HOSPITAL PRACTICE &

PATIENT CARE
RAD 204
 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.
 Tiers of the health care system
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
 Teaching hospitals
 Federal medical centers
 Specialists hospitals
 Types of Hospitals in Nigeria
 Teaching hospitals: - They are usually owned by
universities with medical students. Teaching
hospitals are under the tertiary health care and are
therefore specialized.
 Specialist hospitals: - These are hospitals that
accept specialized medical personnel e.g.
Neuropsychiatrist hospitals, orthopaedic hospitals
etc. They also give training to students.
 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
 Body planes
 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.
 Midsagittal plane: - This is a sagittal plane
through the middle of the body and dividing
into right and left halves.
 Axial/Transverse plane:- This is an imaginary
plane dividing the body into superior and
inferior parts.
 Body planes
 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.
 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.
 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.
 Body planes
 Transumbilical/Umbilical plane: - This is an
horizontal line through the abdomen at the
level of the umbilicus.
 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.
 Body planes
 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.
1.) for assessment of liver size
2.) for assessment of heart sound
3.) 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
The Nine Regions of the Abdomen and the
Organs in them.
The Nine Regions of the Abdomen and the Organs in them.

 Right hypochondriac region

 Epigastric
 Left hypochondriac region
 Right lumbar region
 Umbilical region
 Left lumbar region
 Right iliac region
 Hypogastric region
 Left iliac region
 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
 Descending 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
  
Medical Terminologies/ Abbreviations.

 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
  
Medical Terminologies/ Abbreviations.

 Ectasis - dilation
 -itis – a medical condition accompanied by
inflammation
 Cholelitihiasis – gallstones
 Bronchiectasis –abnormal permanent dilation
of the bronchial tubes
  
Medical Terminologies/ Abbreviations.

 # - 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)
  
Medical Terminologies/ Abbreviations.

 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
  
Medical Terminologies/ Abbreviations.

 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
  
Medical Terminologies/ Abbreviations.

 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
  
Medical Terminologies/ Abbreviations.

 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
  
Medical Terminologies/ Abbreviations.

 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
  
Medical Terminologies/ Abbreviations.

 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
 Body Systems
 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
 Care of Patients
 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. 
 Care of Patients
 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
How To Achieve Radiation Protection
 - 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
How To Achieve Radiation Protection

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
 How To Achieve Radiation Protection
 - 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
 Categories of drugs and uses
 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
 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
 Routes of drug administration
 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
 Routes of drug administration
 3.) Topical - application to the skin (Rubbing)
 4.) Inhalation
 5.) Anal route- for suppositories
 6.) Instillation- drops
Routes of drug administration
 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.