Introduction to Sonography and Patient Care

Contents
Contributors vii
Reviewers of Second Edition ix
Reviewers of First Edition xi
Preface xiii
Acknowledgments xv
PART 1: INTRODUCTION TO SONOGRAPHY
CHAPTER 1: Foundations for the Sonography Student 2
• Going Back to School 6
• Stress: Inevitable but Manageable 7
o Financial Preparedness 9
o Emotional Stability and Support 10
o Physical Well-Being 12
• Time Management 12
• The Importance of Establishing Personal and Educational Goals 13
• Classroom Survival Skills 14
o Pertinent Coursework 15
o Preparing for Tests 16
o Maintaining Motivation in the Classroom 19
• Clinical Survival Skills 19
o The Sonographer: A Brief Overview 19
o Utilizing the Scan Lab 23
o Essentials of Professionalism in Clinical 24
o Essentials of Work Ethic in Clinical Settings 26
• Clinical Orientation and Information Gathering 28
o Understanding Workflow 29
o Imaging Departments and Modalities 30
• Radiography 31
• Computed Tomography 32
• Nuclear Medicine Technology 34
• Mammography 35
• Magnetic Resonance Imaging 35
• Cardiovascular Interventional Technology and Vascular Interventional Technology 37
• Appreciating Critical Thinking 37
o Student Application of Critical Thinking 40
• Summary 41CHAPTER 2: The Sonographer: A Closer Look 46
• Know Yourself Before You Know Others 48
o Identifying Your Personality Type 49
o Emotional Intelligence 52
o Strength Recognition and Professional Maturation 53
• Serving in Healthcare 54
o Character 55
o Competent Care and Flexibility 57
o Courtesy and Respect 57
o Compassion, Empathy, and Altruism 58
• The Cost of Caring and Finding the Balance 61
o Accountability, Honesty, and Integrity 62
o Self-Motivation and Enthusiasm 63
o Hunger for Knowledge 64
o Self-Confidence 64
o Final Thoughts on Character 64
• Clinical Responsibilities and Workplace Challenges for the Sonographer 65
o Sonographic Reasoning and Clinical Correlation 66
o Appreciating Anatomy, Physiology, and Pathology 70
o Sonographer Reports 71
o Occupational Stress for the Sonographer 71
• Student Interaction with Sonographers 77
o When and How to Communicate 78
o Acquiring Scan Time 78
• Student Interaction with Interpreting Physicians 78
• Summary 80
CHAPTER 3: Historical, Current, and Future
Applications of Ultrasound in Medicine 87
• The Study of Sound 92
• Ultrasound in Medicine 95
o Imaging Modes and Doppler 98
• Display Options 98
• Doppler Technology 101
o Tissue Harmonic Imaging 105
o 3D and 4D Technology 105
• Specialties in Sonography 108
o Abdominal Sonography 108
• Small Parts Sonography 110
o Breast Sonography 116
o Neurosonography and Pediatric Sonography 118
o Musculoskeletal Sonography 120
o Gynecologic Sonography 120
o Obstetric Sonography 125
o Fetal Echocardiography 127
o Vascular Sonography (Contributed by Dr. Traci B. Fox) 130
o Echocardiography (Contributed by Maureen McDonald) 133• Transthoracic Echocardiograms 134
• Stress Echocardiography 136
• Transesophageal Echocardiography 138
• Pediatric Echocardiography 139
• Additional Technologies and Future Applications 139
o Therapeutic Ultrasound 140
o High-Intensity Focused Ultrasound 140
o Contrast-Enhanced Ultrasound and Ultrasound-Guided Brachytherapy 141
o Ultrasound Elastography 142
o Fusion Imaging 142
o Intravascular Ultrasound 143
o Automated Ultrasound 143
o Focused Assessment with Sonography for Trauma 144
o Miniaturization 145
o Wireless Technology 145
o Future Possibilities and Artificial Intelligence 145
• Summary 147
CHAPTER 4: Professional Environment, Leadership,
and Career Establishment 153
• Professional Environment 154
o Academic Accreditation (CAAHEP , JRC-DMS, JRC-CVT) 155
o Professional Organizations and Associations (SDMS, SVU, ASE, SOPE, AIUM, ASRT) 156
o National Certification (ARDMS, CCI, ARRT) 157
• Maintaining Certification 159
o Laboratory Accreditation 160
• Leadership Roles in Sonography 160
o Leadership Styles and Followership 162
o Staff Sonographer 164
o Advanced Practice Sonographer 165
o Management in Sonography 165
o Sonography Educators 166
o Travel Sonographers 166
o Consultants or Technical Advisors 167
o Sales/Application Specialist 167
o Sonography Entrepreneur 167
• Career Establishment 167
o Searching and Applying for Jobs 168
o Resume Writing and Social Networking 169
o Interview Tips 171
• Summary 171
CHAPTER 5: Ergonomics and the Prevention of Work-Related
Musculoskeletal Disorders 176
• What Are Work-Related Musculoskeletal Disorders? 178
• Ergonomics 179
• Body Mechanics 180• Personal and Environmental Risk Factors 182
o Posture and Body Positioning 183
o Repetitive Motions and Force or Pressure 185
o Room Design 187
o Equipment Design 188
o Job Design 191
o Underlying Predisposing Conditions 192
• Inflammatory Diseases Linked to Work-Related Musculoskeletal Disorders 192
• Best Practices and Ergonomic Interventions for the Sonography Student 194
o Shoulder and Elbow 194
o Wrist and Hand 196
o Neck and Back 202
o Lower Extremities 203
• General Treatment of WRMSDs and Review of Warning Signs 203
• Summary 204
CHAPTER 6: Ethics and Professionalism 209
• Ethics and Personal Values 210
o Ethical Theories 211
o Ethics in Action 213
o Medical Ethics and Codes of Ethics 214
o The Sonographer Code of Ethics 215
o Ethical Issues in Diagnostic Medical Sonography 217
• Nondiagnostic Use of Ultrasound 217
• Ultrasound Screening for Vascular Disease 218
• The Role of the Sonographer in the Abortion Debate 218
• Professionalism 220
o Professional Etiquette and Teamwork 221
o First Impressions for the Sonography Student 221
• Summary 223
CHAPTER 7: Legal Essentials and Patient Rights 228
• Law Basics 230
• Types of Law 231
o Common Law 231
o Statutory Law 231
• Administrative Law 231
• Criminal Law 232
• Civil Law 232
• Sonographer Scope of Practice 238
• Good Samaritan Laws 242
• Patient Rights 242
o HIPAA and Patient Confidentiality 243
o Patient Rights Related to End-of-Life Issues 244
• Sonographer Documentation 245
• Summary 245CHAPTER 8: Basic Principles and Knobology 250
• Directional Terminology and Patient Positioning 252
• Transducers 253
o Transducer Manipulation 253
o Transducer Orientation and Scanning Planes 255
• Medical and Vascular Sonography Scanning Planes 259
• Transthoracic Echocardiography Scanning Planes 260
o Care and Cleaning of Transducers 260
• B-Mode and Basic Doppler Overview 262
• Essential Universal Knobology 266
o Acoustic Power 266
o Annotation Keys 266
o B-Color 266
o Body Markers 266
o Calipers 267
o Cine (Cine Loop) 268
o Clip (Clip Store) 268
o Color (Doppler) and Power Doppler 268
o Continuous-Wave Doppler 268
o Depth 269
o Dual Image 269
o Ellipse 270
o Field of View and Extended Field of View 270
o Freeze 270
o Zoom (Zoom vs. Res) 270
o Image Store (Print or Save) 270
o MultiHertz 271
o Overall Gain 271
o Time Gain Compensation 272
o Tissue Equalization 273
o Trace 273
o Trackball 274
o Transducer Select 274
o M-Mode 274
o Pulsed-Wave Doppler 274
o Transmit Zone or Focus 275
o Calcs (Calculations) 275
• Summary 278
PART 2: INTRODUCTION TO PATIENT CARE
CHAPTER 9: Communication, Diversity, and Cultural Awareness 284
• Primary Human Needs 285
• The Grieving Process 286
• Communication 288
o Five Elements of Communication 288• Nonverbal Communication 288
• Verbal Communication 290
o Additional Potential Barriers to Effective Communication 290
• Diversity and Cultural Competence 295
• The Sonographic Examination: 10 Steps 297
o Step 1: Assessment of Relevant Documents 297
o Step 2: Examining Reports and Images 298
o Step 3: Preparing the Examination Room and Protocol Review 299
o Step 4: Introducing Yourself and Patient Confirmation 299
o Step 5: Gathering Clinical History 299
o Step 6: Patient Education 301
o Step 7: Conducting the Sonogram 301
o Step 8: Completing the Sonographer’s Report 301
o Step 9: Sonographer Interaction with Interpreting Physician 302
o Step 10: Discharging the Patient 302
• Summary 302
CHAPTER 10: Fundamental Patient Care 307
• Patient Assessment 309
o Body Temperature 310
o Pulse (Appendix 3, Procedure 10-1) 311
o Blood Pressure (Appendix 3, Procedure 10-2) 314
o Respiration (Appendix 3, Procedure 10-3) 318
• Patient Assistance 319
o Evaluating the Patient’s Mobility 320
o Transferring and Transporting Patients (Appendix 3,
Procedures 10-4, 10-5, 10-6, and 10-7) 320
o Circumstances Requiring Unique Assistance 321
• Care for Patients with Intravenous Infusion 321
• Care for Patients with Urinary Catheters 323
• Care for Patients on Oxygen Therapy 325
• Assisting Patients with Bedpans or Urinals 327
o Portable Sonography 328
• Introduction to Electrocardiography for Echocardiography Students 329
o Lead Placement 330
o Simplified Heart Anatomy and Circulation 332
• The Cardiac Conduction System 333
• Normal Sinus Rhythm 334
• Summary 335
CHAPTER 11: Medical Emergencies 339
• The Role of the Sonographer in Emergency Situations 341
• Assessing the Patient’s Neurologic and Cognitive Function 341
• Types of Emergencies 342
o Shock 342
o Syncope 345
o Seizures 346o Cerebrovascular Accident (Stroke) 348
o Diabetic Emergencies 348
o Emergencies Requiring Immediate Cardiopulmonary Resuscitation 349
• Summary 350
CHAPTER 12: Infection Control for the Sonographer 354
• Infection 357
o Conditions that Favor the Growth of Pathogens 359
o The Cycle of Infection and Modes of Transmission 359
o Nosocomial and Healthcare-Associated Infections 362
• Workplace Exposure for the Sonographer 364
o Methicillin-Resistant Staphylococcus aureus 365
o Vancomycin-Resistant Enterococcus 365
o Clostridium difficile 366
o Tuberculosis 366
o Bloodborne Pathogens 368
• Viral Hepatitis 368
• HIV and AIDS 369
• Breaking the Cycle of Infection 369
o Standard Precautions 369
o Hand Hygiene (Appendix 3, Procedure 12-1) 370
o Personal Protective Equipment 372
• Gloving 374
• Other Personal Protective Equipment (Appendix 3, Procedure 12-2) 374
o Transmission-Based Precautions 374
o Medical Asepsis in the Sonography Department 378
• Personal Hygiene and Dress in the Workplace 379
• Cleaning Equipment 379
• Nonsterile Probe Covers 381
• Proper Disposal of Examination Waste Items (Appendix 3, Procedure 12-3) 382
• What If You Are Exposed? 382
• Summary 382
CHAPTER 13: Invasive Procedures and Surgical Asepsis 387
• Surgical Asepsis 388
o The Rules of Surgical Asepsis 392
o Preparing for an Invasive Procedure 392
o Skin Preparation and Draping (Appendix 3, Procedure 13-1) 393
o Opening a Sterile Pack and Adding Items to a Sterile Field (Appendix 3,
Procedure 13-2) 394
o Sterile Gloving 396
o Draping a Transducer with a Sterile Probe Cover and Needle Guide 398
o Syringe Assistance and Needle Disposal 400
• Sonography in the Operating Room 403
o The Surgical Scrub 403
• Sterile Gowning 404
• The Surgical Team 405CHAPTER 14: Sonographic Examinations and Guidelines 410
• Quality Assurance 411
• As Low As Reasonably Achievable and Clinical Safety of Ultrasound 412
• Abdominal and Small Part Sonography 413
o Liver 413
o Gallbladder and Biliary Tract 413
o Pancreas 414
o Spleen 414
o Bowel 415
o Peritoneal Fluid 415
o Abdominal Wall 416
o Kidneys and Urinary Bladder (Renal Sonogram) 417
o Renal Vascular Assessment 417
o Abdominal Aorta and Inferior Vena Cava 417
• Breast Sonography 418
• Scrotal Sonography 418
• Thyroid, Cervical Lymph Node, and Parathyroid Sonography 419
• Musculoskeletal Sonography 420
o Shoulder Examination 420
• Gynecologic Sonography 420
o Sonohysterography 421
• Obstetric Sonography 421
o First Trimester 421
o Second and Third Trimesters 422
• Vascular Sonography 423
o Carotid Sonogram 423
o Peripheral Venous Sonography 424
o Upper Extremity Venous Sonogram 425
o Peripheral Arterial 425
• Transthoracic Adult Echocardiography 426
• Summary 426
Appendix 1: Medical Terminology 431
Appendix 2: Translation Resources and English-to-Spanish Phrases 437
Appendix 3: Patient Care Procedures 443
Appendix 4: Electrocardiographic Dysrhythmias 459
Appendix 5: Laboratory Tests 462
Index 465