Concepts of Emergency Nursing Flashcards
1
Q
Trauma Hospitals
A
- Designation vs Verification
- Levels 1-5
- Level 1 Most comprehensive
— UCLA Level 1
— Henry Mayo level II
— Providence Holy Cross Level II
— Dignity Health Northridge Level II
2
Q
Emergency Department (ED) Environment
A
Characterized by:
- Rapid change
- Multispecialty care
- Crowded, noisy conditions
- Crucial communications pre-hospital helicopter personnel
- Complex age and demographic range of patients
3
Q
Interdisciplinary Team Members
A
- Prehospital care providers
- Emergency medical technicians (EMTs)/ paramedics- Basic Life Support
- Emergency medicine physician
- Nurse practitioners and physician assistants
- Support staff – Radiology, Ultz, Resp Therapist, Lab, SW, CNA’s, Clerical Staff
- Nurses, including:
— Forensic nurse examiners (for victims of rape, child abuse, domestic violence)
— Psychiatric crisis nurse team
4
Q
Scope and Practice of Emergency Nursing
A
- Emergency management traditionally refers to urgent and critical care needs.
- Has increasingly been used for nonurgent problems
Emergency management broadened to include concept an emergency is whatever the patient or family considers it to be - ER nurse needs special training, education, experience, and expertise in assessing and identifying health care problems in crisis situations
- The emergency department (ED) staff works as a team
5
Q
Assessment of the ED Patient
A
- Most important task of ER Nurse
- Rapid assessment of normal vs abnormal data
- Interpretation of assessment findings
- Communication
- Priority setting
- Technical and procedural skills
6
Q
Training and Certification
A
- Basic Cardiac Life Support (BCLS)
- Advanced Cardiac Life Support ( ACLS)
- Pediatric Advanced Life Support (PALS)
- Certified Emergency Nurse (CEN)
7
Q
Reasons People Seek ED Care
A
- Pain (most common)
- Injuries (especially falls in older adults)
- Abdominal pain
- Chest pain
- Breathing difficulty
- Headache
- Fever
- SNF’s
8
Q
Issues in Emergency Care
A
- Patient identification/Patient Privacy
- Consents to treat
- Injury prevention for patients
- Risk for errors and adverse events
- Injury prevention for staff
- Limiting exposure to Health Risks
9
Q
Staff & Patient Safety Considerations
A
- Violence can come from patients and families
- Drugs and alcohol use
- Gang membership
- Long wait times
- Crowded conditions
- Patients in custody
- Health Care workers are 4 times more likely to be attacked at work than any other occupation.
10
Q
Providing Holistic Care
A
- Patients have variety of heath care needs
- Cultural considerations
- Care of patients with mental illness/homelessness
- *Disposition and (difficult) discharge needs
— some pts cant go home;
— is their house suitable/ can they perform ADLs - Case management
- Patient/family teaching
- Death in the ED
11
Q
Cultural Awareness
A
- Customize discharge instructions to address patient needs
- Consider patient’s reading level, primary language, visual acuity
- Educational materials/instructions at 6th-grade reading level
- Materials available in Spanish, other regional languages; use interpreters
12
Q
*Discharge Planning
A
- Depends on nature of injury, facility’s resource capability
- Transport immediately to OR or interventional radiology suite
- Admit to trauma critical care unit, step-down unit, or surgical floor for continued care
- Transfer to facility with higher level of care
- *Senate Bill 1152 – Effective Jan 1, 2019
- *discharge with:
— *a place to go w/ transportation
— *medications in their hand
— *Clothes
— *meal
13
Q
*Care of the Elderly ED Patient
A
- *½ of all older adults who visit ED are admitted
- *Focus on preventing and reducing risks to older adults like falls, med errors, skin breakdown, HAI’s.
- *Communication challenges
- *Complicated medical histories
- *Comorbid conditions that make care difficult
- *Memory impairment may cause difficult history taking
- *May have difficult discharge needs
- *Consider safety issues after discharge
14
Q
Patient and Family Interventions
A
- Provide Comfort
- Relieve Anxiety
- Reassurance
- Treat the unconscious as if conscious
- Ensure patient safety
- Keep Family informed
15
Q
Death in the ED
A
- Sudden/unexpected” death
- Family presence during resuscitation
- Special circumstances when medical examiner case involved
- Dealing with family members in crisis
- ED personnel dealing with death
- coroner’s case: need of an autopsy/ unknown cause of death
— leave all tubes/ drains in
16
Q
- Helping Family Members Cope with sudden Death Chart 72-2
A
- *The nurse takes the following actions:
— *Take the family to a private place.
— *Talk to the family together so that they can grieve together and hear the information given together.
— *Reassure the family that everything possible was done; inform them of the treatment rendered.
— *Avoid using euphemisms eg. “passed on.” Show the family you care by touching, offering coffee, water, and services of chaplain.
— *Encourage family members to support each other and to express emotions freely (grief, loss, anger, helplessness, tears, disbelief).
17
Q
*Helping Family Members Cope with sudden Death
A
- *Avoid giving sedation to family members
- *Encourage the family to view the body if they wish
- *Spend time with the family,
- *Allow family members to talk about the deceased and what he or she meant to them
- *Encourage the family to talk about events preceding admission to the emergency department.
- *Do not challenge initial feelings of anger or denial.
- *Avoid volunteering unnecessary information (e.g., the patient was drinking).
18
Q
ER Nursing Principals Triage
A
- Sorts/classifies patients into priority levels according to illness or injury severity
- Highest acuity needs get quickest evaluation, treatment, prioritized resource utilization
- Must be applied consistently by nurses, endorsed by physicians
- 3 Tier System- Emergent, Urgent and Non urgent
- Emergency Severity Index (ESI) /Canadian Triage
- Acuity Scale (CTAS) most reliable
19
Q
ER Nursing Principals Triage
A
- 3 Level Triage
- Emergent - Life Threatening
- Urgent – needs quick tx. But not life threatening- Re-assessment
- Non Urgent – Could wait several hours
- Nurses spend many hours learning to classify different illnesses
20
Q
*Primary Survey and Resuscitation Interventions
A
- Primary survey organizes order of approach to patient by:
- (A) Airway/cervical spine
- (B) Breathing
- (C) Circulation
- (D) Disability
- (E) Exposure
21
Q
Secondary Survey and Resuscitation Interventions
A
- Comprehensive head-to-toe assessment
- Identifies other injuries/issues that must be managed or may impact course of treatment
- Gastric tubes
- Urinary catheters
- Diagnostic studies
22
Q
Airway Obstruction
A
- Life Threatening medical emergency
- Partial or complete
- Leads to death if not resolved
- Foreign bodies vs Disease Process
- Assess signs and symptoms
- Establish an airway
- Most Common
— Allergic Reaction
— Infection
— Angioedema
23
Q
Airway Obstruction
A
Oropharyngeal/Nasopharyngeal
Airway Insertion
24
Q
Endotracheal Intubation
A
25
Q
ET tube
A
26
Q
Hemorrhage
A
- Stop the Bleed
— Internal vs External - Assess for Shock
- Replace the fluids
— Isotonic Fluids
— Colloids – Hetastarch, Albumin
— Blood Components
—- Warmed?
27
Q
Wounds
A
- Goal is to restore look and function
- Proper documentation
- Photographs
- Assessment of how wound occurred
- Use aseptic technique
- Primary vs delayed Primary Closure
28
Q
Crush Injuries
A
- Assessment and Diagnostic Findings
- Bleeding
- Spinal Cord Injury
- Skin injuries
- Fractures
- Acute Kidney Injury
