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CEN Review > Professional Issues > Flashcards

Professional Issues Flashcards

1
Q

What is EMTALA?

A

Emergency Medical Treatment & Active Labor Act

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2
Q

ALL PATIENTS are entitled to a medical screening exam to determine if they have an emergency medical
condition. This includes pregnant women who are in labor. The ED is obligated to provide treatment until
patient is stable or to stabilize within its capabilities & transfer

A

EMTALA

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3
Q

You need an accepting provider, bed and transfer summary due to this

A

EMTALA

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4
Q

What are the 3 S’s of EMTALA?

A

screen, stabilize, send somewhere (home, inpatient, another facility)

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5
Q

Assessment is always ABCs. When would it be CABC?

A

significant hemorrhage

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6
Q

ALWAYS assess airway first. Consider cervical spine protection if trauma related. What are 6 ways to maintain an airway?

A

-Jaw-thrust/chin lift
-Suction
-Oral/NP airway
-ETT
-Needle cricothyrotomy
-Tracheostomy

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7
Q

When assessing breathing, we look at rate, pattern, work of breathing. Compromised or absent breathing requires immediate intervention. What are 4 interventions?

A

-Supplemental O2
-BVM ventilation
-Positioning
-Needle decompression

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8
Q

How do we assess circulation during the primary survey? (4)

A

-Pulse present or absent
-Bleeding controlled or uncontrolled
-Perfusion acceptable or unacceptable
-Assess heart sounds

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9
Q

What are 5 interventions for circulation during the primary survey?

A

-Apply pressure to uncontrolled bleeding
-Volume (crystalloid/blood products) * -CPR
-Cardioversion/defibrillation
-MAST/PASG

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10
Q

How do we remove medical anti-shock trousers (MAST)?

A

SLOWLY to prevent bleeding

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11
Q

What is included in the primary survey?

A

-Airway
-Breathing
-Circulation
-Dilability (AVPU, GCS, pupils, motor and sensory assessment)
-Expose & Environmental

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12
Q

What is included in the secondary survey? (8)

A

-History of Present Illness (HPI)
-Mechanism of Injury (MOI)
-Medical – Surgical history
-Social, psychological and environmental factors
-OPQRST
-Vital Signs
-Head to Toe assessment
-Focused assessment

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13
Q

When are orthostatic vital signs measured?

A

Measure HR and BP at 1 and 3 mins after position changes

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14
Q

What are positive orthostatic vital signs?

A

-SBP drop ≥ 20 mm Hg
-DBP drop ≥ 10 mm Hg
-HR increase ≥ 20 bmp

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15
Q

A patient presenting to the ED has a narrow complex tachycardia at a rate of 160 bpm and is unresponsive. BP is 70/50 mmHg. Which of the following is the highest treatment priority?

A. Administer synchronized cardioversion

B. Administer oxygen at 100% by way of a NRB mask

C. Administer verapamil (Calan) 5mg by IV bolus

D. Administer an unsynchronized cardioversion

A

A. Administer synchronized cardioversion

(B would be initial but not highest priority)

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16
Q

During the primary assessment, appropriate airway management
includes all of the following interventions except:

A. Instituting mechanical ventilation

B Assisting with nasotracheal intubation

C. Initiating a jaw thrust

D. Providing oral suctioning

A

A. Instituting mechanical ventilation

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17
Q

5 tiered triage

A
  • Resuscitation (Level 1) – Seen immediately
  • Emergent/Very Urgent (Level 2) – Seen within 10 minutes
  • Urgent (Level 3 ) – Seen within 30 minutes
  • Semi/Less Urgent (Level 4) – Seen within 60 minutes
  • Nonurgent ( Level 5) – Seen within 120 minutes
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18
Q

A patient presents with a complaint of a fever of 101 and malaise. The patient states he is currently receiving chemotherapy for
leukemia. Which ESI category is appropriate for this patient?

A. Level 1

B. Level 2

C. Level 3

D. Level 4

A

B. Level 2

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19
Q

During a disaster, which patient is treated first?

A. 40 year old in full cardiac arrest

B. 30 year old 40 weeks pregnant having contractions

C. 29 year old male with an open chest wound and distended neck veins

D. 22 year old male with a head trauma and a large open head wound

A

C. 29 year old male with an open chest wound and distended neck veins
(tension pneumo)

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20
Q

The following patients present to triage almost simultaneously, who should be triaged first?

A. 2 month old baby who stopped breathing earlier, but is breathing now but has inspiratory stridor

B. An alcoholic with strong alcohol breath, states “I think I’m about to have a seizure”

C. A young woman with partially amputated finger

D. A hysterical woman with laceration, crying in triage

A

A. 2 month old baby who stopped breathing earlier, but is breathing now but has inspiratory stridor

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21
Q

Which of the following is least
important to include in the bedside
handover to assure effective continuity of care?

A. Most recent vital signs

B. Pending medications

C. Length of stay

D. Anticipated disposition

A

C. Length of stay

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22
Q

The first step in the research process is:

A. Selecting the correct research design

B. Reviewing the current literature related to the problem

C. Obtaining IRB approval

D. Identifying the research problem or question

A

D. Identifying the research problem or question

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23
Q

Ongoing process of questioning and evaluating practice based on available data, innovating care standards and research. Data should guide practice, NOT tradition, organizational culture, or ritualistic practices.

Examples:
-Objective pain assessment scores
-Use of aspirin and clopidogrel in ACS
-Hyperventilation no longer recommended in severe traumatic brain injury
-Use of saline for endotracheal suctioning is no longer an accepted practice
-Patients receiving enteral feedings should have HOB elevated to 30o

A

Evidence-based Practice

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24
Q

What are some considerations for air transport? (air half the time of ground) (11)

A

-Gas expansion effects on body *In un-pressurized vehicles as altitude increases, partial pressure of O2 decreases
-Potential for dehydration
-Temperature drops
-Acceleration / deceleration forces affect hemodynamic status
-Consider motion sickness
-NGT/OGT placement
-Urinary catheter insertion
-Decrease cuff pressure on ETT
-Do not use air splints
-Position to decrease ICP
-Pneumothorax: be sure to decompress (consider Heimlich Valve)

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25
Q

Implemented by Centers for Medicare & Medicaid Services (CMS) -
This protects health insurance coverage for workers and
their families if they lose their job. Also states that health care providers & plans must implement privacy procedures to protect patient privacy - Protected Health Information (PHI)

A

HIPAA: Health Insurance Portability and Accountability Act

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26
Q

Written documentation that should be obtained
after initial medical screening exam. If patient is unable to sign, two witnesses are often recommended. Can be expressed, implied, involuntary.

A

Consent to Treat

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27
Q

Voluntary consent of an individual seeking medical treatment. Predicated on the patient’s competency. Example: signed or verbal consent to treat.

A

Expressed Consent

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28
Q

Consent obtained in a life or limb threatening situation. Example: Critical or unconscious patient.

A

Implied Consent

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29
Q

Individual refuses or lacks mental capacity to consent to needed medical treatment and yet another individual (physician or police) can ensure that the individual receives treatment. Example: Suicidal patient. The ED clinician can sign a judicial consent for a specific time
period. May require a psychiatrist or judge to co-sign.

A

Involuntary Consent

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30
Q

Requires that the patient understands the nature of the procedure or treatment, they also must have capacity to give consent. * Provider must present 3 essential components before a procedure:
* Describe the procedure to be performed
* Explain the alternatives available to the procedure
* Detail the risks of the procedure

A

Informed Consent

31
Q

3 essential components of an informed consent that must be obtained prior to a procedure

A

-Describe the procedure to be performed
-Explain the alternatives available to the procedure
-Detail the risks of the procedure

32
Q

Action or inaction by a professional health care provider that does not meet the standards of care and results in injury to the patient.
4 elements include:
-Duty to act (relationship established)
-Breach of duty/contract (care was sub-standard)
-Proximate cause (breech was actual cause of injury)
-Result in damage (injury caused by negligence)

Example: a surgical procedure is performed without informed consent

A

Negligence

33
Q

Attempt or threat to touch another person or the person’s possessions without his/her consent.

A

Assault

34
Q

Actual contact with a person or the person’s possessions without consent “unauthorized touching”

Example: When a surgeon performs a procedure without consent

A

Battery

35
Q

Age defining varies state to state - most states 18, some as young as 14 or 15.

Special situations:
-Treatment for STI or pregnancy related emergencies
-Emancipated minor or minor who is married
-Drug or psychiatric evaluation
-Any child who reports to ED without parents (every effort should be made to contact parents or obtain judicial consent)
-Follow your institutions policies

A

Minors

36
Q

Reportable Situations - not a breach of confidentiality if required by
law. Usually must report what 9 things?

A

-Anything that appears as a result of violence
-Gunshot & Stab wounds
-Child and elder abuse
-Intimate/Interpersonal violence, varies by state
-Any death within 24-48 hours of admission to the hospital
-Communicable diseases
-Poisonings
-Fetal deaths
-Animal Bites

37
Q

Only draw the blood if the patient expressly consents. When police have a search and seizure warrant, draw blood without the patient’s consent but do not use physical force. If no warrant and the patient refuses, DO NOT DRAW THE BLOOD!

A

Blood Alcohol Consent

38
Q

-This is all confidential
-Only those involved & debriefing team present
-Helps to find out the facts
-Everyone involved is encouraged to talk
-Express your personal feelings related to the incident
-Discussion of the worst parts of the incident (death or problems encountered)
-Identify possible unresolved issues
-Stress reduction and communication techniques are reinforced
-Final questions answered and it is over

A

Critical Incident Stress Debriefing or Management

39
Q

How do we preserve evidence when collecting? (5)

A

-Minimal handling of solid evidence
-Paper bag each item
-Don’t cut thru holes or marks in clothing
-Hands: don’t wash & consider bagging
-Delay cleaning the pt & wounds (when possible)

40
Q

What 5 things must be considered and addressed when patient has restraints on?

A

-food
-hydration
-toileting
-skin
-positioning

41
Q

What are 3 risks of chemical and physical restraints?

A

-skin breakdown
-strangulation
-respiratory depression

42
Q

aka “Moderate” or “Conscious”
Medically controlled state…consciousness is depressed, yet patient independently maintains airway & protective reflexes and ability to respond to stimuli. Used for procedures & diagnostic evaluation. Sedatives, amnesics, anxiolytics, analgesics may be used. Naloxone &/or flumazenil should be available!

A

Procedural Sedation

43
Q

What is the most effective method of teaching patients?

A

Demonstration

44
Q

Usually develops suddenly and unexpectedly. Requires immediate, coordinated and effective responses by multiple government agencies and private sector organizations to meet human needs and speed recovery.

A

Disaster

45
Q

6 types of natural disasters:

7 types of man-made disasters:

A

Natural: tornadoes, hurricanes, earthquakes, blizzards, epidemics, floods

Man-made: fires, explosions, transportation, accidents, civil disorders, nuclear incidents, terrorist attacks

46
Q

Disaster phase: there is impending danger. There may be some time or prior to the disaster.

A

Warning

47
Q

Disaster phase: disaster occurs

A

Impact

48
Q

Disaster phase: Time from impact till outside help arrives. Utilize available resources.

A

Isolation

49
Q

Disaster phase: Assistance from outside sources arrives, continuous reassessment of event

A

Rescue

50
Q

Disaster phase: Can last for days to years, slowly scale down the response

A

Restoration

51
Q

Disaster phase: All functions return to baseline

A

Normal Operations

52
Q

During a disaster,

-Multiple patients : ≤? casualties (usually single hospital response)

-Multiple casualty : ≤? casualties

-Mass casualty : >? casualties (involves responses from multiple agencies. HCF significantly overwhelmed)

A

-Multiple patients: <10 causalities

-Multiple casualty: <100 casualties

-Mass casualty: >100 casualties

53
Q

Triage color category: Immediate (emergent), life-threatening injury, airway compromise

A

Red

54
Q

Triage color category: Delayed (urgent), major illness/injury, requires treatment within the hour (ex: open fractures)

A

Yellow

55
Q

Triage color category: Minor (non-urgent), walking wounded, can self-treat, can wait several hours

A

Green

56
Q

Triage color category: Deceased (expectant), dead or expected to die (ex: full resuscitation, massive full thickness burns)

A

Black

57
Q

What are 4 disaster management stages?

A

-Mitigation: assessing risk; diminish the effects of the disaster

-Preparedness: education, training and exercises; policies

-Response: use Incident Command System, meet the needs of the event

-Recovery: return to normal operations

58
Q

These give an opportunity to educate hospital employees about emergency preparedness, take a practical look at the plan, give options for alternatives for disaster response; should always critique even a small scale

A

Drill

59
Q

This should be done before bringing patients inside a health care facility. Try to contain all run-off. Use negative pressure room. All clothing and belongings placed in biohazard bags.

A

Decontamination

60
Q

Hazmat zones:
Hot zone
Warm zone
Cold zone

What zone contains the contamination-reduction corridor?

A

Warm zone

61
Q

A patient must understand the nature of the procedure or treatment, the risks involved, the possible consequences, and the available alternatives when giving what type of consent?

A. Involuntary
B. Voluntary
C. Informed
D. Implied

A

C. Informed

62
Q

Duty to act, breach of duty/contract, proximate cause, and resultant damage are the four elements required to establish:

A. Negligence
B. Assault
C. Battery
D. Consent

A

A. Negligence

63
Q

Chain of custody for a piece of evidence may be broken if a health care provider fails to:

A. Obtain the alleged assailants name
B. Limit the amount of handling and the number of people involved
C. Obtain the patient’s name
D. Document the evidence on the nurse’s notes

A

B. Limit the amount of handling and the number of people involved

64
Q

The Joint Commission defines a sentinel event as:

A. Any incident that occurs within the hospital environment at least once a year.
B. Any incident that results in lost work time for a hospital employee.
C. An unexpected occurrence involving death or serious physical or psychological injury or risk.
D. A patient outcome that exceeds hospital days as outlined by the clinical pathway.

A

C. An unexpected occurrence involving death or serious physical or psychological injury or risk.

65
Q

Which of the following would be considered appropriate for constructive criticism of an employee?

A. Always have another employee present during any conversation involving criticism.
B. Do not offer any positive feedback, as it may overshadow the reason for the criticism.
C. State the facts to the employee and focus on the employee’s opinion.
D. Explain the rationale for the error action as part of the criticism.

A

D. Explain the rationale for the error action as part of the criticism.

66
Q

An angry patient enters the ED and fatally shoots two people before shooting himself. After the immediate needs of patient care are met, a recommended management response strategy for the emergency
personnel involved would be to provide:

A. A rotating 3 day leave of absence
B. Critical incident stress debriefing (CISD) sessions
C. Catered food and beverages for all staff
D. Anti-anxiety medicine to anyone displaying symptoms of anxiety

A

B. Critical incident stress debriefing (CISD) sessions

67
Q

During the absence of your nurse manager, you are asked to assist
interviewing a potential new employee. Which of the following questions should be avoided?

A. Work History
B. Clinical and Computer skills
C. Marital status
D. Educational preparation

A

C. Marital status

68
Q

When is it acceptable to notify the local organ procurement organization?

A. Once the patient has been declared brain dead
B. Once the family has agreed to terminate life support
C. Once the family has been notified
D. Once there is a concern that the patient has a nonsurvivable injury

A

D. Once there is a concern that the patient has a nonsurvivable injury

69
Q

The process by which data is collected, results are documented and experiments and tests are validated in order to change a concept is considered to be which concept?

A. Research-focused theory
B. Evidence-based practice
C. Nursing process model
D. Quantitative analysis approach

A

B. Evidence-based practice

70
Q

Assumptions about the adult learner include:

A. The previous experience of the adult learner is always a barrier to the education being provided by the emergency nurse
B. Adult learning can only be accomplished thru the use of lecture and discussion
C. Adults learn best from problem-centered educational experiences
D. Adult learners learn best when given written instructions only

A

C. Adults learn best from problem-centered educational experiences

71
Q

Which of the following statements best describes triage during a mass casualty incident?

A. Triage is done once on the scene before transport.
B. Triage sorts patients by order of severity to determine priority for care
C. Triage is not necessary at the ED since it has already been done at the scene.
D. The purpose of triage is to identify people who are not injured so they can leave immediately.

A

B. Triage sorts patients by order of severity to determine priority for care

72
Q

When planning for emergency operation supplies, the emergency
nurse manager should:

A. Stockpile supplies on unused shelves in everyday treatment rooms.
B. Stockpile types and sizes of supplies not ordinarily used in the ED.
C. List outside vendors who agree to make emergency deliveries.
D. Plan to borrow needed supplies from other hospitals.

A

C. List outside vendors who agree to make emergency deliveries.

73
Q

Important information about hazardous chemicals which is supplied by the manufacturer can be found on:

a. Truck placards
b. (Material) Safety Data Sheets (MSDS)
c. Packing containers
d. Shipping manifests

A

b. (Material) Safety Data Sheets (MSDS)

74
Q

Which of the following is an absolute requirement for use of respirators?

A. Negative-pressure types must be used
B. Open-circuit, positive-pressure types must be used
C. Respirators used must be bulky and heavy
D. The respirator must be fit tested to each individual

A

D. The respirator must be fit tested to each individual

CEN Review (6 decks)

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