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N362: Practice of Nursing III > Week 6 - Start Exam 2 - ER > Flashcards

Week 6 - Start Exam 2 - ER Flashcards

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1
Q

Emergency management traditionally refers to urgent and critical needs, but …

A

the emergency dept (ED) has increasingly been used for non urgent problems and emergency management has broadened to include the concept that an emergency is WHATEVER THE PT OR FAMILY CONSIDERS IT TO BE

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2
Q

It is important that the ED staff works…

A

as a team

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3
Q

What is one of the few places where a co-pay is not needed first and you cannot be turned away for care

A

the emergency room

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4
Q

Emergency Care

A

the care of all encompassing injuries and sudden illnesses

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5
Q

Trauma Nursing

A

this can be described as a continuum of nursing care from resuscitation through to rehabilitation

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6
Q

Trauma typically is a ___ problem

A

surgical (so overall trauma is referring to surgical needs and specialties)

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7
Q

What are 5 important issues in emergency nursing?

A
  1. Legal Issues - Antidumping laws/EMTALA
  2. Occupational health and safety risks for ED staff
  3. Challenge of providing holistic care in context of fast paced, technology driven environment
  4. Treat patients exposure to biologic and other weapons
  5. Mass casualty incidents from natural causes or terrorist events
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8
Q

EMTALA/Anti Dumping Law

A

Federal Law in 1980s

Dictates that anyone who comes through the door wanting a medical screening has to get one - hospitals taking from CMS required to provide a medical screening exam, stabilization, and transport by a provider

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9
Q

___ is the first priority in the ED

A

safety

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10
Q

What are some sentinel events in the ED

A

delay in care

medication error

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11
Q

What greatly influences incidence of sentinel events in the ED

A

patient volume

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12
Q

What should be done for interventions that are patient and family focused in the ED

A

actions to relieve anxiety and provide a sense of security

allow family to stay with the patient if possible to alleviate anxiety

provide explanations and information

additional interventions are provided depending on stage of crisis

(All of these make a safe and confident environment)

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13
Q

TRIAGE

A

sorting patients by hierarchy based on the severity of health problems and the immediacy with which these problems must be treated

Triage means “To sort” in french

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14
Q

What things does the triage nurse do

A

collects patient data and classifies the illnesses and injuries to ensure that the patient most in need of care does no needlessly wait

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15
Q

How does ED triage differ from Disaster Triage

A

Patients that are most critically ill receive the most resources, REGARDLESS of potential outcome

IN a disaster the focus is saving as many people as possible

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16
Q

TRIAGE is a ___ not a __

A

process not a place - patient priorities and conditions change so constantly be traiging

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17
Q

In the Basic Triage System what are the 3 categories

A
  1. Emergent - highest priority
  2. Urgent - serious health problems but not life threatening
  3. Nonurgent - episodic illness
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18
Q

ESI

A

Emergency Severity Index

Assigns patients to one of 5 levels

Depends on condition of patient and allocation of resources

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19
Q

How does ESI level 1 compare to level 5

A

As you head toward one it is more urgent with 5 being least urgent

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20
Q

What ESI level is someone requiring immediate life saving intervention

A

level 1

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21
Q

What ESI level is someone not needing immediate life saving intervention but is in a high risk situation, confused/lethargic/disoriented, or in severe pain/distress?

A

Level 2

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22
Q

If someone is not level 2 ESI but requires many resources, one resource, or no resources - what level are they?

A

5 - no resources needed
4 - one resource needed
3 - many resources needed and stable vitals

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23
Q

What ESI level is someone if they need many resources but have danger zone vitals?

A

level 2 (not 3)

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24
Q

Often waiting rooms are sites where feelings of what kind occur?

A

feelings of dissatisfaction, fear, and anger are channeled violently

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25
Q

Clinicians caring for patients in the ED should act how?

A

Confidently and competently to relieve anxiety and promote a sense of security

ED Nurse should provide comfort, action, advice, and project a calm comfort - Be an expert to the patient - but do not be dishonest

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26
Q

What 2 things are done immediately for every new ED patient

A

A primary and secondary Survey

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27
Q

What is included in the Primary Survey

A

ABCDE

A- Airway
B - Breathing
C - Circulation
D - Disability (neuro status, AVPU mnemonic)
E - Exposure (undress and assess wounds or injury)

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28
Q

What does AVPU mnemonic stand for and mean

A

Alert, Verbal, Pain, Unresponsive

Done in D of the primary survey of triaging ED patients

“Deneuro”

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29
Q

What is included in the secondary survey

A

FGHI

F - Full set of VS, Family
G - Get adjunctive testing like diagnostics and labs, ECG, arterial lines, urinary catheters
H - Head to toe assessment: reassess airway, breathing, VS
I - Inspect POSTERIOR SURFACE

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30
Q

What are the priority emergency conditions where measures should be taken immediately

A
  1. Airway obstruction and establishing an airway and ventilation - anoxic brain injury only takes 3 minutes
  2. Hemorrhage
  3. Hypovolemic Shock (stop bleeding)
  4. Wounds
  5. Trauma and multiple trauma
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31
Q

What are some ways ED reestablishes airway and ventilation

A

Oropharyngeal or Nasopharyngeal Airway Insertion

ENDOTRACHEAL INTUBATION (definitive airway in ED)

King tube or laryngeal mask (more so on ambulance)

Cricothyroidotomy

Ventilation

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32
Q

Cricothyroidotomy

A

Opens airways below the upper airway

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33
Q

If someone has no airway or breathing what is the serious procedure to be done to help

A

Laryngoscope and Endotracheal intubation

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34
Q

What important aspects of the ET tube are there to note

A
  1. A suggested vocal cord marker
  2. Internal diameter in mm marked on the tube
  3. Depth markers in cm to indicate position at the level of the teeth to monitor and document slipping
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35
Q

Hemorrhage may present how on reassessment

A

changes in VS or LOC

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36
Q

What is the key to ED hemorrhage treatment

A

Fluid replacement (give isotonic solutions somewhat and then blood products as to not change the pH too much)

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37
Q

Trauma is housed in surgery - how does this apply to bleeding

A

internal bleeding requires surgery to fix

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38
Q

The goal of treating hemorrhage is

A

prevent improper volume and prevent hemorrhagic shock - cardiac events happen quick from hypovolemia so we want fluid and blood resuscitation

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39
Q

Belmont/Level 1 Mass Transfusion Device

A

a device that can put liters of fluid and blood into the body in moments

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40
Q

Pressure points for hemorrhage control on the body

A

Temporal

Facial

Carotid

Subclavian (near clavicle)

Brachial

Radial and Ulnar

Femoral

41
Q

SAVE-A-LIFE

A

trauma program

provides education to the public on how to use tourniquets and apply pressure to bleeding

made in response to increases in mass shootings

42
Q

Steps of “Save A Life” - What everyone should know to stop bleeding after an injury

A
  1. Ensure your own safety
  2. Look for life threatening bleeding
  3. Ask if Trauma kit is available

A. if no trauma kit –> use any clean cloth –> steady direct pressure directly on the wound

B. If there is a trauma kit –> ask where the wound is

B1: If the wound is arm of leg –> Ask if there is a tourniquet –> if not follow B2, but if there is apply above the bleeding site and tighten until bleeding stops

B2: if the wound is neck shoulder groin –> pack the wound with bleeding control (hemostatic) gauze (preferred), any gauze, or clean cloth) –> apply steady direct pressure

43
Q

What sort of wound treatment is done in the ED

A

ED wounds can be life threatening or not - but a lot of animal bites and lacerations are seen

  1. Cleaning
  2. Primary Closure
  3. Delayed Primary Closure (For Animal Bites)

4 Tetanus Prophylaxis (Shot)

44
Q

Level 1 Trauma Center

A

comprehensive regional resource that is a tertiary care facil,ity central to the trauma system

capable of providing total care for every aspect of injury - from prevention through rehabilitation

research and residency also done here

45
Q

Level 2 Trauma Center

A

able to initiate definitive care for ALL injured patients

needs a 24 hour OR available to be level 2

ex: Wilson Hospital, UHS

46
Q

Level 3 Trauma Center

A

demonstrated an ability to provide prompt assessment, resuscitation, surgery, intensive care and stabilization of injured patients and emergency operations

ex: Lourdes Hospital

47
Q

Level 4 Trauma Center

A

demonstrated an ability to provide advanced trauma life support (ATLS) prior to transfer of patients to a higher level trauma center

provides evaluation, stabilization, and diagnostic capabilities for injured patients

48
Q

Level 5 Trauma Center

A

provide initial evaluation, stabilization, and diagnostic capabilities and prepares patients for transfer to higher levels of care

49
Q

When dealing with a trauma assessment, how does this differ from normal ED triaging?

A

C-ABCDE

Circulation is now first OVER respiratory - we need to control hemorrhaging before anything else then move back into ABCDE

We stop any external hemorrhaging first - tourniquets, pressure, etc

50
Q

What also should be considered with C-ABCDE of trauma assessment

A
  1. Does Pt needs a C Collar for surgical spine?
  2. GCS - Glascow Coma Scale - <8?
  3. Intervene during assessment as needed
51
Q

What is the rule for intubation and glascow coma scales

A

If less than 8, intubate

52
Q

Trauma Assessment needs to look at what?

A

1. Nature of the Emergency AND Chief Complaint bringing them to the ED - MVC, GSW, fall, burn, etc

What is the c/c

What caused the injury

Any treatments already initiated - From Pt or EMS?, did it help?

Is unlawful activity suspected?

What is reportable to law enforcement?

53
Q

What are two other important aspects for treating trauma beside assessment and interventions?

A
  1. Collection of Forensic Evidence
  2. Injury Prevention
54
Q

Tips for Forensic Evidence Collection with Trauma Nursing

A

If a gunshot wound, maintain area around gunshot wound on clothes to maintain evidence

Put bullets and objects in a PAPER BAG, not plastic to not compromise the evidence

55
Q

What ways should injury prevention be done (primary prevention) with trauma nursing

A
  1. Education
  2. Legislation
  3. Automatic Protections (ex: Airbags)
56
Q

Automatic Protections

A

things existing in everyday life that we use to prevent trauma that does not rely on people and patients actually changing their behavior

57
Q

Poison

A

Any substance that when ingested, inhaled, absorbed, applied to the skin, or produced within the body in relatively small amounts injures the body by its chemical action

Poisoning can include exposure, intentional, accidental, ingestion, overdose, or even ROH intoxication

58
Q

Treatment goals for poisoning

A

remove or inactivate the poison before it is absorbed

provide supportive care in maintaining vital organs systems (if removal or inactivation not possible)

administer specific antidotes

implement treatment to hasten the elimination of the poison

59
Q

Assessments for management of patients with ingested poisons

A

ABCs

monitor VS, LOC, ECG, UO (kidney fxn)

lab specimens

determine what when and how much substance was ingested

s/s of poisoning and tissue damage

health hx

age and weight

60
Q

Why is weight so important to know with poisoning

A

Weight determines amount of medicine and antidotes used

61
Q

What is the number 1 measure to remove the toxin/poison or decrease absorption

A

Activated Charcoal

62
Q

Measures to remove a toxin/poison or decrease absorption

A

use of emetics (can cause aspiration risk and sepsis)

gastric lavage (stomach pumping - dangerous)

activated charcoal

cathartic when appropriate

administration of a specific antagonist as early as possible

other measures may include diuresis, dialysis or hemoperfusion

63
Q

Why is it so important not to induce vomiting with poisoning occurrence

A

risk for aspiration and sepsis

if its corrosive agents like acids or alkalines there is destruction of tissue by contact so vomiting can make that worse

64
Q

With drug overdose, clinical manifestations…

A

vary with the substances overdosed on

65
Q

Overdose is a type of __ and __

A

ingestion and poisoning

66
Q

Treatment Goals for Drug Overdose

A

support resp and cardiovascular fxn

enhance clearance of the agent

provide safety of patient and staff

67
Q

IV drug users are at a high risk of what things

A

HIV

Hep B and C

tetanus

68
Q

Alcohol si a ___ toxin

A

multisystem / neurotoxin

69
Q

Management of Acute Alcohol Intoxication / Substance Abuse

A

Alcohol poisoning can cause death*

Maintain airway and observe for CNS depression and hypotension

Rule out other potential cause of the behaviors before it is assumed the patient is intoxicated

use a nonjudgmental and calm manner

may need sedation if noisy or belligerent

examine for withdrawal delirium, injuries, and evidence of other disorders

70
Q

What is at a higher propensity with chronic drinking problems

A

Higher likelihood of falling normally - and due to having a smaller brain and more friable brain vasculature they risk bleeding and head injury

71
Q

It is important to also try and find information on what two things with patients with substance abuse

A
  1. Occult Disorders and Injuries
  2. Nutritional imbalances
72
Q

Management Goals of Patients that are victims of sexual assault

A

provide support

reduce emotional trauma

gather available evidence for possible legal proceedings

73
Q

What is needed in order to examine a sexual assault victim

A

SANE Certified / SART teams - training on examining sexual assault cases

74
Q

What sort of interventions may be done for a patient that is a victim of sexual assault

A

physical examination

specimen collection

treating any potential consequences/issues - STIs, pregnancy

encouraging follow up care - work with victim advocates

75
Q

Common Behaviors/Aspects of Victims of Human Trafficking in ED

A

Cowering

Frightened

Agitated

Deferring to the person accompanying them

May present to ED with injury and accompanied by boyfriend or travel partner

Hx of chronic runaway, homelessness, self mutilation

76
Q

What are some common complaints from victims of human trafficking in the ED

A

injuries

poor healing

abdominal pain

dizziness

headaches

rashes or sores

77
Q

What behaviors may victims of human trafficking demonstrate

A

addiction

panic attacks

impulse control

hostility

suicidal ideations

78
Q

The nursing role and interventions for victims of human trafficking

A
  1. Offer opportunities for the patient to speak alone without the companion (ex: Speak to them while asking for urine sample)
  2. Use targeted appropriate questions: are you in control of your money? are you able to come and go as you please? who is the person(s) accompanying you?
  3. ID any potential issue here and offer help or resources - they may want to decline assistance (ex: The National Human Trafficking Hotline)
79
Q

NYS Mental Health Law

A

Law that determines in what situations a referral and transportation can be made to get care from the ER - ex: intoxication, psych care, inebriated

80
Q

9.41 NYSMHL

A

New York Mental Hygiene Law determines that police officers can bring someone to the ER

ex: if you think someone is going to commit suicide

81
Q

9.45 NYSMHL

A

Indicates that a Psychologist, Psychiatrist, Community Director, or Social Workers can indicate a patient being brought to the ER if intoxicated, needs psych care, or is inebriated

82
Q

9.57 NYSMHL

A

indicates a Physician can have a patient brought to the ER

83
Q

NYSMHL 22.09

A

Emergency services for persons intoxicated, impaired, or incapacitated by alcohol and/or substances leading to them being unable to care for themselves are brought to ER until cleared

84
Q

Overactive Patients

A

Patients with violent behavior, underactive behavior, depressed patients, and suicidal patients

85
Q

Management of Overactive Patients

A

Maintain safety of all persons and gain control of the situation

Determine if the patient at risk for harming self or others

Maintain persons self esteem while providing care

Determine if the person has a psychiatric history or is currently under care to contact that therapist

Crisis intervention specific to each condition - least restrictive measures sued first

86
Q

What is a common problem in the ER where up to 50% of healthcare professionals will experience it in their career?

A

Agitation and Violence

87
Q

___ to ___% Psych ED Patients are armed

A

4-8%

88
Q

In large urban EDs ___ weapons/day are confiscated and greater than ___% of major trauma patients are armed with lethal weapons

A

5.4 weapons/day; 26%

89
Q

What is important to do as an ER Nurse to ensure careful interactions

A
  1. REMEMBER PERSONAL SAFETY

Keep your distance

Be non confrontational

Listen

Dont make false promises

Set boundaries with patient choice if possible

What are the patients expectations

Safe Room with safe exit

Security and help nearby

Ask for help if needed

Safe rooms with no ligament risks for suicidal Patients

90
Q

3 Important ways to prevent violence in the ED

A
  1. Non violence crisis intervention training (primary tool)
  2. Emphasizing prevention among staff
  3. Safe staffing patterns
91
Q

What is a non violence crisis intervention training program

A

program to train employees how to recognize cues of escalating behavior and stop aggressive acts before they start

92
Q

When emphasizing prevention of violence among staff, they should think…

A

about personal safety and alert security when something seems suspicious

93
Q

What are some safe staffing patterns

A

appropriate number of staff for the time of day

appropriate use of 1:1 observation/sitter

94
Q

Ways to provide holistic care in the emergency setting

A

KEEPING PATIENT EXPERIENCE IN MIND:

Distraction and Guided imagery

Deep Breathing Techniques

Ambient or dimly lit rooms

Music

Nutrition education / NPO measures

Ambulation techniques and education

Social work consults

Family presence if available- advocates and helps a lot

95
Q

Issues impacting self concept in the ED

A

Fear - of health, interventions, pain

Embarrassment

Lack of knowledge - on services available and how to access

No where else to go

Lacking support system

Caregiver role strain

96
Q

The ER sees a lot of what

A

the large spectrum of society - heavy for the nurse

97
Q

___ is sometimes the only place a person cannot be turned away

A

ED

98
Q

Important Aspects of Discharge Teaching for ED Patients

A

Follow up with primary care

Understanding of current condition present

Caregiver understanding

Any resources needed and referred

Non pharmacological methods for Symptom release

Telling people what to watch for and when to come back

99
Q

Tips for Being a Successful ED Nurse

A
  1. Learn everything you can - be hands on
  2. TEAM work
  3. Ask questions - even to other types of HCW
  4. Prioritize patients - not just who is easiest to care for but who has poorest potential outcomes
  5. Time management is key - be efficient and fast
  6. Keep it together, rely on others, stay organized

N362: Practice of Nursing III (15 decks)

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