Hospital Practice and Patient Care

Nigeria health care system

Nigeria has three tiers of health care system. The Nigerian federal ministry of health formed the
National health care policy. This organization makes out policies that provide comprehensive health care
services to all citizens of Nigeria using the available resources such that individuals and communities are
ensured adequate health condition and enjoyment of living. To achieve this goal, the healthcare system
was divided into three:

- Primary health care

- Secondary health care

- Tertiary health care

Primary health care

 The main objective is to provide basic health care

 It is the responsibility of the local government.

 Under this tier we have health centers, health district & health units .

 At the primary health center, there are sanitation services, health orientation, family planning,
ante-natal, first-aid treatments, delivery, immunization, circumcision vaccinations e.t.c

 Workers include nurses, lab attendants, sanitation workers & doctors.

 Private health practitioners are under the primary health care system.

 The primary healthcare system is under the supervision of the district health officer through the
district hospital.

 It is found mostly in rural areas.

Secondary health care

 This tier is under the administration of the state government

 They are called general hospitals

 Each government has a general hospital and they offer more specialized services than the
primary health care centers
  General hospitals are a point of reference after the primary health care has failed

 The general hospitals have more specialized and advanced services e.g. surgery, lab services,
diagnostics, physiotherapy, pharmacy, medical laboratory services and so on.

 They are more medical personnel under the secondary health care system.

 There are no private practitioners under this system

 The secondary health care system is under the supervision of the commissioner of health
through the state ministry of health

Tertiary health care

 It is under the administration of the Federal government.

 It is under the supervision of the federal minister of health through the federal ministry of
health

 The hospitals under the tertiary health care are very elaborate.

 These hospitals have different departments and numerous specialists e.g. pediatricians,
radiologist, neurosurgeons, cardiologists e.t.c

 All the services provided in the primary and secondary health care can be found in the tertiary
health care.

 It is usually found in urban areas

Types of Hospitals in Nigeria

1.) Teaching hospitals

2.) Federal medical centers

3.) Specialists hospitals

1.) Teaching hospitals: - They are usually owned by universities with medical students. Teaching
hospitals are under the tertiary health care and are therefore specialized.

2.) Specialist hospitals: - These are hospitals that accept specialized medical personnel e.g.
Neuropsychiatrist hospitals, orthopaedic hospitals etc. They also give training to students.
 3.) Federal medical centers: - They are not owned by universities but offer training to medical field
aspirants.

Management of hospitals

 Teaching hospital management board

 Orthopaedic hospital management board

Sections of a hospital

 Clinical medicine

 Diagnostic/Investigative (Radiographers, Medical laboratory scientists)

 Rehabilitative

 Preventive

 Therapeutic medicine

We are the eye of medicine

Body planes

1.) Sagittal/lateral plane: - This is an imaginary plane passing from the front through the centre of
the body to the back and dividing the body into right and left.

2.) Midsagittal plane: - This is a sagittal plane through the middle of the body and dividing into right
and left halves.

3.) Axial/Transverse plane:- This is an imaginary plane dividing the body into superior and inferior
parts.

4.) Coronal plane/Frontal plane:- This is a vertical imaginary plane running from side to side from
right to left and dividing the body into anterior and posterior parts.

5.) Transpyloric/Addison's plane:- An imaginary line located at the level of L1 (first lumbar
vertebrae) and is halfway between the suprasternal (jugular) notch and the pubis symphysis.
 6.) Subcostal plane:- This is an imaginary horizontal plane at the level of L3 and bisects the body at
the level of the 10th costal margin. It touches the lower border of the kidney.

7.) Transumbilical/Umbilical plane: - This is an horizontal line through the abdomen at the level of
the umbilicus.

8.) Supracostal plane :- This is a transverse plane passing through the anterior superior iliac
spine(ASIS) marking the boundary between lateral and umbilical region superiorly and the
inguinal and pubic region inferiorly.

9.) Mid-clavicular line[plane] :- This is an imaginary line parallel to the lung axis of the body passing
through the midpoint of the clavicle on the ventral surface of the body. It is important for a
number of reasons.

- for assessment of liver size

- for assessment of heart sound

- To find the location of the gallbladder. The gallbladder is at the intersection of this line and the
transpyloric plane.

The Nine Regions of the Abdomen and the Organs in them.

The abdomen is divided into nine regions using the midclavicular lines, the subcostal line and
intertubercular lines

Right hypochondriac region :- right lobe of liver

- right kidney

- right sides of large intestine

- right side of small intestine

Epigastric region:- liver

 - stomach

- pancreas

- spleen

- duodenum

- adrenal glands

Left hypochondriac region:- Tip of the liver

- stomach

- pancreas

- spleen

- left kidney

- large intestine

- Small intestine.

Right lumbar region:- ascending colon

- right kidney

- small intestine

Umbilical region:- transverse colon

- duodenum

- small intestine

Left lumbar region:- ascending colon

- small intestine

- left kidney

Right iliac region :- appendix

- small intestine

- ascending colon

- caecum
Hypogastric region :- urinary bladder

- sigmoid colon

- gonads

Left iliac region:- descending colon

- sigmoid colon

- small intestine

Medical Terminologies/ Abbreviations.

 Cardio - heart

 Pulmonary - lungs

 Hyper - excessive

 Hypo – deficient

 Lethal - deadly

 Glycemia – presence of glucose in the blood

 Cyesis - pregnancy

 Pseudo - false

 Cutaneous - skin

 Subcutaneous - below the skin

 Ptosis – the prolapse of a body organ

 Nephroptosis - The condition in which the kidney drops down into the pelvis when the patient
stands up

 Poly – many (multi)

 Hypertrophy – an increase in the size of an organ or tissue due to the enlargement of its
individual cells

 Agenesis - any imperfect development of the body.

 Renal agenesis – imperfect development of the kidney

 Ectasis - dilation

 -itis – a medical condition accompanied by inflammation

 Cholelitihiasis – gallstones

 Bronchiectasis –abnormal permanent dilation of the bronchial tubes

 # - fracture

 ?# - unknown fracture

 RTA - road traffic accident

 FH,FHX,HX - indicates both parents are diabetic (family history)

 Hb,Hgb – haemoglobin

 LMP - last menstrual period

 GA - gestational age (4/52 -4 weeks pregnancy)

 HHD - hypertensive heart disease

 CCF - congestive cardiac failure

 CHD - congestive heart disease

 CAD - coronary artery disease

 IVP - intravenous pyclogram/pyclography

 ?MI – Myocardial infarction (heart attack)

 Pt - patient

 RBC - Red blood cell count

 Rbc - red blood cell

 R/o - rule out

 SOB - shortness of breath

 SOBE - shortness of breath on exertion

 Rx - treatment

 UTI - urinary tract infection

 URTI - upper respiratory tract infection

 TPR – Temperature, pulse and respiration

 CBC - complete blood count

 ?Ca – Cancer, Neoplasia, Tumour

 HR - heart rate

 BP - Blood pressure

 NPQ – nil per oral

 PMH - past medical history

 Dehydration –The condition in which water in the body drops below normal levels.

 Hypovolemia – A state of decreased blood volume.

 CHF - congestive heart failure

 CNS - central nervous system

 COAD - chronic obstructive airway disease

 COPD - chronic obstructive pulmonary disease

 ROM - Range of motion

 FBS - Fasting blood sugar

 FBC - full blood count

 CVA - cardiovascular accident (stroke)

 DX -diagnosis/disease

 CC - Chief complaint

 ENT – Ear,nose & throat

  ECG - electrocardiography

 STI - sexually transmitted infection

 STD - sexually transmitted disease

 SICU - surgical intensive care unit

 RBS - random blood sugar

 IVU - intravenous urography

Assignment

-List all the body systems and their chief functions

-List all the body cavities.

BODY SYSTEMS

1.) Cardiovascular/Circulatory system: - Heart, Blood vessels (veins, arteries & capillaries) and Blood.

2.) Musculoskeletal system: - Muscles (smooth, cardiac and skeletal) and Bones

3.) Nervous system: - Brain, Spinal cord and nerves

4.) Respiratory system: - Trachea, Bronchi, Bronchioles & Alveoli

5.) Reproductive system: - Gonads and Genitalia

6.) Excretory/Urogenital system: - Ureter, Bladder & Kidney

7.) Endocrine system: - Glands

8.) Integumentary system: - Skin, Hair and Nails

9.) Digestive system: - Gastrointestinal tract

10.) Lymphatic system: - Lymph nodes, Lymph & Thymus

Body Postures

Supine: - Lying on its back (face up)

Prone: - Lying face downward (face down)

Recumbent: - Lying down on a side (right or left)

Oblique

Erect

Care of Patients

1.) Physical preparation - Removal of all materials that can interfere with the radiographic graphic test

2.) Psychological preparation - Reassuring the Patient so as to gain their cooperation during the
radiographic test

3.) Radiation protection - Do the Right test on the right patients

- use proper exposure factors (KVP , mA,mAs, time, FFD[focus film distance])

-use proper techniques (positioning,centering and instruction)

- avoid repetition

4.) Chemical/Pharmacological preparation - For special exams we use chemicals such as Barium meal.
Before the patient ingests the barium meal, they are given Aperients e.g. (dulcolax) to remove fecal
matter.

5.) Environmental preparation - Get the diagnosis room ready and tidy
-Arrange the request forms

-Sort out emergency forms

-Select your cassette.

Others

- Protect patients from injury (chemical, physical & electrical)

- Help the patients down from the examination table

- Protect patients from nosocomial infection

- Clean the examination table thoroughly after use

*A nosocomial infection is an infection you get while you are in the hospital for another reason. It is also
called a hospital-acquired infection.

Aim of Radiation Protection

To ensure that the patient receives the minimum dose of radiation that is able to give a good quality
diagnostics radiograph

How To Achieve Radiation Protection

- Limiting the beam site to the area of interest using beam diaphragm (The beam diaphragm is very
important for children and pregnant women)

- Use good technique to avoid repetition

- Use the fastest film screen continuation consistent with good radiographic details

- Good positioning and centering of the patient

- Proper immobilization of the patient

- Use appropriate exposure factors

KVP - Kilovoltage peak (pemetrating power)

mA - tube current (Fine focus =30-100 ,Broad focus=100-250)

Time - Period of exposure(in seconds or milliseconds)

mAs - product of mA and time (determines how dark the radiograph is and how much radiation the
person receives)

FFD - focus film distance

New mAs = (new FFD)2/(old FFD)2 x old mAs

New mAs = 2002/1002 x 20

New mAs = 40000/10000 x 20

New mAs = 80mAs

- Use of AEC( automatic exposure counter)

- Film identification

- Good/optimum film-processing

- Use of image intensifier (fluoroscopy)

- 10 day rule (The 10 day rule says that unless it is extremely important, a radiographer must know never
perform a X-ray of the lower abdomen of a female of childbearing age after 10 days of the last
menstrual cycle. The scan should be within 10 days of the last menstruation.

- Filtration

Drugs used in radiology

A drug is a chemical substance that is administered into the body for diagnosis, therapy or treatment so
as to alter some body physiological processes.

Categories of drugs and uses

1.) Preparation of patients –

Aperients e.g. Dulcolax (used to remove fecal matter)

Charcoal tablets (used to remove excess gas)

Antihistamines e.g. Loratidine (prevents allergies)

2.) Painkillers – Analgesics

3.) Contrast Media –

Positive (increases the intensity) e.g. Barium, Urogratin

Negative (decreases the intensity) e.g. air/gas

*Barium meal

(medicine) A preparation of barium sulfate (a radiopaque compound) which the patient ingests for the
purpose of producing clear radiographs of the esophagus, stomach and duodenum.

barium meal (ingested orally)

barium enema (ingested anally)

Routes of drug administration

1.) Per Oral –

Licking

Swallowing

Chewing

Sublingual (deposited below the tongue and left to dissolve)

2.) Parenteral routes –

Intradermal – in the dermis

IM ( intramuscular) – in the muscle e.g. Deltoid ,Gluteus maximus

IV (intravenous) – in the veins

Subcutaneous - below the skin

3.) Topical - application to the skin (Rubbing)

4.) Inhalation

5.) Anal route- for suppositories

6.) Instillation- drops

Vital signs

- BP

- Temperature

- Pulse

- Respiration

Assignment

Find the normal range for BP, Pulse, Body temperature, Respiration rate, stating the instruments used in
each case.