3.2 Patient Assessment & Monitoring

Why Radiographers Assess and Monitor

Radiographers are frequently the health professional physically closest to a patient during imaging, especially for portable, trauma, contrast, and interventional exams. Recognizing a deteriorating patient early is a scored Patient Care skill. Assessment means gathering objective data (vital signs, level of consciousness, skin color) and subjective data (what the patient reports). A radiographer must know the normal ranges, recognize deviations, and escalate appropriately rather than diagnosing.

Normal Adult Vital-Sign Ranges

Vital signs are the baseline measures of body function. Memorize the adult reference ranges; ARRT questions frequently ask for a single normal value.

Pulse is best palpated at the radial artery for a conscious adult and at the carotid for an unresponsive patient; assess rate, rhythm, and strength. Respirations are counted unobtrusively (patients alter their breathing if they know they are being watched) for depth and effort as well as rate. Blood pressure reflects systolic (contraction) over diastolic (relaxation) pressure; use a correctly sized cuff, because a cuff that is too small falsely raises the reading. SpO2 is measured with a pulse oximeter on a finger; nail polish, cold extremities, and poor perfusion can produce falsely low readings. Temperature can be taken orally, tympanically, temporally, axillary, or rectally, with the route noted because ranges differ.

Pediatric and Geriatric Variation

Normal is age-dependent. Infants and young children run faster pulses and respirations and lower blood pressures than adults. As a rough reference, infants have a pulse near 100-160 bpm and respirations near 30-60/min; these slow toward adult values through childhood. Older adults may have a higher baseline systolic pressure and blunted temperature response to infection. A classic exam trap is labeling an infant's rate of 140 bpm as tachycardia; for an infant, that is within normal limits.

Interpreting Deviations

A single abnormal value is a signal, not a diagnosis. Rising pulse with falling blood pressure suggests hypovolemia or shock; a falling SpO2 with rising respiratory rate suggests respiratory compromise. The radiographer's job is to recognize the pattern, stay with the patient, and summon help, not to treat. Trend matters more than one reading, so recheck and document.

Level of Consciousness and Mental Status

Beyond numeric vitals, assess level of consciousness (LOC). A quick field tool is AVPU: is the patient Alert, responsive to Verbal stimulus, responsive to Pain, or Unresponsive? A more detailed hospital scale is the Glasgow Coma Scale (GCS), which scores eye, verbal, and motor responses from 3 (deep coma) to 15 (fully alert). A dropping LOC during a study is an early warning of deterioration, contrast reaction, or hypoglycemia and warrants stopping the exam and calling for help. Note orientation to person, place, and time, and compare against the patient's baseline; confusion that is new is more concerning than long-standing baseline confusion.

Measuring Vitals Correctly

Common measurement errors are tested. Use a correctly sized blood-pressure cuff (a too-small cuff falsely elevates the reading), support the arm at heart level, and avoid taking pressure in an arm with a dialysis fistula, PICC line, or on the side of a mastectomy. Count respirations discreetly for a full 30-60 seconds because patients alter their breathing when observed. For SpO2, remove nail polish and warm a cold finger, since poor perfusion produces a falsely low value. When a reading looks abnormal, recheck before acting, but never delay summoning help for a clearly deteriorating patient.

Taking a Focused Clinical History

The radiographer obtains a focused history to help the radiologist interpret the images and to catch safety issues (pregnancy, allergies, prior reactions, implants). Two questioning styles are used: open-ended questions ("tell me what happened") to gather narrative, and closed/direct questions ("does it hurt when I move this?") to pin down specifics. A structured approach is the sacred seven: localization, chronology/onset, quality, severity, aggravating/alleviating factors, associated manifestations, and the clinical context or reason for the exam.

Key rules for history-taking:

• Ask about the mechanism of injury for trauma (helps target projections).
• Verify allergies and prior contrast reactions before any contrast study.
• Screen for renal function cues (diabetes, kidney disease) before iodinated contrast.
• Confirm pain and mobility limits so positioning is safe.
• Document objectively in the patient's own words where possible.

Menstrual and Pregnancy Screening

Before any elective abdominal or pelvic imaging on a patient of childbearing potential, the radiographer must screen for possible pregnancy. Ask the last menstrual period (LMP) and whether pregnancy is possible. Two historical scheduling concepts appear on exams: the 10-day rule, which recommended scheduling elective lower-abdomen exams during the 10 days after the onset of menstruation when pregnancy is least likely, and the broader 28-day/elective-exam approach, which posts that any patient could be pregnant and defers non-urgent exposure. Modern practice emphasizes asking directly, documenting LMP, and, when pregnancy status is uncertain and the exam is elective, deferring to the radiologist or ordering a pregnancy test.

When imaging cannot be deferred, ALARA measures apply: justify the exam, tighten collimation, and shield outside the primary beam per current facility policy. The radiographer never decides unilaterally to image a known or possible pregnancy for an elective study; that risk-benefit judgment belongs to the radiologist and referring physician, with the patient informed.