Test 2 disaters & brain/spinal injury Flashcards
- Botulism manifestations (ch.15 pp slide 11)
Diplopia
Dysarthria
Dysphonia
Dysphagia
- Botulism complications (ch.15 pp slide 11)
Paralysis of motor & autonomic nerves
Drooping of eyes
Generalized muscle weakness
Paralysis of respiratory muscles
- Smallpox manifestations (ch.15 pp slide 12)
Asymptomatic for 1st 7-14 days before rash develops
High fever (101-104F)
Rash beings on face, progresses to extremities (similar to chickenpox lesions)
- Anthrax nursing considerations and medical management (ch.15 pp slide 8)
Treated w/antibiotic therapy: Cipro, Levaquin (tx lasts 4 weeks or longer)
Use standard precautions/hand hygiene & appropriate PPE
- Nerve agent poisoning manifestations & medical management
Manifestations (CH.15 pp slide 15):
Bradycardia
Bronchoconstriction
Increased GI motility (N/V , diarrhea)
Cholinergic crisis including bilateral miosis (constricting of pupils)
Weakness
Medical Management (CH.15 pp slide 16):
Atropine sulfate
Diazepam (Valium) – to control possible seizures
- Gas, radiological, and chemical exposure nursing management, and priority assessment (ch.15 pp slide 4)
Priority: to direct clients to decontamination area & assess for respiratory function
With chemical inhalation advise clients to go to higher ground
Administer substances that interfere w/organ concentration (lead) or speed up removal of radioactive substance
Limit external contamination: stay indoors, go to centrally located room/basement w/few windows, turn off all fans, AC, forced air heating unites, remove & place clothing & shoes in plastic bag, shower/wash w/soap & water. Keep outdoor pets outside
- Cyanide medical management (ch.15 pp slide 17)
Wear protective garments & respirator masks
Administer cyanide antidote: amyl nitrite, sodium nitrite (IV route), IV sodium thiosulfate
- Triage steps for disasters (triage pp slide 2)
Evaluate the emergency or disaster: type of incident, # of victims, resources
Ask questions: sort victims, find emergency team & plan
Follow the systematic route to victims: start in & work out quickly
Evaluate & tag each victim
Treat victims
Document triage results
- Red tag
(immediate): can’t survive w/out immediate tx but have chance of survival requires tx w/in 5-30mins)
Airway & breathing difficulties
Uncontrolled or severe bleeding
Decreased LOC
Severe medical problems
Shock (hypoperfusion)
Severe burns
- Yellow tag
(delayed): require observation, condition stable, no immediate danger of death. Requires tx w/in 30mins-2hrs)
Burns w/o airway problems
Back injuries w/ or w/out spinal cord damage
Major or multiple bone or joint injuries
- Green tag
(minor): Victims who are wounded but can walk, they will need medical care at some point after more critical injuries have been treated
Minor fractures
Minor soft tissue injuries
- Black tag
(deceased): victims who are dead or injuries are so extensive they will not able to survive
Obvious death
Obviously nonsurvivable injury (major open brain trauma)
Full cardiac arrest
- CSF leakage manifestations (ch.39 pp slide 15)
Clear drainage from nose (look for halo sign)
- Epidural hematoma manifestations (ch.39 pp slide 13)
Loss of consciousness then a brief period of alertness followed again by LOC – COMA
Increased ICP
Most deadly (medical emergency due to increased ICP)
Bleeding between dura mater & skull (usually arterial blood)
N/V
- Epidural hematoma medical management (ch. 39 pp slide 12)
Indications of surgical emergency: rapid change in LOC, signs of uncontrolled increased ICP
Burr holes/ Trephining (surgery)
Intracranial surgery (craniotomy, craniectomy & cranioplasty)
- Post intracranial surgery priority assessment. (ch.39 pp slide 16)
Supine or side- lying position
Regular monitoring (observe for increased ICP)
Monitor temp: elevated can increase brain metabolism & damage
Control thrombus or embolus, cerebral edema (limit fluids)
- Subdural hematoma manifestations (ch.39 pp slide 14)
Bleeding between dura mater & arachnoid (usually venous blood)
CSF may leak into subdural space
Increased ICP
N/V
Change in LOC
Headache can come 24-48hrs after injury
Some neurological deficits/confusion can still develop months after injury
Later: bradycardia
- Autonomic dysreflexia manifestations (ch.39 pp slide 20)
(Long term effect after spinal shock has resolved)
Above T6
Pressure ulcers
Orthostatic hypotension
DVT’s
Diaphoresis
Severe headache & nausea
- ICP manifestations
Decreased LOC
Changes in pupils
Headache (more sever in the morning)
Vomiting
Papilledema
Restless, confused, periodic disorientation
Cheyenne stokes respirations
- Spinal shock client education and manifestations (ch.39 pp slide 20)
Manifestations:
Loss of activity below the point of injury normally happens immediately
Body will adjust and return
Poikilothermia (body temperature of the environment)
Paralysis, numbness
Pain, difficulty breathing
Hypotension, bradycardia
Warm, dry skin
Client Education:
Monitoring V/S is priority including temp (wont be able to perspire at point of injury, look for hyperthermia)
recovery can be a week to months
- What are the primary survey triage letters and what do they stand for? (CH.15 pp slide 24)
A: airway
B: breathing
C: circulation
D: disability
E: exposure
(PRIMARY THINGS TO ASSESS)
- Spinal cord injury functions C1-C3(PG.509 Table 39-3)
Use power wheelchair w/movement of head & neck control
Swallow & speak
Operate computer or appliances (TV, lights) Using voice activation device or mouth stick
Breathe w/assistance of ventilator
- C4-C5
Breathe w/ventilator assistance or possibly independently
Use a power wheelchair w/sip-and-puff or hand control
Drink independently using a long straw & bottle
- C6-C8:
Eat, groom, bathe & attain bed mobility w/assistive devices
Transfer from bed to chair using a slide board
Perform self-catheterization (men), more difficult for women
Use manual wheelchair in flat environment
Drive w/hand controls
- T1-T6
Perform personal care & household activities independently
Use manual wheelchair, including up & down curbs
Stand between bars w/leg splints
- T7-T12
Transfer from bed to wheelchair independently
Propel wheelchair over uneven surfaces & rough terrain
Care for bowel & bladder independently
Perform light housekeeping & meal preparation
balance on legs
Walk w/splints or long leg braces
- L1-L2
Drive a car w/hand controls
- L3-L5
Walk w/support of walker or crutches
- S1-S5
Walk normally w/out assistive devices
Control bladder, bowel & sexual functions
- Spinal cord injury complications during recovery period (Pg. 509)
Respiratory arrest & spinal shock
DVTS, Autonomic dysreflexia, orthostatic hypotension
- Concussion client education (ch.39 pp slide 3)
Contact primary provider, return to ED if sx of increased ICP occur:
-severe headache
-slurred speech
-vomiting
-unilateral weakness
- Respiratory Toxin Poisoning nursing management (CH.15 pp slide 18)
Remove victims clothing
Remove contact lens
Avoid fatality by assisting victims to fresh air, higher ground
Wash skin w/soap & water
- Role of nursing in a Disaster based on priority ABCs in a disaster (CH.15 pp slide 23)
Preparation of public in case of disaster
Triage: divided into triage categories/system (immediate, delayed, minimal, expectant)
- Nursing interventions in a disaster ( ch.15 pp slide 23)
Administer 1st aid to victims in immediate category by keeping airway open, covering wounds, controlling bleeding, splinting fxs
Delegate the care of those w/minimal health needs to volunteers w/1st aid skills
