Nur 3552 Emergency Care

8/3/2019 Nur 3552 Emergency Care

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NUR 3552 DISASTER &

EMERGENCY NURSING

EMERGENCY

CARE


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DEFINITION

EMERGENCYA sudden and unexpected occurrence

which requires urgent attention.

Emergency is a sudden and

unexpected happeningthat makes it

necessary to act quicklyespecially insaving a persons life during being in

critical condition


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EMERGENCY CARE

Delivery of urgent treatment, either as a

temporary measure until full investigationand treatment is practical, or as a life-saving measure.

Medical or other health treatment,services, products or accomodationsprovided to an injured or ill person for asudden onset of a medical condition of

such nature that failure to renderimmediate care would reasonably result indeterioration of the injured person'smedical condition


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EMERGENCY NURSINGThe emergency department (ED) is

an area of the hospital that is trulydifferent each and every dayand canquickly shift from the quietest to the

most hectic department in thehospital in literally a matter ofminutes.

The types of patients that come tothe emergency department for careas well as the numbers of patientsthat show up in hospital emergencydepartments often depend on things


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ED nurses can expect to care forpatients of all ages; heart attack,

stroke, and asthma victims; and theoccasional pregnant woman whosedelivery is progressing faster than sheanticipated.

Emergency room nurses arent limitedto working in hospitals. Nurses withexperience in emergency nursing might

be found in EMS and pre-hospitaltransport, flight nursing in medicaltransport helicopters, the military,poison control centers, administrative

and managerial positions, educators in


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Emergency care nursing sounds

exciting, ED nurse should have.

Good listening, interpersonal and

customer service skills?The ability to think and act decisively on

your feet?

The ability to perform many taskssimultaneously?

Stamina?


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The ability to shift gears, refocus and

reprioritize quickly?

Good coping skills?

The ability to remain calm in tense,highly stressful situations?

A sense of humor (laughter is a great

way to deal with difficult situations)?


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EMERGENCY NURSEBackground

Emergency nurses specialize in rapidassessmentand treatment when everysecond counts, particularly during theinitial phase of acute illness and trauma.

Emergency nurses must tackle diversetasks withprofessionalism, efficiency,and above allcaring.

Emergency nursing is a specialty area ofthe nursing profession like no other. Toprovide quality patient care for people ofall ages, emergency nurses must

possess both general and specificknowled e about health care to rovide


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ED NURSES ROLES

Patient Care-Emergency nurses care for patients and

families in hospital emergency

departments, ambulances, helicopters,urgent care centers, cruise ships, sports

arenas, industry, government, and

anywhere someone may have a medical

emergency or where medical advances orinjury prevention is a concern.


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Education

-Emergency nurses provide education to

the public through programs to promotewellness and prevent injuries, such as

alcohol awareness, child passenger

safety, gun safety, bicycle and helmetsafety, and domestic violence prevention.

Leadership and Research

-Emergency nurses also may work asadministrators, managers, and

researchers who work to improve

emergency health care.


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PRIMARY SURVEY

Focuses on airway, breathing,circulation and disabilityand servesto identify life threatening conditionsso that appropriate interventions

could be initiated
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The primary survey is a processcarried out to detect and treat life-

threateningconditions.As these conditions are

detected, lifesaving measures aretaken immediately, and earlytransport may be initiated.

The primary survey is a treat-as-you-go process. As each majorproblem is detected, it is treatedimmediately, before moving on tothe next.

During the primary survey, should
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A status decision is a judgment

about the severity of the patientscondition and whether the patientrequires immediate transportto a

medical facility without asecondary survey at the scene.

Ideally, theABCDE steps, status,

and transport decision should becompleted within 10 minutes of

your arrival on the scene.
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A=Airway

- An obstructed airway may quickly lead to

respiratory arrest and death- Assess responsiveness and, if necessary, open

the airway

B=Breathing

- Respiratory arrest will quickly lead to cardiac

arrest

- Assess breathing and if necessary, provide

rescue breathing.

- Look for and treat conditions that may

compromise breathing, such as penetrating

trauma to the chest
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Airway with cervical spinestabilization and /or

immobilization

__________________________________Primary signs and symptomsin patient with a compromised

airway

__________________________________Treatment

Airway obstruction of saliva,bloody secretions, vomitus,

sputum, laryngeal trauma,facial trauma, fractures, andthe tongue.__________________________________Dyspnea, inability to vocalize,presence of foreign body in

the airway, and trauma to theface or neck.__________________________________a)Opening the airway usingthe jawthrust maneuver

(avoiding hyperextension ofthe neck).b)Suctioning and removal offoreign body.c)Endotracheal intubation(ETT).

AIRWAY
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Breathing to ensure adequateventilation to the upper and

lower airway

__________________________________Patients with these conditionsmay experience a variety ofsigns and symptoms

__________________________________Treatment

Breathing alterations arecaused by many conditions

such as fractured ribs,pneumothorax, penetratinginjury, allergic reaction,pulmonary emboli, and asthmaattack.__________________________________Dyspnea (due to pulmonaryemboli), paradoxic orasymmetric chest wallmovement (flail chest),decreased or absent breath

sounds on the affected site(pneumothorax), visible woundto chest wall (penetratinginjury), cyanosis (due toasthma), tachycardia andhypotension.__________________________________

BREATHING
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C=Circulation

-

If the patients heart has stopped, blood and

oxygen are not being sent

to the brain.- Irreversible changeswill begin to occur in the

brain in 4 to6 minutes; cell death will usually occur within 10 minutes.

- Assess circulation and if necessary,

provide CPR
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Circulation is to ensure an effectivecirculatory system including the

heart, intact blood vessels, andadequate blood volume__________________________________Sign and symptoms should beassessed for circulation

__________________________________Intervention

Uncontrolled internal or externalbleeding places a person at risk for

hemorrhagic shock.

__________________________________A central pulse (carotid) andperipheral pulses should bepalpated, assess skin for color,

temperature and moisture, delayedcapillary refill (longer than 3seconds) and mental status are themost significant signs of shock.__________________________________Intravenous lines are inserted into

veins in a massive fracture or aninjury that affects limb circulation.Blood samples are obtained todetermine ABO and Rh group.Typespecific packed red bloodcells should be administered if

needed. In an emergency situation,uncrossmatched blood may be

CIRCULATION
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D=Disability

- Serious central nervous systeminjuries can

lead to death

- Assess thepatients level of consciousness

and,

if you suspect a head or neck injury,

apply a rigid neck collar

- Observe
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Disability is indicated with a briefneurologic examination (ismeasured by the patients level ofconsciousness)__________________________________A simple mnemonic to remember

__________________________________Intervention

Determining the patients responseto verbal and/or painful stimuli toassess the level of consciousness.__________________________________A : AlertV : Responsive to VoiceP : Responsive to PainU : Unresponsive__________________________________Glasgow Coma Scale (GCS) is usedto further assess the patientsconsciousness. Pupils should alsobe assessed for size, shape,equality and response to light.

DISABILITY
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E= Expose

-You cannot treat conditions you ha

ve not

discovered. Remove clothingespecially if

the patient is not alert or

communicating or any life-threatening injuries.

- Protect the patients

privacy and keep the
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SECONDARY SURVEY

After each step of the primary surveyis addressed and any lifesaving

interventions are initiated, the

secondary survey begins.

The secondary survey is a brief,

systematic process that is aimed at

identifying all injuries.
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When the primary survey is completed,resuscitation efforts are wellestablished, and the vital signs are

normalizing, the secondary survey canbegin.

The secondary survey is a head-to-toe

evaluation of the trauma patient,including a complete history andphysical examination, including thereassessment of all vital signs. Each

region of the body must be fullyexamined.X-rays indicated byexamination are obtained.

If at any time during the secondary
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PARAMETER ASSESSMENT

Exposure andEnvironment Control

Remove clothing for adequate examination. Keeppatient warm with blankets, warmed IV fluids,overhead lights.

Full Set of Vital Signs Obtain vital signs: temperature, BP, respiratoryrate, HR.

Five Interventions Heart rhythm, 0 saturation, insertion of urinarycatheter, insertion of gastric tube, blood forlaboratory test.

Facilitate FamilyPresence

Determine family's desire to be present duringinvasive procedures or cardiopulmonaryresuscitation.

Give Comfort Measures Level of pain, anxiety.

History and

HeadtoToeAssessment

Detail of the incidence, medication history,

allergies, note general appearances (head, neck,face), chest (observe rate, depth, breathingpattern, breathing sound, obtain ECG), abdomenand flanks (sign of injury, bruising, bleeding,abrasions, lacerations, punctures, abdomendistention, assess for bowel sounds), pelvis and

perineum (assess genitalia for blood, ecchymosis,rectal bleeding, etc), extremities (sign of external
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PLANNINGEmergency Care Planning

Definition:A process that includes allactivities, tools and policies/proceduresused to assist clinicians during attending

patients on what actions to take if amedical problem or change in conditionoccurs

An emergency care plan ensures that

you have a back up plan in place if youare suddenly unable to provide care. Anemergency care plan ensures there iswritten documentation nominating who

provides care, how to provide care and

NURSING ACTIONS
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NURSING ACTIONS Giving care to patient

Emergency nurses care for patients &families anywhere, to someone whohave a medical emergency or where

medical advances or injury prevention isa concern.

Provide education

Emergency nurses provide educationto the public through programs topromote wellness and prevent injuries,

such as alcohol awareness, child
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Involved in leadership and

researchEmergency nurses also may workas administrators, managers, and

researchers who work to improveemergency health care.

DOCUMENTATION
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DOCUMENTATIONDocumentation in Emergency

Department (ED) is important, as itimproves patient care and providingeffective risk management

Proper Emergency NursingDocumentation is essential forcontinuity of care, patient safetyandfor hospital ED reimbursement, by

determining and documenting the EDlevel of care.

ED Nursing Documentation teachesthe critical patient documentation skills

which are necessary from a clinical,
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This is divided between goodclinical care andproper nursedocumentation

It also emphasizes the

importance of good nursingdocumentation forpatient care,risk management and proper

facility reimbursement
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Documents

Nur 3552 Emergency Care