICU environment should focus on

these therapeutic elements:

Windows and art that provide natural

views; views of naturecan reduce

stress, hasten recovery, lower blood

pressure andlower pain medication

needs


3. Post cardiothoracic surgery.

4. Drug toxicities limited to potential arrhythmogenic compounds such as digitalis and tricyclics.

5. New onset supraventricular arrhythmias (atrial fibrillation or flutter, PSVT, etc.)

6. Suspected pacemaker malfunction.

7. Observation post pacemaker or defibrillator placement or post ablation.


8. Syncope when an arrhythmia or other cardiac disorder is a suspected etiology.

9. Suspected defibrillator discharge.

10. Unstable angina of low or intermediate grade (new onset angina without EKG or enzymatic changes, crescendo angina in patient with history of coronary disease).

11. Study drug protocols requiring cardiac monitoring as a part of the protocol.


Prior to discharge from the Telemetry Unit, patients shall meet the following criteria:

1. Physician shall order the discontinuation of Telemetry monitoring.

2. Patient shall be free of chest pain for 24 hours prior to discharge.

3. Patient's vital signs shall be stable


4. Patient does not require intravenous vasoactive medications.

5. Patient shall be able to perform minimal ADLs without shortness of breath.

6. Patient shall have normal sinus rhythm, stable rhythm, or controlled arrhythmia for thepast 24 hours

DIAGNOSTIC INFORMATION

SYSTEM

Today's physicians and other

caregivers have access to more than

5,000 different patient tests to help them

evaluate, diagnose, and treat patients.

The problem is that physicians receive

these test results from a wide range of

disparate sources that use vastly

different reporting formats


SYSTEM

Displaying test results in fragmented,

variable and incomplete formats

prevents physicians fromefficiently

reviewing and analyzing vital patient

information. This can lead to:

Clinicians spending far too much time

(an estimated 30%) gathering and

organizing data


SYSTEM

Critical information being missed which

can cause medical errors

Redundant testing (an estimated 14%

to 30% of the 30 billion diagnostic tests

done annually in the US are non-

contributory and avoidable)


SYSTEM

The inability to share or exchange vital

clinical information among providers

Underutilization of EHRs and other

health IT applications and an

unnecessary reliance on paper,

telephones, and fax machines

In order to provide cost-

effective, high quality care, physicians

and other caregivers need immediate

access to accurate, timely, and

comprehensive clinical information.

THE PATENTED DIS SOLUTION

The patented DIS solution provides rapid access to cumulative patient information in an easy to read and analyze format that increases the accuracy and efficiency of patient care and improves the productivity of physicians, nurses and others at all points of care.


DIS can aggregate and collate more than 5,000 different patient test results and display them all in one place in the same user-friendly format. Its ease of access and use adds immediate value to the health care delivery process:

Converts raw patient test results data into organized, meaningful information for easy access,viewing, and analysis


Provides a standardized reporting format that unifies test results from all data sources for usersat all points of care3.

Integrates test results data on all levels (data, application, system and network) increasing efficiency, accuracy and productivity


Reduces the number of pages and

screens on which results are displayed

by an average of 80percent5.

Saves time and helps physicians

minimize duplicate and non-

contributory testing


The DIS technology solution was specifically designed for immediate use by all test results data users in physician offices, hospital inpatient facilities and outpatient clinics and community health centers. Its implementation will depend on collaborative innovation among a number of interdependent stakeholders.


These include all the test results data providers in hospital and community-based clinical laboratories and in imaging and other testing facilities and the vendors of EHRs and PHRs, as well as the vendors of HIE data integration and exchange platforms and the HIOs/HIEs that they serve

MECHANICAL VENTILATOR

Is a machine that generates a controlled flow of gas into a patients airways. Oxygen and air are received from cylinders or wall outlets, the gas is pressure reduced and blended according to the prescribed inspired oxygen tension (FiO2), accumulated in a receptacle within the machine, and delivered to the patient using one of many available modes of ventilation.


The mechanics of inspiratory support are more complex than previously considered. It has been established that cyclical inflation and deflation injures lung parenchyma and worsens outcome:

(1). Large tidal volume ventilation, to normalize blood gases has been shown to worsen outcome in lung injury


(2), presumably due to excessive pressure induced stretch injury of the parenchyma. Modernventilation strategy involves attempting to achieve an adequate minute volume with the lowest possibleairway pressure (as this relates to the degree of alveolar distension). The pressure that we areinterested in minimizing is at the level of the alveolus, the plateau pressure.


Ventilator cycling refers to the mechanism by which the phase of the breath switches from inspiration to expiration. Modes of ventilation are time cycled, volume cycled or flow cycled. Time cycling refers to the application of a set controlled breath rate. In controlled ventilation a number of mandatory breaths are delivered to the patient at a predetermined interval.


The respiratory rate may be controlled by the operator or the patient. The patient may breathe spontaneously, and with modern ventilators these breaths are supported either by delivering facsimiles of the controlled breaths synchronously with the patient’s effort or by allowing the patient more subjective control.


Pressure support is a form of

flow cycled ventilation in which the

patient triggers the ventilator and a

pressure limited flow of gas is delivered.

The patient determines the duration of

the breath and the tidal volume, which

may vary from breath to breath

CT SCAN

CT scans are a specialized type

of x-ray. The patient lies down on a

couch which slides into a large circular

opening. The x-ray tube rotates

around the patient and a computer

collects the results. These results are

translated into images that look like a

"slice" of the person.

CT SCAN

Sometimes a radiologist will decide that contrast agents should be used. Contrast agents are iodine based and are absorbed by abnormal tissues. They make it easier for the doctor to see tumors within the brain tissue. There are some (rare) risks associated with contrast agents and you should make sure that you discuss this with the doctor before arriving for the examination

CT SCAN

CT is very good for imaging

bone structures. In fact, it's usually the

imaging mode of choice when looking at

the inner ears. It can easily detect

tumors within the auditory canals and

can demonstrate the entire cochlea on

most patients.

MRI

MRI is a completely different

animal! Unlike CT it uses magnets and

radio waves to create the images. No x-

rays are used in an MRI scanner.

MRI

The patient lies on a couch that

looks very similar the ones used for

CT. They are then placed in a very long

cylinder and asked to remain perfectly

still. The machine will produce a lot of

noise and examinations typically run

about 30 minutes.

MRI

The cylinder that you are lying in is actually a very large magnet. The computer will send radio waves through your body and collect the signal that is emitted from the hydrogen atoms in your cells. This information is collected by an antenna and fed into a sophisticated computer that produces the images. These images look similar to a CAT scan but they have much higher detail in the soft tissues. Unfortunately, MRI does not do a very good job with bones.

MRI

One of the great advantages of

MRI is the ability to change the contrast

of the images. Small changes in the

radio waves and the magnetic fields can

completely change the contrast of the

image. Different contrast settings will

highlight different types of tissue.

MRI

Another advantage of MRI is the ability to change the imaging plane without moving the patient. If you look at the images to the left you should notice that they look very different. The top two images are what we call axial images. This is what you would see if you cut the patient in half and looked at them from the top.

MRI

The image on the bottom is a

coronal image. This slices the patient

from front to back. Most MRI machines

can produce images in any plane. CT

can not do this.

MRI

Contrast agents are also used

in MRI but they are not made of iodine.

There are fewer documented cases of

reactions to MRI contrast and it is

considered to be safer than x-ray dye.

Once again, you should discuss

contrast agents with your physician

before you arrive for the examination.

ICU

The ICU environment should focus on

the set herapeutic elements:

Windows and art that provide natural

views; views of nature can reduce

stress, hasten recovery, lower blood

pressure and lower pain medication

needs

ICU

Family participation, including

facilities for overnight stay and

comfortable waiting rooms

Providing familiarity in the ICU

environment through personalization,

warmer colors, natural materials, and

artwork

ICU

Providing a measure of privacy and personal control through adjustable lighting, adjustable curtains and blinds, accessible bed controls, and TV, VCR and CD players

Noise reduction through computerized pagers and silent alarms

Medical team continuity that allows one team to follow the patient through his or her entire stay

ICU

A tele-ICU system involves a

command center with the technological

capability to remotely monitor patients in

off-site intensive care units. The command

center is staffed with intensivist physicians

and critical care nurses who use two-way

audio-visual monitoring systems to provide

support and guidance to the bedside staff

in those ICUs.

ICU

And critical care nurses play a

major role in the success of a tele-ICU.

They have a great deal of potential when

it comes to bridging distance barriers,

influencing patient safety and even

mentoring bedside nurses, noted Karen

Harvey, MSN, RN, certification programs

specialist for the corporation

LABORATORY TESTING

What are the indicators of test reliability?

Four indicators are most commonly used to determine the reliability of a clinical laboratory test. Two of these, accuracy and precision, reflect how well the test method performs day to day in a laboratory. The other two, sensitivity and specificity, deal with how well the test is able to distinguish disease from absence of disease.

LABORATORY TESTING

The accuracy and precision of each

test method are established and are

frequently monitored by the professional

laboratory personnel. Sensitivity and

specificity data are determined by

research studies and are generally

found in medical literature.

LABORATORY TESTING

Although each test has its own

performance measures and appropriate

uses, laboratory tests are designed to be

as precise, accurate, specific, and

sensitive as possible. These basic

concepts are the corner stonesof

reliability of your test results and

provide the confidence your health care

provider has in using the clinical

laboratory.

LABORATORY TESTING

Accuracy and Precision

Statistical measurements

of accuracy and precision reveal a lab

test's basic reliability. These terms,

which describe sources of variability, are

not interchangeable. A test method can

be precise (reliable reproducibility)

without being accurate (measuring what

it is supposed to measure and its true

value) or vice versa.

LABORATORY TESTING

Precision (Repeatability)

A test method is said to be precise

when repeated analyses on the same

sample give similar results. When a test

method is precise, the amount of random

variation is small. The test method can be

trusted because results are reliably

reproduced time after time.

LABORATORY TESTING

Accuracy (Trueness)

A test method is said to be accurate

when the test value approaches the

absolute ³true´ value of the

substance(analyte) being measured.

Results from every test performed are

compared to known "control specimens"

that have undergone multiple evaluations

and compared to the "gold" standard for

that assay, thus analyzed to the best testing

standards available

LABORATORY TESTING

Accuracy (Trueness)

Although a test that is 100% accurate and 100% precise is ideal, in practice, test methodology, instrumentation, and laboratory operations all contribute to small but measurable variations in results. The small amount of variability that typically occurs does not usually detract from the test ¶s value and statistically is insignificant. The level of precision and accuracy that can be obtained is specific to each test method but is constantly monitored for reliability through comprehensive quality control and quality assurance procedures.

LABORATORY TESTING

Accuracy (Trueness)

Therefore, when your blood is tested more than once by the same laboratory, your test results should not change much unless your condition has changed. There may be some differences between laboratories in precision and accuracy due to different analytical instrumentation or methodologies, however, the test results are reported with standardized reference intervals specific for that laboratory.

LABORATORY TESTING

Sensitivity and Specificity

The tests that a provider chooses in order to diagnose or monitor a medical condition are based on their in herentability to distinguish whether you have the condition or do not have the condition. Depending on the symptoms and medical history, a provider will order tests to confirm a condition (tests with high sensitivity) or tests to rule out the condition (tests with high specificity).

LABORATORY TESTING

Sensitivity

Sensitivity is the ability of a test to correctly identify individuals who have a given disease or condition.

For example, ascertain test may have proven to be 90% sensitive. If 100 people are known to have a certain disease, the test that identifies that disease will correctly do so for 90 of those 100 cases (90%). The other 10 people (10%) tested will not show the expected result for this test.

For that 10%, the finding of a "normal" result can be misleading and is termed false-negative

LABORATORY TESTING

Sensitivity

A test's sensitivity becomes particularly important when you are seeking to exclude a dangerous disease, such astesting for the presence of the HIV antibody. Screening for HIV antibody often utilizes an ELISA test method, whichhas sensitivity over 99%. However, a person may get a false-negative if tested too soon after the initial infection (lessthan 6 weeks).

LABORATORY TESTING

Sensitivity

Thus, the result of a false-

negative gives a person the sense of

being disease-free when in fact theyare

not. The more sensitive a test, the fewer

false-negative results will be produced.

LABORATORY TESTING

Specificity

Specificity is the ability of a test to correctly exclude individuals who do not have a given disease or condition.

For example, a certain test may have proven to be 90% specific. If 100 healthy individuals are tested with that method,only 90 of those 100 healthy people (90%) will be found "normal" (disease-free) by the test.

LABORATORY TESTING

Specificity

The other 10 people (who do not have the disease) will appear to be positive for that test.

For that 10%, their "abnormal" findings are a misleading false-positive result. When it is necessary to confirm a diagnosis that requires dangerous therapy, a test's specificity is one of the crucial indicators.

LABORATORY TESTING

Specificity

A patient who has been told

that he is positive for a specific test yet

truly does not have that disease may be

subjected to potentially painful or

dangerous treatment, additional expense,

and unwarranted anxiety. The more

specific a test, the fewer false-positive

results it produces.

LABORATORY TESTING

The FDA requires that developers and manufacturers of a new test provide target values for test results and provide evidence for the expected ranges as well as information on test limitations and other factors that could generate false results. Thus it is critical for the health care provider to correlate the laboratory results with an individual's clinical condition to determine if repeat testing would be needed.

Elec ii

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