UNIT 2: Care of the Emergency patient Flashcards
As an ER nurse what is our scope of practice?
- Recognize life threatening illness or injury
- An emergency is whatever the patient or family considers it to be. It is not our choice what makes an emergency
- The emergency nurse has special training, education, experience and expertise in assessing and identifying care problems in crisis situations
What should we know about ER triaging?
- Process of rapidly determining a patients acutity
- Represents a critical assessment skill
- The triage system identifies and categorizes so the most critical are treated first
What is our primary assessment as and ED nurse?
Simply put it is our A (with cspine stabilization, BCDE(enviroment)
This is when we determine what is going to kill our patient the fastest
What is our secondary assessment as and ED nurse
Our full HEAD TO TOE. Looking for anything and everyhting… talking to EMS, starting vitals..
Add slide 7 after talking to Elizabeth
What should we know about death in the ED?
- Must recongize the importance of hopstial rituals in preparing the breaved to grieve.
- Determine if the patient could be a candidate for non-heart beating donation– percurment officer will talk with family.
- Medical exmainer is called with any patient that dies suddenly in the ED. Keep anythin invasive in the patient but do your best to clean up and make presentable.
What are some gerontologic considerations for emergency care?
Elederly are at high risk fo rinjury r/t
1. Decreased visual acuity and peripheral vision
2. Hearing loss
- Esp. high frequency sounds
3. Pre-existing disease and mediction use
4. Dementia and cognitve impairment- dont assume they have dementia right off the bat… try and confirm.. could be hypoxia related… try oxygen
What is heat exhaustion?
- Prolonged exposure to heat
- Occurs when the body is unable to cool itself.
what are s/s of heat exhustion?
Symptoms may be vague
1. Determined by temperature–to be heat exhuastion temp must be between 99.6-105.8
1. Fatigue, n/v and extreme thirst
What causes heat exhautstion?
- Dehydration
- Extreme or strenous activity in hot humid weather
- can also be sedntary patients
How is heat exhustion treated?
- cool fluids po if possible otherwise IV
- Remove constrictive clothing,
- monitor labs: abgs
- Monitor cardiac rhythm
- Will be given nomral saline
- Observe for 3-4 hours if no better consider admitting.
What are your s/s of a heat stroke?
- Anxiety-confusion
- skin hot & dry
- Impaired sweating
- Listlessness
- Cerebral edema- seizures, delirum, coma
- Increased body temp ABOVE 105
- Increased pulse and resp rate
- HYPOtension
- Na and K depletion
- Nuero- hullucinations- loss of muscle coordination
Death from a heat stroke is directly related too
Pt body temp remains elevated.
How do we manage heat stroke
- Cooling
- rest
- fluid and electrolytes
- Remove constrictive clothes
- fan
- ice pack in groin and arm pits
- wet sheet
Aggressive temp reduction until core temp reaches 102
What do we need to be careful of when cooling a heat stroke patient?
- Shivering: increases core temp and complicates cooling efforts. TREATED with IV chlorprmaizne
What med is used to prevent shivering in a heat stroke patient?
- IV chlorpromazine
What do we want to monitor our heat stroke patient for?
- Montor for signs of rhabdomyolysis, myogloburia, and dissemiated intravascular coagulation
- CK-MB improtant lab
- Rhabdo whill have tea colored pea
What do we need to know about a frost bite injury?
- Damage to the skin from freezing (ice crystals in the tissue)
- Superficial frost bite
- Injured tissue is friable
- Rewarming requires medical control
- Thawing frozen tissue is EXTREMELY painful
Vasocontriction occurs and decreases blood blow. Depth depends on the ambient tmep and how long they were exposed
Treatment for frostbite includes?
- Rewarming w/pain meds on board
- removing wet/dry clothing
- GIVE tetnus shot
- monitor
- May or may not have antibiotic
What should you never do to a frostbite injury?
Do not rub or lay heavy blankets could cause blankets to sheer skin off.. can use a bed cradle to drap blankets over
What are the different levels of hypothermia?
- Mild hypothermia: 93-95 f
- Moderate hypothermia: 86-93 f
- Severe hypothermia: less than 86
- Death usually occurs when core temp is below 78f
How do we treat mild hypothermia
Passive or active external remwarming
1. Bear hugger, warm air blower
How do we treat mod to severe hypothermia?
Active core rewarming
1. Enema with warm water, warm saline down NG, warm IV fluids
AFTER DROP- occurs once you have rewarmed the patinet and they have reached 95 and everything starts working again. The cold blood from the core will circulate and the cold from the periphery will come to hear making them cold again. So you may have to warm them again.
What is a submersion injury?
Person becomes hypoxic due to submersion in water
What is a drowining?
Death from suffocation after submersion in water
What is IMmersion syndrome?
Occurs when immersion in cold water, which leads to stimulation of the vagus nerve and potentially fatal dysrhythmias
What is a near-drowining?
Survival from potential drowning.
How long should you keep a near drowing patient?
4-6 hours beacuse they could develope pulmonary edema
How do we treat submersion injuries?
- A with cspine stabilization BCD
- Establish airway
xray and foley are not priority
